Australian Medical Association

The AMA Joint submission highlights the real risk that the new scheme will erode the medical board’s ability to protect patient safety, and addresses four major concerns with the proposed registration arrangements:

1. There is no recognition or guarantee of the continued role of medical colleges in determining specialist qualifications for, and conferring them on, medical practitioners;
2. The scope of practice for the other health professions will be able to be expanded without any obligation for one health profession board to consult with other boards, particularly the medical profession board;
3. The scheme seeks to introduce new onerous continuing competence/CPD requirements, which will effectively create a new scheme for the medical profession, and does not recognise the role of the colleges in continuing competence and professional development for the medical profession;
4. The medical board will be able to register a person who does not meet the requirements for registration in certain circumstances.

The Medical Board of Australia, as part of incoming national registration arrangements, will be establishing a register of specialists. This register will include GPs.

The AMA has made a submission to the Medical Board of Australia recommending that when it formulates the criteria for inclusion on the new specialist register, it should put in place transitional arrangements to ensure that vocationally registered GPs are included on the register when it is first established. This would be in addition to Fellows of the relevant College.

The AMA is seeking members’ comments to inform and shape the direction of AMA submissions to the Government on the reviews of funding arrangements for diagnostic imaging and pathology services.

On 16 November 2009, the AMA released its Priority Investment Plan for Australia's Health System.

The Plan sets out the initiatives that the AMA believes require immediate implementation to improve productivity in the health system, place a greater focus on people and their health needs, and improve the quality and safety of health care.

The AMA has re-endorsed the Plan for formal submission to the Government as the AMA’s 2010-11 Budget Submission.

The Plan includes a range of high priority initiatives focussing on key areas of the health system.

The Confederation of Postgraduate Medical Education Councils (CPMEC) has prepared a discussion paper on the structure and content of the internship - the year of supervised clinical training completed by graduates of an Australian Medical Council-accredited medical school.

The AMA Council of Doctors-in-Training has written to CPMEC and given broad support to the discussion paper’s recommendations as they align with the AMA’s position on the duration of the intern year, its core terms and the role of placements in community settings.

In November 2008 the Council of Australian Governments' agreed to introduce a nationally-consistent approach to activity-based funding for public hospital services to allow comparisons of efficiency across public hospitals.

Subsequently, the Australian Government asked the Productivity Commission to examine and report on the relative performance of the public and private hospital systems. In June 2009, the Productivity Commission released a paper seeking information and feedback on a range of issues including treatment costs, including out-of-pocket patient expenses and rates of fully-informed financial consent, rates of hospital-acquired infections and other relevant performance indicators.

Below are the two submissions the AMA made to the Productivity Commission on the Performance of public and private hospital systems. The AMA submissions also address the Commission's term of reference on informed financial consent.

Establishment of the Healthcare Identifier Service was agreed to by the Council of Australian Governments in 2006 as part of the national approach towards accelerating work on electronic health records to improve the safety of patients and improve efficiency for healthcare providers.

In July 2009, the Department of Health and Ageing released a discussion paper on legislative proposals to support the establishment and implementation of unique identifiers for healthcare purposes and the privacy of health information.

The AMA submission on the discussion paper is supported by the AMA Position Statement on Unique Healthcare Identifiers in 2008.

The consortium of eleven graduate medical schools is seeking the ACCC’s permission to continue its policies and practices for selecting applicants to graduate medical schools. These include the preference policy where applicants submit a single application to the Graduate Australian Medical Schools Admission Centre, and the one interview policy whereby applicants receive only one offer for an interview.

In its submission the AMA has said that, on balance, the public benefits from authorising the graduate medical school consortium to continue these polices and practices outweighs any potential drawbacks;  however, the AMA has noted that where a graduate medical school uses the interview process to look for certain qualities in an applicant, there is the potential for the applicant to be disadvantaged by the interview process in some circumstances. The AMA has encouraged the ACCC to address these issues in the authorisation process.

AMA response to nurse practitioner and midwife legislation that the Government announced in the 2009/10 Federal Budget.

In the 2009/10 Federal Budget, the Government announced that it would move to allow some nurse practitioners and midwives to provide services funded under the Commonwealth Medicare Benefits Schedule (MBS) and to prescribe medications that are subsidised under the Pharmaceutical Benefits Scheme (PBS).  It also announced that the Commonwealth would subsidise indemnity insurance for midwives, although it decided not to extend this cover to home births.

The Government recently introduced three Bills into the Parliament to implement its Budget announcements. These are the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009.

These Bills have been referred to a Senate Community Affairs Legislation Committee Inquiry and the AMA has provided a detailed submission to this Inquiry. The AMA submission highlights that, if implemented carefully, the legislation may help address unmet community health needs - provided it is done in a coordinated way and medical practitioners are still involved in the overall care of the patient. The AMA has warned the Committee that if the legislation is not implemented carefully, it will fragment care, increase the risks of inadvertent patient outcomes, cause duplication and increase costs.

The AMA submission outlines detailed recommendations designed to ensure that the ultimate arrangements work in practice and patient safety is safeguarded.

The AMA submission to the Senate Community Affairs Committee inquiry into the Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009 highlighted:

• the Bill provides a framework for the Government to systematically withdraw its funding of the Extended Medicare Safety Net (EMSN);
• the shortcomings of the Centre for Health Economics Research and Evaluation Extended Medicare safety net review report 2009 upon which the Government’s decisions to cap certain services were based;
• the absence of Government consultation with the medical profession to determine the real impact on patients.

• that the Minister be required to consult with the relevant medical groups about their fee structures and any proposal to introduce and/or change a EMSN cap before making future determinations to impose EMSN caps on particular medical services;
• that the Government be required to commission an independent evaluation of the impact of this measure and the associated determination containing the 2009-10 Budget caps by 1 January 2012, and for the evaluation to be tabled in Parliament as soon as it is completed.