In a member communication, they have confirmed that there have been off-label usage of influenza vaccines Fluarix Tetra and Fluvax which poses a safety risk for children.
The RACGP says the GSK Fluarix Tetra is being incorrectly administered to children under 3 years (including half doses of the vaccine). The vaccine isn’t registered for this age group.
The Seqirus’ (BioCSL) Fluvax is also being incorrectly administered to children.
Health is shaping up to be one of the major election issues, with proposed changes to Medicare rebates and the Pharmaceutical Benefits Scheme (PBS) potentially costing patients more to receive health care.
Our new research shows that, by the end of June 2020, an average full-time GP will have lost A$109,000 in total income due to the freeze since July 2015.
By July 2019, this GP would need to charge their general patients an A$11.40 co-payment per consultation to make up for their lost income (relative to 2014-15).
Our modelling also shows the Coalition’s proposed increase to the PBS co-payment will most affect pensioners.
What is the ‘freeze’?
When GPs bulk-bill their patients, they directly charge the government for the service provided. What GPs are paid for each consultation depends on the Medicare Benefits Schedule (MBS) item charged, with longer and more complex consultations earning them more. A “standard” consultation rebate is A$37.05, while a “long” consultation rebate is A$71.70.
Traditionally, the amount for each item increases year to year to account for the increased cost of care. This is called indexation. Since July 2014, the government has paused or “frozen” this indexation. The government initially planned this freeze to last until 2017-18.
At the time, we modelled the effect of this initial freeze. We found that by 2017-18, a bulk-billing GP would have a relative income loss of 7.1% (5.8%-8.5%) compared with their 2014-15 level of Medicare income.
We concluded that if GPs wished to keep bulk-billing their concessional patients (those with a government health care card), they would need to charge their non-concessional patients an A$8.43 (A$6.71-A$10.16) co-payment for each consultation to make up this loss.
Using the same assumptions we used in our previous modelling, we found that by 2019-20, a bulk-billing GP will have had a relative Medicare income loss of 11.6% compared to their 2014-15 income level (assuming a CPI of 2.5% a year).
However, CPI has been lower than earlier projected. The CPI projections in the federal budget were 1.25% in 2015-16, 2.0% in 2016-17 and 2.25% in 2017-18. Using these figures and assuming CPI of 2.25% per year in 2018-20, we estimate a relative income loss of 9.4%.
For an “average” GP (who bills 5,050 consultations a year), this 9.4% income loss will equate to approximately A$26,300 in 2019-20 alone. For an average full-time GP (7,680 consultations a year, assuming 160 consultations per 40-hour week, 48 weeks a year) the loss of relative income will be A$40,000 in 2019-20.
By June 30 2020, a full-time GP will have lost a total of A$109,000 since 2014-15 due to the freeze.
What does this mean for patients?
The 9.4% reduction in income may force GPs who bulk-bill to cover their loss by charging general patients (who make up 45.6% of encounters) a co-payment. This co-payment would need to be A$11.40 to maintain 2014-15 levels of income.
Our estimates are conservative as they would be the minimum charge needed to make up for the GP’s lost income. We did not account for:
administrative costs in implementing new billing systems
increased bad debt from patients who are charged, but never pay
the previous freeze of fees
lost income when a GP chooses to bulk-bill general patients facing financial hardship.
It’s therefore likely that GPs who opt to charge a co-payment will charge more than our estimates. Further, after abandoning bulk-billing, some GPs may take the opportunity to charge more than required to merely recoup their rebate loss.
A poll by Australian Doctor, a newspaper for GPs, found that over the next 12 months, almost one-third of the responding GPs said they would charge A$35 or more. More than half the sample said they would charge their general patients A$25 or more for a standard consultation.
In 2013, the Australian Medical Association (AMA) recommended a fee of A$73 for a standard GP consultation. That equates to a co-payment of over A$35 if GPs chose to charge this amount, and even this would only be at 2013 AMA rates.
