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Wednesday, 12 May 2010
Page: 3331

Ms GRIERSON (6:11 PM) —I rise to give support today to this amendment to the Health Insurance Act 1973, the Health Insurance Amendment (Pathology Requests) Bill 2010. This important amendment aims to improve patient choice in respect of pathology services. The act in its current form requires that, in order for a Medicare benefit to be payable for a pathology service rendered by or on behalf of an approved pathology practitioner, a request for the service must be made to that particular pathology practitioner or to the approved pathology authority, who is the proprietor of the laboratory through which the service is rendered. The Health Insurance Amendment (Pathology Requests) Bill amends the Health Insurance Act by removing this restriction.

To explain it more simply, under the current act a patient is effectively required to attend the approved pathology practitioner or authority named on the request form by a GP or specialist. This legislative change will allow patients to take a pathology request to a pathology provider of their choice and will encourage providers to compete on price and convenience for patients. It improves choice and increases convenience for patients, and that is something the Rudd government is committed to providing in the healthcare sector. Doctors will still be able and encouraged to advise patients on their choice of pathology provider. It is anticipated that in most cases patients will attend the approved pathology practitioner or approved pathology authority recommended by their doctor. It must also be mentioned that pathology providers will still be allowed to produce branded request forms that include a provider’s company logo and address and provide these to requesting practitioners.

This proposal will be implemented from 1 July 2010, with a transition period of 12 months in respect of the changes to the regulations, to minimise any regulatory impact on practices. This amendment will ensure that patients have real choice in pathology services. Most importantly, it will make access to pathology services easier for patients. I must stress that, in my own electorate of Newcastle, having choice in terms of access to medical services and having convenience in accessing those services is an issue that is front and centre.

Recently in Newcastle we saw the closure of the Lambton Family Medical Centre. When we do not see a patient centred approach to the provision of medical services, as elected representatives we certainly learn all about it. The medical centre that I am referring to was owned by Primary Health Care. This centre was closed by Primary Health Care with no notice to staff or patients. In fact, it was closed on Friday, 19 March. Anyone who turned up at the door of that surgery or who rang trying to arrange future appointments or get access to other information or services on that Friday was told of the closure. Staff and doctors themselves were informed on that very day. A sign was placed in the window of the Lambton Family Medical Centre informing anyone walking past that the practice was closed, that the transfer of the practice would happen over the weekend and that Primary Health Care would take the Lambton Family Medical Centre to its other Newcastle based medical centre, located at Charlestown.

I must stress that the Lambton Family Medical Centre premises have been used as a general practice surgery in Lambton for 108 years. Lambton is a suburb with many long-term residents, so you can imagine that there is an amazing attachment to that centre by those much older patients. The premises were leased to Primary Health Care by one of the doctors working with that practice.

When the distress of patients over the closure became obvious, naturally I wrote to Primary Health Care for some explanation as to why they would close that practice so abruptly without regard to patient need, as was being brought to my attention. I received a response from Dr Bateman, the CEO of Primary Health Care, and I spoke to him personally on the phone. He said to me that the LFMC was no longer a viable practice and he could not be assured that the lease would be renewed or of the continuity of availability of the two full-time GPs and four part-time GPs operating from that centre. He also said that it was tough managing medical practices, that the rebate was not sufficient to make them viable and that he actually used his own pathology services to cross-subsidise the practice. I can say to you that the patients were not particularly interested in these excuses. They were very concerned, particularly when on the following day, Saturday, a company called Sidameneo, acting on behalf of Primary Health Care, came in to vacate those premises and ‘make them good’. I have seen photos and I have looked through the window at the damage done to that surgery. It is extensive, it is extreme and certainly there would be concerns that there was some intent to do as much damage as possible. I looked up that company, Sidameneo, in the Australian Securities and Investments Commission records, which showed that this company is a one-share, one-dollar company and it has four directors: Thomas Henry Carwardine Bateman, Edmund Gregory Thomas  Bateman, Edmund James Carwardine Bateman and Mr Andrew Duff, the Secretary of Primary Health Care.

Obviously the patients were witness to the fate of that practice—it is in their local shopping centre—and they were distressed by it and concerned that a practice that they had frequented and felt a sense of loyalty towards was being treated in such a way. I am told that there were 11,900 people registered with the Lambton practice who were active patients in the last two years. As I mentioned, they started to contact me immediately after the closure, concerned for their patient records, for the continuity of their care and about the transfer of the practice and their records to Primary Health Care’s Charlestown centre.

I visited the site of the former Lambton Family Medical Centre. I had advertised my planned attendance at the centre only that morning on local radio and, when I arrived, there were already 70 people waiting to see me. Over 100 people came during the next two hours to talk about their experiences. They expressed to me their anger towards Primary Health Care for the way the practice had been closed and for how they had not been informed. They expressed that there was now some great distrust towards Primary Health Care. Many patients told me of the disruption to their care. One IVF patient needed constant monitoring by her doctor. Another patient was booked in for heart surgery, but, because specialist results were no longer available and no-one could track those down in time, his heart surgery had to be deferred.

