'Tis the season for Christmas parties, commented my taxi driver recently, then wondered; “end of year, end of school, perhaps even end of days…”
Taxi drivers don't have an end of year celebration, he mused. They may work in the same industry, largely know each other but often they don't get on: “It's a business, you know.”
A lot has happened in the four years since the Divisions and Networks of General Practice were defunded by the Federal government. Money is tight and primary health care is feeling the effects. It is likely to get tighter in the future. Grand schemes are on hold or abandoned. There is a pervasive feeling of the need to buckle down and just get through to the next election; three years at the grindstone!
GPSpeak is the voice of the Northern Rivers General Practice Network (NRGPN). It is an independent voice chronicling the health issues on the North Coast and advocating for solutions to those problems.
The Federal government's December 2015 Mid-Year Economic Fiscal Outlook (MYEFO) statement took the profession by surprise. It foreshadowed a further series of defundings in the health portfolio, with a proposed abolition of bulk billing incentives for pathology and radiology.
After an outcry this turned out to be too politically unpalatable for the government and was swapped for a legally dubious cap on rents for space in general practice surgeries by pathology companies.
The MYEFO, however, was soon followed by the May Federal budget and then the July Federal election. Once again health was a target, with an extension of the freeze on Medicare rebates for four more years.
The profession was gob smacked. Even the Feds agree that investment in primary care is likely to pay dividends down the track. General practice is an easy target, however, and Treasury just told the Minister for Health to take the money and run.
GPSpeak has chronicled the dismay many in our area have felt with the reorganising and refinancing of GP Training that has come into effect this year. Doing more with less supposedly lifts your efficiency, if not your mood, and is not much consolation.
Increases in costs for continuing medical education and practice accreditation (CME) continue unabated and the principle of user pays is being expanded in novel ways by the CME industry.
It seems likely that revalidation will be the next issue to confront Australian general practitioners. It is to be hoped we can escape the bureaucratic mess that British GPs face and that sense will prevail with efforts being directed to quality improvement activities both within general practice and the wider primary health care system.
In the last few years the North Coast has been the site for a number of successful programs in this area, jointly sponsored by the North Coast Primary Health Network and the Northern NSW Local Health District.
Our area is not part of the Federal government’s Medical Home trials and it would be disappointing if the expertise in integrated care built up by these two organisations is lost. Thankfully there are moves afoot to explore the Medical Home model of care outside of the Federal trials.
Drug, alcohol and lifestyle problems along with mental health care have been a frequent focus forGPSpeak this year. Progress in these areas is always slow and difficult but the potential gains are large. We will continue to report on and advocate in these areas.
The uptake of the My Health Record (MHR) system has seen significant advances in the last six months following the acknowledgement, finally, by the Department that general practice needed to be properly financed to make the system work. While a step in the right direction, the failure of the MHR to support the download and population of the GPs' electronic health records is a serious cap on the system's utility. There appears to be no suggestion that the Department is intending to address this.
GPSpeak magazine, newsletter and website are the main focus of the Network's activities, but we have also initiated two small IT projects which are within its limited capacity to support.
The Northern Rivers Medical Exchange (NRMX) facilitates data exchange between surgeries, allied health practitioners and pharmacists on the North Coast. Its goal is limited to rapid communication and it makes no attempt to be a common platform for a patient's ongoing care, which is an important component in chronic and complex disease management. It will therefore dovetail with the North Coast's "Orion" health project to manage such patients and is due to come online in the latter half of next year.
The NRGPN has also worked in partnership with the local Health Promotion Unit to disseminate public health messages and announcements through GP surgery televisions. Advances in communication technologies give individual practices the opportunity for greater control over the messages they display to their patients than those provided by commercial interests.
During the financial year to July 2016 the Network lost just under $15,000 as shown in our Financial Statements. While disappointing this represents a $5,000 improvement on the previous year. Pleasingly two thirds of that loss related to a decrease in the value of the investment portfolio, which should recover. The loss from operating activities was under $5,000. This augurs well for the future sustainability of the Network.
In recent months the Board has debated whether its current activities in general practice advocacy, media and communication should remain its core focus. Addressing local clinical issues was the raison d'être of the initial Divisions of General Practice and it was by making a difference locally that general practitioners became enthusiastic about the organisation.
The next NRGPN Board will have to address its representation, relevance and engagement with its members. As my taxi driver noted, it is a difficult task.