The freeze is likely to have a greater impact on practices that serve socioeconomically disadvantaged people, as the practices would have to absorb the reduction in gross income, which may not be viable.
Labor’s alternative
Isn’t Labor proposing to reverse the freeze?
Well, yes and no. Labor announced it will reintroduce indexation from January 1, 2017. This means the freeze will remain until then.
Prime Minister Malcom Turnbull has dismissed the potential impact of Labor’s proposed increase, saying:
If the indexation were to be restored from 1 July, the increase in the benefit paid to doctors would be around 60 cents. 60 cents. And by 2019-20, it would be A$2.50.
This is true only if you are talking about the rebate for a single “Level B” item (which is below the average rebate per consultation) and if indexation was set at only 1.65% a year, well below the CPI projections in the 2016 federal budget.
A more accurate estimate would be to use the average rebate claimed per consultation (A$50) and use the CPI projections in the budget. This would mean an average increase per consultation of A$1 in 2016-17 and A$4.50 in 2019-20.
Compared with continuing the freeze, the indexation would mean an additional A$34,700 in earnings in 2019-20 alone for an average full-time GP and an additional A$84,400 combined to 2020.
Changes to the cost of medication
The government subsidises the cost of important medications through the PBS. General patients currently pay a maximum of A$38.30 for a PBS-subsided medication and concessional patients pay a maximum of A$6.20. These thresholds are indexed yearly, usually in line with CPI.
In the 2014 federal budget, the Coalition proposed that these co-payments increase by A$5.00 and A$0.80 respectively – additional to the regular indexation. So far, this proposal has been blocked in the Senate, but associated savings are included in the May 2016 budget.
While it would seem that the A$0.80 increase for concessional patients is small, our modelling from 2014 shows this increase would be larger in dollar terms for concessional patients. Nearly all medications prescribed for concessional patients face this increase, whereas only a fraction of medications prescribed to general patients cost more than the current threshold, so far fewer medications would incur an additional cost.
An average 45- to 64-year-old would pay an additional A$12.99 a year if they were a general patient and A$16.59 if a concessional patient.
The patients most impacted by the PBS co-payment increase will be aged pensioners, who on average would see their co-payment for medications increase by A$29.65 a year.
These estimates are conservative as they only include the number of instances where a script is written and do not include any repeats scripts provided on these occasions.
Primary care services form the backbone of health care in most high-income countries. Yet, there are growing concerns about the effects that numerous changes in the content and delivery of primary care have had on the workload of primary care practitioners. In a retrospective analysis in The Lancet, F D Richard Hobbs and colleagues1 investigated the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK, and present data from consultations of patients registered at 398 English general practices between April, 2007, and March, 2014.
The Royal Australian College of General Practitioners believes after-hours doctor services shouldn’t advertise to the general public and should only be accessed through their general practice.
RACGP President Dr Frank R Jones wrote in the college’s ‘In Practice’ newsletter: “Many issues of concern were identified by practicing GPs, especially around quality clinical assessment and continuity of care, as the patients’ normal treating doctor often receives variable and limited information about their patients’ after-hours visit.”
After-hours visiting services have become increasingly popular in recent years, which the college says coincides with an increase in the use of after-hours MBS item numbers.
“The increase in the use of after-hours related MBS item numbers could be attributed to the emergence of new business models offering dedicated after-hours home visiting services,” the college wrote in its statement.
After-hours visits classified as ‘urgent’ receives a rebate of $130-$150 compared to a non-urgent visit of $55 and $36 for a standard visit in the GP surgery.
The RACGP’s position is:
Only vocationally registered GPs, non-VR GPs, doctors on a pathway to Fellowship or GP registers with appropriate supervision should provide after-hours doctor services that attract an MBS rebate.
Patients should only be able to access after-hours services through their GP practice
Practices should provide information about access after-hours services to patients.
After-hours visiting services should have a formal connection with the patient’s usual GP.
