Towards an integrated model for child and family services in central Australia

An innovative model for the delivery of child and family services

The Central Australian Aboriginal Congress is a large Aboriginal community-controlled health service based in Alice Springs in the Northern Territory. Since the 1970s, Congress has developed a comprehensive model of primary health care delivering evidence-based services on a foundation of cultural appropriateness.

In recent years, the community-elected Congress Board has focused on improving the developmental outcomes of Aboriginal children. This has led to the development of an innovative model for the delivery of child and family services, based on the belief that the best way to “close the gap” is to make sure it is not created in the first place.

Early childhood development

It is well established that social and environmental influences in early childhood shape health and wellbeing outcomes across the life course. Adverse childhood experiences are correlated with a wide range of physical health problems and with increased levels of depression, suicide attempts, sexually transmitted infections, smoking and alcoholism.1

The pathways for these effects are complex; however, we know that during the first few years of life, the interactions between genetics, environment and experience have a dramatic impact on brain development. During this critical period, children need stimulation and positive relationships with caregivers to develop the neural systems crucial for adult functioning.2

This evidence indicates that we should not wait to intervene until a child is ready for school at around 5 years of age. By this stage, children have passed many developmental gateways for language acquisition, self-regulation and cognitive function, and their developmental trajectories are set. Of course, developmentally challenged children must be provided with appropriate services during their school years and later in life, but such interventions require increasing amounts of resources (Box 1)3 and produce diminishing returns as the child gets older.4

Governments and policy makers have now widely recognised the importance of investing in the early years.5 The Organisation for Economic Co-operation and Development has advised that investing in early childhood is the most important measure that Australia can take to grow the economy and be competitive in the future.6

Successful programs

There are well evidenced programs for young children and their families that significantly improve health, educational and social outcomes throughout the life course, and which are highly cost-effective compared with later interventions (or with doing nothing, which is the most expensive option).

Congress has taken particular interest in two preventive programs that have been successfully implemented in disadvantaged communities overseas. These are the Nurse–Family Partnership (NFP) and the Abecedarian approach to educational day care. Both programs work with caregivers and children before developmental problems arise, providing children with the stimulation, quality relationships and access to the services they need for healthy development.

The NFP is a program of nurse home visitation which begins during pregnancy and continues until the child’s second birthday. Pioneered in the work of Olds and colleagues,7 trained nurses use a structured program to address personal and child health, quality of caregiving for the infant, maternal life course development and social support. Special attention is given to establishing a safe, nurturing and enriched parent–infant relationship. Over many years of working with low income, socially disadvantaged families in the United States, the NFP has achieved improvements in women’s prenatal health8 and reductions in child abuse and neglect, maternal use of welfare, substance misuse, and contact with the criminal justice system.9 Children who participated in the program showed long term benefits, such as reduced antisocial behaviour and substance misuse during young adulthood.10

The Abecedarian approach provides a centre-based preventive program for children who are at high risk of developmental delay. It has three main elements — learning games, conversational reading and enriched caregiving — with a priority on language acquisition. The approach has been rigorously evaluated, and longitudinal studies that followed children into adulthood found that participants did better at school; gained more years of education; had better employment outcomes;4 showed reduced rates of smoking, drug use and teen pregnancies and led a more active lifestyle.11 There is also evidence of a significantly lower prevalence of risk factors for cardiovascular and metabolic disease for participants (particularly men) when they reach their mid-30s.12 These effects work against the social gradient, with children from more disadvantaged environments benefitting the most,13 which makes the approach a potentially powerful contributor to social equity.

The situation in central Australia

While the cultures and histories of Aboriginal communities in central Australia make them unique, they share many characteristics with communities in which these programs have been effective.

In particular, many Aboriginal children in and around Alice Springs grow up in an environment marked by poverty, substance misuse and lack of responsive care, with low levels of formal education and school attendance coupled with economic marginalisation and social exclusion.

This is reflected in figures from the Australian Early Development Census (AEDC), which show that by the time they start school, 43% of Indigenous children in the Alice Springs region are vulnerable on two or more of five developmental domains. This is six times the rate for non-Indigenous children (7%) (NT AEDC Manager, Early Childhood Education and Care, NT Department of Education, personal communication, 1 April 2016).