When told about the transfer of records to the Charlestown centre, patients were particularly telling me that it was inconvenient. It is not a great distance from Lambton, about seven kilometres, but it is across a major highway, with little public transport connectivity, and very inconvenient for older patients to attend. Some alleged they had attended that centre to ask for their records or to ask what was happening, and there were long queues of people outside the surgery trying to find out about their records. They also had no access to recent medical tests. Many of the older patients are on a special anticoagulant drug that needs constant monitoring. They wanted someone to tell them that their records or their test results were there and they needed to find their GPs.

At that stage I had 200 patients sign a petition requesting that their records not be left with Primary Health Care and that GP Access, our local division of general practice, manage the distribution of their records. I wrote to Primary Health Care suggesting that they could perhaps consider entering into an agreement with GP Access to manage the transfer of the 11,900 patient records. GP Access, of course, is the nation’s leader in after-hours care and has a call centre available all day. It offered to manage record transfers at no cost to Primary Health Care and no cost to patients. The patients who were arriving at Charlestown were told that, if they did not find a GP to help them access those records within a month, they would be charged up to $100 for their records. They had great difficulty, given the shortage of GPs, getting an appointment with another GP.

Fortunately GP Access provided some special after-hours clinics at the local centres that they operate to renew prescriptions and to attend to any urgent matters for those patients. Some local GPs whose books were closed offered one consultation for the patients of Lambton Family Medical Centre just to help them out—and remember this was two weeks before the Easter period, so it was a very hard time for those patients. That offer was refused by Primary Health Care, as was their right. They said to me that they were competitors. GP Access and Primary Health Care are commercial competitors in the medical services field. They said they would not be entering into any agreement. That was disappointing because it would have brought some credit to Primary Health Care and would have shown some concern for their patients.

The difficulty was that only one doctor transferred to the new Primary Health Care centre from the Lambton centre. Of course he was able to make appointments for any Lambton Family Medical Centre patients, but patients then told me of the difficulty of getting an appointment and the queues that they had to endure to access any doctor at the new centre. Unfortunately, things did not end there. It seems that Primary Health Care had entered into a contract with the previous doctors who worked with them, and then they proceeded to exercise restraint of trade clauses. This is in a regional city that already has shortages of medical general practitioners. It is a difficult situation where five doctors are taken out of circulation and Primary Health Care can only offer access to one, but then seek to exercise a restraint of trade clause through litigation.

There was also litigation from the landlord, a doctor who owned the premises, for the damage to property. It is a fairly nasty situation. As the member for Newcastle, my priority concern is patient care. I would like to share with you some of the stories of patients at that practice. For example, one of my constituents says she had been a patient at that centre for more than 36 years. She had two pulmonary embolisms nine years ago and has weekly blood testings to determine her medication levels. Usually she could ring the family medical centre and get the results over the phone without having to speak to her doctor. When she rang the new Primary Health Centre at Charlestown for results after her records were transferred, she was put on hold for 30 minutes before being told those results were not available. She called four times the next day for those results but still was not given an answer. She had her number taken each time and was told she would be called back, but she was not called back. During the last call she was told her new doctor would have to call back to get her results. She was not called back until 7.30 pm the following evening, two days after her initial inquiry.

Another constituent of mine from North Lambton is a 33-year-old mother of two. Her husband tragically passed away on Good Friday of a terminal illness. As a former patient of one of the doctors who had practised at Lambton Family Medical Centre, she was required to contact her doctor to have the death certificate of her husband signed. She went to the Charlestown Centre on Saturday, the day after her husband died, to ask if her previous doctor was available to sign the certificate. But she was told that they were unable to contact that doctor and that no other doctor was available to sign the death certificate. Fortunately GP Access did assist her to find that doctor and have the death certificate signed. Primary Health Care must have realised that their actions were extremely rude and inconsiderate and so they asked her to come and speak to them about that. They spent a few minutes apologising before spending the rest of the time justifying their actions, seeking sympathy for their own position. Her words to me were, ‘I don’t like to be rude, but, after 10 minutes of hearing them justify their position, I left.’ That is just unacceptable.

Another constituent told me that his neighbour, a former Lambton patient, had a serious diabetes condition and for over 20 years had been with one of the former doctors. He was unable to access the new surgery and when he tried he faced long waits to see his doctor. Because he had built up trust with that doctor, he did not want to see other doctors. He did manage to find another GP in a nearby suburb, but his health deteriorated rapidly and he was faced with a wait of up to a week for an appointment. Unfortunately that patient passed away shortly after. I do not draw any connection to that, but what I have to say is this was distressing for very many aged patients. There were no measures put in place by Primary Health Care to monitor high-needs patients and respond to their needs. Another patient complained of the loss of independence. One of my constituents, who is blind and has a guide dog, could walk to the surgery and now feels that his whole independence has been taken away from him.

