Taking it back to Mr. Rudd.

Members of the Need More GPs group met with the Prime Minister Kevin Rudd’s representative on October 31, at his Griffith electorate office.

We pointed out that the ideas (in respect of the critical GP shortage) that we put to Mr Rudd at a meeting in May (and to Nicola Roxon in September) still have not been satisfactorily addressed despite a welter of correspondence from Canberra public servants.  Mr Samuel Walker, of the Prime Minister’s Griffith electorate office, said he could understand our concern, and undertook to refer the issue back to the relevant Departmental officers.

In summary, our suggestions to relieve the GP shortage in the short to medium-term are:

1.To assist the urban crisis: a short moratorium (say, 6-12 months) on the provider number restriction, with some other conditions: only Australian residents or citizens who are fully registered and have a demonstrable urban commitment. This could allow an uptake of IMGs into urban practices at risk of closing, without causing an exodus from the bush

2.A reduction of the time-limit on IMGs obtaining unrestricted provider numbers from 10 to three years. Three years seems a reasonable amount of time to demonstrate a commitment to the country. It is also short enough to make up skilling not too much of an issue for IMGs who have not found work in Australia for whatever reason. We also suggest that as a three-year requirement is less intimidating than a 10-year one this may increase the number of doctors prepared to consider going to the bush.

3. A ‘Welcome Back’ package; an up skilling and mentoring program to assist doctors return to work and temporary assistance to GPs who wish to work part-time while their children are under-school age, in the form of a subsidy of their medical indemnity cost, to be repaid (as is the student HECS bill) when their working hours increase substantially.

4. Increase rural Medicare rebates by 20-30%.  At present there is no difference income-wise between rural and urban doctors.

For a fuller discussion, please go to "The Solutions Discussion" link at the top of the sidebar. 

UK - Trained GPs ready to help us.

It seems that help for our GP workforce shortage problem is waiting in the wings - or could be, if the powers that be would allow it. 

We have received the following email from Mr Ron Crause, Chairman of the Australian Association of Medical Recruitment Agencies (AAMRA).

"I have read your submission to Mr Rudd. We at AAMRA would be most supportive of your initiatives. I thought I would also bring to your attention that the last federal government introduced, under Mr Abbot a program in 2004, called Strengthening Medicare which has been very successful in bringing in over 600 GPs into Australia during this period. This program has not been renewed by the current government even though tenders went out for it in December 2007. Submissions have been made to Ms Roxon to entreat her to continue the program but without any success.  With the current economic downturn in the UK we have the opportunity to get some really good UK trained GP’s and the continuation of this program or anything similar would also help."

So, Mr. Rudd and Ms. Roxon, what is the go here? Is there some really good reason that that this program has not been continued? If there is, please tell it to us - and especially our rural colleagues.

Recruiting GPs from a developed nation such as the UK avoids the ethical dilemma of taking doctors from countries that can ill-afford to train them in the first place, never mind then losing them to wealthier countries.

GP Shortage: The Australian: The Article.

The Australian has picked up the story of our campaign.

It is HERE if you are interested.



P.S to Mr. Rudd: we are eagerly awaiting your response to our meeting.



P.P.S To readers of this blog. If you are concerned, please consider signing our e-Petition to the State Government, which can be done HERE.

Mr. Rudd's Response.

We have received a response from Mr. Rudd in relation to our meeting with him at his mobile office on May 10. We discussed with him our suggestions for improving the GP workforce issue (see the link in the sidebar to the Solutions Discussion).

He says:

"As discussed, my staff have submitted a representation on your behalf to Rod Glover, Senior Advisor in the Department of Prime Minister and Cabinet, to investigate your proposal in detail with a view to national methodology. I have requested he obtain input from the Department of Health and Ageing regarding measurements of GP's and non-specialists across metropolitan areas throughout Australia."

Thankyou, Mr. Rudd.

It is Happening ... Elsewhere

We here in Mr Rudd's electorate are not alone, which may or may not be reassuring.

In Tasmania, from the ABC: Northern GP shortages for another 6 years
http://www.abc.net.au/news/stories/2008/04/15/2217445.htm

In WA, from the ABC: Acute GP shortage in rural WA
http://www.abc.net.au/news/stories/2008/04/15/2216999.htm

P.S Still no response from Mr Rudd on our specific suggestions to alleviate this problem (see the Solutions Discussion link in the sidebar.) Tell us they are good suggestions, Mr. Rudd. Tell us why they wont work, Mr Rudd. Tell us we are crazy for trying. Tell us anything at all, just for the sake of good manners.

Support from the Courier Mail.

Madonna King, the ABC journalist and Courier Mail columnist has given over her Saturday column to our issue today.

Thankyou Madonna, for helping the general public understand the many issues underlying the imminent crisis in general practice.

Madonna's article can be read HERE.

The Financial Review.

Doctor's jab sullies watershed moment.

Laura Tingle of The Australian Financial Review has seen fit to comment on our grass roots campaign; the article is in the Opinion section, page 83, in today's edition. Here is an extract:

"Not everyone in Australia loves Kevin Rudd at the moment. At home in his seat of Griffith, a grass roots campaign has begun to try to get some action on a chronic shortage of doctors.

