Australian Medical Association

The AMA submission to the Australian Institute of Health and Welfare and the Royal Australasian College of Surgeons highlights that: urgency categories should facilitate patients being prioritised for surgery fairly and equitably; category definitions should take account of all the factors relevant to a patient's requirement for surgery; the primary driver for surgeons to categorise elective surgery will always be clinical urgency; and elective surgery waiting time should be counted from the time the patient is referred by a general practitioner to a surgeon for assessment until the time surgery is performed.

The AMA has identified medical workforce shortage as a major health issue. The Regional/Rural Workforce Initiatives - 2012 Position Statement looks at all the issues affecting workforce shortages in regional and rural Australia and outlines initiatives and measures which would offer solutions to the current workforce shortage.

The AMA conducted a survey of its members in January 2012 to ensure that the draft Guide to Using PCEHR is as useful and relevant to practising medical practitioners as possible. Responses were used to prioritise and inform the guidance given in the document.

The Personally Controlled Electronic Health Record System (the PCEHR) is an Australian Government program to provide Australians with a system of access to health information relating to consumers of healthcare.

The AMA has drafted the AMA Guide to Using the PCEHR to assist medical practitioners to consider if they want to participate in the PCEHR system and if so, how they might use the PCEHR in their day-to-day practice.

The AMA has provided a submission to the Royal Australasian College of Physicians (RACP) in response to their discussion paper Linked Dual-Trained Physician Care in Rural Communities. The AMA supports efforts to improve patient access to to medical care in regional and rural Australia and the RACP model has merit for further development. It needs more detail and refinement to ensure such a model is attractive for potential trainees, effective in delivering care and sustainable in the long term for rural communities.

The AMA has reviewed the Government’s Draft Ten Year Roadmap for National Mental Health Reform (the Roadmap) and is pleased to see that some of the directions set out in the plan incorporate elements of the AMA Position Statement on Mental Health 2011, in particular those Roadmap actions related to reducing stigma and discrimination, increasing access to early intervention and support and improving accessibility of mental health and support services. The AMA has nevertheless critiqued the Government on funding cuts to the Better Access Program (as this action does not match the policy intent outlined in the Roadmap to improve provision of mental health and support services to those who need them) and for failing to adequately recognise the vital and increasing role that GPs play in caring for patients with a mental health issue and their families. The AMA comments also highlighted the importance of specifically targeted programs for special needs groups, and the need to develop measures to address systemic barriers to mental health services.

The AMA's submission to the Independent Hospital Pricing Authority on a pricing framework for public hospital services calls for hospital services to be funded on the basis of an 'effective' rather than an 'efficient' price. An effective price is one that provides sustainable and equitable access to high quality hospital services. The submission details the AMA's support for appropriate funding of post-hospital care; investment in teaching, training and research; and small and medium sized hospitals.

The AMA wrote to the Pharmaceutical Society of Australia on 15 November 2011 opposing the continued dispensing proposal under the Fifth Community Pharmacy Agreement. Continued dispensing will represent a significant change in the professional role of pharmacists and their role within the health care team. The draft guidelines circulated by the Pharmaceutical Society of Australia heighten the AMA's concerns that continued dispensing will undermine the collaboration between pharmacists and medical practitioners.

The AMA has identified the medical workforce shortage as a major health issue with the overall distribution of doctors being skewed heavily towards major cities such that regional, rural and remote areas shoulder a disproportionate workforce shortage burden. There is a strong preference amongst much of the current medical workforce to live and work in major cities. So much so that attracting young professionals to rural locations is extremely difficult. The AMA believes the factors affecting the supply of medical workforce in rural areas should be viewed in the context of generalism; remuneration and incentives; hospital infrastructure; compensation and family support; costs of establishing a practice and access to community; high on-call demands and the need for rosters and locum services;and recruitment of international medical graduates (IMG) doctors.The submission makes a series of recommendations addressing these issues as well as the effect of the introduction of Medicare Locals, anomalies with the ASGC scheme and the need to extend MBS telehealth items.