Responding to the developmental needs of Aboriginal children

The Congress integrated model for child and family services is the culmination of its efforts to develop an innovative service response to these challenges based on the best available evidence (Box 2).The key elements of the model include nurse home visitation through the Australian Nursing Family Partnership Program (ANFPP); the Preschool Readiness Program (PRP); the Healthy Kids Clinic; family support services, such as Targeted Family Support and Intensive Family Support; and the Child Health Outreach Program. Congress also runs a childcare centre.

As part of this model, Congress has delivered two short-term programs drawing on the Abecedarian approach. The first was an intensive intervention run through the PRP in 2011 and 2012.14 In the second, Congress is collaborating with the University of Melbourne to assess the impact of a limited implementation of the Abecedarian approach with children attending the Congress childcare centre.

The importance of integration

The Congress model is founded on a long term population health approach that is expected to deliver results in health and wellbeing across the life course. Integration of services under a single provider is the key to achieving this potentially transformative change, enabling children and families to be referred seamlessly to the services that best meet their needs. Such integration is now recognised as a crucial reform needed to increase the cost-effectiveness of services and improve access and outcomes for children and their families.15

The advantages of the Congress integrated model are that:

it supports a consistent approach to screening, allowing children and families to be referred to the programs that best meet their needs;
it allows internal efficiencies between programs to enhance services, thus making a better use of available resources;
it is built on the existing relationships that Congress has with Aboriginal families in Alice Springs through the delivery of culturally appropriate primary health care;
it allows a common evidence-based approach, modified to meet the cultural and social needs of our clients;
it may provide secondary gains for other health programs (eg, working with client families on healthy lifestyles or addiction problems); and
it encourages partnerships with researchers to evaluate progress and with other service providers for follow-up of clients.

Promising early results

This integrated model for child and family services may take many years to show all its benefits. Nevertheless, the early signs are promising.

While maintaining engagement with any disadvantaged population is a challenge, the ANFPP shows a high level of client acceptance, largely due to the inclusion of Aboriginal community workers alongside the nurses. This is reflected in good retention rates: the attrition rate before the child reaches 1 year of age is 44.1%, lower than in the overseas implementations where it is 49.5%. Moreover, a preliminary analysis shows an infant mortality rate of 8.3 per 1000 live births for the 240 infants whose mothers have been on the Congress program, which compares favourably with the NT rate of 13.7 infant deaths per 1000 live births. While these small numbers must be interpreted with caution, they are consistent with the reductions in infant mortality demonstrated in randomised control trials in the US.16

The PRP, which incorporated the Abecedarian approach, also showed positive results even with a limited program delivery. This included developmental gains in expressive language and social skills,17 higher preschool attendance rates and improvements in confidence and school readiness.15

While the data from the collaboration between Congress and the University of Melbourne to implement the Abecedarian approach at the Congress childcare centre are not yet available for publication, an early analysis suggests that they will also show significant benefits in children’s language acquisition and attention.

Conclusions

The integrated model implemented by Congress is already yielding some important lessons on addressing early childhood development in Aboriginal Australia.

First, there is a need for an evidence-based approach adapted to local social and cultural conditions. This requires fidelity to the original program design allied with the local knowledge that Aboriginal community-controlled health services such as Congress have built up over the years. We contrast this approach of responsible innovation with reckless innovation, which ignores what has already been achieved and proceeds on the basis of little or no evidence.

Second, there are the benefits of integrated solutions before school age being provided through the primary health care sector where possible. It is this sector which, through its delivery of antenatal and perinatal care, establishes supportive relationships with mothers, families and children in the period from conception to 3 years of age. Thereafter, the education sector should continue to take responsibility for preschool and primary education.

