Editorial
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Volume 2012 Number 1
Health Politics
Neil Johnston: Friends of Science in Medicine
Peter Sayers: Confessions of a Frustrated PharmacistEPublications
GPs were the ‘gatekeepers’ to the health system. Will they remain so?
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PDF version | James Ellerson |
James Ellerson is passionate about developing primary health care services across the spectrum of all health care practitioners working in a practical alliance, whether in an urbanised or a remote setting. | |
It’s often hard to tell which party is in favour of what outcome when reading some of the media coverage on doctor, pharmacy, nurse practitioner prescribing issues. Here are a few examples to ponder: • the Guild is opposed to pharmacist prescribing • pharmacists and nurse practitioners are to be given limited prescribing rights • most GPs do not actually consult with a patient before issuing a repeat script.
I read recently that Dr Pesce and the AMA intend protesting long and loud to the Health Minister and the Prime Minister over the decision to give pharmacists limited prescribing rights under the ‘medication continuance’ program proposed in the 5th CPA.
It seems the AMA sees this as a clear signal the government intends to carve up the traditional role of the local family doctor. In short Dr Pesce believes the future of quality health care in Australia is under threat. He might well be right. But what if he is wrong? Perhaps it’s more that the traditional role of the local family doctor is about to change. That’s a far cry from “being under threat”.
Most people don’t like change. It can be uncomfortable, it can mean more work, and it can threaten those with complacent attitudes.
“Without change, something sleeps inside us, and seldom awakens.
The sleeper must awaken.”
Frank Herbert, American science fiction writer 1920-1986
The world keeps advancing. Technology is driving change. Mobile phones, blue tooth, GPS, iPods and iPads are everywhere. We have to keep up or we will get left behind.
The Guild is driving change in its world, hungry for more power and control over its domain. Its focus is clear; keep a lid on the number of pharmacies, drive its robotic system into the market, get access to the MBS and control the escript exchange space and the consumer’s medication record.
By comparison GPs don’t seem so keen change. They have seen their role in primary care as the gatekeepers to the health system; which in years long gone they were. But their world has suddenly changed around them.
A new type of gatekeeper is required. For far too long the doctor and representative bodies like the AMA, RACGP and AGPN have had a golden opportunity laid out before them to strengthen their position and re-engineer primary care to ensure they remain the gatekeepers and coordinators of health care. But they have let that opportunity slip slide away. In fact, if you believe in the role of the GP as the gatekeeper of the healthcare system you will be forced to conclude that they have failed themselves and those whom they treat. Is it now too late? Has the horse has bolted?
Perhaps the ‘gatekeeper’ role is now old hat, outdated and superseded. Perhaps a new gatekeeper is badly needed. With the recently announced Primary Health Care Organisations (PHCO) a new gatekeeper has emerged on the horizon. With $355 million earmarked in the federal budget to build 23 new GP super clinics, in addition to the 31 super clinics announced at the last election, we now have a total of 54 GP Super Clinics in the pipeline, with some already fully operational. Further, a ‘substantial’ amount of that money has been earmarked to upgrade 425 primary care facilities in Australia which, when upgraded, can be ‘likened’ to a super clinic in everything but name! So in effect, when this construction program is complete almost 480 ‘super-type’ clinics will be up and running across the nation!
Although it’s a bit late for GPs to start arguing for dispensing rights the next best thing would be to have pharmacists located in medical practices as part of the coordinated primary health care team. The Guild is against that happening. I wonder why.
Could it be that the combination of pharmacists, escripts from doctors, internet prescribing, mail order pharmacy and robotic dispensing all pivoted around a busy medical practice, dare I say ‘ Super Clinic’ (wash your mouth out with velvet soap Johnny) might be the very thing the Guild does not want to see eventuate. Could it be the forerunner to making the Guild irrelevant and the PSA supreme?!
The key question in this whole scenario is whether these new PHCOs should evolve from a restructuring of the Australian General Practice Network (AGPN) and a consolidation of Divisions of General Practice, or, whether some other model should be adopted. Dr Djakic, Chair of the AGPN, has stated “PHCOs, will evolve from our Networks”. He said “funding for the first wave of Primary Health Care Organisations announced in tonight’s budget will transform existing general practice networks into up to 15 PHCOs by July 2010, with the rest in place by July 2012”.1.
With doctors leading PHCOs will they remain the ‘gatekeepers’?!
Oh, for the quiet life.
1. 11 May 2010, AGPN Media release, Primary health care organisations – transforming Australia’s health care future.
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