Its revamp would cost an additional billion dollars a year in Medicare funding .

NEWSPIX

Paul Smith THE AMA has called for a major restructuring of GP attendance items with new time tiers and new rebates .

It says the current items have not changed since the introduction of Medicare 40 years ago , with the exception of the new level E item last year for consults over an hour .

The AMA ’ s suggestion is for a total of seven time tiers with a rebate for a consult

‘ BEACH data has shown that female GPs often spend longer in consults with patients .’

lasting between 16 and 25 minutes initially pegged at $ 78.25 ( see table ).

The AMA says the cost of its plan would be $ 1.01 billion in the next financial year , rising to $ 1.23 billion in 2028 / 29 .

Pitched as a policy response to the rise in demand for complex GP mental health and chronic disease care , it says it would also better support female GPs .

“ BEACH data has shown that female GPs often spend longer in consults with patients , despite the current Medicare system effectively providing a disincentive to do so ,” its federal budget submission states .

The reformed rebate structure

is based on a “ microanalysis ” of GP behaviour .

“[ The plan ] provides a modest lift for shorter consultations — $ 2.15 in additional funding for a 10-12 minute patient consultation .

“ However , it simultaneously recognises that the patients who need to see their GP for an extra 5-10 minutes will receive an additional $ 35.40 in the patient rebate to allow this to occur .

“ This will enable the patient to pay

Dr Danielle McMullen .

less out of pocket , with more GPs able to provide the longer care , while limiting the out-of-pocket impact .”

The proposed revamp comes during a review of the current MBS attendance items by the Federal Government ’ s MBS Review Advisory Committee , which is assessing whether the tier structure is fit to support contemporary clinical practice .

Chaired by Professor Adam Elshaug , professor of health policy at the

D 40-60 mins $ 122.15 E ≥60 mins $ 197.90

University of Melbourne , its report is expected to go out for consultation at the end of this year .

AMA president Dr Danielle McMullen said reform of GP attendance items was urgent .

“ The value of general practice care has also been systematically devalued through decades of inadequate indexation and the prolonged Medicare freeze .

“ We are facing a critical juncture — a point of no return .”

Antony Scholefield A GP has admitted grabbing a twoyear-old and smacking his bottom after the child kept turning on and off the lights during his older brother ’ s appointment .

The doctor wrote in his consult notes that the children ’ s mother — who was deaf and using an Auslan interpreter on FaceTime — had “ no control ” over her children , aged two and four .

“ The little brat switched off the light , was told not to do that by me , and he did it again in defiance ,” the GP , aged 70 , recorded .

“ Then I picked him up and smacked him on the bottom after he ignored my warning ( this was over heavily padded trousers and no doubt a nappy under that ).

“ The only injury inflicted was to the child ’ s pride .

“[ The mother ] objected and I told her through the sign interpreter that the consults for her and her son were forthwith cancelled .”

Queensland ’ s Office of the Health Ombudsman initially wanted the GP suspended under emergency powers , but the GP ’ s lawyers successfully argued the GP was not a serious risk to child patients .

The GP told the Queensland Civil

and Administrative Tribunal that he understood he should never have smacked the boy .

The tribunal said the GP had worked for two years without a break due to COVID-19 and had no other disciplinary history in 43 years of medical practice .

It said his concern that the boy would hit the nearby safety switches , which would have shut off power to

‘ The only injury inflicted was to the child ’ s pride .’

the consultation room and disrupted most of the practice , was another factor that motivated him to act inappropriately .

The tribunal said it was “ satisfied that [ the GP ] did not intend to hurt the little boy and in fact did not ”. And calling the boy a brat in the consultation notes was inappropriate , but it was “ more likely than not that [ the GP ] made that derogatory note at a time when he was still angry ”.

The mother made a statement to police , who did not pursue charges .

The doctor was fined $ 5000 and reprimanded .

FROM PAGE 1

Paper , underscores

the importance of tailoring

treatments to individual needs .”

Dr Newson said menopause specialists would consider higher doses of transdermal oestradiol , oral oestrogen or compounded oestrogen implants where standard treatments were “ insufficient ”.

“ In these situations , doctors may need to prescribe higher-than-licensed doses in order to effectively treat a patient ,” Dr Newson said .

Dr Newson also stressed the difference between prescribing off-label and prescribing unlicensed medications .

When asked about prescribing daily doses of oestrogen at 200-300μg , she said : “ The optimum dose and duration of menopausal hormone therapy ( MHT ) is decided according to the severity of a woman ’ s symptoms , her response to treatment and how the MHT is absorbed and metabolised in her body .” She did not specifically address Professor Davis ’

concerns about heightened cancer risk .

But she added : “ Every woman is different , so a one-size-fits-all approach to MHT is not the best for women .

“ Medicine uses both scientific evidence and clinical experience to respond to individuals .”

She also referred to her recent co-authored paper , published in Menopause , tracking serum oestradiol concentrations in 1508 perimenopausal and

‘ It is not one size fits all .’

— Dr Louise Newson

postmenopausal women attending

her clinics who had been prescribed on-label and off-label doses of transdermal oestradiol .

She said the study had found considerable variation between

patients , with the data suggesting that up to one in four women may need off-label doses to achieve therapeutic levels .

The paper also stated : “ There is no clinical threshold above which oestradiol levels are known to be harmful .”

When asked to comment on the findings , Professor Davis said the reasons for the variability based on the doses administered to the women were not clear cut and were potentially influenced by contamination of blood samples from where the gel was applied .

But she also stressed that the paper did not deal explicitly with the cancer risk .

“ Off-label prescribing is fine , but one is applying this to doubling the upper available dose of oestrogen and a correspondingly high progestogen with absolutely no data regarding breast cancer risk or endometrial protection .”

Referring to the paper ’ s statement that there was no clinical threshold above which oestradiol levels were known to be harmful , she said : “ The converse of this statement is that the safety of continuous exposure of women to massively supraphysiological doses of oestradiol is not known .”

Menopause 2024 ; 17 Dec .