The new reality show for doctors: RACGP’s own Q&A

RACGP Member Forum

Excellent panellists: RACGP President Dr Frank Jones, Dr Edmund Poliness, Presenter Ali Moore, Dr Rashmi Sharma and Dr Evan Ackermann.

Hosted by TV journalist and radio broadcaster Ali Moore, the Royal Australian College of General Practice last week presented a new concept: an entertaining panel discussion with audience participation around topics such as funding of general practice and overuse of antibiotics.

I’ve made a selection of the live recorded discussion about the Medicare rebate freeze and the future of Medicare. The complete video is available below and on the RACGP YouTube channel.

Patients come first

“Our first and foremost responsibility is to our patients,” said RACGP president Dr Frank Jones, “and this is really the message from the College in the You’ve been targeted Campaign, because this is about the fact that we cannot sustain quality general practice under the present Medicare freeze.”

“This has galvanised general practice to more than I have ever experienced in my whole professional career, and feedback from our members tells us pre-budget there were 30 per cent of GPs about to change their billing rates, and it’s now over 60 per cent – that’s what our surveys tell us.”

“This is a real watershed for general practice

“This is a real watershed for general practice. What we need is a long-term vision for sustainable quality general practice in Australia and the College has to lead this because nobody else is.”

Is the GP worth paying for?

Dr Evan Ackermann: “Treasury wants to know why would I invest in general practice? What sort of outcomes are worth paying for? If you take that perspective then there are a lot of benefits that general practice does provide: we provide a lot of preventive healthcare, we’re providing the efficiencies in the health system that stop the hospital admissions, we’re the key drivers of the system for efficiency.”

“The model that we’ve had for funding general practice is gone

“The model that we’ve had for funding general practice is gone, and those days are not going to return. We’re going to have to start looking at paying for some services, we’re going to have to look at what patients really want and trying to get a model to fit that. In the future general practice is going to be key because of how we contribute to the whole health sector.”

The risk of loss of quality

Dr Rashmi Sharma explained that practices need to look at increasing fees, or they risk reducing the quality of patient services:

“Or we don’t take those steps to increase our fees but reduce our quality; so we don’t hire the extra nurse or we don’t actually teach anymore because it’s not cost-effective. I think those are the casualties that are a little bit more abstract and not so apparent in the immediate term, but actually the longevity and quality of general practice is what is at risk at the moment.”

“I certainly know that we’re going to put our fees up, and we’re going to explain that to our patients

“In terms of what it means to me: I certainly know that we’re going to put our fees up, and we’re going to explain that to our patients. I think it is about those conversations that you need to have and it is as simple as saying: ‘the reason that I bill you more on a Sunday is because I’m paying my receptionist time-and-a-half.’ That small business message needs to be out there.”

Conversations with patients

Dr Edmund Poliness about the Medicare rebate freeze: “For us it means a lot. I work with some of the most vulnerable people: I work at a homeless drop-in and at the Aboriginal community-controlled health organisation for Geelong. When a number of years ago the proposed five dollar co-payment came in we realised that we weren’t going to be able to afford to keep going. The five dollar co-payment went, but it has been replaced by the freeze and we’ve had to look at different ways of funding ourselves.”

“All those things cost money, they’re not free of charge

Dr Rashmi Sharma: “If you want quality, if you want a nurse to ring you up with the results, you want a recall system at your practice, all those things cost money, they’re not free of charge. It’s those conversations that you need to have with patients. The evidence is there that if we talk to them about smoking they eventually give up. Each time patients come to see you, you get those messages trough.”

“Let’s have the posters on the wall, let’s get the petition signed because that’s getting the conversation started. And if we fail in reversing the rebate freeze than that conversation will have to continue, and if we succeed, well that’s not the solution, it’s still a woeful rebate. If the rebate is unfrozen we shouldn’t stop that conversation.”

A new perspective on bulk billing

Dr Evan Ackermann about the longstanding habit of doctors to bulk bill: “It has been an ingrained culture. Ever since Medicare has been available the message was: you need to bulk bill, you need to bulk bill. That culture has changed overnight. It’s now: because you bulk bill that patient you’re supporting the moral hazard, you’re supporting more use of a valuable resource.”

“That bulk billing rate is actually a confusing indicator. We need to look at a series of indicators including patient out-of-pocket costs, not just the bulk billing rate, and that gives you a true picture of what is going on. That’s where we need to start getting the argument across to the community; the bulk billing rate does not mean good affordability or good access to general practice.”

Watch the Youtube video below for the complete recording. The concept of a live recorded member forum was developed directly from member feedback as a new and innovative way forward for the RACGP. The intention is to increase engagement with members who are not currently on RACGP boards or committees, and to be able to discuss emerging topics and important issues shaping the future of general practice.

Support your GP

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

6 thoughts on “The new reality show for doctors: RACGP’s own Q&A

  1. I have watched most of the recording. I support the idea of increasing discussion within our our discipline and within our College about how the organisation and funding of general practice can be improved to enable GPs to do even better as the most cost-effective and therefore the most important part of the health care system. However, the forum did not make for riveting viewing. I liked Evan Ackermann’s inconoclastic points of view and proposals. Your transcript of selected bits is very useful for the many who simply won’t be willing to watch the whole show.

    If “The intention is to increase engagement with members who are not currently on RACGP boards or committees”, was this achieved in the member forum? I saw a lot of people in the audience and asking questions who are heavily involved in the RACGP boards and committees, including I think all four contenders for the Presidency, and staff of the RACGP as well. I would like to see a list of who was in the audience and what role(s) if any each person there has in the RACGP.

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    • Hi Oliver, thanks for the feedback, glad you like the concept. I personally love the concept and feel it is a great way to engage with grassroots members. It is another opportunity for the College to hear from members. I enjoyed listening to the speakers and there were some good questions from the floor. Please note: This was a proof of concept of the Member Forum (Senate) only – not yet the real deal – hence you saw staff and active RACGP members in the audience. Feel free to email me if you have any suggestion how to further improve the forum. Members will be given the opportunity to vote on the new governance model later in the year.

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      • Thanks for the explanation. I must have missed any notice that said that this was a proof of concept. I think that in future ‘real’ forums, it would be good to have more questions from the audience and less lengthy statements by and discussion amongst the panel and the moderator. It would also be good in subsequent forums to have some reporting about any action that the RACGP has taken in response to questions or issue raised the previous forum or forums.

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  2. I was bemused by Beres Wenck’s wish to have the assignment of Medicare benefits by patients called ‘direct billing’ instead if bulk billing. ‘Direct’ billing’ was something of an Orwellian Newspeak masterstroke by I think our former federal health minister Dr. (non medical – PhD in politics) Neal Blewett, to quite deliberately suggest that the government pays GPs and that the Medicare benefit is all of the payment that GPs deserve and should receive.

    For these reasons, I strongly recommend that the RACGP never uses the expression ‘direct billing’.

    If anybody cares to ask Dr. Wenck, I would be interested to know her reasons for wanting the expression ‘direct billing’ resurrected.

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    • I thought it was a great question because it got people thinking. The Member Forum/Senate will be a great place to exchange thoughts & ideas and discuss new concepts and proposals. But it will only work if we all encourage questions from members/the audience.

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      • I didn’t see anybody really reply to Beres Wenck’s proposal to resurrect the expression ‘direct billing’. I think that it would have been good for Ali Moore or anybody on the panel to ask Beres why she wanted this.

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