WA News Doctor Polls
Poll Results
GP - Poll comparisons 1995-2000

We take a look at multiple polls on single issues - how opinions have changed (or not).

Is some benchmark (such as accreditation) needed to set community standards in general practice? August 1996

Yes 47%

No 51%

Undecided 2%

Will government use accreditation to control GPs in a way that is not necessarily in our best interests? August 1996

Yes 82%

No 4%

Undecided 14%

From what you have heard about accreditation so far, would you pay $1,200 to have your practice accredited? August 1997

Yes 7%

No 74%

Undecided 19%

Will your practice be paying $1,200 per full-time GP to have your practice accredited so that it qualifies for extra income under the PIP (amount yet to be determined by government)? July 1998

Yes 19%

No 28%

Undecided 53%

Is it appropriate to link any government payment to accreditation? July 1998

Yes 11%

No 68%

Undecided 21%

Would you prefer that accreditation is marketed to the public as an initiative likely to lead to private billing rather than link it to the government's Practice Incentives Payment? September 1998

Yes 58%

No 17%

Undecided 25%

Accreditation is now established. From your assessment, is it a marketable entity for consumers? January 2000

Yes 20%

No 47%

Undecided 33%

Are blended payments a desirable change for general practice? June 1996

Yes 24%

No 60%

Undecided 16%

Are you in favour of increased blended payments for general practice, like BPP (ie. less from fee-for-service)? June 1997

Yes 7%

No 82%

Undecided 11%

Are you getting all that you want from your local division? October 1996

Yes 49%

No 27%

Undecided 10%

Can you recall an instance where a WA division has, either directly or through you, improved the delivery of some aspect of health care to the community? March 1999

Yes 63%

No 28%

Undecided 9%

Divisions and funding: Do you believe divisions should be involved with budget holding?June 1996

Yes 24%

No 62%

Undecided 14%

Divisions and politics:Should divisions be actively involved in medical politics? June 1996

Yes 60%

No 32%

Undecided 8%

Should divisions in WA play a greater role in medical politics involving GPs? November 1999

Yes 54%

No 35%

Undecided 11%

Is the AMA, given its resources, doing enough to support GPs? June 1996

Yes 17%

No 74%

Undecided 8%

Around half of your AMA subscription goes to the federal office for national activities. Is this appropriate, or would you like to see more go to local AMA activities? November 1998

It's appropriate 20%

Spend more locally

45% Undecided 17%

In terms of your WA experience, how would you rate the relevance of the actions of the AMA WA Branch to your working life in general practice? May 1999

Very relevant 0%

Slightly relevant 18%

Undecided 28%

Little relevance 50%

Not relevant 4%

How would you rate the performance of AMA WA in representing the interests of WA general practitioners over the last 12 months? November 1999

Improved 19%

Worsened 26%

Unchanged 55%

Is the RACGP, given its resources, doing enough to support GPs? June 1996

Yes 28%

No 57%

Undecided 15%

Do you believe the only route to VR should be the FRACGP? December 1996

Yes 15%

No 81%

Undecided 4%

Is the RACGP's intentions to establish a ‘specialty' of general practice what general practice needs? December 1996

Yes 34%

No 45%

Undecided 21%

Should the RACGP play a greater role in medical politics involving GPs? November 1999

Yes 39%

No 45%

Undecided 16%

How would you rate the performance of the RACGP WA Faculty in representing the interests of WA general practitioners over the last 12 months? November 1999

Improved 11%

Worsened 26%

Unchanged 63%

Do specialists care about the difficulties GPs are under? June 1996

Yes 11%

No 77%

Undecided 12%

Should specialists have time-tiered consultation fees under Medicare, similar to GPs? August 1997

Yes 63%

No 13%

Undecided 24%

Is the written clinical feedback you get on abnormal pathology test results adequate in terms of explanation and suggested course of action? July 1998

Always adequate 4%

Mostly adequate 74%

Often inadequate 17%

Mostly inadequate 5%

How often do specialists you refer to repeat tests you have done rather than check with your practice first? July 1998

Mostly 8%

Often 33%

Sometimes 45%

Rarely 14%

For non-urgent referrals to specialists, what do you consider to be the maximum acceptable response delay by way of specialist letter or phone call after the day of consultation? January 1999

1-2 weeks 62%

2-3 weeks 27%

3-4 weeks 8%

4-5 weeks 3%

GPs admit to writing, at times, specialist referrals with inadequate detail. Specialists privately complain about the standard of some referrals. In your honest opinion, what factors explain inadequate referrals? July 1999

