"Medical Mess"

A letter from a patient published in the Courier-Mail today, April 7.

Medical Mess.

As an 88-year-old* patient of one of the practices referred to in Madonna King's article "Patients before Paperwork" (C-M, Apr 5-6) I applaud her turning the spotlight on this anomaly in medical care.
I realise this anomaly was not of Kevin Rudd's making but it is now within his power, and it is his responsibility, to bring common sense to bear on the problem.
To suggest that, if my GP's practice has to fold, I could go by public transport to the proposed superclinic 10 km away (which may take a year or two to set up), when there are qualified, competent GPs in my area, is ludicrous. I have been a patient of this practices for the past 12 years, and they have all my medical records, and my doctor is familiar with my care. The solutions suggested in Ms Kings's article are sensible and practical - and the need is now, Mr Rudd, not in a couple of years' time.
V.A.H....
Holland Park West

[small correction: Vi is a mere 80 years old]

Letter to the Editor.

The press coverage continues with the publication this week in the South East Advertiser of my letter to the editor.

Press powers GP crisis solution.

Dear Editor,

I would like to thank you for your recent articles in respect of the general practitioner shortage in Stones Corner and Greenslopes, in the Prime Minister’s electorate of Griffith. You have drawn attention in your newspaper to the imminent crisis in GP supply, and to the campaign started by a concerned local citizen with the aim of addressing the issue. I am the principal of one of the practices featured in your newspaper as being at risk of closing due to the shortage of GPs.

We believe that good general practice is the cornerstone of good primary care, and that everything possible must be done to ensure that it survives and thrives. Any further worsening of the GP workforce will have serious impact on health care in the community, and will put further pressure on the already over-burdened hospital system. We know that the situation is similar in other urban areas in Queensland as well as interstate, and we are determined to put the focus onto finding a solution to the problem, rather than eternally analysing it and complaining about it. We hope that our blog at needmoregps.com will help publicise the issue and act as a forum for ideas.

I would like to inform you and your readers that the local campaign has attracted interest from the broadcast media and the national press. This would not have happened without your enthusiastic support. You have provided a fine example of the power of the local press.

Dr Janet Clarkson,
Logan Road General Practice.

Letter to Medical Observer.

The Medical Observer featured my letter to the Editor in the edition of March 28. This is what I said:

Dear Editor,

The GP workforce issue has been recently reinforced with a vengeance for me, as you highlighted in your article last week. My practice is in a designated ‘Inner Metropolitan’ area of Mr. Rudd’s electorate of Griffith. Once upon a time this little shopping precinct had eight busy doctors, in a few weeks time there will be two. I am sixty years old and have no succession plan for my practice. I admit to completely giving up trying to find a solution to the problem two years ago.

I have been shaken out of my resigned, cynical sloth by the loyalty and support of patients and locals, who are enthusiastically researching the issue, coming up with ideas, and signing a petition.

We do not need any more statistics: any further government recourse to data-collecting is avoidance behaviour, pure and simple. We resent the patronising reassurances from government (and our own professional bodies) that ‘we understand the problem’. We would laugh at the proposed ‘solutions’ such as Super Clinics if they were not so fundamentally flawed as to be tragic.

We all want this problem solved. It will not be solved without a determinedly problem-solving attitude and genuinely open, vigorously creative debate in which we and our patients are involved. It will most certainly not be solved by bureaucrats. We want to get the debate going and the ideas flowing. To that end we now have a blog which we hope will provoke discussion and stimulate ideas. It is at http://needmoregps.blogspot.com/ , and we invite your comments and input.

Yours sincerely,

Dr Janet Clarkson,
Logan Road General Practice
Stones Corner
Brisbane 4120

GP workforce problem in all states.

We are in Brisbane, but we know that the GP workforce problem is acute in many urban areas in other states: the Sydney Morning Herald recently highlighted the seriousness of the problem in both Sydney and in Victoria.

If we ask you "Is there a GP workforce shortage in your own area?", how would you respond? Please let us know: email us at brisbanegp@gmail.com with your response.

To: The Divisions.

The following email has been sent to the over fifty urban Divisions of General Practice around the country.

Dear Colleagues,

You may be aware of the national coverage of the GP workforce issue in the Prime Minister’s own electorate of Griffith over the last week. My practice is one of those at the centre of the publicity. In summary, both this and a neighbouring practice are facing closure in the relatively near future due to our inability to find doctors eligible for employment in our inner metropolitan area. I am sixty years of age, with no succession plan for the practice. In the shorter term we will not meet accreditation standards when we are reviewed next March, unless we can find another doctor.

A local campaign was started by a concerned patient several weeks ago and has been received with great enthusiasm by the community. It has received attention from television, radio, local and national newspapers. The first batch of petition signatures has been handed in to Kevin Rudd’s Griffith electorate office; a second batch will follow shortly.

We know that many of you in urban areas in other states are in a similar situation. We believe the problem can be solved, if there is a will to do so. We have some practical ideas and suggestions which we have already forwarded to the Prime Minister and to the Minister for Health (although we have not to date received any response other than the formulaic one.)

