Saturday 23rd August 2008
Robust exchanges suggest there is no love lost between the new Federal Government and the doctors’ peak body, the Australian Medical Association (AMA).
Federal Health Minister Nicola Roxon and the Australian Medical Association (AMA) have been slugging it out and at the heart of their dispute is the role of nurses and allied health professionals in primary care.
Roxon told the Australian Institute of Health and Welfare (AIHW) conference in June that the Government’s National Primary Health Care Strategy – the heart of its health reform program – would give nurses and other healthcare professionals a greater role to help address a GP shortage.
An AIHW national survey had just revealed access to doctors dropped 9% in the eight years to 2005. The number of GPs has tumbled from 108 full-time practitioners per 100,000 people to 98.
Nicola Roxon said there was now a GP shortage right around the country and a new approach was needed.
‘People wait weeks for an appointment, or can’t get in at all as lists are closed, with GP surgeries bursting at the seams,’ she said. ‘We need to have a primary health care system that enables people to see the right health professional for their needs, in an appropriate place at the right time. That may mean rethinking who the “right health professional” is in certain situations.
‘That health professional may be their local GP; it may be a practice nurse; or it may be an allied health professional, such as a psychologist, physiotherapist or dietitian.’
AMAs wants to keep nurses down
AMA president Rosanna Capolingua had a vigorous reply at the same conference.
‘Is the Government suggesting that we move away from that model (of GPs referring patients to other health workers), and have independent nurse practitioners, with prescribing rights, even though they don’t have the training to take a history, devise a management plan and order investigations? We would see that as compromising quality care and we would be very concerned,’ she said.
Capolingua has since continued a concerted campaign against the Government’s approach, saying doctors are the best people to provide primary care.
‘GPs are the most effective gatekeepers in primary health care,’ she told the Canberra Press Club.
In the same speech she unloaded a thinly disguised broadside at the Government.
‘The AMA is not in the way … the AMA is the way. The Government talks the talk. Let’s see them walk the walk,’ she said.
Broad support for federal health plan
The Federal Government’s approach does have a number of other supporters including other doctors’ associations.
NSW GP Tony Hobbs is the chairman of the Australian GP Network, the reference group that will shape the Government’s new strategy.
He says the aim of reform was a ‘system that puts the patient at the centre, not the health care professional at the centre’.
The Productivity Commission recommended that other types of health workers, including nurses, should have access to Medicare funds alongside doctors in a 2006 report on the health workforce. The Howard Government let the report gather dust after opposition from the AMA.
New Commonwealth Chief Nurse Rosemary Bryant, unsurprisingly, also strongly supports an expanded role for nurses in primary care.
‘Nurses, at an advanced level, are able to diagnose many of the conditions for which many of us would see our GP,’ she told the ABC’s Health Report.
On the same show Roxon restated her belief in nurses’ ability to take on a more prominent role.
‘I’m very confident we have highly skilled nurses in our system being held back by outdated restrictions. We have to modernise the system,’ she said.
Bad blood spills into NT intervention
The battle over reform of primary care is not the only area of contention between the AMA and the Federal Government.
In June the AMA declined to take up another $10 million contract to recruit doctors for the Northern Territory intervention targeting remote Indigenous communities.
The decision came after the AMA was accused of profiting about $150,000 under its previous contract with the Federal Government, which expired on 30 June.
The Australian revealed in June that the AMA stood to reap up to $150,000 – double the amount previously disclosed – for recruiting doctors to participate in the scheme under a contract offered to them by the Howard Government, three days before the Federal Election.
The Indigenous health group most closely involved with the intervention, the Aboriginal Medical Services Alliance Northern Territory, told the Australian it was ‘shocked and disappointed’ that the AMA sought ‘to profit from the intervention’.
Nicola Roxon said the AMA was the only professional organisation that had asked to be paid to help secure health professionals to take part in the intervention.
‘I’m sorry they didn’t think the process was a satisfactory one, but I am confident that there are many hundreds of health professionals across the country who still want to be involved in the intervention.’
The balance sheet of argy bargy
so far between the Government and the AMA: