John Deery, Chair, AGPA

Some of you may be wondering why AGPA wrote directly to the profession last month calling for an end to the disrespect of General Practice by successive governments. The simple answer is that it was overdue.

The reality is that running a GP practice in Australia has become increasingly problematical in the face of issues such as the Medicare freeze, changes to rebate rates in various geographical areas, restrictions on the GP workforce, and the attempts to cut a sweetheart deal with pathology on co-location rentals. The cavalier attitude adopted to the legitimate fears over access to patient and practice data inherent in the PIP QI arrangements is just the latest example of a failure to listen to General Practice.

As GP owners our motivation is to provide the best possible service to our patients. Most GP owners want to ensure that the patients with the greatest needs, particularly those with chronic and complex needs, mental health issues or high risk factors get the preventative and maintenance care they require. But the economics of what are essentially small enterprises means constantly balancing those needs against what is frequently an economic imperative to limit appointment lengths and ensure adequate throughput to maintain viability.

The stress and pressure of practice ownership is not why most of us got into medicine. At the same time practice ownership can be the source of huge satisfaction as it can provide us with the possibility of practising medicine in a way that reflects our interests and values. It is a privilege and can lead to the development of incredibly satisfying relationships with patients and the wider community.

This is why there is so much frustration among GP owners that there is so little formal recognition of the role of General Practices. As my colleague Dr Nathan Pinskier points out in an article Practice Matters this month the role of the General Practice unlike the General Practitioner is totally undefined.  And yet the sustainability of General Practices is crucial to the effective functioning of the public health system. There simply must be far more attention paid to the environment in which most Australians receive their most basic health care.

This is why AGPA has worked so assiduously on pursuing the PIP QI issue, from releasing the paper authored by a group of eminent GPs that got the issue rolling in July to recommending to members to not upload data sets to their PHNs unless they can do it using their own clinical information systems. 

It is a bizarre idea that practices were expected to simply accept the right of third-party data extractors working on behalf of the PHNs to bolt on to their clinical information systems and extract data in order to receive PIP QI payments.

AGPA was also of  the view that the collection and storage by 31 PHNs of the PIP Eligible Data Sets, as compared to a trusted and experienced player in the cyber security space such as AIHW, was amplifying the privacy risks.

Representations by AGPA to the Department and the minister for health resulted in some clarification of the position but ultimately AGPA felt it had no choice but to recommend members seek a time extension on the upload of data until such time as the capability upgrades were implemented by CIS systems to enable internal collection of the data sets.

Underlying the concerns by Practices has been the risk of compromise of patient, doctor and commercial information. And in this context AGPA was of the view that a privacy assessment should have taken place. It is also disturbing that until the issue was raised by AGPA that there was no provision within the PIP QI arrangements for patient opt-out and it seems the responsibility for the process of patient consent for data usage has been duck-shoved back to practices.

The problem is that although consultation with the profession over the PIP QI took place it was never really subjected to a Practice prism. It is obvious that none of the peak lobby groups, worthy though they may be in the education and standards space, have a sufficient Practice focus. This is why we are calling on other Practice Owners and aspiring GP owners to join with us to ensure the long term sustainability of independent General Practice.

In the end we succeeded in putting enough pressure on that many practices received time exemptions from the Department of Health to explore better ways of delivering the PIP-QI data but it should not have been so difficult.

*John Deery is a Canberra GP Owner