Empowering General Practice

The AMA Submission to the Government’s Primary Health Care Review highlights the robustness of the Australian health system, particularly the crucial role of general practice, and stresses the need to build on the proven track record of general practice with significant new investment.

AMA President Professor Brian Owler said that the Review must focus on strengthening the parts of the system that deliver quality, accessible, and affordable care to the community, most notably general practice.

“This is not the time to throw the baby out with the bathwater,” Professor Owler said.

“In terms of both cost and health outcomes, the Australian health system is performing very well by world standards, and general practice delivers outstanding public health outcomes from modest Government investment.

“We must avoid radical change for change’s sake.

“Some of the potential reforms raised in the Primary Health Care Advisory Group’s (PHCAG) discussion paper have been tried or are in place in other countries, and there is only very limited evidence about any significant positive impact.

“General practice in the UK, for example, has been the subject of several rounds of funding reforms, and the GP workforce in the UK is now being reported as demoralised and suffering from extreme shortages.

“We do not want or need to repeat the same mistakes here. It is concerning that some of the failed UK experiments are still on the table here for PHCAG consideration.

“For the Review to have genuine credibility, the Government must change its reform language – it must start talking about primary care reform as an investment, not a cost or a saving to the Budget bottom line.

“There is no doubt that extra investment in general practice will deliver long term savings to the Government, and improve the sustainability of the health system.

“The Government needs to take a long term view and make this investment now, in the knowledge of savings in later years, better patient outcomes, and less pressure on our hospital system.

“Significant new investment in general practice and the urgent need to lift the current freeze on the indexation of Medicare patient rebates must be priorities for the Review, or they will be priority issues for voters at the next election,” Professor Owler said.

With the growing burden of chronic disease and the long term impact this will have on the health system, the AMA is encouraging the PHCAG to consider reforms that will better support these patients in accessing high quality GP-led care.

The AMA Submission highlights a number of areas for change, including:

provided there is no overall reduction in funding, reform of existing Medicare chronic disease items to strengthen the role of the patients usual GP, cut red tape, streamline access to GP referred allied health care services and reward longitudinal health care;
the adoption of pro-active models of care-coordination for patients with higher levels of chronic disease and who are at risk of unplanned hospitalisation – similar to the Coordinated Veterans’ Care program that has been established by the Department of Veterans’ Affairs;
the introduction of an incentive payment through the Practice Incentives Program to support quality improvement, informed by better data collection;
the introduction of non-dispensing pharmacists in general practices to help improve medication management, particularly for patients with chronic disease;
an enhanced role for private health insurers to fund targeted programs that support general practice in caring for patients with chronic disease;
the utilisation of Primary Health Networks to support GPs in providing care for patients, particularly in improving the connection between primary and hospital care; and
better use of technology, including the use of point of care testing.

While the AMA Submission promotes a number of reforms, it also emphasises that fee-for-service should remain the primary source of funding for General Practice.

Professor Owler said that the fee-for-service model works well for the majority of patients in the Australian context.

“Fee-for-service provides patients with autonomy and choice, and access to care based on clinical need as opposed to the potential for rationed care that arises under some other funding models,” Professor Owler said.

“It also supports the doctor-patient relationship, with patients receiving a Medicare rebate to support them in accessing GP services.”

The AMA Submission to the Primary Health Care Review is at submission/ama-submission-primary-health-care-review

John Flannery

AMA in the News – 21 September 2015

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Annual budget for each patient under GP plan, Adelaide Advertiser, 5 August 2015
The Primary Health Care Advisory Group published a discussion paper, outlining radical changes to GP care and inviting comment by September 3. AMA President Professor Brian Owler said the discussion paper challenged the profession to consider new payment models, and this is something that will require an ongoing discussion.

Happy little home brew puts Vegemite in the firing line, Sunday Times, 9 August 2015
Australia’s iconic Vegemite could be ripped from supermarket shelves in remote communities because it is being brewed into booze. Professor Owler said the impact home brew could be devastating, with alcohol abuse still one of the greatest issues facing Australia.

State of bad health, The Herald Sun, 13 August 2015
Stress, poor role models and beliefs that bullying is character building are blamed for the culture of intimidation and harassment in Australia’s surgical ranks. Professor Owler called for gender balance in senior roles to help promote more inclusive workplaces. Saying quotas were one of the most effective tools available.

