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If you agree sign the letter with your RACGP member number. If you are a GP belonging to another college and you agree, also sign with your relevant information!

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Open letter to RACGP president and CEO - Please survey members on whether they want mymedicare/capitation

Dr. Nicole Higgins and Mr. Paul Wappett,

Dear Nicole and Paul,

I am writing to you both to express my deep concerns regarding the blind endorsement of mymedicare by the RACGP and the fact that this goes against the wishes of the vast majority of GPs.

Dr Higgins has urged GPs to fully embrace mymedicare, with the potential risk of harm if we do not. Risks suggested include that GPs will be replaced by pharmacists or nurses who are perhaps more likely to embrace capitation changes.

I am saddened that this appears to be a shift on Dr. Higgin's stance during the previous elections. I believe the outcome of the last election would have been different if voters had known Dr. Higgins would be endorsing mymedicare to this extent.

I share Dr. Higgins concern that we are in a difficult position with task substitution. I completely disagree with the long held RACGP view that the best way to ameliorate harm caused by government is to be complicit with it.

Being complicit in instituting widespread capitated funding in general practice will have the opposite effect and make task substitution far more likely. Capitated block payments to practices will encourage practices to utilise practice nurses and pharmacists to perform roles classically performed by a GP. This will be in the best interests of practices owners, but will unlikely be a benefit to GPs or their patients. If the intent of the RACGP is to encourage task substitution, then a transparent and honest account of this to the membership base would be the best approach for members to best decide on who to vote for in board and presidential campaigns. It also doesn't make sense to state the risk of task substitution as a reason to endorse mymedicare if this is the likely outcome of capitation through mymedicare.

I have articulated the more likely outcomes of mymedicare and capitation many times in the past. To briefly summarise - without effective control over the process (and the fact the president is urging us to be complicit or be replaced shows we have zero control), the outcome of capitation will be an ongoing fee for service freeze in real terms as items are not kept up with inflation, with increasing paperwork and hoops for an increasingly sidelined and demoralised general practice as government focuses on its aims of cost containment, increased bureaucratic control and data mining.

Instead of being complicit in schemes that will harm general practice and our patients, if we are unable to stop government from harming patients, or if we are threatened that if we are not complicit we will be sidelined, that suggests we are ineffective in our lobbying, and that government has no consideration for us as a lobbying force to act in the best interests of patients.

I would like to commend Dr Higgins for the tremendous work she has performed to change the RACGP into an effective amateur and grassroots lobbying organization. I do not believe anyone could be doing a much better job in this respect. The lack of ability of RACGP to still prevent negative government policy and continued funding cuts in real terms (for example the funding increase this year for fee for service rebates is still less than inflation) suggests that professional lobbying is required.

I am also concerned regarding the continued endorsement of schemes in which we have no idea what the actual details are. I would urge the RACGP to stop endorsing mymedicare as even after its implementation we have absolutely zero detail about what it means to the coal face GP.

I urge you both to realise that the goals of government and the goals of general practice and the RACGP are different. It is impossible to act in blind good faith in this instance as government does not have excellent world class well funded general practice as its primary goal. We will continue on a path of cherry picked funding cuts endorsed by academic general practice with unrealistic dreams of a well funded capitated utopia until this vital truth is understood.

The RACGP recently released a 'Member Engagement Survey' - with not one question asking if every day GPs want capitation and mymedicare. I urge the RACGP to remember that you exist for members, and members do not want this. I urge the RACGP to remember that we are here to provide world class care to our patients - cost containment, increased bureaucratic control and datamining will not do this. I urge the RACGP to survey its members on whether they actually want capitated payments through mymedicare, and if they don't, actually represent them.

As always I am a proud member of the college, and as always I have offered my services to both of you in any capacity I am needed. I simply want the best for our profession and our patients.

Yours

Dr. Chris Irwin