WA News News & Reports After-Hours Comment
After-Hours Comment
Written by Jan Hallam
Wednesday, 28 June 2017

The Medicare Benefits Schedule Review Taskforce into urgent after hours primary care services delivered its preliminary report for consultation and is recommending changes to the four urgent after-hours item numbers (597-600) only.

Last issue we spoke to the WA Deputising Medical Services about its decision join a break-away group with three other deputising services from the peak body, the National Association for Medical Deputising Services.

At the heart of the discontent was not so much the use of urgent item numbers, though there is certainly consternation about what constitutes ‘urgent’, but the intense marketing focus on the consumer by some after-hours service providers as an alternative to a daytime GP.

This distinction is understandably blurred in consumer-land where an after-hours service that is bulk billed and comes to you is pretty irresistible.

The distinction is sharply defined in the minds of Government which has to pay dearly for the convenience and for daytime GPs who have all the costs of providing a bricks and mortar service and the prospect of patients defecting not for any other reason than perceived convenience.

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Since the report’s release on June 7, there has been a plethora of argument on both sides of the after-hours service divide, some which show evidence that after-hours services have, contrary to earlier reports, contributed to a decline in ED presentations, depending on how and when you look at the numbers.

Certainly, no one wants to return to the dark days of the 1990s where it was almost impossible to get any doctor to make a home visit after hours. However, that’s a long stretch from consumers calling doctors in for prescription repeats and sick notes when time is money even if it is frustratingly wasted time for a doctor who has a list as long as his arm.

Changes to the criteria of urgent after hours are needed, so those people whose only other redress is the emergency department are seen appropriately by an after-hours GP.

If another model of primary care is needed for those consumers who want regular GP services after hours, then that conversation should start outside the precinct of urgent after hours.

By Jan Hallam

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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