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Tuesday, 13 June 1989
Page: 3840


Senator COULTER(12.30) —This morning we are debating the Community Services and Health Legislation Amendment Bill 1989, the Supported Accommodation Assistance Bill 1989 and the Aged or Disabled Persons Homes Amendment Bill 1988. The principal piece of legislation incorporates seven Bills which amend various Acts of this Parliament. It is difficult to deal with this legislation because of the way in which it has been presented. But there are two sections in particular which have caused a great deal of concern to general practitioners and the private health insurance area, and it is those two sections with which I will be dealing most extensively. Both of them are particularly complex matters because they involve the assessment of detailed and esoteric data which is difficult to assess. A lot more time is required to collect figures and make assessments and, for that reason, we will be supporting the reference of both these matters to a Senate select committee.

Dealing sequentially with those matters, the first matter is the creation of a register for general practitioners and the circumstances that surround the creation of that register. I remind the Senate that doctors graduate after six years of university work and become registered after a further year of hospital work. It is a very long course and covers a wide range of subjects. If I might say so, it is a good general education but there is certainly insufficient training in that course-either in the university part of the course or in the hospital year-to train somebody to work as a general practitioner. Let me tell the Senate of my experience back in the 1950s when I did a medical course in Adelaide. I suppose that 50 per cent of the time of general practitioners is occupied with dealing with family related problems. We had only a dozen lectures in what was called psychological medicine, and those lectures covered everything from the most serious psychological disability through to the sorts of emotional traumas that beset families all the time-totally inadequate training for dealing with that part of a general practice which occupies about 50 per cent of a general practitioner's time. It was certainly disconcerting to go, as I did, from completing those six university years and my residency in Royal Adelaide Hospital to sitting across the desk from patients for the first time dealing with the sorts of problems that I felt I was ill-equipped to deal with following the training course that I had been given.

Of course, most doctors go into general practice. They learn on the job. They probably make a few mistakes initially, but I do not doubt that the majority of them become excellent general practitioners. Of course, that is recognised in the legislation which the Government is proposing because the register will contain the names of those doctors who have had a sufficient period as general practitioners and they will be recognised for the purposes of the register. But one of the consequences of this inadequacy of training is that general practice has been looked down upon by the academics in the universities. Certainly in my three years of clinical training, much of the training was done by specialists-we had no contact with general practitioners at all-or by those who taught for the hospital year. People going through that hospital year are taught largely by specialists. For that reason there is extremely little contact with general practitioners and with the sort of work that general practitioners have to deal with.

There has been very extensive lobbying on this Bill, particularly from organisations like the Royal Australian College of General Practitioners and the Doctors Reform Society. Both of those bodies have pointed out that, in order to address this lack of status and lack of initial quality of general practitioners, they have been attempting for some years to get more appropriate training introduced within both the university years and the compulsory hospital year. They have been remarkably unsuccessful, in that apparently there is a perception by academics in the university or lack of academic rigour in general practice and a perception of lack of relevance by doctors who are themselves specialists and who are responsible for much of the training within the compulsory hospital year. Having spoken to a number of medical colleagues and having been lobbied very extensively on this matter over recent weeks, I understand that the quality of medical education still leaves a great deal to be desired with respect to education appropriate for general practice.

The Government's move is a serious attempt to raise the status of general practitioners in the eyes of the community and in the eyes of fellow practitioners, specialists and academics working in universities. It is also a serious attempt to raise the quality of general practice and to give recognition of that through the establishment of a register, the requirement for continuing medical education to remain on that register and the payment of a higher fee to those doctors whose names are on the register. It seems to me that the intention of this legislation is entirely laudable. It may well be the only way to go. By a rather ironic feedback mechanism, it may indeed bring about those very things that the College, the Doctors Reform Society and other organisations have been unable to achieve by other means. Once the status of general practice is recognised, once general practitioners are involved in continuing education, it may be that those doctors that are on the register will gain in status in the eyes of other doctors and that there will be a greater willingness to introduce general practice education back into the six university years and the compulsory post-graduate hospital year.

But this move by the Government has very seriously divided the medical profession. It is difficult to find any action by this Government in recent months which has so galvanised a group of people as the intention to set up this register. I must say that initially the majority of letters and phone calls I was receiving were totally opposed to this legislation-they were running at a ratio of about 10:1 against the legislation. There was a period about a fortnight ago when the numbers swung marginally the other way and the majority of those who were lobbying me were in favour of the legislation. But more recently, the numbers have swung back again very strongly against this legislation. Honourable senators will recall that last week I submitted a petition from 1,644 doctors from Victoria alone who were all opposed to this legislation. Even if the majority of those doctors misunderstood the legislation and its intention and could be persuaded that it was in their interests, I do not think it is appropriate for the Government to proceed at this time with legislation which clearly a large number of doctors either do not understand or do not want. There needs to be the interposition of a period of review by a committee so that those matters which perhaps have been unjustifiably misunderstood can be dealt with and fears allayed. Those matters which do have substance can be properly dealt with and brought before a committee. Perhaps this may lead to modification of the legislation.

The Australian Democrats, therefore, support the reference of this matter to a committee. We have slightly modified Senator Puplick's proposal to establish a Senate select committee to consider a reference relating to general practitioners and report by the first sitting day in August by asking the committee also to consider private insurance proposals, with which I will be dealing in a minute, and to report on that reference by the first sitting day in March next year.

Out of the lobbying which has gone on, one can already identify a number of matters which need to be addressed by that committee. Without foreshadowing how the committee may deal with these matters, I think it is worth while mentioning them because they have some substance. There is a need to give consideration to what body would be appropriate to accredit general practitioners. It may be that, in the lobbying that has gone on, there has been an element of politicking between the College and the Australian Medical Association. But let us leave that aside and accept that, particularly in medicine, groups of specialist practitioners have in the past set up colleges and gained accreditation and higher fees. As a general principle I believe that a body which provides accreditation which results in a higher fee being chargeable should, as far as possible, be independent of the professional in-group which benefits from that accreditation. I think that is something that needs to be addressed.

The terms by which a general practitioner shall get accreditation and remain accredited also need close scrutiny. There is a great deal of concern that, in some respects, the terms are quite excessive, particularly in relation to those people who may, for various reasons, fall below the requirement and then seek to go back on to the register later on. I also draw attention to something that is a bit of an oxymoron-that is, subspecialities of general practice. Several examples of this have been brought to my attention: for instance, those practitioners who choose to see mainly patients with sexually transmitted diseases. Family planning may be another one. If the proportion of patients they see gets to the point where the majority of their practice is occupied in that subspeciality then they may cease to be general practitioners for the purposes of the register and may only be able to attract a fee at a lower rate. That would seem to be unfair. The quality of the service that those practitioners are providing to their patients is at least as good as, and maybe even better than, that which they were providing when they were fully within general practice.

Finally, attention has been draw to the lack of any appeal mechanism in relation to the removal of a name from the register.

Debate interrupted.

Sitting suspended from 12.45 to 2 p.m.