Referring GP is not the primary care GP. 40%

GPs under too much time pressure.. 48%

GPs uncertain about the information particular specialists want 18%

GPs don't want to show their lack of in-depth understanding of the patient's problem. 5%

Specialists ignore the information provided and do their own thing. 23%

Other. 33%

In the last few years have you been given information by a patient that seriously calls into question the competence of a specialist, perhaps to the extent of medical negligence? November 1999

Yes 30%

No 50%

Perhaps 20%

Are you thinking about decreasing your practice's bulk billing? June 1996

Yes 51%

No 43%

Undecided 6%

Are you taking steps to decrease your practice's bulk billing? October 1996

Yes 42%

No 44%

Don't bulk bill 14%

In the last two months have you taken steps to decrease your practice's bulk billing? April 1997

Yes 32%

No 64%

Don't bulk bill 4%

Has your practice reduced its level of bulk-billing in the last six months? March 1998

Yes 39%

No 56%

Don't bulk bill 5%

Please respond to this statement. "Consumer pressure is now so great, it is economically or politically impossible for the majority of general practices to abandon bulk billing for non-concession card holders." January 1999

Strongly agree 19%

Agree 19%

Undecided 3%

Disagree 27%

Strongly disagree 32%

If GPs continue to deliver most services "free" at the point of sale, do you believe the Australian community will truly come to value general practice, even if GPs pursue or meet quality standards? March 1999

Yes 6%

No 86%

Undecided 8%

Are you considering charging private fees for concession cardholders? May 1999

Yes 41%

No 38%

Undecided 2%

Already doing so 19%

Are you taking steps to inform your patients about any difficulties you are encountering in maintaining your standard of care under the present Medicare arrangements? August 1996

Yes 56%

No 40%

Doesn't apply 4%

For every dollar the average GP earns in providing services under Medicare, a further 1.3 dollars of flow-on costs are generated in diagnostic imaging, pathology, PBS scripts and the consultation costs of specialist referral. Did you expect the 1.3 figure to be: February 1997

Higher 50%

Lower 28%

The same 22%

Have you changed your style of patient care (eg. test ordering, prescribing, repeat consultations) out of fear of reprisal from the HIC? June 1997

Yes 34%

No 55%

Undecided 11%

Do you feel pressure to end some consultations prematurely (and before the problem at hand is fully dealt with), because of financial pressures caused by low remuneration from Medicare rebates? July 1998

Often 36%

Sometimes 45%

Never 19%

Under WorkCover, are Vocational Rehabilitation Providers working effectively to return your workers' comp patients earlier to work? December 1996

Yes 26%

No 35%

Undecided 39%

How would you describe workers' compensation cases, on average? September 1998

Rewarding 10%

No big deal 39%

A real pain 41%

Best to avoid 10%

 
Referrals to Specialists

Patient doctor shopping and pressures on GP consultation times may be affecting the nature of referrals from GPs. A poll of 155 specialists over 8 disciplines brought a 31% response rate and insights.

Referral can come to you from chance encounter GPs or from the patients primary care GP. By your estimate, what percentage of your referred patients do come from their primary care GP?

Average 78% (range 40 - 95%)

How has this percentage changed over the last 5 years?

Increased 4%, decreased 33%, unchanged 63%.

If the referring GP is not the primary care doctor, this could create an awkward situation for you as a specialist. In these circumstances:

Do you feel obliged to send a copy of your letter of response to the patients primary care GP?

Yes 68%

No 32%

Do you think it is best practice to do so?

Yes 89%

No 11%

Can you think of circumstances where sending copies of your letter to both referring and primary care GP might not be in the patient's best interest?

Yes 67%

No 33%

How often do GPs make phone contact with you regarding their patients referral?

Rarely (<1%) 7%,

Occasional (1-5%) 74%,

Often (5-20%) 17%,

Frequently (>20%) 2%

What percent of referrals you receive from Gps would you consider lacking in important relevant clinical information. (eg. clinical history or test results).

28% (1-90%),

How has this percentage changed over the last 5 years?

Increased 3%,

Decreased 3%,

Unchanged 84%.

Studies have shown that doctor shopping in general practice occurs least in elderly patients with chronic illnesses or health problems that require regular consultations. These are the sort of patients more likely to require referral for specialist opinion. Doctor shopping is more common in young, healthy patients, among disadvantaged patients, and those with psychological or relationship problems. (Our survey did not include psychiatrists.)