Box 1 –
Rates of return for human capital investment for disadvantaged children

Modified from Heckman and Masterov3

Box 2 –
Central Australian Aboriginal Congress integrated model for child and family services

Description

Primary prevention*

Secondary prevention^†

Child focus

Carer focus

Child focus

Carer focus

Centre based

Most work is done at a centre where a child or families come in to access service

Abecedarian educational day care; immunisations; child health checks; developmental screening

Health advice to parents in clinic (eg, nutrition, brushing teeth, toilet training)

Child-centred play therapy; therapeutic day care; Preschool Readiness Program; antibiotics

Filial therapy; circle of security; parenting advice/programs; parent support groups

Home visitation

Most work is done in the homes of families where staff outreach to children and families

Mobile play groups

Nurse home visitation; families as first teachers (home visiting learning activities)

Child Health Outreach Program; ear mopping

Targeted Family Support; Intensive Family Support; case management models for children at risk; Parents under Pressure

* The primary prevention targets children with no current problems, but who are at risk of developing them — the identified risk is usually based on low socio-economic status or maternal education level. † The secondary prevention targets children with current problems identified early in life when they are most likely to respond to intervention and before the problems get worse — it is determined by screening or referral to services.

Dr Google aims to become more medical

With 1% of all Google searches related to medical symptoms, chances are some of your patients have searched on Dr Google before arriving at your door.

However for many, searching for symptoms on the internet can be a hindrance and not particularly trustworthy, particularly when a ‘worried well’ patient finds themselves researching a serious and probably unlikely condition after searching for a fairly mild symptom.

With this in mind, Google has announced they’re streamlining medical based searches to help people navigate medical content on the web.

In the future, when people search for symptoms like ‘headache to one side’, they’ll be shown a list of related conditions (for example “headache,” “migraine,” “tension headache,” “cluster headache,” “sinusitis,” and “common cold”).

The information will show up as a summary at the top of the page so people don’t have to crawl through multiple sites and blogs to find what they need.

They will also be given an overview description as well as self-treatment option and when it might be time to visit the doctor.

Product Manager Veronica Pinchin writes on the official Google blog that all the information has been collated alongside medical doctors and experts at Harvard Medical School and Mayo Clinic.

Although at this stage, the new changes will only be seen on US mobile searches, the company anticipates it will be gradually released in other languages and markets.

“By doing this, our goal is to help you to navigate and explore health conditions related to your symptoms, and quickly get to the point where you can do more in-depth research on the web or talk to a health professional,” she wrote.

Latest news:

Simple processing and clever apps? Don’t hold your breath for a user-friendly Medicare IT system

The privatisation of Australia’s Medicare organisation has become a hot issue in this election with the Labor party accusing the Liberals of wanting to privatise Medicare.

The Liberal Government earlier this year earmarked A$5 million to fund consultants to review the digital payment services of Medicare. This was with a view to cutting costs on Medicare’s processing of A$50 billion in annual claims.

The “digital payments services taskforce”, which promised to examine how Medicare’s systems could be modernised, no longer seems to be running.

Prime Minister Malcolm Turnbull has also stated there are no plans to proceed with a privatisation of Medicare’s payment systems.

It is misleading to talk about Medicare’s payment system as if it was a single system that could be easily outsourced to a private company. Medicare’s IT systems are the product of an evolution of government policy that dictates who is to be paid for health service encounters and under what circumstances.

The payments service is further complicated by the fact it has to interface with thousands of different providers and millions of end users.

Medicare processes medical expense claims for potentially every encounter between an eligible Australian and a health professional or organisation. There are a series of rules that govern what can be claimed and whether the organisation, health professional or individual is responsible for making the claim.

Some of these payment claims are handled through software provided by any one of dozens of different vendors. These software companies have all gone through a process whereby their systems are certified to interface with those of Medicare’s.

Medicare also manages the issuing of cards, identifiers and runs a “public key infrastructure” which provides health professionals with cryptographic signatures that can be used in conjunction with the payments system.

From Medicare’s perspective, its major goal is to provide a reliable service so the entire system processes payments correctly and with an acceptable timeframe. The secondary role would be to provide a digital interface to its customers, especially the general public.

Medicare has certainly been very slow to fulfil this latter role. Its moves in this direction have missed the mark when compared to the slick and user-friendly apps most modern tech companies are now providing.

However, this is also true of some of the private companies that were put forward as possible providers of Medicare’s payment system. Companies such as Telstra and Australia Post are not that far behind Medicare in terms of the technology they have provided their own customers.