The idea of a chaperone may seem old fashioned. But patients differ in their preception of what is required during a medical examination,  particularly if the patient comes from a different background. The presence of a chaperone is one way to minimise complaints being made against doctors.

Whenever you are conducting an examination, whether it is in a suburban surgery or in a busy hospital, consider whether you should have a chaperone present.

Did you know that the RACGP Vocational Training Standards are changing? The new draft standards involve significant change and a move to an outcomes based approach. Supervisors and doctors-in-training have expressed concern about some elements of the draft standards. Find out what the changes to the Vocational Training Standards could mean for you by reading our submission.

The provision of out-of-hours care is a key part of general practice. The AMA Out-of-Hours Primary Medical Care 2011 position statement has been developed to guide the design of these services, outlining the essential feature of a successful model of out-of-hours primary medical care.

This submission responds to the HWA draft background paper - Rural and Remote Health Workforce Innovation and Reform Strategy released in July 2011 as part of the consultation process.

The AMA believes it is important that the Government gets it right to ensure that the health workforce in rural and remote areas is sustainable and that people in rural communities can access affordable, appropriate health care services when needed.

National Minimum Terms and Conditions for GP Registrars - revised November 2011

The 2010 agreement has been updated and contains the rates which apply from the start of the 2012 training year.

The AMA has made a submission to the Medical Board of Australia on its Proposed Registration Standard – Granting registration as a medical practitioner on completion of intern training. The Board's proposed standard includes the option for health services to provide interns with exposure to emergency medicine (EM) in a general practice context. Of utmost concern to the AMA is the absence of clear criteria about what would constitute appropriate exposure to EM under this type of arrangement. As a result, the AMA has offered to be part of the team that will prepare guidelines to better define the Board’s requirements. In the mean time, the AMA maintains that all interns should have access to a term in an Emergency Department.

The AMA's submission to the Senate Finance and Public Administration Committee on the National Health Reform Amendment (Independent Hospital Pricing Authority) Bill 2011 highlights the importance of the Pricing Authority, the Australian Commission on Safety and Quality in Health Care, and the National Health Performance Authority collaborating on their roles and responsibilities, for example, on data collection requirements.

It also points out that the Pricing Authority should consider the standards set by the Performance Authority when calculating the national 'efficient' price, that is, it must take into account the performance that must be achieved. In addition, the National Health Reform Agreement allows states to pay hospitals less than the determined efficient price, therefore, we recommend that the actual payments made to hospitals are reported to Parliament so that it is clear when poor performance is linked to insufficient funding.

Overall the Bill before Parliament responds to the AMA's lobbying last year to ensure the Pricing Authority considers the range of variables affecting the actual costs of providing health care services when calculating the national efficient price. However we recommend that the Authority is explicitly required to ensure hospitals can fulfil their teaching and research obligations.

On 2 August 2011, the Commonwealth, State and Territory governments finalised the National Health Reform Agreement. A summary of the Agreement's key points can be found here.

Second Submission

The AMA submission to the Department of Health and Ageing position paper on the role and governance of Lead Clinician Groups released on 20 May 2011 emphasises that the Commonwealth Government's attempts to provide doctors with a meaningful role in how local hospitals are run has failed.

First Submission  - 17 February 2011

The AMA submission to the Department of Health and Ageing discussion paper on the role and governance of Lead Clinician Groups released on 25 January 2011 strongly opposes the limited role for doctors proposed. The AMA submission provides a model for Lead Clinician Groups that ensures doctors are involved in decisions made at the local hospital level about resource allocation, service planning and provision, and patient care.

The AMA has made an additional submission to the Department of Health and Ageing to raise concerns identified by AMA member junior doctors. This submission:

• emphasises the need to ensure that time-based targets do not impact on the ability of public hospitals to provide quality clinical education and training;
• calls for ongoing resources to support the ability of emergency departments, the hospital and community providers to fulfil education and training obligations; and
• recommends that the monitoring and evaluation of the impact of targets also includes the impact on education, training and junior doctor experiences.

This submission supplements the submission lodged by the AMA on 25 May 2011.