There should be a summary document detailing clinical management forwarded to the patient’s usual GP by the next morning.
After-hours services should only take appointments during after-hours periods.
There should be appropriate triage processes from GP, nurse or other properly trained professional to minimise the amount of home visits required.
After-hours services are more expensive to the tax payer and should be subject to specific regulation and accreditation.
After-hours services should avoid advertising directly to the public.
The National Association for Medical Deputising (NAMDS) says it agrees in principle with the RACGP’s statement.
President of NAMDS, Ben Keneally, said: “We strongly support the view that Medical Deputising Services should work in support of General Practice.”
However they believe deputising services should be able to raise their own awareness. NAMDS said until recently, many patients weren’t aware of after-hours services and would inappropriately present at emergency departments instead.
“It is true that there has been growth in both after-hours clinic consultation and after-hours home visits. Indeed, in terms of volume, the growth in after-hours clinic visits has been much greater. This growth reflects the success of deliberate government policy to improve availability of primary healthcare in the after-hours period.”
Despite a push to find last minute funding, it has been announced that the Family Medicine Research Centre which runs the Sydney University BEACH project will close on 30 June 2016.
BEACH has been running for 18 years and collects information about clinical activities in general practice.
After a notification was received on 7 April 2016 by the Department of Health that funding would not be continued, the program ceased collecting data. At the time, the University provided funds to allow the analysis of the 2015-16 BEACH data and the preparation of two final reports by 31 August 2016.
However the team announced today that a long-term source of funding was not able to be found.
In a statement announcing their closure, the team wrote: “This resource is unique in its ability to inform research, policy and practice and it is of deep concern that there is currently nothing to replace it.”
The BEACH database will be maintained by the university.
Large increases in opioid prescribing in Australia have led to calls for there to be more awareness about the challenges of dealing with patients who are seeking prescription drugs.
There has been a threefold increase of the total number of opioid prescriptions on the Pharmaceutical Benefits Scheme between 1992 and 2007 and oxycodone was the seventh leading drug prescribed in general practice in 2014. Disturbingly, over 800 Australians died from the prescription painkiller oxycodone between 2001 and 2012.
The most common drugs that people seek prescriptions for are opioids and benzodiazepines.
According to an article in Australian Prescriber, GPs should be aware of typical drug seeking behaviours, such as:
Aggressively complaining about a need for a drug.
Asking for specific drugs by name.
Asking for brand names.
Requesting to have the dose increased.
Claiming multiple allergies to alternative drugs.
Anger or irritability when questioned closely about symptoms such as pain.
The authors note that some patients seeking drugs of dependence may present without these behaviours. They say common contexts for drug-seeking behaviour includes those who develop dependence after taking opioids, benzodiazepines and other psychotropic drugs, those dependent on illegal opioids such as heroin who have an unmet demand for treatment of those illicit substances, people who want to sell drugs of dependence and people who would never associate themselves with ‘people who use drugs’ but may self-medicate to feel better.
Dr Jenny James, Medical Coordinator for the Substance Misuse Program at the Sydney West Aboriginal Health Service says all GP practices should have a strategy to outline their approach to prescribing drugs of dependence.
“GP practices need to respond to the strong evidence that serious harms can result from misuse of prescription drugs of dependence.”
The authors say an advantage of a practice policy is that it gives GPs a response when they find it difficult to refuse requests for drugs of dependence.
“A GP can say ‘I don’t prescribe drugs of dependence’, or ‘It is our practice policy not to prescribe drugs of dependence’, or ‘It is recommended by health guidelines that we do not prescribe these medicines’. Further explanations are not needed. The GP can then suggest that the focus is shifted to seeing what other strategies can be used to help the patient with their presenting problem,” the authors wrote.
All GPs should register with the Prescription Shopping Information Service, where they can find out if a patient has been identified as a prescription shopper in the previous three months. The patient’s consent is not necessary for this inquiry.