Local patients and GPs have started a website called needmoregps.blogspot.com/ because shortages of doctors-and difficulties experienced by local clinics with the bureaucracy in hiring overseas trained doctors – are claimed to threaten two clinics, leaving 7,500 patients without a doctor.

This isn’t some remote part of Australia but suburban Brisbane in the spotlight, and the PM’s own electorate to boot.

The locals have been underwhelmed with the response from Rudd so far.

In a week in which the Prime Minister is setting off around the world to establish his credentials as a middle-power statesman, and hosting a significant Council of Australian Governments meeting why are we so concerned about doctor shortages in Griffith?

Because in a ‘six degrees of separation’ way, they show how all international and federal politics – and all that talk that seems to be going on – can ultimately rebound locally.

Australia’s reputation abroad after last year’s Haneef affair has made it hard to attract over seas trained doctors to Queensland.

Even the ones who are here and determined to stay are being driven made by bureaucratic processes in which states don’t seem to have had adequate records of who has worked where and, even if they have, require different qualifications for registration in other states.

There is also the issue of which areas are declared as areas of medical workforce shortage – areas that get precedence in the placement of overseas trained doctors. The electorate of Griffith isn’t one of them, so even overseas trained doctors who live in the area have to go and work in areas of designated shortage in the bush."

From the Local Newspaper ....

STONES CORNER, March 26: "When it comes to improving Australia's health system, as Prime Minister, the buck will stop with me.''

Those were the words Prime Minister Kevin Rudd used in the lead-up to last year's Federal election to convince voters he was the best person to tackle the country's health system.
Four months after being elected, the Member for Griffith has dodged questions on his plans for fixing a shortage of General Practitioners in his own electorate.

Read the remainder of the article HERE.

Medical Observer observes.

Workforce Crisis hits home for Rudd.
Desi Corbett

KEVIN Rudd is feeling the sharp end of the GP workforce crisis with his own electorate in Queensland calling on him to relax rules governing the placement of overseas doctors.

Locals have warned the situation in the Prime Minister’s inner Brisbane electorate of Griffith will reach “flash-point” this month when the fifth practice in a two-kilometre radius closes and the Logan Road General Practice loses a doctor, leaving up to 8000 patients without a GP.

Griffith is one of many inner metropolitan areas facing GP shortages, but practices in these areas are unable to employ international medical graduates (IMGs) because federal laws only allow them to work in designated Districts of Workforce Shortage.

Inner metropolitan areas are not eligible for District of Workforce Shortage status.

Dr Janet Clarkson, principal of the Logan Road practice, said three GPs from Canada, New Zealand and China were willing to work but she was unable to take them on.

Patients and GPs in the area called on the government to lift the ban on IMGs working in inner-metro areas with a known medical workforce shortage.

Dr Clarkson, 60, threw down the gauntlet for the government to tell her patients where to go for treatment if she retired.

AMA Queensland president Dr Ross Cartmill said the situation showed the workforce shortage was not only affecting rural areas.

Mr Rudd’s office did not respond to MO’s requests for comment in time for deadline.

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.

Dear Mr.Rudd ....

15 February, 2008

Dear Mr. Rudd,

I wish to bring to your notice the problem concerning the impending closure of a yet another general medical practice in your electorate.

It was reported recently in the South-East Advertiser (local newspaper) that another general practice, namely Logan Road General Practice, 329 Logan Road, Stones Corner, Brisbane, is likely to close in the near future as they are unable to employ suitable doctors to join the practice.

This is not the first medical practice in this area to be closed in recent times. Greenslopes Family Practice is in the process of closing and recently at least three medical practices that I know of, in the close vicinity of Stones Corner, have closed. All experienced the same problem – inability to employ overseas trained doctors (OTDs).

This is not because there are no doctors interested in joining them. It is due to the federal government’s policy with regard to overseas trained doctors. The area serviced by the Logan Road General Practice and the other medical centres that have closed is not classed as a ‘district of workforce shortage’ (DWS), therefore overseas trained doctors cannot be employed as they are not eligible for provider numbers for work in this region.

This is a region of high density population which includes a significant number of aged people, a migrant population, and pockets of people of low socio-economic background, as well as the young families that are moving into the area. I know that the Logan Road General Practice serves the community well as they work with interpreters and other support groups.

There is a public hospital in this area (The Princess Alexandra Hospital) that may be able to service some of the people’s medical needs, but this would be an added burden to the already stretched public hospital system.

So this inner city, high density area is not classed as a DWS. In light of the fact that several medical practices have already closed and others are about to close, and the fact that most existing medical centres in the area have closed their books to new patients, where will people go for medical care?

Will the Princess Alexandra Hospital and the Mater public services and existing GP services in the area be able to service the needs of this population? I think not. Already the hospitals are overburdened and existing medical services have closed their books. I was told by a local chemist that some people have had to go as far afield as Springwood to find a doctor who would be able to attend to them.

The closure of these medical centres therefore pushes local people further afield to find medical care. This is not a viable, let alone easy, option for elderly or chronically ill people.