Women also harass men: senior doctors, Sydney Morning Herald, 13 August 2015
Sexual harassment goes both ways in the surgical room, according to senior doctors, who say that female doctors and nurses do not hesitate to use their sexuality to get ahead. Professor Owler said now was not the time for senior doctors to try to justify their actions, rather they should encourage a behavioural change in medicine.

Safety advocates call to put brakes on road toll, Northern Territory News, 15 August 2015
Autonomous emergency braking is the new focus for cutting the death toll on Australian roads. ANCAP and the AMA have launched a joint campaign on AEB, claiming the technology could be as important as seatbelts in cutting the road toll.

Doctors ordered, The Saturday Paper, 15 August 2015
Professor Owler planned to visit Nauru to see for himself whether healthcare in the Australian-run detention centre was up to scratch, but attempts were delayed.

Medibank insurance strategy under fire, Australian Financial Review, 20 August 2015
Doctors and other medical professionals are turning up the heat over an increasingly bitter dispute with Medibank Private over hospital insurance cover. Professor Owler said the idea that the Government does not have a role in this dispute is ludicrous.

Detention boycott debated by doctors, Sydney Morning Herald, 20 August 2015
Responsibility for the health care of asylum seekers in detention should be stripped from the Department of Immigration and Border Protection to steer off the prospect of a doctor boycott. Professor Owler said he did not support a boycott.

Medibank row: Feds urged to intervene, Canberra Times, 20 August 2015
Professor Owler has ramped up calls for the Government to intervene in Medibank Private’s bitter dispute with Calvary hospitals. Professor Owler said they can continue to stay out of the game, or they can get involved and start to fix up some of the mess they created.

Doctor Pot holds clinic, Canberra Times, 29 August 2015
Doctors are facing increasing pressure from patients demanding answers on whether cannabis might ameliorate their pain, and if so, where can they find it. Dr Stephen Parnis said we accept there is a legitimate place for treating some problems with cannabis.

Medirank, The Daily Telegraph, 28 August 2015
Medibank wants hospitals to sign a contract where it would refuse to pay for more than 165 preventable and sentinel events. AMA Professor Owler is concerned the new contracts are heading towards a US-style managed care system.

$220m bill for dodgy GP visit, The Sunday Telegraph, 30 August 2015
GPs have raised concerns about a home doctor service providing free bulk billed home visits after 4pm that is costing taxpayers $220 million a year. AMA Chair of General Practice Dr Morton said it is not free. It is paid for by all taxpayers and should be respected for that.

‘Secret’ deal on hospital care, Adelaide Advertiser, 31 August 2015
The public must be told the terms of a controversial contract deal between Medibank and Calvary hospitals so patients know if the fund will not pay for certain events. Professor Owler criticised as unacceptable the secrecy surrounding the 11^th-hour agreement.

A king hit on games boxing, Courier Mail, 4 September 2015
The AMA wants boxing banned from the Olympic and Commonwealth Games, but Australia’s top boxers claim it would send the game underground. Professor Owler said the aim of boxing is inherently dangerous, and sometimes fatal.

Ley cops Medicare blast, West Australian, 4 September 2015
Doctors have accused the Abbott Government of softening the ground for cuts to health after it released alarmist figures on rising Medicare costs. Professor Owler said Ms Ley was treating the one million-a-day claims figure as if they were separate visits to the doctor.

Doctors want protection from ice rage, The Canberra Times, 4 September 2015
The AMA has warned crystal methamphetamine is making the work of doctors more dangerous, and called for additional security in hospitals. Professor Owler said doctors nationwide had noticed a significant rise in the number of people using ice, and associated symptoms such as aggression and psychosis.

Radio

Dr Stephen Parnis, 612 ABC Brisbane, 13 August 2014
Dr Stephen Parnis talked about the risks of travelling overseas for treatment. Dr Parnis said cosmetic surgery and dental surgery are the main reasons people travel for medical treatments.

Professor Brian Owler, 2UE Sydney, 20 August 2015
Professor Owler talked about allocating medical resources to ailing patients. He said most health resources are used to prolong people’s lives, in the last few months of life, and sometimes when patients are unable to indicate whether they would like the action taken.

Professor Brian Owler, 6PR, 4 September 2015
The AMA is calling for combat sports which encourage violence to be banned. Professor Owler said, while these sports continue the AMA wants to ensure there are trained medical personnel who can look after the participants.