The problem all companies face, especially those that aren’t technology companies, is their internal IT is usually underfunded. It is also often set with expectations of reliability and security that run counter to being able to innovate and move quickly. Often, the technology produced by these departments is a reflection of how the companies do business, so clunky mobile apps reflect the same lumbering processes.

Changing culture in these departments is very difficult because new leaders have to make do with staff who have become “acculturated” to a specific way of doing things are done. They can therefore be reluctant to change their practice through fear of change or lack of ability.

When a system is as complex as Medicare’s, it is extremely expensive to rebuild. It is not possible to simply “retrofit” an off-the-shelf product from another company.

IBM’s attempts to redevelop Queensland’s payroll system, for example, were plagued with delays and budget blow-outs, resulting in a system that didn’t work very well. In large part this was caused by the complexity of the system’s arcane rules and a lack of real understanding of these rules by the people interfacing with IBM and others.

Attempts to privatise Medicare’s systems would be met with similar challenges.

IT is often a reflection of the underlying company business models and processes, so improvements to IT systems cannot happen unless there is a change to the underlying processes they implement.

Medicare has a much greater challenge. Not only are business processes an issue, the politics that drove these policies and processes would need to change. Given the politics of Medicare as a public good, it is very difficult to disassociate tackling any part of that service from being seen to be challenging Medicare’s role in public life.

As a result, it is unlikely very much will change to any significant extent in Medicare’s IT services, even if there was a technological way forward and a team of people, internal or otherwise, to implement them.

David Glance, Director of UWA Centre for Software Practice, University of Western Australia. This article was originally published on The Conversation. Read the original article.

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AMA Awards

President’s Award

Dr Paul Bauert OAM and Dr Graeme Killer AO

Two doctors, one a passionate advocate for the disadvantaged and the other a pioneering force in the care of military veterans, have been recognised with the prestigious AMA President’s Award for their outstanding contributions to the care of their fellow Australians.

Dr Paul Bauert, the Director of Paediatrics at Royal Darwin Hospital, has fought for better care for Indigenous Australians for more than 30 years. More recently, he has taken up the battle for children in immigration detention.

Dr Bauert arrived in Darwin in 1977 as an intern, intending to stay for a year or two. In his words: “I’m still here, still passionate about children’s health and what makes good health and good healthcare possible for all children and their families. I believe I may well have the best job on the planet.”

Dr Graeme Killer, a Vietnam veteran, spent 23 years in the RAAF before becoming principal medial adviser to the Department of Veterans’ Affairs. Over the next 25 years, he pioneered major improvements in the care of veterans, including the Coordinated Veterans’ Care project.

Dr Killer has overseen a series of ground-breaking research studies into the health of veterans, including Gulf War veterans, atomic blast veterans, submariners, and the F-111 Deseal and Reseal program. He was also instrumental in turning around the veterans’ health care system from earlier prejudicial attitudes towards psychological suffering.

Dr Bauert and Dr Killer were presented with their awards by outgoing AMA President, Professor Brian Owler, at the AMA National Conference Gala Dinner.

Excellence in Healthcare Award

The Excellence in Healthcare Award this year recognised a 20-year partnership devoted to advancing Aboriginal health in the Northern Territory.

Associate Professor John Boffa and Central Australian Aboriginal Congress CEO Donna Ah Chee were presented with the Award for their contribution to reducing harms of alcohol and improving early childhood outcomes for Aboriginal children.

Associate Professor Boffa has worked in Aboriginal primary care services for more than 25 years, and moved to the Northern Territory after graduating in medicine from Monash University.

As a GP and the Chief Medical Officer of Public Health at the Central Australian Aboriginal Congress, he has devoted his career to changing alcohol use patterns in Indigenous communities, with campaigns such as ‘Beat the Grog’ and ‘Thirsty Thursday’.

Ms Ah Chee grew up on the far north coast of New South Wales and moved to Alice Springs in 1987. With a firm belief that education is the key pathway to wellbeing and health, she is committed to eradicating the educational disadvantage afflicting Indigenous people.

Between them, the pair have initiated major and highly significant reforms in not only addressing alcohol and other drugs, but in collaborating and overcoming many cross-cultural sensitivities in working in Aboriginal health care.

