If it ain’t broke, why fix it? They just don’t listen

ANOTHER year, another 5000 trees to plant. Our family’s commitment to the environment is now 35,000 little carbon sinks.

The fencelines are in and the ground ripped. I knew something was wrong when the phone didn’t ring all night. Perhaps the GP After Hours Helpline had kicked in, or maybe the Medicare Local. But I soon figured it out. There’s nothing quite like an excavator cutting through copper cable 10 times.

We checked before we dug, but the map, like the ASGC-RA, was useless and hadn’t shown the line.

At least Telstra had the grace to take responsibility and not charge me.

The past months have been busy, with two medical students to supervise and train in addition to registrars and a PGPPP participant.

On the RDAA front, there have been discussions with the federal health department on our ASGC-RA and after-hours concerns. Unfortunately, everyone seems to get it but the bureaucrats.

The Senate inquiry into the ASGC-RA and rural incentives now has overwhelming evidence that the scheme simply isn’t working.

If it was a drug company trial the ASGC-RA would have been abandoned years ago because of the damage it’s causing.

As well as the avalanche of complaints from practices, RDAA has been fielding increasing registrar concerns about having to do after-hours in small country towns but getting the same incentives as doctors in major regional centres, given many of the locations now come under the same inner regional classification.

Meanwhile, rural practices are learning just how much they will lose when the government removes the after-hours PIP incentives on 1 July 2013, trashing decades of comprehensive rural care and the PIP itself.

Under the PIP, a practice with 3000 SWPEs (standardised whole patient equivalents) currently providing 24/7 services in  RRMA 5 will lose $24,000 each year in recurrent funds.

I recently visited a practice providing full after-hours care through its surgery and local hospital in a small community on the NSW-Victorian border. It will lose almost $80,000 a year.

The government mouths reassuring words but we cannot get a response from the minister, the department or Medicare Locals to a simple question – will practices providing 24 hours after-hours care, including emergency care through their local hospital, be fully compensated for the loss and if so how?

Even in major regional centres doctors are pulling out of established services and Medicare Locals’ after-hours looks set to be nothing more than a Sunday afternoon clinic in a regional centre and a video link to a hospital in smaller towns.

They don’t listen and they don’t get it.

Why replace a simple and effective system with a complicated expensive one? In about 120 rural NSW towns, under the RDANSW hospital agreement, the cost of call-outs to provide after-hours emergency services from midnight to 7am is far less than $1 million annually.

The great health reform agenda is pretty much dead. Kevin Rudd’s principles of a ‘rational national’ approach to primary and hospital-based care with more efficiency, less duplication and avoidance of cost shifting has been muddled. We now have three layers of funding, three bureaucracies involved, and more opportunities for cost-shifting and political cronyism.

Meanwhile, I promised an update on my letter to our Medicare Local seeking a commercial payment for use of our practice facilities for their services. Not surprisingly, I haven’t had a response.

Think I’ll go plant more trees.

Dr Paul Mara
President, RDAA

You can contact Dr Paul Mara at president@rdaa.com.au