Dr Stephen Parnis, 612 ABC Brisbane, 4 September 2015
Dr Stephen Parnis talked about a ban on combat sports. Dr Parnis said they are opposed to sports where the primary goal, is interpersonal violence, to stop the opponent continuing.

Television

Professor Brian Owler, Ten Eyewitness News, 12 August 2015
A new report has revealed half of Australians have a chronic disease, and one in five have multiple illnesses. Professor Owler is calling for an investment in health care. Health Minister Sussan Ley says throwing money at the problem isn’t the answer.

Professor Brian Owler, The Today Show, 13 August 2015
Professor Owler speaks to the Today Show about the emergency breaking system available in Europe and America that the AMA would like to see become standard in all new cars sold in Australia.

Professor Brian Owler, Channel 7, 25 August 2015
Doctors have hit out at a suggested extension of the GST to health care, not long after the controversial GP co-payment was dumped. Federal Treasurer Joe Hockey said such a measure could help fund tax cuts. Professor Owler said it would impact those with chronic and complex disease.

Professor Brian Owler, Channel 10, 3 September 2015
Australia’s Medicare bill has doubled in the past decade and the Federal Government says we can’t afford such an increase. Professor Owler said the Health Minister is using the figures to develop a narrative around how she needs to cut costs in health.

Malcolm a chance for a fresh start on health

The AMA has urged new Prime Minister Malcolm Turnbull to lift the freeze on Medicare rebates as part of a fresh approach to health policy by the Coalition Government.

AMA President Professor Brian Owler was quick to congratulate Mr Turnbull on his election as Liberal Party leader, and said the medical profession was keen to work with him on “practical solutions” to the challenges facing the health system.

The incoming Prime Minister has had little to say on health policy in recent years, and assumes national leadership at a time of significant disruption and uncertainty in the health sector, much of it stemming from radical Government policy measures – not least proposals for a GP co-payment.

“Poor health policy plagued the Coalition following the 2014 Budget, and the Government has struggled to fully recover,” Professor Owler said, citing the ill-fated GP co-payment plan and the highly controversial move to walk away from public hospital funding commitments.

The AMA President said the Government’s management of the health portfolio had since improved, but several measures, not least a freeze on the indexation of Medicare rebates until mid-2018, continue to put a strain on its relationship with the health sector.

Professor Owler paid tribute to the commitment of outgoing Prime Minister Tony Abbott to Indigenous health, and acknowledged his central role in killing off the GP co-payment.

But the AMA has ongoing concerns about the effects of several other policies, and Professor Owler said that one of Mr Turnbull’s first acts should be to scrap the Medicare rebate freeze because it would reduce access to care, particularly for the disadvantaged and chronically ill.

Already, the effects of the policy are being felt, with medical practices across the country confirming they are reducing bulk billing, lifting fees and, in some cases, closing down because of the squeeze on their finances.

While removing the rebate freeze should be the top priority, Professor Owler said there were many other pressing issues that also demanded the attention of the Turnbull Government, including reinstating Commonwealth funding for public hospitals, reviewing the private health insurance system, boosting investment in general practice, ensuring genuine consultation with the medical profession regarding the on-going reviews of the Medicare Benefits Schedule and leading a coordinated national approach to medical workforce planning.

Though Mr Turnbull is yet to announce the composition of his frontbench, it is widely expected that Health Minister Sussan Ley will retain her portfolio. She is seen to have been effective in rebuilding the Government’s relations with the health sector.

Adrian Rollins

Photo: Flickr CC2.0 ITU Pictures

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Stronger general practice key to Primary Health Care reform

AMA President, Professor Brian Owler, said this week that the Review must focus on strengthening the parts of the system that deliver quality, accessible and affordable care to the community, most notably general practice.

Professor Owler cautioned the Primary Health Care Advisory Group’s (PHCAG) against change for change’s sake and pursing reforms of which there is only very limited evidence about any significant positive impact.

“The AMA has put forward to the PHCAG a measured, workable plan to improve access to care for patients, particularly those with chronic disease,” Professor Owler said.

This includes practical reform of existing MBS Chronic Disease items, funding directed to general practice to support pro-active models of care coordination and incentives to support quality improvement.