I know that each patient has an individual situation, but these were just a few of the hundreds of patients who shared their stories with me. It is not good enough for Primary Health Care to adopt a corporate approach to the delivery of medical services. Under duty of care, under negligence laws, it must be a case of them having to do a little bit more than they did in the case of the Lambton Family Medical Centre. I am distressed for my constituents that Primary Health Care conducted themselves in such a manner. I do feel there was an opportunity for decent collaboration that would have assisted continuity of care and certainly Primary Health Care could do everything it wanted after that, after it fulfilled that responsibility, to compete hard for their share of patients.

I would have thought that the bottom line of any business would always improve when customer service was at least part of the plan. When I look at the media records around Primary Health Care—their closure of the Lambton Family Medical Centre, their closure of another practice here in Canberra in a similar way and the speed at which Dr Bateman and Primary Health Care enter into litigation, a very good way of stopping any opposition—I have to say to Dr Bateman: that is not acceptable practice.

I was so concerned about that sort of action that I wrote to all the peak bodies in Australia asking them how they enforce or encourage best practice and ethical standards in such an important area, patient care. I asked them:

  • Does your professional code of conduct encompass ethical behaviour regarding notification to patients and staff of the closure of medical practices?
  • What principles do you think should apply to the notification and management of closures?
  • As each state and territory has different laws governing patient records, what general principles and protocols around the management of patient records do you include or do you think should be included in your professional code of conduct?
  • Given the GP shortage, particularly in regional areas, how does your organisation view the current mismatch between the professional duty of care to patients and the application of commercial provisions such as restraint of business clauses that restrict access and competition?

I have received one response in that short period of time, from the Australian Medical Council. They have been instrumental in drawing up a national code of professional conduct for medical practitioners. That new code, Good medical practice, is very much needed because we are looking at requiring national registration of medical practitioners from the middle of this year. (Extension of time granted) I thank my parliamentary colleagues for their support in allowing me to extend my time to address these issues.

I am pleased that there is going to be a national code of conduct, but how is it going to be enforced? If it is going to be enforced through litigation, how are people going to withstand that conduct? We know that Primary Health Care has undertaken litigation around the use of the term ‘primary health care’—a phrase that preceded their existence. They are claiming all commercial rights to that phrase. I understand the issues of commercialisation and profit and return, but I do not think they fit well with a patient centred approach to medical care. I say to Primary Health Care: you would do well to try to marry your commercial needs with the needs of patients in a more humane and ethical way.

As you can imagine, Madam Deputy Speaker, I became very involved with the Minister for Health and Ageing, Nicola Roxon, and her office and with the Prime Minister on these issues. I am delighted to see in the budget that, just as in the legislation we are discussing, we have put patient care at the centre of the relationship between doctors and pathology services.

The situation with the Lambton Family Medical Centre in my electorate is unresolved. GP Access have done everything they can to help the patients to find new doctors and to assist the doctors who have been misplaced, but litigation continues. The litigation is now even extending to other places that host doctors from the LFMC who have not been satisfied to stay under the umbrella of Primary Health Care. I note from recent press articles that Primary Health Care adopted a practice at some of their centres of charging a copayment up front. When a patient walked into one of these centres and said, ‘I want to see a GP,’ they would pay a co-payment. They might be told, ‘It’ll be 30 minutes wait.’ If they had to leave before actually seeing a doctor, to pick up their child from child care or whatever, even if they had sat there waiting for two or three hours, they would have to forfeit the co-payment. I find it extraordinary and unbelievable that that would be acceptable to any firm in general practice. I say to Primary Health Care: please reconsider taking legal action in the case of doctors involved at the Lambton Family Medical Centre, please reconsider your conduct for the sake of your reputation, and please follow the codes of conduct that are being developed by the professional medical peak bodies.

Patients in Newcastle will be very pleased that the Rudd government is addressing some of these problems. E-health records will be such a benefit. Patients having control of their records will be exemplary in the area of patient centred care. At this stage in Newcastle people are receiving half a page of notes to represent 20 years of interaction with their doctors. That is not a patient record. I do not know why Primary Health Care are not giving patients their full records, but I do not think it is acceptable. E-heath records will be an improvement, as will be the ability for doctors to apply for infrastructure grants. Looking at the destruction of the Lambton Family Medical Centre, I know it is going to take a grant to restore it to a surgery. I am told by the landlord that the improvements that were damaged are his improvements; they do not belong to Primary Health Care. That is, of course, a matter of legal dispute. Grants for infrastructure will be a great thing, as will Medicare Local, using local networks of GPs, who can cooperate around these issues. Those are very welcome developments.

I thank Minister Roxon. I thank the Prime Minister for his interest in this matter. I particularly thank GP Access, who did everything they could to assist the patients of LFMC in this regard.