New AMA President Dr Michael Gannon has declared that the Medicare rebate freeze is “unfair…and wrong”, and must be scrapped.
In his first public statement following his election at the AMA National Conference, Dr Gannon reaffirmed the peak medical organisation’s commitment to overturning the freeze, which he warned could force some doctors to abandon bulk billing and begin charging patients up to $25 a visit.
“GPs are at breaking point. They can’t take too many more cuts,” he said. “I would not be surprised if those practices that move away from bulk billing, and decide to invest in the infrastructure required to collect the fees, turn around and collect something like a fee between $15 and $25”.
The Federal Government’s decision to extend the current freeze on Medicare rebates an extra two years to 2020 has provoked outrage among GPs and the broader medical profession. The AMA has mounted a nationwide campaign against the policy, which is also the target of television ads by the Royal Australian College of General Practitioners that warn patients the freeze means “you will pay more”.
Dr Gannon has assumed the presidency in a highly politically-charged environment, with the nation embroiled in one of the longest Federal Election campaigns in decades. Opinion polls have the two major parties locked in a close contest.
THe Western Australian obstetrician has held discussions with Health Minster Sussan Ley, Shadow Minister Catherine King and Greens leader Richard Di Natale, and promised to “pursue a consultative style [to] try and find constructive ways forward”.
He said there was an opportunity to improve the AMA’s relationship with Ms Ley, and said the AMA should “always try and be constructive when it criticises policy of governments or opposition to come up with alternatives”.
Dr Gannon warned that, “when you criticise Government on any area of policy you need to realise that there might be a cost in that area or in other areas of your agenda”.
But he said the Medicare rebate freeze had to go, and reiterated the AMA’s support for Labor’s policy to end the freeze. Both Labor and the Greens have promised $2.4 billion to reinstate rebate indexation from 1 January next year.
Dr Gannon called for the Coalition to “change tack” on the freeze.
“Unravelling the freeze is so important,” he said, adding that such a move should be the start of a broader discussion about improved support for general practice.
“Successive governments have under-invested in quality general practice. That is the cornerstone of the health system,” he said. “High quality primary care reduces the need for more expensive hospital admissions. Unravelling the freeze is not a solution to the underfunding of general practice. We need to do so much better.”
The AMA President also attacked Commonwealth cuts to public hospital funding.
“I don’t think that there’s room to cut hospital funding; in fact, quite the opposite,” Dr Gannon said.
While the AMA needed to be “responsible” in calling for greater health funding, he lamented that both the Federal and State tiers of government had failed to comprehend the rise in hospital costs stemming from the ageing population and health epidemics like obesity and drug use.
But Dr Gannon said his advocacy would not be limited to general practice and hospital, and the AMA’s “very strong” platform on social issues would continue under his leadership.
He said he was committed to “continuing the AMA’s long history in trying to close the gap between Indigenous and non-Indigenous Australians”, and also made particular mention of mental health and “speaking up for people who can’t speak for themselves”.
The Australian Medical Association’s new president has told reporters that he’d like to build a more constructive relationship with the Turnbull government if they’re re-elected, “but we will speak up fearlessly when they produce bad policy.”
Western Australian obstetrician and gynaecologist, Dr Michael Gannon was voted into a two year term as President at last weekend’s AMA National Conference in Canberra.
Dr Gannon is the outgoing president of the WA branch of the AMA and is the head of the Department of Obstetrics and Gynaecology at the St John of God Subiaco Hospital.
On ABC’s Radio National this morning, he said: “I think that the AMA should always try and be constructive when it criticises policy of governments or opposition to come up with alternatives.”
One particular campaign that the AMA won’t be backing down on is the Medicare rebate freeze, a policy of key debate prior to July’s federal election.