For the Review to have genuine credibility, the Government must change its reform language – it must start talking about primary care reform as an investment, not a cost or a saving to the Budget bottom line.

“There is no doubt that extra investment in general practice will deliver long term savings to the Government, and improve the sustainability of the health system.

“The Government needs to take a long term view and make this investment now, in the knowledge of savings in later years, better patient outcomes, and less pressure on our hospital system.

“The Government has raised the expectations of the community, as well as stakeholders, and it must now deliver the significant real new investment needed to achieve genuine reform that benefits patients and communities.”

AMA Submission to the Primary Health Care Review

This post was first published on GP Network News.

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[Correspondence] Academic primary care and the general practice workforce

Most developed health systems increasingly recognise the key role of primary care. The report from the Primary Care Workforce Commission seeks to address the worsening clinical manpower issues for the National Health Service (NHS), at a time of growing demand and complexity for primary care. The Commission, however, does not consider the potential relevance of the academic primary care workforce in its findings since this was considered beyond remit. But is there a link between general practice and its academic discipline?

Substandard medication-related processes in primary care costing millions

Poor medication-related processes in the primary care setting is resulting in hospital admissions that could be costing hundreds of millions of dollars, a study has found.

Researchers Dr Gillian Caughey and colleagues from the University of South Australia and the BUPA Health Foundation analysed the hospital admissions of 83 430 older patients between July 2007 and June 2012.

They used data from the Department of Veterans’ Affairs and found that a quarter of admissions were due to substandard medication related processes.

The results have been published in the Medical Journal of Australia.

They found that for those who were hospitalised for fractures after a fall, 85.4% of those patients aged 65 or over had been prescribed a falls-risk medicine before admission.

For patients hospitalised for chronic heart failure, 17% hadn’t been dispensed an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) in the previous 3 months prior.

Similarly, “about one in 10 admissions for renal failure occurred in patients with a history of diabetes who had not received a renal function test in the year before admission and were not dispensed an ACEI or ARB,” the authors wrote.

The authors say the study highlights conditions where there are gaps in medication management in the older population.

“The results could be used to inform and focus the development of interventions and efforts to improve the quality of health care delivery, potentially reducing morbidity and health care costs,” they write.

To read the full study, visit the Medical Journal of Australia website.

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How new technologies are shaking up health care

New tests and drugs have impacted health care for many decades. But we’re now seeing the emergence of completely different kinds of technologies that will radically alter how health care is both accessed and delivered.

In the past, patient and doctor, or other clinician, would generally meet in person. The clinician would employ the traditional process of seeking a history, undertaking physical examination and perhaps organising tests, to obtain details of the patient’s health-care needs and preferences.

The clinician would then relate this information to current knowledge of disease, prognosis and therapeutics, hopefully involving the patient, and together they would make decisions about a management plan.

A changing world

The internet has changed all that. Health professionals or not, we already share similar access to vast amounts of information about disease processes and their management. Much of this is readily available so that patients can be, and often are, highly knowledgeable about their health and care options.

A growing number of health apps – of varying quality – are available to support patients’ decisions about those options. And social media provide an instant network of peers with whom to share health concerns and experiences.

Biosensitive wearable technologies now monitor basic physiological processes, such as pulse rate and physical activity, permitting analysis and interpretation in real time. Future wearables and home-based sensors will track a growing range of measures, providing data for increasingly sophisticated assessment of the wearer’s current health status, and decision support for their care.

Many pharmacies and other primary health-care facilities offer point-of-care testing for use on site or at home. Right now such tests are largely limited to simple biological measures, such as blood glucose or cholesterol. But the range and number of possible tests are expanding rapidly, and coming down in price.

Soon it will be possible not only to diagnose a specific infection, but to accurately predict which anti-infective (if any) would be most effective for its treatment. All this will be done within minutes, and often without the need for a doctor, nurse or other health-care professional to examine, test and prescribe.

At the same time, advances in human genomics are providing the basis for redefining and reclassifying diseases. These advances enable increasingly accurate prediction of risk; new opportunities for effective prevention; and rapid confirmation of a growing number of diagnoses, clarifying the patient’s likely prognosis as well as informing treatment selection.

This is the basis of personalised medicine, which seeks to match health-management advice to the individual and not just to their disease. Parallel developments in genetic analysis of tumours and of the pathogens that cause infections are further refining the possibilities for matching the treatment to the patient and their disease.