Our specialist respondents have indicated that about one in four patients are not referred by their primary care GP. Harmless reasons for this include referral from a partner in a group practice. Less harmless reasons include the unavailability of their normal doctor outside working hours, refusal of the primary care GP to give a referral, dissatisfaction with the service given by the primary care GP, unavailability of the family doctor to do home visits.

A growing consumerism amongst patients has seen them move more between GPs for convenience and choice in recent years. Some patients seek out different Gps for different types of problems.

In our survey, respondents have confirmed their trend to doctor shopping by 33% responding that the incidence of referrals from primary care Gps has decreased over the last 5 years.

What has this trend done to the working relationship between GP and specialist?

it is common sense to suggest that referral from a chance encountered GP is likely to increase the duplication of tests and treatment and lessen the patients compliance with treatment. The lack of continuity of care that results may increase hospitalisation and adverse events.

It seems that these potential problems may be compounded by the attitudes of specialists. Although 89% of our respondents considered it best practice to send a copy of their letter to the primary care GP when referral was from a chance encounter Gp, only 68% felt obliged to do this and 67% said they could think of circumstances in which it was not in the patient's best interest to do it. A number of respondents provided comment that they ask the patient first and if the patient disagreed, would not send a report to the primary care GP.

Is this reason good enough? One could imagine that many patients would disagree simply because they were embarassed by the fact that they had gone to another GP for matters of convenience. One respondent suggested that patients go to alternate Gps due to a refusal to refer by the main GP or because the patient has been repeatedly mismanaged. Another respondent commented that patients are demanding referral often inappropriately, before the GP has a chance and that this is getting worse.

Particularly disturbing to note is that about one third of referrals are considered lacking in important relevant clinical information. Those specialists who offered comment pointed to test results and drug history. Certainly, these details should be considered as a essential components to any referral.

 
Greatest barrier to successful management

Are GPs really interested in managing their affairs?

...poor remuneration - always worried if we can afford this or that - inability to pass costs on to the consumer as other businesses can.

...individualism.

...dollars, dollars and more dollars.

...lack of management skills by doctors.

...wasting time on GP FaxPolls when you are already a few patients behind.

...remuneration.

...is what happens between the eyes and fingers.

...a sense of humour.

...the reception staff.

...a society that thinks responsibility for health ends with the medical profession and abuses its own responsibilities.

...doctors and their wives who have zero management skills and believe receptionists know less. Also, doctor's wives who degrade the position of Practice Manager just so they can income split with their husbands.

...chronic government interference.

...red tape.

...me!

...getting up these cold mornings.

 
Practice Managers let loose on GP amalgamation

What do Practice Managers think? We asked them during our Faxpoll to complete the sentence:

...having an increase in Medicare rebates.

...Kim Beazley and Pauline Hanson getting married.

...getting Hussein out of Kuwait!!!

...getting the Liberal and Labour Parties to agree on anything!

...reuniting the former Yugoslavia, Serbia, and Croatia.

...submitting oneself to the guillotine!

...trying to marry half a dozen people!

...a relaxed dinner with Hannibal Lechter.

...politicians who promised to build a bridge when there is no river!!

...mating pandas.

...Michael Wooldridge scrapping Medicare!

...stimulating sloths!

...making a salad dressing-if the ingredients are well shaken together, they eventually coalesce.

...Joe Bjelke Peterson and Richard Court sharing a Jacuzzi.

...getting President Clinton and Saddam Hussein to co-star on Oprah Winfrey on "lies I have told".

...getting some sense out of Brian Harradine.

...surviving a flight in a brick and tile glider!

...getting eight teenagers to write a paper on the benefits of a superannuation fund.

...amalgamating politicians from different parties.

...keeping two wives happy!!

...keeping mother-in-law happy.

...getting Gough Whitlam, Malcolm Fraser, Bob Hawke, Paul Keating and John Howard together to run a fish and chip shop.

...as easy as pie (but there's a big difference between a cordon bleu restaurant and a fast food outlet).

...mixing water and oil.

...getting my dog to fill in the holes he digs in the garden.

...resolving the troubles in Northern Ireland.

...converting the Pope to Hinduism.

...doing a haemorrhoidectomy in the dark.

...A.B.C.

...running the bulls at Pamplona.

...using sandpaper as toilet paper.

...taking away a politicians super.

...arranging leave (possible but hard).

...marriage!!

...getting John Howard to apologise.


 
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