Are you ready for the Auditor - AMA WA

Opinion
Making Sense of After-Hours...
... if we can
by Dr Steve Wilson
Chair, AMA (WA) Council of General Practice
The whole structure of after-hours GP services has changed
so much in the last couple of decades. Once the proud duty of
most family physicians, it is now largely the inescapable duty
of amazing rural colleagues. The Royal Australian College of
General Practitioners (RACGP) also many years ago insisted
GPs cannot do after-hours work unless they are VR, thus
wiping out an entire workforce which also gained valuable
experience. Much after-hours work is performed almost
exlusively by OTDs who access A1 rebates for working the
most unsociable hours. Welcome to Australia!
At an AMA GP Breakfast last year attended by metropolitan
GPs, almost all full-time and/or practice principals, the afterhours
section was chaired by now–Vice President Richard
Choong. When he asked if we wanted to take on true afterhours
work in addition to our current workload, of more than
60 attendees, not one hand shot up. After-hours issues are
complex, but any clinician with passing knowledge of GP
workforce/financing will have a good understanding.
The fact is many GPs like myself are so flat out with current
worloads there is no capacity to take on much, if any, afterhours
work, and less desire, even if we felt the moral obligation.
There are even fewer financial incentives. Indeed, in a GP
Opinions survey two years ago, money was NOT the issue at
all for GPs, young or old, but lifestyle, saying they wouldn’t get
out of bed at 0200 hours for even $300.
So what are the solutions? DoHA has taken what I see as an
extraordinarily metrocentric approach to trying to deal with
after-hours. An After Hours GP Helpline has been operating
nationally now since 1st July 2011. About one fifth of all calls to
Healthdirect Australia are being referred to the GP Helpline.
Half of these callers are advised to see their GP the next day,
15% are referred to 000 or an Emergency Department (ED),
and another 8.5% were referred to ED because no after-hours
services were available in their area. No surprises there. Many
of these would be outer-metro or semi-rural patients of cities
and regional towns, and it is simply not economically viable
or often safe for Deputising Medical Service doctors to attend
these regions.
More comprehensive statistics are available mid-year when
the AMA’s After Hours Technical Working Group meets in
June. AHTWG will be asked to consider options for adding
videoconferencing to the Helpline, with this to start from 1
July 2012. The AHTWG will also be providing input to the
Stage 2 Medicare Locals After-Hours Guidelines, and on the
evaluation framework for after-hours primary care.
Of course this all ties in with the Personally Controlled
e-Health Record (PCEHR). The current arrangements for
GPs extracting an Event Summary from the National Health
Call Centre Network (NHCCN) after a patient has contacted
the After-Hours GP Helpline are considered inadequate and
burdensome. Given we’re waiting with bated breath for the
launch of the PCEHR, for which none of us who contribute
will see any government-driven specific remuneration, there
is concern that more streamlined measures have not yet
been developed for event summary conduits. The AMA has
raised its misgivings with the NHCCN in consultation with
Medibank Health Solutions (the provider) and specifically
my colleagues and I on AMACGP have been asked to provide
feedback on interactions with the After-Hours GP Helpline,
accessing the event summary, any noticeable changes in
demand for after-hours service since the introduction of the
Helpline and issues around the evaluation framework.
Notably, doctors contracted by Medibank are being paid
over $220/hr without any costs; nice work if you can get it. Yet
GPs providing after-hours support (such as rural, regional and
true outer-city GPs, and GPs attending aged care facilities in
unsociable hours) are getting paid nothing for providing the
service AND they often know the patients in
question. Concern has also been raised
by the AMA regarding the lack of
experience of some of the doctors
on the call centre service, their
credentialling and the process
for approving applicants.
Currently the minimum
credential is three years’
postgraduate experience,
however quite rightly the
RACGP says it should be 10
years.
Furthermore, Medicare Locals
are meant to provide the future
organisational capacity, yet there is little
or no information at all from the NHCCN,
After
hours
issues are
complex
who seem as in the dark as we are as to how this will all roll
out. Simultaneously, the after-hours Practice Incentives
Program (PIP) money for general practice disappears from
July 2013, and there will be even less incentive for existing
practices to be involved. It could spark an increase in
attendance to EDs, for those Australians who are fortunate
enough to have the ability to do so.
This may also lead to substantial bypassing of private
providers whose after-hours services may then be non-viable,
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18 MEDICUS May