A voice for general practice in health reform
The Hon Nicola Roxon MP, Minister for Health and Ageing, Address to the Royal Australian College of General Practitioners National Conference
1 October 2009
Introduction
Thank you for having me here at your annual conference, and for giving me the opportunity to address the leaders of Australia’s General Practice community.
And thank you for the support and leading role you have played in advising us, devising and approving guidelines and promoting the roll out of the swine flu vaccine. I know this means many of you will be very busy in your practices in the coming weeks and months and appreciate the effort and planning you have already put into making this happen as smoothly as possible.
We are at an exciting time in the health debate. Rarely does it happen that the urgent need for reform coincides with a Government determined to implement it.
Today, I am here to invite you, Australian general practitioners – doctors who are in the front line of our health system – to be partners in our reform agenda.
I hope to put to rest some fears you have about our reform agenda – but still challenge you to keep looking forward, and be part of sensible change.
I am sure not one of you will disagree that while the Australian Health system has numerous strengths – not least our strong health outcomes and highly skilled workforce – it is also a system that is under pressure.
For years now the strains and pressures have been building, and various band-aids have been applied to paper over the cracks. Everyone here also knows that the cracks will only increase in time as our baby boomers age and succumb in greater numbers to chronic disease.
The reform agenda
I’m sure you’ve all noticed recently that I have been travelling around the country with the Prime Minister discussing health reform. There is a clear acceptance in the community of the need for serious debate on the future shape of our health system, and you have a Government with the will to implement serious intergenerational reform to our health system.
GPs will play a key part in informing that debate and demonstrate what is working well, and how we address the gaps in the system.
The point I would make for now is that the proposals that we have on the table will mean a lot of change for the health workforce – changes that will challenge some of you but actually hold great opportunity if you choose to be part of it. GPs are already at the centre of how health services run in Australia – and the proposed reforms strengthen this further with their emphasis on primary care.
What is different about the health debate today is that after years of listing the problems, we now are on the home run for implementing solutions. Reform is actually going to happen.
At the end of my speech I will take you more formally through the work that we are undertaking on the health reform process and have time for questions and answers as part of our consultation process. These occasions are an important part of this process as GPs and primary care are so central to many of the recommended reforms. I will speak in more detail about the Commission’s Report shortly.
The key directions of the Commission’s Report build on and extend many areas of the Government’s health reform agenda so far, in areas like workforce initiatives, primary care, prevention, better performance and accountability and addressing gaps and inequities.
Investments in Primary Care
While we are undertaking an extensive consultation process on health care reform, we recognised that there was urgent action we needed to take upon coming to office.
We are actively building the General Practice workforce by increasing the number of prevocational placements in General Practice through the PGPPP, have lifted the cap on GP training places which will expand by more than 30 per cent by 2011 and have committed to providing ongoing funding and a 50 per cent expansion in the Remote Vocational Training Program.
We have transformed the Rural Medical Infrastructure Fund (RMIF) into a successful program that extends support for training infrastructure in rural areas, while also working closely with the College and United General Practice Australia (UGPA) to look at further infrastructure needs for training.
We have also recognised the fragmentation of our workforce training and planning mechanisms and through the Council of Australian Governments made a $1.6 billion commitment to the health workforce – the single largest investment in the health workforce made by Australian governments.
This workforce agreement will support clinical training for 13,800 medical students, 38,500 nursing students and 18,000 allied health students in 2010 – helping to build the workforce we know we will need into the future.
We hope to work with states through this agency to expand intern training places, including into community settings like general practice.
We have recognised the important role of General Practice Divisions, which we believe can be the stepping stone to a broader primary care approach, and updated the formula upon which their funding is based to ensure that it reflects current population data.
This year’s Federal Budget also delivers more than $200 million to help tackle the shortage of doctors and health workers in rural and remote Australia, and to improve access to the health and medical services of seven million Australians who live in regional or remote areas.
And despite the initial resistance to GP Super clinics- we now have contracts signed in 26 locations. Every single one of these involves General Practitioners. 7 have local Divisions as active partners, 13 currently have University involvement with another 5 currently in negotiations with Universities. All will play an active part in teaching the next generation of health care professionals.