Their service model on alcohol and drug treatment resulted in a major alcohol treatment service being funded within an Aboriginal community controlled health service.

AMA Woman in Medicine Award

An emergency physician whose pioneering work has led to significant reductions in staph infections in patients is the AMA Woman in Medicine Award recipient for 2016.

Associate Professor Diana Egerton-Warburton has made a major contribution to emergency medicine and public health through her work as Director of Emergency Research and Innovation at Monash Medical Centre Emergency Department, and as Adjunct Senior Lecturer at Monash University.

Her just say no to the just-in-case cannula has yielded real change in practice and has cut staff infections in patients, while her Enough is Enough: Emergency Department Clinicians Action on Reducing Alcohol Harm project developed a phone app that allows clinicians to identify hazardous drinkers and offer them a brief intervention and referral if required.

Associate Professor Egerton-Warburton has been passionate about tackling alcohol harm, from violence against medical staff in hospitals to domestic violence and street brawls.

She championed the first bi-annual meeting on public health and emergency medicine in Australia and established the Australasian College of Emergency Medicine’s alcohol harm in emergency departments program.

In addition, she has developed countless resources for emergency departments to facilitate management of pandemic influenza and heatwave health, and has authored more than 30 peer-reviewed publications.

Professor Owler said Associate Professor Egerton-Warburton’s tireless work striving for high standards in emergency departments for patients and her unrelenting passion to improve public health made her a deserving winner of the Award.

AMA Doctor in Training of the Year Award

Trainee neurosurgeon Dr Ruth Mitchell has been named the inaugural AMA Doctor in Training of the Year in recognition of her passion for tackling bullying and sexual harassment in the medical profession.

Dr Mitchell, who was a panellist in the Bullying and Harassment policy session at National Conference, is in her second year of her PhD at the University of Melbourne, and is a neurosurgery registrar at the Royal Melbourne Hospital.

Presenting the award, Professor Owler said Dr Mitchell had played a pivotal role in reducing workplace bullying and harassment in the medical profession and was a tireless advocate for doctors’ wellbeing and high quality care.

MJA/MDA National Prize for Excellence in Medical Research

A study examining the impact of a widely-criticised ABC TV documentary on statin use won the award for best research article published in the Medical Journal of Australia in 2015.

Researchers from the University of Sydney, University of NSW and Australian National University found that tens of thousands of Australians stopped or reduced their use of cholesterol-lowering drugs following the documentary’s airing, with potentially fatal consequences.

In 2013, the science program Catalyst aired a two-part series that described statins as “toxic” and suggested the link between cholesterol and heart disease was a myth.

The researchers found that in the eight months after program was broadcast, there were 504,180 fewer dispensings of statins, affecting more than 60,000 people and potentially leading to as many as 2900 preventable heart attacks and strokes.

AMA/ACOSH National Tobacco Scoreboard Award and Dirty Ashtray

The Commonwealth Government won the AMA/ACOSH National Tobacco Scoreboard Award for doing the most to combat smoking and tobacco use, while the Northern Territory Government won the Dirty Ashtray Award for doing the least.

The Commonwealth was commended for its continuing commitment to tobacco control, including plain packaging and excise increases, but still only received a B grade for its efforts.

The Northern Territory received an E grade for lagging behind all other jurisdictions in banning smoking from pubs, clubs, and dining areas, and for a lack of action on education programs.

State Media Awards

Best Lobby Campaign

AMA NSW won the Best Lobby Campaign award for its long-running campaign to improve clinician engagement in public hospitals.

The campaign started after the Garling Inquiry in 2008, which identified the breakdown of trust between public hospital doctors and their managers as an impediment to good, safe patient care.

It led to a world-first agreement between the NSW Government and doctors, signed in February 2015 by Health Minister Jillian Skinner, AMA NSW and the Australian Salaried Medical Officers’ Federation NSW, to embed clinician engagement in the culture of the public hospital system, and to formally measure how well doctors are engaged in the decision-making processes.

Best Public Health Campaign

AMA NSW also took home the Best Public Health Campaign award for its innovative education campaign on sunscreen use and storage.