Mental health too

It’s not just physical health care that’s being affected; information and communication technologies are transforming psychological care. Psychologists and psychiatrists rarely examine patients physically, so video-consultations are becoming more common.

A growing number of websites provide online psychological assessment and advice for the user. These range from straightforward screening for common mental problems to sophisticated measurements of cognitive and emotional functioning, which can predict responsiveness to specific therapies.

Psychological treatments, such as cognitive behavioural and mindfulness interventions, are readily available online. There is strong evidence for their effectiveness when used appropriately.

Communications technology can also enable real-time monitoring of patients’ adherence to prescribed medical treatment: this has obvious applications in the care, for example, of people with dementia. And smart dispensers can help all of us remember to take our medicines.

These developments remove the need for patients and their clinicians to meet in person, or even to communicate synchronously, unless physical interaction such as surgery is required. The array of generic and patient-specific information, and of electronic decision support aids that both patients and clinicians can access, are redefining the role of the clinician.

Doctors will increasingly play a role as expert guides to available resources, facilitating patients’ choices and decision making. Physical infrastructure for emergency management, surgical intervention and care of the very sick will still be needed. But information technology’s ability to collapse time and space will increasingly alter how health care is accessed and delivered in the community, enabling the right care every time, and at the patient’s convenience.

The implications for health service planning and policy, and for health professional education, are profound. Key considerations will include enabling equity of access to the potential benefits of information technology and ensuring that this enhances rather than distracts from the human connection we all need when we feel ill or fearful about our health.

Tim Usherwood is Professor of General Practice at University of Sydney

This article was originally published on The Conversation. Read the original article.

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Main image: Intel Free Pass/flickr

Fourth University of Queensland measles case confirmed

A vaccination clinic will be set up at the University of Queensland (UQ) after a fourth measles case was confirmed.

The student attended lectures at the St Lucia campus last week with another student who had contracted the illness.

They also had visited a pub and a shopping centre when they were unaware they were infectious.

The person visited:

University of Queensland, St Lucia, Tuesday 11/8 & Wednesday 19/8
Indooroopilly Shopping Centre Thursday 13/8
The Royal Exchange Hotel Saturday 15/8
Taringa Day & Night Medical Centre evening of Sunday 16/8

Metro North Public Health Unit will set up a vaccination clinic at UQ’s St Lucia Campus this week and students who live in the university’s colleges are urged to get vaccinated if they’re unsure of their status.

Queensland Health has put out an alert telling students and others who were in the above premises to be alert for measles symptoms.

This is the fourth Queensland measles alert in the last month. The first was from a UQ student who contracted the disease overseas in July.

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Govt needs to relieve strain on health system’s heart

The benefits of co-ordinated care are widely recognised, and worldwide work is progressing to develop and implement systems and models of care that facilitate and support it.

In Australia, improving the continuity of patient care through better co-ordination has been on the agenda for almost two decades. As a GP, it is frustrating when the role of GPs in the co-ordination of patient care is so often undervalued by Governments in their ongoing quest for cost savings.

Despite the Government’s rhetoric acknowledging general practice as being central to the health system and its desire to rebuild it, the indexation freeze and other attempts to cut rebates stand in stark contrast to this intent.

Every time general practice is undermined with a rebate cut, the loss of an incentive, or an indexation freeze, our capacity to provide a higher level of care is compromised.

We have care planning and team care arrangements that recognise the GP’s central role in co-ordinating services to support patients to better manage their chronic and complex conditions. However, these arrangements are limited, inconsistent with established referral practices, and encased in red tape. This impacts on their effective use.

More than $1 billion has been “invested” by the Federal Government in a shared electronic health record to help ensure continuity of care. Unfortunately, most of that investment could have been saved if greater stock had been put in the advice of clinicians and the medical profession. In particular, that it must be an opt-out system and that information uploaded to the shared health recorded needed to be clinically relevant.

In the past decade there have been multiple trials around co-ordinated and collaborative care. We’ve had the Co-ordinated Care Trials in Queensland, HealthPlus in South Australia, the recent Diabetes Care Project trial, and Victoria is currently running the Care Point trial.

To varying extents, these trials recognise the role of general practice. We must build on the lessons learned from them, bearing in mind the recent findings of a report on nurse-led, hospital-based co-ordinated care interventions that found no demonstrated effect. What this shows, I believe, is that the best place for care co-ordination is at the central point of health care, which is general practice.