We have started a blog at http://needmoregps.blogspot.com/ to publicise the campaign and act as a focus for the debate we have to have if this problem is to be solved. We do not need or want any more analysis of the problem. We welcome your suggestions and comments.

Yours sincerely,

Dr Janet Clarkson.
Logan Road General Practice
Stones Corner
Brisbane
3394 3622
0417 718 375

“After-Hours”

An open letter to the Hon. Nicola Roxon, Federal Health Minister.

In response to the local publicity on the GP shortage in the Stones Corner/Greenslopes area you were reported as pointing out that OTDs can in fact work in designated ‘Inner Metropolitan’ areas – provided that they work after-hours (i.e 6 pm to 8 am).

This response, Ms. Roxon, is unsatisfactory. It is clearly the response provided to you by your advisors. It is patronising and unhelpful. It serves only to highlight the abyss that gapes between GPs working at the coal-face and bureaucrats working from their ivory towers.

I one wants to find out about knitting, one does not ask a carpenter. May I respectfully suggest that if you want to find out what is really happening in general practice on a day-to-day basis, that you do not ask a bureaucrat.

I offer the following comments, which I would be grateful if you would pass on to your Departmental advisors during your next discussion.

1. If you are suggesting that each individual practice could solve their workforce problem by employing an OTD after-hours, could you please explain how this would assist a practice which cannot find a doctor to fill the morning shift from Monday to Friday to meet their accreditation requirement (based on the RACGP Standards) to have a doctor available during office hours (8 am to 6 pm)? As you are aware, practice accreditation is linked with remuneration, and hence financial survival.

2. In any case, to suggest that every small individual practice could afford to employ an after-hours doctor is ludicrous. It would necessitate the employment of after-hours administration and security staff, which would be financially impossible for every practice I know. Some of the large corporate practices tried this in Brisbane some years ago, but even with their economies of scale, they were not able to make it a viable business proposition. There may be two remaining 24 hour practices left in Brisbane.

3. Inner metropolitan practices do in fact employ OTDs ‘after-hours’ – but most do it via a subscription to the commercial After-hours service.

4. This ‘solution’ is equally unnacceptable to the community if it is offered as a substitute for availability during office hours. A mother of an infant is not going to want to take her child for routine vaccination at 9 at night because the practice does not have a doctor available at another time, nor is a frail elderly lady going to venture out on her own late at night to get her blood pressure checked.

I look forward to your response.

Yours sincerely,

Dr Janet Clarkson

Logan Road General Practice.

Thoughts on Super Clinics.

An open letter to Mr. Rudd and Ms. Roxon, from a GP at the coal-face.

Dear Mr. Rudd and Ms. Roxon,

I would like to make the following comments in regard to the Super Clinics which you have offered as a solution to the GP shortage.

1. Unless there is a net increase in the total number of GPs, this simply represents people-moving.

2. These Super Clinics are apparently to be staffed by the large number of GPs that you 'hope’ will result from the increased number of medical students currently attending our universities.

(i) Assuming that this increased cohort does eventuate, it will not be for nearly a decade. Do you have any strategies for our survival in the meanwhile?

(ii) One quarter of the current Year 1 students at the University of Queensland School of Medicine are overseas students, who will not be allowed to stay in the country after they graduate.

(iii) Of the remaining 303 Australian first-year students, assuming that they all complete their course, is it not a fantasy that a large number will become GPs given that:

(a) it is acknowledged that the popularity of the general practice as a career choice has been declining world-wide for years.

(b) this has been reflected in a decreasing number of applicants for each general practice training place for a number of years. We understand that in the late 1990’s there were three applicants per place, compared to 1.1 applicants per place in 2005.

(c) there are said to be sufficient training places in specialist colleges that every student could access one of these, making it theoretically possible that there could be no applicants at all for the general practice progam.

To build a concept of Super Clinics based on what can only be called optimism of the highest order can surely not qualify as a strategy, can it?

3. The Super Clinics are apparently going to attract these mythical graduates on account of the state-of-the art facilities that they will offer. This sort of statement, Mr. Rudd and Ms Roxon, is, quite frankly, an insult to future and current practitioners.

4. The Super Clinics are to be subsidised by governement. Will not this represent unfair competition to GPs who have struggled to maintain their community practices for years? I do not know if it is unconstitutional. I do not know if it breaches the Trade Practices Act. I do know that it is unfair.

5. And finally, in your reply to our letters regarding the local problem you described the planned Super Clinic concept. As, by your own definition, Super Clinics will be set up in Districts of Workforce Shortage, and, by your own definition, this area (Stones Corner and Greenslopes) is not a District of Workforce Shortage, can you please explain how this will help solve the local area problem?

Yours sincerely,

Dr Janet Clarkson,

Logan Road General Practice.

UPDATE, 27 March, 2008

Proposal to pay incentives to doctors to work at Super Clinics; read the Medical Observer Article.