The campaign drew on new research which found that many Australians do not realise that sunscreen can lose up to 40 per cent of its effectiveness if exposed to temperatures above 25 degrees Celsius.

The campaign received an unexpected boost with the release of survey results showing that one in three medical students admitted to sunbaking to tan, despite knowing the cancer risk.

Best State Publication

AMA WA won the highly competitive Best State Publication award for its revamped Medicus members’ magazine.

The 80-page publication provides a mix of special features, clinical commentaries, cover articles and opinion pieces to reflect the concerns and interests of WA’s medical community and beyond.

The judges said that with its eye-catching covers, Medicus made an immediate impact on readers.

Most Innovative Use of Website or New Media

AMA WA won the award for its Buildit portal, a mechanism for matching trainee doctors with research projects and supervisors.

The judges described Buildit as taking the DNA of a dating app and applying it to the functional research requirements of doctors in training, allowing for opportunities that may have otherwise been missed.

National Advocacy Award

AMA Victoria won the National Advocacy Award for its courage and tenacity in tackling bullying, discrimination and harassment within the medical profession.

AMA Victoria sought the views and concerns of its members, and made submissions to both the Royal Australasian College of Surgeons’ inquiry and the Victorian Auditor-General’s audit of bullying, harassment and discrimination within state public hospitals.

The judges said that tackling a challenge within your own profession was a particularly difficult task, especially in the glare of public scrutiny, making the AMA Victoria campaign a standout.

Maria Hawthorne

AMA calls for fair go for bush health

The AMA has encouraged all major political parties to deliver significant real funding increases for health care in regional, rural and remote Australia.

Immediate-past President Professor Brian Owler made the appeal when he launched the AMA’s plan for Better Health Care for Regional, Rural, and Remote Australia at Parliament House last month.

Professor Owler said that the life expectancy for those living in regional areas was up to two years less than the broader population, and up to seven years less in remote areas, and needed to change.

“It is essential that Government policy and resources are tailored and targeted to cater to the unique nature of rural health care and the diverse needs of rural and remote communities to ensure they receive timely, comprehensive, and quality care,” Professor Owler said.

The AMA plan focusses on four key measures – rebuilding country hospital infrastructure; supporting recruitment and retention; encouraging more young doctors to work in rural areas; and supporting rural practices.

The plan encourages Federal, State and Territory governments to work together to ensure that rural hospitals are adequately funded to meet the needs of their local communities. More than 50 per cent of small rural maternity units have closed in the past two decades.

Professor Owler said rural hospitals needed modern facilities, and must attract a sustainable health workforce.

“We need to invest in hospital infrastructure,” Professor Owler said. “When hospitals don’t have investment, when their infrastructure runs down, it makes it much harder for rural doctors to service patients in their communities.”

He called on the Council of Australian Government (COAG) to consider a detailed funding stream for rural hospitals, backed by a national benchmark and performance framework.

Professor Owler visited a rural GP practice at Bungendore and spoke with the local doctors about the issues and barriers of delivering high quality timely health care to the community.

“General practice is the backbone of rural health care, providing high quality primary care services for patients, procedural and emergency services at local hospitals, as well as training the next generation of GPs,” Professor Owler said.

“Rural GPs would like to do more, but face significant infrastructure limitations in areas such as IT, equipment, and physical space.

“Rural general practices need to be properly funded to improve their available infrastructure, expand services they provide to patients and support improved opportunities for teaching in general practice.”

The AMA has recommend that the Government fund a further 425 rural GP infrastructure grants, worth up to $500,000 each, to assist rural GPs.

Professor Owler added that timely access to a doctor was a key problem for people living in rural areas, with the overall distribution of doctors skewed heavily towards the major cities. He said the burden of medical workforce shortages fell disproportionately on communities in regional, rural and remote areas.

The number of GP proceduralists or generalists working across rural and remote Australia has steadily been declining. In 2002, 24 per cent of the Australian rural and remote general practice workforce consisted of GP proceduralists. By 2014, this level had dropped to just under 10 per cent.

The AMA and the Rural Doctors Association of Australia have together developed a package that recognises both the isolation of rural and remote practice and the need for the right skill mix in these areas.

