GP Consult: From the Chair

As a working GP in contact with colleagues across the state, it is impossible not to be aware of the pressures that continue to challenge us.

And as chair of the AMA SA Committee of General Practice, I can only agree – but also offer some insight into the work we are doing to support colleagues who have chosen general practice because of the vital role it has played in Australia’s health system for decades.

We continue to front up and offer this care despite the determined efforts by governments to push us towards providing brief, transactional care; despite the experience that tells us the average appointment is longer, not shorter, and often involving more complex conditions (including the ADHD consultations that governments have decided should be ours to take on); despite us repeatedly explaining how much work the current system expects of us beyond the consultation timeframe; despite the clear impact on costly hospital presentations of reduced resources for primary care.

This issue was highlighted when AMA SA was asked to comment on SA Health’s proposed mental health and general practice shared model of care.

In our response, we outlined significant concerns with the proposal, including that the model did not recognise that mental health providers may not be aware of a patient’s other medical issues, which could interact with prescribed treatment and medication options. Yet for GP specialists, mental health is only one of many elements that are discussed in our consultations. We provide – and increasingly are expected to provide – holistic care that may range from bandaging an ankle to prescribing ADHD medication. Yet governments refuse to help us help them support South Australians in a proven, consistent, cost-effective manner. 

In responding to the ‘shared care’ model, we pointed out that the role and significance of a patient’s ‘care team’ – which may involve community mental health, general practice, private psychiatry and home support – should be appropriately acknowledged and resourced. 

Meanwhile, we GPs know our patients appreciate the care they receive from the doctors, nurses, allied health practitioners and admin staff at their GPs. They turn to us and trust us. While the AMA continues to work for us – including through the advocacy discussed here – we continue to demonstrate, every day, the value of our service.

AMA secures a win regarding assignment of benefits

AMA SA GP members contributed to federal AMA opposition to changes to the assignment of benefits that were scheduled for implementation from 1 July. We let the government know that many of the changes were unworkable – particularly with extremely short notice. One of the concerns was the lack of an enduring assignment of benefit option, which presented particular issues for doctors working in aged care.

AMA advocacy led the government to agree to changes that seek to address our concerns, including establishing a 12-month transition period.

Informed consent and ACD pathways

AMA SA was this month asked to provide feedback on draft policies and forms outlining SA Health pathways for patients whose caregivers may have reason to question their decision-making capacity. In our response, we focused on ensuring that everyone involved considers the patient and related issues from a foundation of key principles: that a person does not lack capacity because they do not understand the specific details of information; that they can only remember information for a limited time; that they may fluctuate between having capacity and losing capacity; and that they have the right to make mistakes and choices that others may not agree with.

From a clinical perspective, we believed it important to note that capacity is not ‘diagnosed’, and that caregivers and others involved in decision-making understand why we take the steps we must so we all ensure the rights and the wishes of patients are followed.