WA News News & Reports Crowded House
Crowded House
Written by Jan Hallam
Thursday, 28 July 2016

Concerns have been raised from the RACGP and GPs as to whether all of the players in the crowded after-hours market are true deputising services for daytime GPs or they’re simply running their own race.

201608-Keneally-Ben-Dr Jul16Mr Ben KeneallyMedical Forum spoke to Ben Keneally, the CEO of National Home Doctors Service, a newish player in the WA market, and president of the peak body, National Association for Medical Deputising (NAMDS), who was visiting Perth last month, about some of these concerns. The message was clear. After 20 years of a poor performing and in some instances non-existent after hours’ service, which saw a flood of non-acute presentations at hospital EDs, there was traction at last for these consumers to return to where they belonged – the primary care sector.

Medicare stats
Ben said the Medicare statistics showed the greatest growth (in numerical terms) in after-hours’ services were in consulting rooms (items 5020, 5040) than home visits (items 597, 599) though there had been increases in those as well.

“What we’re seeing is the success of government policy,” he said. “But to speak to those GP concerns, the total number of after-hours home visits represents less than two visits per GP per week. In the 1950s when GPs were responsible for their own homes visits, they would have done at least that number of home visits. Yes, there has been growth, but it’s been off an extremely low base.”

“However, there is a distinction between those organisations that genuinely behave in support of general practice and those that have set up with no connection to general practice at all.”

“At National Home Doctor Service, and for NAMDS members generally we ,are very strict about collecting GP details from 90% of callers, which reflects the proportion of people who don’t have a regular GP. So we report back to the GP; we don’t provide referrals; and we don’t get involved in check-ups. There is a clear and detailed triage protocol to preclude routine work. Though there are websites that promote referrals after hours and that is clearly inappropriate and shouldn’t be happening.”

The RACGP is waiting and watching.

Continuity of care
Ben argued that after hours’ deputising, if done properly, provided that strongest continuity of care but if it came to be relied upon as an alternative to seeing a daytime doctor then that was a problem.

“A well-run deputising service doesn’t allow that to happen. Every month we review different time frames to see if patients have been presenting too frequently, in which case we will be in touch with them and their GP around appropriate restrictions because we don’t want to become an alternative to their regular GP.”

In response to the College’s criticism about services advertising, Ben said deputising services had to raise awareness.
“We’ve tried the RACGP’s preferred model – consumers finding out about a service out through their GP – and it didn’t work. In order to provide universal access we need to make people aware.”

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.)

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