Private health insurers appear to be slowly coming around to the view that if they want to stem the rise in hospital-based claims (and their resultant payouts), then they need to start looking at supporting primary health care. They need to recognise that general practice holds the key for them, and that the challenge is to develop a funding model that will enable them to support GPs in keeping their patients out of hospital.

As AMA President Professor Brian Owler said in his address to the National Press Club during this year’s Family Doctor Week, there needs to be urgent recognition of the costs of providing high quality care.

If private insurers can recognise that general practice is where they need to be investing, then it is time the Federal Government did so as well.

The current review into primary health care, led by former AMA President Dr Steve Hambleton, provides a vital chance to shift the focus of our health system back to its heart.

GP pay up for grabs in primary health overhaul

Set fees and performance payments are among changes to GP remuneration being considered as part of efforts to remodel the primary health system to improve the care of patients with chronic and complex conditions.

The Federal Government’s Primary Health Care Advisory Group, led by immediate-past AMA President Dr Steve Hambleton, has canvassed a number of GP payment options in a discussion paper outlining potential reforms to address the rising chronic care challenge.

While the current fee-for-service model worked well in the majority of instances, the Better Outcomes for People with Chronic and Complex Health Conditions through Primary Health Care Discussion Paper said it did not provide incentives for the efficient management of patients who required ongoing care.

Instead, it suggested alternatives included capitated payments, where GPs, health teams, practices or a Primary Health Network receive a set amount to provide specified services over a given period of time; or pay-for-performance, where remuneration is tied to the achievement of particular care outcomes; or some combination of all three.

The discussion paper also suggests ideas about how care is organised and managed, including the creation of medical homes, GP-led team-based care, improved use of technology and upgrading techniques to monitor and evaluate care.

AMA President Professor Brian Owler welcomed the release of the discussion paper, but warned the Government that reform would not succeed without significant investment in general practice.

Professor Owler said several of the options for reform canvassed by Dr Hambleton’s Group had long been supported by the AMA, including GP-led team-based care, the improved use of technology, care coordinators, and an expanded role for private health insurers.

He said the new payment models outlined were a challenge for the medical profession, and would need ongoing discussion.

But he warned that the Government needed to support general practice if it was genuine in seeking to improve care.

“What is missing from the discussion paper is an explicit statement that we need to better fund and resource general practice if we are to meet the health challenges of the future,” Professor Owler said. “The final outcome from this Review must be more than simply re-allocating existing funding.”

Dr Hambleton emphasised that the paper had been developed to encourage discussion, but warned that things needed to change.

He said increasing life expectancy meant more patients were presenting with multiple chronic and complex health complaints, and current arrangements were increasingly struggling to meet their care needs.

More than a third of Australians have a chronic health condition and the discussion paper said that because the system was not set up to effectively manage long-term complaints, many were turning up unnecessarily in hospital and emergency departments, adding millions of dollars to the nation’s health bill.

Health Minister Sussan Ley said it was “essential” to review the provision of chronic care, because Medicare benefits for chronic care were soaring – up almost 17 per cent to $587 million in 2013-14 alone.

“We are committed to finding better ways to care for people with chronic and complex conditions and ensure they receive the right care, in the right place, at the right time,” Ms Ley said. “This discussion is a real opportunity to cater for the increase in chronic and complex conditions, and this approach ensures that health professionals and patients continue to be central to this process.”

But Professor Owler said the reality was that primary health review was being undertaken at a time when general practice was under sustained attack from the Government, and a “more positive” attitude was urgently needed.

“General practice has been the target of regular Budget cuts that undermine the viability of practices, and threaten the long term sustainability and quality of GP services,” he said. “The freeze on Medicare patient rebates is the prize example. It is causing great harm to GPs, their practices, and their patients.

“If the Government is genuine about improving how we care for patients with chronic and complex disease in primary care, greater investment and genuine commitment to positive reform is needed,” Professor Owler said.

As part of its consultation process, the Primary Health Care Advisory Group is conducting an online survey that will be open until 3 September. To access the survey and discussion paper, visit www.health.gov.au

In addition, the Group is holding a series of public meetings in major cities and regional centres around the country, and will host a nationwide webcast on 21 August.

It is due to present its final report to the Government by the end of the year.

Adrian Rollins