“What we’ve tried to say for many years now is that successive governments have under-invested in quality general practice. That is the cornerstone of the health system: GPs providing quality care in decent visits will give you a saving. So even if you want to make an economic argument, you will have less people requiring hospital admissions, which are a lot more expensive down the track. Quality general practice is an investment in our community, it’s not a cost,” he told the ABC.
Dr Gannon did say that he intends to tone down the criticism of the asylum seeker policy, an area that Brian Owler’s leadership often commented on.
“If you ever hear me talking about it I’ll be talking about the health of asylum seekers, I won’t be making any comments about broader policy,” he explained.
The AMA conference also saw Victorian GP and outgoing President of AMA Victoria, Dr Tony Bartone elected Vice President.
His body shook as tears ran down his face, faster than he could wipe them away.
I had told him the truth.
It wasn’t what he had expected to hear from his doctor, nor was it something that he had ever heard from anyone else.
It had penetrated straight to his heart and overwhelmed him.
It had cut through all the bravado, the layers of self protection that he had erected around his heart to prevent him from getting hurt.
Despite the pain that riddled his body, sometimes rendering it useless to him and the worthlessness and overwhelming guilt that he felt, these words were a searing hot sword straight into the depth of his spirit.
I had said to him that whilst everything seemed to be up against him and that although he wanted to end everything, I saw him as strong.
I saw him as strong and because had kept going after all these years, even as his body had started to fail, he had kept going for his wife, for his children and for a better future. He had never missed an appointment, always tried new treatments to help his health and never lost his sense of cheekiness and humour until now.
I saw a strong man, persistent and relentless in pursuit, hoping for the best days to come.
As I said these words to him, my spirit identified with them, allowing me to speak this truth with confidence and certainty.
I am sure that this encouragement from his doctor meant a great deal to him because it carried weight and helped to change the direction of his thoughts.
Why your words matter
As a father, husband and doctor, I am sold on the importance that words have on a person’s life.
Be it spoken in haste and anguish, hurtful and demeaning words can have far reaching negative effects, long after they are vocalised.
Words of encouragement on the other hand can change a person’s trajectory, their world view and the change wrong path that they are on.
Much more than that I believe that carefully chosen words of truth can paint a beautiful picture and cast inspiring vision, perhaps of a future that a person cannot see, after being battered by negativity and their own self doubt.
Words of encouragement bring life.
Words of encouragement give hope.
Words of encouragement inspire confidence.
Words of encouragement soften hearts.
I didn’t do very much that day with respect to the practice of traditional medicine. I didn’t prescribe anything nor did I initiate any investigation, but I gave him something that he needed the most, confidence, a word of truth through my encouragement.
Make no mistake, health professionals are not the only people in the business of encouragement, we all are.
We all have it inside of us, but the distractions of life and importantly, our lack of practice keeps the words of encouragement from being breathed into someones life.
We’ve all most likely had excellent service before (I hope) and wanted to say something more than thank you, but we didn’t. Perhaps we’ve seen something meaningful inside of our children and wanted to encourage this, but the words didn’t formulate in our conversation. And we’ve all most certainly had a kind or encouraging thought of a friend flash into our minds, but we didn’t bring ourselves to vocalise this.
My word of encouragement to you, is not to wait but to speak life into someone today.
Lift them up. Encourage a friend. Give them a picture that they cannot see. Cast a vision that inspires hope.
Live your life intentionally using your words carefully. They matter.
Dr. Jonathan Ramachenderan is a rural generalist from Albany, WA who writes a blog called The Healthy GP which is dedicated to inspiring hope for those within “busy” season of life of raising children, being successful at work and growing a strong marriage. This blog was previously published on TheHealthyGP and has been republished with permission. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.
Substantial progress is being made in the implementation of electronic health records (EHRs) in hospitals, ambulatory care, and primary care practices globally, but uncertainty remains about how these large financial investments will translate into tangible patient, population, and societal benefits.1 This question is topical for all governments, but particularly pertinent for the UK and the USA, since important decisions on government health information technology (HIT) strategies related to EHRs are imminent.
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