Senator EGGLESTON(7.20 p.m.) —I would like to make some comments about what I perceived as the cynical attitudes of senior officers of the Department of Health and Family Services towards the medical profession and GPs in particular revealed during the course of the recent Senate estimates hearings. I have to declare that I have an interest in the matter, having been in medical practice since 1975. That also means that I speak from a position of considerable knowledge.

The first matter I would like to comment on is the fact that the key performance indicators of the Medicare program do not include any assessment of the views of the providers of the service, the doctors. I find it quite unbelievable that, in this day and age, an assessment of the views of the providers is not included as a performance indicator because the service providers are a major stakeholder and must be viewed as such.

In my opinion, not including the assessment of the views of the service providers as a KPI in the assessment of Medicare is an unacceptable omission. It appears to me that the exclusion of the assessment of the views of the service providers can only be interpreted as strongly suggesting an unwillingness on the part of the department to consider any view that may differ from its own predetermined policy. Assessment of the views of service providers should be regarded as a standard modern management practice. Routine assessment of the providers' opinions concerning the program could help to reveal both strengths and weaknesses. In reply to a question I put on notice about including the views of the providers as a KPI of the Medicare program, the department made the following reply:

The Department does not believe that the views of providers is an appropriate performance indicator as clearly there would be many cases where the interests and satisfaction of providers would not coincide with the objectives of the programme.

I have written to Dr Wooldridge, the Minister for Health and Family Services, expressing my concern that the performance indicators of Medicare did not include as a KPI an assessment of the views of the medical profession as service providers. I have requested that Dr Wooldridge give consideration to issuing a ministerial directive that provider assessment be made a key performance indicator of the Medicare program in the future.

Another matter which concerned me was that, during the estimates hearings, a senior departmental official suggested that each additional GP in practice costs Medicare $176,000 per year in rebates paid out due to the fact that doctors encourage patients who are not really sick to see them. He said that doctors were encouraging patients to return for more visits than were really necessary. Furthermore, I was concerned that a little later in the proceedings another health department official stated that general practitioners encourage patients with colds to come and see them, clearly implying that GPs are routinely overservicing by encouraging visits from patients with the most minor of complaints. As I said, the clear implication of this remark was that GPs are overservicing to generate extra income by getting patients with trivial illnesses to come and see them.

These remarks struck me as being extremely cynical and an unacceptable reflection on the professional integrity of medical general practitioners. In my experience of 20 years as a general practitioner, I have found GPs to be a group of hardworking, dedicated, professional people. As I said, I was profoundly disturbed by the cynical attitudes towards GPs exhibited by the senior officials of the Department of Health and Family Services at the estimates hearings. This is a very serious matter that should concern the Senate. Health services are very important to members of the community. The public expects there to be a harmonious and cooperative partnership between the bureaucrats administering the health system and the service providers who, in this case, are the general practitioners of Australia.

There is an enormous level of dissatisfaction among GPs in this country. This was revealed in a 1995 Australian National University epidemiology unit survey of GPs across Australia. There were 2,165 GPs in the survey who, on average, had been in practice for 15 years, 95 per cent of whom were vocationally registered. I had this report tabled in the estimates hearings. Senators will no doubt be concerned to learn that the report showed that 76.3 per cent of GPs were disillusioned and that 83.7 per cent cited poor remuneration as a factor in this. A figure of 34.4 per cent of GPs said that they would leave general practice immediately if they could, and 94.6 per cent felt that their contribution to Australian medicine was not valued by the government. From my impressions at the Senate estimates hearings, one would have no alternative but to conclude that the doctors were quite correct in their perception that their contribution to Australian medicine appears to be undervalued, at least by the Department of Health and Family Services.

Finally, I would like to put on record in the Senate my view that the department cannot have it both ways. They cannot on the one hand call upon GPs to practise better medicine and then on the other criticise them when they comply with that request. In the interests of thoroughness, GPs cannot spend more time with patients, resulting in having longer consultations, ordering more tests, writing more prescriptions and making more selective referrals. only to have the most senior officials of the department cynically criticise them for overservicing. I request that the ANU survey be tabled and incorporated in Hansard.

Leave granted.

The document read as follows—

Preliminary Report on the Future Role and Operation of Australian General Practice

A questionnaire on the future role and operation of Australian general practice was circulated with the August 4th 1995 edition of the Australian Doctor. 2187 completed questionnaires were returned by the end of October.

The circulation list for the Australian Doctor which contained the questionnaire included 16,900 `general practitioners in private practice'. A follow-up telephone survey showed this list to be outdated, inaccurate and somewhat duplicated, with 30 per cent of the doctors listed not responding on the given telephone number, no longer in practice or away for an extended period. The estimated response rate is therefore approximately 18.5 per cent. However, the profile of responding GPs on a range of socio-demographic and practice characteristics was not significantly different from non-respondents interviewed in the telephone survey. The profile of respondents to this survey was also remarkably consistent with that of a similar survey conducted in 1991, results of which are incorporated in `W(h)ither Australian General Practice' (NCEPH discussion paper No. 1, 1991), and with the profile of Australian GPs obtained from HIC data. The profile of respondents to the 1991 and the 1995 surveys indicates that respondents are broadly representative of the general practice community in Australia. Representativeness aside, the results of the survey reflect the opinions of a considerable proportion of Australian GPs.

The results of the survey are currently being explored in a number of themes, and we anticipate publishing a number of reports. This preliminary report is being widely distributed both to those who participated in the survey and requested copies of the results, and to various stakeholder organisations. There is no copyright to the information. We simply ask that in citing the figures reported here, reference is made to Bailie RS and Douglas RM: `The future role and operation of Australian general practice survey results', NCEPH, Canberra 1995.

R.S. Bailie and R.M. Douglas

NCEPH, ANU, Canberra

National Centre for Epidemiology and Population Health

The Australian National University, Canberra ACT Australia

The Australian National University

National Centre for Epidemiology and Population Health

The Future Role and Operation of Australian General Practice

General Practitioner Survey

10. Demographics

10.2 Sex (2,172) Male—73.2%; Female—26.8%

10.3 Year of graduation (2,145) Mean 1975 (SD 9.13) Median 1976 (Range 1944-1993)

10.12 Nature of your practice (tick one) (2,155)

Solo private practitioner (601)—27.9%

In a formal private arrangement with other GPs (1,294)—60.0%

Other (260)—12.1%

Privately employed practitioners only

10.23 What is your current bulk billing practice? (tick one) (2,091):

I bulk bill all my patients—31.8%

I bulk bill health care card holders only—38.6%

I bulk bill a limited number of my patients—25.0%

I do not bulk bill at all—4.6%

10.24 For the provision of after hours consultations do you (1,989):

Engage a locum service—47.6%

Roster with other practice members—46.7%

Work at local after hours service?—5.7%