The AMA Better Health Care for Regional, Rural, and Remote Australia is available at gp-network-news/ama-plan-better-health-care-regional-…

Kirsty Waterford

Greens make multi-billion commitment to chronic care

General practices would receive $1000 for each chronic disease patient enrolled with them under a plan outlined by Australian Greens leader Senator Richard Di Natale.

Upping the ante on Coalition policies regarding support for the treatment of chronic illness, Senator Di Natale said the Greens would inject $4.3 billion over four years to boost care.

Under the plan, not only would practices get an extra $1000 for each patient with a chronic illness who voluntarily enrolled with them, but $2.8 billion would be allocated to being allied health services within the public system and bolster Primary Health Networks to coordinated team-based care.

“Stretched GPs need a system which is set up to really support them in working with a team to better plan and organise care, and to improve outcomes for chronic disease patients over time,” Senator Di Natale said.

The Greens leader said the $4.3 billion commitment amounted to a “dramatic refocusing of our primary care sector to effectively respond to chronic disease”, and would establish a blended payment system that would complement the existing fee-for-service structure.

“As a former GP myself, I know the pressure that doctors are under to focus on responding to the immediate ailments of patients,” Senator Di Natale said. “But chronic illnesses are complex, and effective management requires long-term treatment and monitoring of symptoms by a range of health practitioners, working together.”

The Greens announcement follows the Government’s Health Care Homes initiative earlier this year, under which medical practices would receive bundled payments to provide integrated and coordinated care for patients with complex and chronic illnesses.

The Government has committed $21 million to a two-year trial of up to 200 Health Care Homes involving around 65,000 patients.

The AMA has welcomed the Health Care Home proposal but is critical that not more money has been allocated to the trial.

Senator Di Natale echoed the criticism, arguing that although the Health Care Homes initiative showed a welcome focus on an important area of care, “the trial is inadequately resourced and lacks any real detail”.

“Our plan is detailed, commits the funding necessary to be a success, and in the long-term will lead to savings as we better manage chronic disease and avoid hospital admissions,” he said.

Adrian Rollins

Nation ‘can’t afford’ barriers to care: King

AMA advocacy was “critical” in convincing Labor to make its $2.4 billion commitment to reinstate Medicare rebate indexation, Shadow Health Minister Catherine King told the AMA National Conference.

Highlighting what she said was a “huge gulf” between the major parties on health policy, Ms King said Labor’s promise to lift formed part of its plan to strengthen primary care, enhance preventive health efforts and reduce health inequality.

The Coalition has seized on figures showing that bulk billing has climbed to record levels to dismiss warnings that the rebate freeze will force many doctors to abandon bulk billing and begin charging patients.

But Ms King said the freeze would eventually result in higher out-of-pocket costs for patients.

“Sooner rather than later we know that the freeze will result in less bulk billing, and more and higher co-payments,” the Labor frontbencher said.

“When one in 20 Australians already skips or delays seeing a GP because of cost, that is not something we can afford to let happen.

“When our population is ageing and chronic disease is growing, we should be investing more in primary care, not less.”

Ms King said similar concerns underpinned Labor’s $971 million plan to scrap increases of between 80 cents and $5 to Pharmaceutical Benefit Scheme co-payments and changes to safety net thresholds.

“Cost is a barrier for access to prescription drugs,” she said. “We know that up to one in eight Australians doesn’t fill their scripts because medicines are already unaffordable for them.”

Ms King admitted that the policies, together with other health measures including an extra $15 million for Indigenous health, more than $25 million for cancer treatment and research and $35 million for palliative care, were expensive.

Labor has said it will fund the measures by axing the Coalition’s $50 billion business tax cut.

Ms King said the decision to fund these health policies had not been easy “given the current fiscal circumstances and competing demands. But in the end, budgets come down to choices and values”.

Adrian Rollins

AMA has a responsibility to ‘speak up’: Owler

Former AMA President Professor Brian Owler has lashed the Coalition over its conduct of health policy in the past two years, accusing it of allowing short-term budgetary measures to triumph over long-term policy vision.

In a typically forthright speech in his last address to the AMA National Conference as AMA President, Professor Owler said decisions to extend the Medicare rebate freeze, slash public hospital funding and try to impose a GP co-payment had been driven by a focus on savings without regard for their impact on patients and health system.