This region may appear to have a good doctor to population ratio. A check of the Yellow Pages however, indicates that many of the doctors listed for this area are specialists or GPs specialising in particular areas, e.g. mole clinics, weight loss clinics, etc. This, together with the fact that many clinics have closed their books to new patients would indicate that this is not so.

As it is well acknowledged that primary health care is the cheapest overall approach to health care, it seems to me that it is in the interests of the community, the hospital system and the economy, to help sustain GP medical centres such as Logan Road General Practice.

In a good GP clinic, as opposed to the proposed ‘super clinics’, patients with chronic illnesses, age related illnesses and certain psychiatric conditions, are monitored and treated. This often means that people are treated before they reach the stage of hospitalisation. This requires time, building a relationship between patient and doctor and enough doctors to make this primary care viable.

I do not know the criteria for determining whether a region is a ‘district of workforce shortage’, however, perhaps the criteria need to be reviewed in the light of demographic conditions that would indicate potential medical needs of people in the region.

The situation in regard to medical care that this area is facing is dire. It would seem to me that there are two aspects to a solution: the short term and the long term.

The long term solution is being attended to by government through increased medical places at university.

In the short term is it possible to:

• ease the placement requirements for certain overseas trained doctors? For example, if an overseas trained doctor comes to Australia with her spouse who is on transfer, because of federal policy, she is unable to take work in a local area so that she can remain with her family. Her skills are lost to the profession, the community, and the economy.
• make access to re-skilling easier for doctors who have left the workforce for various reasons and who may be induced to return? This would include help with medical indemnity and cost of re-skilling.
• give support and incentives to doctors who would prefer to work part time?
• make bulk billing more attractive for GPs? (In this electorate the bulk billing rate is 10% below the national average.)

The most recent edition of the South-East Advertiser the federal health minister, Ms. Nicola Roxon is quoted as playing down the concerns about health services in this region and ‘said because the area was classified as “inner metropolitan”, it was not entitled to employ OTDs to work conventional hours’. This is unrealistic as it does not take into account zoning laws and people’s actual needs. Should we plan to visit our GP at 10.00 p.m. or midnight?

So, in the light of general practice closures, the inability of many existing medical centres to take on new patients, and a high density of population, I ask for a review of the criteria for the placement of OTDs so that existing practices are able to continue to serve the community.

Should this review not be possible, give the patients of these clinics directions as to where they will be able to receive their primary health care within a reasonable distance of their residence.

Finally, Mr. Rudd, I offer you my heartfelt congratulations on your election victory.

Yours faithfully,

Dr. Barbara Reynolds-Hutchinson, Ph.D.

7 Rowland Street,
Coorparoo Qld. 4151

Cc:

The Hon Nicola Roxon MP,
Minister for Health and Ageing.

Senator the Hon. Jan McLucas,
Parliamentary Secretary to the Minister for Health and Ageing.

The Hon. Anna Bligh,
Member for South Brisbane

The Hon Stephen Robertson,
Minister for Health,

The Hon. Gary Fenlon,
Member for Greenslopes

AMA Federal Secretariat

AMAQ

RACGP College House

National Seniors

The Story Begins.

This story began for me on the day that my staff showed me the above article in the local community newspaper. I am ashamed to admit that my first reaction was purely selfish – I did not want to cope with the overflow of patients from this adjacent clinic, particularly in view of the fact that we are going to lose a doctor from our own practice in the first week of April. The anxiety was sufficient to put me firmly into denial mode.

I have just celebrated my 60^th birthday. I do not have a succession plan for my practice. I have found some fine doctors over the years, but all have been overseas-trained, and are therefore unemployable by us as we are not classified as a District of Workforce Shortage. I admit to having completely given up on the problem.

A few years ago there were four practices within a few hundred metres of each other in this inner suburban shopping precinct, representing about eight full time practitioners. We are the only practice left, and when we lose one of our doctors, we will be down to slightly less than 2 FTEs. We service the local community, including a significant number of refugees, as well as a large number of commuters from the outer metropolitan area. I truly do not know where these patients will go if we close.

I was humbled out of my denial by the response of patients of the practice when they read the follow-up article which explained our own plight. One of those patients has started a petition, and the first batch of signatures has been handed in to the office of our local member – Mr. Kevin Rudd.

All of us working at the coal-face in general practice are tired of the same assurances and promises. We are certainly tired of the workforce issue being analysed. There have been at least four large workforce studies since 1996. Every time the figures are done the sitution is worse. Any further data-collecting exercises must be seen as an excuse for real action on the part of the Government.

I have always felt that General Practice is the most creative form of medicine: so many of our patients do not fit any mould, and so many are sent back to us when all specialist solutions are exhausted, yet we must keep coming up with ideas and assistance. I do not believe that this problem is insoluble, if we generate a true spirit of discussion.

Mr. Rudd wants to fix the Health System.
We want to fix the Health System.
Our patients definitely want us to fix the Health System.

At the risk of sounding like an old cynic, it seems that our joint adversary is the Bureaucracy.

We must find some solutions that do not frighten the bureaucrats.
We must find some solutions that do not worsen the bottom line.
We must simultaneously address the Rural Health problem.