We believe that this is an important investment, and one that recognises for the first time that Government has a role to play in helping you build the infrastructure to facilitate a multidisciplinary approach to primary health care in the community, with a focus on teaching and training the next generation of health professionals.
Which brings me to a change that I understand you have some anxiety about.
Nurse Practitioners
For those of you who are not aware – I’m confident you all are – we have recently introduced changes into parliament to enable eligible Nurse Practitioners and Midwives access to the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme.
The measures will mean that nurse practitioners, who can currently legally work and prescribe in all jurisdictions in Australia, will now be able to provide their patients Medicare subsidised services and PBS-subsidised medicines.
I want to take a moment to outline our view of these changes.
We believe this will facilitate more effective use of the nurse practitioner workforce, enabling them to take a greater role in the provision of health services while improving overall access to these services by the community, particularly in primary health and aged care, and in rural and remote locations.
I know that many of you are concerned about the impact of these changes on the continuity of care for patients.
As I said on introducing this legislation to the parliament and I quote:
“The Commonwealth’s reforms are designed to complement and boost the work performed by our doctors and specialists as part of a collaborative, team-based environment. Our reforms are not about challenging vested interests. Improving patient outcomes was, is, and always will be, the government’s number one priority.”
So there it is – improving patient outcomes is our number one priority.
Improving outcomes will need continuity of care, and more integrated care.
We understand many of you and your GP colleagues are nervous about the potential to further fracture care to patients. I can expressly assure you we are alive to this risk and do not intend to implement these changes in a manner that allows that.
Business strategies and plans based on this assumption are frankly taking a great risk – and getting way ahead of where the government’s reform thinking is going.
Precisely because of the importance of getting this right – we are consulting closely on what the exact collaborative arrangements will look like.
Your representative Dr Patrick Byrnes is sitting round the table of the Nurse Practitioner Advisory Group (NPAG). Also sitting at the table are the AMA representative Dr Steve Hambleton, the ACCRM representative Associate Professor Ruth Stewart, Dr Alison Edwards from the Autralian General Practice Network and the Rural Doctors Association of Australia representative Steve Sant.
With the first meeting already held, plans for the first technical group meetings in October, and the next broader meeting to be held in November we hope that you continue to provide constructive input into this process.
So my message is consistent wherever I go: while the Government is not interested in and won’t defend turf wars, we are interested in better health outcomes for Australians – and we know continuity of care is vital for this.
Please work with us on what can be a very positive change – rather than assume the worst. The time for resisting change, rather than making change work for patients is over.
Primary Care Strategy
So I hope you can see that we recognise the centrality of General Practitioners in providing primary care services to the Australian community and the centrality and importance of primary care in developing a health care system for the 21 st century.
At the end of August, the Prime Minister and I launched the Draft National Primary Health Care Strategy, which provides a road map to guide future policy and practice in primary health care in Australia.
The development of this Draft Strategy has allowed the Government to take stock, identify major pressure points, consider how the strengths of our current primary health care system can be built on, and canvas new approaches to meeting future needs.
The Draft Strategy is quite clear that general practice has a key role within primary health care and every effort must be made to ensure the already outstanding level of service GPs provide is supported and enhanced.
Conclusion
As you can see the Rudd Government has been busy – working hard to put in place the programs and policies that will ensure Australia’s general practitioners can continue to provide the high-quality health care that the Australian community needs and deserves.
We enjoy some of the best health outcomes in the world and I believe one reason for this – perhaps the fundamental reason – is the dedication and commitment of the men and women in general practice.
We are on the verge of the biggest reforms to health since the introduction of Medicare 25 years ago, but these reforms can only succeed if they are fully supported by the health workforce including, of course the Royal Australian College of General Practitioners.
We will need to discuss, debate and agree on our choices and priorities if we are to make a better long-term system.
So I say again – I want you, the Government wants you – to be our partners in reform. Please join us on this journey.
Thank you again for having me today.
And now I’ll launch straight into my colourful slide show, to give you all a taste of what is contained in the Reform Commission Report and the draft National Primary Care Strategy.