“As confirmed by [Health Minister Sussan Ley] herself…the health portfolio is not run by the Minister for Health. It is run by Treasury and Finance,” he said.

Professor Owler said the history of the last two years had shown that the Government had a problem when it came to health policy, “but the problems are not the making of the AMA [or] of an outspoken AMA President”.

“The failures of this Government are of their own making – a failure to consult with genuine intent, a failure to listen.”

The former President detailed how the Government set a combative tone for the relationship early on.

“In my first meeting as AMA President, I met with the Health Minister, Peter Dutton, who delivered an ultimatum: ‘As I see it,’ he said, ‘the AMA can either support the Government’s co-payment plans or you can be on the outside’.”

Professor Owler said it was an easy choice: “I was not going to sell out our members, and I certainly wasn’t going to abandon our patients”.

He told the conference how the Government responded after asking the AMA to develop an alternative to its co-payment policy.

“We dutifully did this. We worked hard, we kept it in confidence, and we delivered it to the Minster,” he said. “In return, the Minister ignored the plan and [described it] as a ‘cash grab by greedy doctors’. So much for working closely with Minister Dutton.”

Professor Owler said the Medicare rebate freeze was affecting the viability of medical practices, was punishing patients and was “not sensible policy. It affects the whole system”.

He said it was pleasing that, as a result of intense AMA lobbying, Labor had committed end the freeze, and said it was not too late for the Government to follow suit.

In his speech, Professor Owler took aim at private health insurers, who he said wanted to introduce US-style managed care.

He said the medical profession needed to be “endlessly vigilant” to the threat.

“We must never let private health insurers undermine our health care system, whether it be by interfering with the doctor-patient relationship or by disturbing equity of access in general practice,” he said. “Australians are…relying on you to defend against the actions of insurers, for whom the interests of shareholders come first, and patients are a distant second.”

Professor Owler acknowledged that some AMA members had been made “anxious” by the Association’s statements on asylum seeker policy.

But he said that with the AMA’s influence also came a “responsibility to speak up when governments overstep the mark – that is what happened with Australia’s approach to asylum seekers”.

The former President also highlighted AMA advocacy on Indigenous health and public health, including on family and domestic violence, road safety, alcohol, climate change, immunisation and physical activity.

Adrian Rollins

Less than a quarter of GP practices ready for e-health changes: survey

The Australian Medical Association has written to Health Minister Sussan Ley and Shadow Health Minister Catherine King urging them to reconsider new rules regarding GP compliance for the new My Health Record System.

They have conducted a survey across 658 practices and found that just 24% of medical practices are ready to comply.

The new rules that came into effect last month penalises practices that fail to upload shared health summaries for at least 0.5 per cent of their standardised whole patient equivalent each quarter.

Practices that can’t upload this quota are ineligible for payment under the newly-branded PIP Digital Health Incentive.

Related: Changes to PIP eHealth initiative

The survey found that 39.5% of practices are unable to comply and 36% of practices are unsure. Of the practices that can’t comply, they will lose on average $23,400 in incentive payments.

AMA President Dr Michael Gannon said the rule is unfair as the My Health Record system is still a work in progress.

“The AMA has strongly backed the introduction of a national e-health record because of the real benefits it could provide for patient care,” he said.

“But the My Health Record system is plagued with shortcomings that need to be fixed before the Government tries to foist it on patients and practices.”

He also pointed out that many practices are already facing increased financial pressure due to the extension of the rebate freeze.

“The extension of the rebate freeze has already pushed many practices to the financial brink, and the last thing they need is to have thousands more ripped away from them because of a flawed process to introduce a national e-health record system,” he said.

Other concerns the practices had were:

My Health Record was not a reliable source of clinical information for GPs (65.%).
There was no demand from patients (66.7%).
There was no financial support for the extra work involved in preparing and uploading shared health summaries (67.5%).
There were unresolved issues regarding the security of the My Health Record system (61.5%).
Other health providers are not using the My Health Record and GPs see little value in using it (61.3%).

Dr Gannon warned rushing the My Health Record trial risked undermining the support of the medical profession.

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