As part of a service to all of our members the AMA has mediated an agreement between GP Registrars and GP Supervisors that sets out minimum terms and conditions for GP Registrars. This agreement is negotiated every two years by the National GP Supervisors Association (NGPSA) and GP Registrars Australia (GPRA), with the AMA's assistance.

The 2011 agreement applies from the start of the 2011 training year.

The AMA submission on the proposed PCEHR expresses concerns that the proposed form of the PCEHR will provide only limited safety benefits and these are significantly outweighed by its inherent clinical and medico-legal risks for medical practitioners and the administrative burden it will impose on medical practices.

The AMA submission highlights that the Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010 already govern the management of health care practitioners who have blood-borne viruses and makes the point that there is no need to de-register a medical practitioner because they have a blood-borne virus.  The AMA has asked the Board to clarify its role in regulating the scope of practice of medical practitioners who are infected with a blood-borne virus in isolation from the way this issue is managed by medical practitioners and the health care organisations in which they practice.  The AMA has suggested the Board undertake a second round of consultation once it has clarified what action would constitute a breach of guidelines and that action the Board might take in such cases.

The AMA has made a submission to the Department of Health and Ageing, on the implementation of elective surgery and emergency department targets, which strongly advocates for an evidence-based approach to implementation. The AMA supports measures to improve the timeliness and quality of patient care in public hospitals but cautions against imposing arbitrary time-based targets that may carry more risks than potential benefits if they are not slowly, carefully and cautiously implemented.

The Department of Health and Ageing is seeking applications from eligible individuals and organisations to develop, test and evaluate innovative models of practice for nurse practitioners in residential and community based aged care. To ensure collaborative care models between GPs and nurse practitioners are part of the trial, the AMA encourages its members who practice in the aged care sector to apply.

Applications close at 2:00pm (AEST) on 14 June 2011.

The AMA supports the development of an electronic system to record and monitor controlled drugs that can be used to help address abuse and misuse of schedule 8 drugs. A project to develop an electronic system is being funded as one of several programs under the Fifth Pharmacy Agreement. The AMA has made a submission to the Department of Health and Ageing in response to a consultation paper released as part of the development phase of the project. The submission notes that any system designed for medical practitioners must be simple, easy to operate and avoid duplication of effort.

The AMA made a submission to the Department of Health and Ageing on 13 April 2011 responding to a proposal that pharmacists could continue prescription medicines to a patient under defined circumstances. The AMA is strongly opposed to pharmacists dispensing prescription medication without a valid prescription and without reference to the patient’s treating medical practitioner. Only medical practitioners are adequately trained to make assessments about a patient’s clinical condition, the need to begin treatment with a prescription medication, and consequently to continue, adjust or cease that treatment.

The AMA supports the introduction of a system to allow medication charts in residential aged care facilities to be used as a prescription for PBS purposes. This has the potential to significantly improve the efficiency of providing medical care to aged care residents and increase medication safety. A project to develop this system is being funded as one of several programs under the Fifth Pharmacy Agreement. The AMA has made a submission to the Department of Health and Ageing in response to a consultation paper released as part of the initial stages of the project. The submission attaches a list of key principles the AMA considers should form the basis of implementing the chart-based prescribing system.

The AMA submission to the Senate Finance and Public Administration Committee inquiry into AHPRA highlights that the administrative failure by AHPRA to properly plan for and coordinate the transition to national registration has had a detrimental effect on individual medical practitioners, and on services to patients.  In failing to ensure that every medical practitioner transitioned smoothly to national registration, AHPRA failed to act in the public interest.  Patient care was put at risk because medical practitioners could not work.

The purpose of this Guideline is to clarify the responsibilities of medical practitioners, patients, and relevant third parties regarding certificates certifying illness ("sickness certificates") within the context of the doctor-patient relationship.

Medicare Locals have the potential to impact on a wide range of health care services.  The AMA believes they should be introduced in a manner consistent with the AMA's overall health vision and which is respectful of the exisitng role of the General Practitioner and other community based specialists.   This position statement includes details of the AMA position on the governance, functionality, accountability, fundholding and boundaries of Medicare Locals.