WA News News & Reports All Eyes on GP Numbers
All Eyes on GP Numbers
Written by Jan Hallam
Wednesday, 22 June 2016

A couple of issues ago we reported that the CEO of WAGPET Dr Janice Bell (now adjunct professor) had been appointed chair of the Curtin Medical School External Advisory Board. The other positions on the board have since been filled and it doesn’t lack clout.

Curtin-Medical-School-Board-MainFront row (L-R):Prof John Cordery, Adj/Prof Janice Bell, Prof Gary Geelhoed, Mr Kim Snowball Middle row (L-R): Adj/Assoc/Prof Robyn Collins, Dr Richard Choong, Dr Karen Pitman, Mr Kieran Gulvin Back row (L-R): Dr Alan Eggleston, Prof William Hart (Dean), Prof Bryant Stokes Absent: Prof Con Michael, Prof Michael Berndt, Ms Vicki O’Donnell, Ms Michele Kosky Joining her are former AMA WA President and WAPHA chair Dr Richard Choong, State Manager of AHPRA, Adj A/Prof Robyn Collins, former Senator Dr Alan Eggleston, Chief Medical Officer and former AMA WA President Prof Gary Geelhoed, student rep Kieran Gulvin, consumer advocate Michele Kosky, chair of the WA Medical Board Prof Con Michael, Aboriginal Health Council member Vicki O’Donnell, GP Dr Karen Pitman and former DGs of Health Kim Snowball and Prof Bryant Stokes.

Adj/Prof Bell said the board and the medical school had a shared intention to develop “capable, compassionate doctors willing and able to work where they are needed most”. The statement went on to say that a Curtin degree would allow graduates to meet the needs of currently under-serviced areas of health care including primary care, chronic disease, ageing, Indigenous and regional health.

This came in the thick of a federal election campaign in which doctors, especially GPs, had been especially outspoken about policies to cut health costs.

Just a couple of weeks ago a report written by former Victorian president of Rural Doctors Australia Dr Mike Moynihan and economist Bob Birrell blamed what they described as a “growing glut” of doctors for the record-high bulk billing rates. They said GP numbers had grown almost 50% over the past decade (more than twice the population growth) and called for a lowering of the intake of overseas-trained doctors and new limits on where Medicare-funded doctors, including those locally trained, were able to practise.

The pair went on to dismiss warnings from the AMA and the RACGP that the prolonged freeze on MBS indexation could force GPs to abandon bulk billing, saying that the competition for new patients was so stiff few GPs would risk charging a co-payment.

While the report focuses on cutting the number of OTDs, the authors were concerned about the growth of local medical graduates, a concern shared by the AMA WA. It is an outspoken critic of the Curtin Medical School with the then President Dr Michael Gannon writing in Medical Forum in July last year describing it as “one of the worst decisions in WA health in decades”.

“After talking with many colleagues and hearing their extensive concerns about training bottlenecks as they already exist, I do not resile from this view,” he added.

Accusing the government of making a decision based on “votes, property development and urban renewal” Dr Gannon wrote:

"This was a backroom deal struck by a small number of powerful players with vested interests none of whom would have been able, or indeed willing, to provide critical thought on the likely impact on training places, on already limited teaching opportunities, or ask in a genuinely critical way how another 60 or 100 medical graduates will provide more GPs to remote and rural areas.”

Now national AMA President, Dr Gannon was a little more temperate in response to the Moynihan/Birrell claims. He was reported as saying in the national media that their argument about GP numbers was “slightly false”, applying only to densely populated areas in capital cities, and arguing that a growing GP workforce was a plus for Australia as such an investment kept patients out of hospitals and emergency departments.

“GPs are the gatekeepers of the system and provide enormous value of money, being only about 6% of national health costs,” Dr Gannon said. “There’s no question we’re much closer to having a maldistribution rather than oversupply.”

The Curtin advisory board will be reassured by this apparent change in tone from AMA HQ as many of them have strong ties with the organisation. The first intake of Curtin students commences in 2017.

 

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

Normal 0 false false false EN-AU X-NONE X-NONE