Plea to Roxon on care plan paperwork (link)

Not sure why Dr Stephenson is so worried about claiming a mental health item, if the patient has a mental health problem that needs psychologist treatment, they qualify for a Mental Health Care Plan. A lot of my patients have benefited from the service. My problem is that patients may not always be able to afford the gap fee. Also MHC Plans can't be used for psychiatrist visits, and I often need to refer to a psychiatrist to get the correct diagnosis eg if I suspect Bipolar disease.

Mimika

About time somebody pointed this out. ¾ of all the paper work done by nursing home sisters writing in columns the blooming obvious e.g what is the aim of the treatment !!!

The only plan of any real use is the CMA on admission to a nursing home. . If all the unnecessary paperwork done by nurse would be scrapped, they would have time better spent with the patients. And all the silly payments for silly paper work needing to be done by GPs were done away with, we would all be happier, and our fees could rather be increased for treating patients , not for filling forms

 Isaac Brajtman

I totally agree - Dr Stephenson is obviously one of those doctors that lets his head and heart rule his hip pocket (though he probably is also one that doesn’t have the time to add to the day’s burden with nonsense paperwork). Better outcomes with most careplans are dubious at best, other than the reassurance for the health minister that GP’will not whinge about there lot in life because they have a fertile pasture to graze in. Good on you Peter for voicing your thoughts.

Dr Chris Allen

These numbers are not for the benefits of the patients or the Doctors. These numbers are designed by economic rationalists to fit medicine into a series of numbers they can count, as if the world exists in little boxes. This is flat earth thinking for health budgets and policy decision makers. If it’s not a number, it can’t exist or be meaningful. At the risk of sounding paranoid it is for them to know what we are doing. The bean counters are trying to peer into every consultation. Fitting the world into a series of boxes satisfies only those people who think the complex world of humanity and general practice can be reduced into a series of predictable numbers or tasks. There is no sense of care for patients Doctors or the profession and there is certainly no understanding of it. There are some people who can’t think globally, they do task oriented professions like accounting and end up in Canberra.

Karen

I totally agree that Care Plans are a burden and unnecessary.

Dr. Gonzalo Bernal-Hoyos, Liverpool

I agree that care plans rarely add significantly to patient care and are a significant time burden upon time poor GPs therefore eroding time spent doing more useful things. We are encouraged to do them for financial reasons and pressure from patients for subsided allied health and dental work. Furthermore, I can't believe the paperwork required to allow DVA patient to have free webster packs. This trivial benefit

($20/month) requires numerous phone calls to the DVA (who provide incorrect information) and an equal number of phone calls to frustrated pharmacists and this entire process must be repeated every 6 months.

Dr Philip Healey

In reply to Dr Peter Stephenson's question:

“If we need mental health plans to send a patient to a psychologist, why are we not having specialist referral plans for specialists?” asks Dr Stephenson.

I guess the response to this is "because Medicare doesn't have to fork out up to $1410.60 (up to 12 sessions at $117.55) every time we send a patient to a specialist!"

I agree wih Dr Stephenson's argument, but I can see why there needs to be some sort of accountability. Would love to know what the solution is!

Dr Toby Taleb Nasr

Oh! EPC items. Cash cow which played a large part in driving me out of general practice after 20 years.

Peter Stephenson words it so simply yet clearly. I, too, wanted to get paid for getting people better & preventing them getting sick, not for doing paperwork.

EPC items made me more money. But did nothing for patient care (in my hands) And I couldn’t tolerate being paid extra, to shift my focus from good patient care to doing admin.

Dr Ian Truscott, Maryborough Qld

I have found mental health care planning to be nothing but beneficial for both myself and my patients who benefit not just from being able to proceed to a psychologists for an appropriate number of sessions at reasonable cost, but from the time I am actually able to spend with them as their GP delving into their mental health concern. I no longer feel under pressure in doing this because I can designate this time knowing a reasonable fee will be generated. Too many GP's I know will brush over evident mental health concerns that come up during other consults because they just don't feel they can afford the time to delve.

Dr B. East Bentleigh.

Thank you Dr Peter Stephenson; I entirely agree.

I doubt there is any evidence for improved outcomes with all the EPCs, GP Plans, Team care, Mental Health, MMRs & CMAs.

I do a lot of Residential aged care and now get pressure to do CMA or review CMA when all the information is already in my clinical notes on file. But if a new CMA can identify depression or behavioural disturbance the facility gets more funding.

I resent the frequent facility initiated Pharmacist Medication Reviews which often misrepresent data on adverse reactions, and ignore any benefit-risk decision considered by the prescriber. For example, Avapro frequently causes hyperkalaemia, and haloperidol should be used for behavioural disturbance in dementia rather than risperidone because of the increased risk of CVA . I generally ignore the Phamacists Review rather than claim another unnecessary Medicare fee for agreeing with the obvious, or arguing against the irrelevant. The facility is under pressure to do these for accreditation, and the government is paying pharmacists for an unnecessary service. MMRs should be limited to complex cases and only initiated by a GP (or scrapped entirely).

I say scrap the lot of the Care Plans, CMAs & MMRs; use the money saved to pay for limited allied health services on simple referral by GPs, and pay GPs for doing clinical work, not filling out forms.

Dr Stewart Fox, Brookvale, NSW

Too right, but don’t expect the hollow men in the DHAC to see it your way. To them, complexity is good, process is always more important than outcome, documentation more important than doing. The RACGP was a willing accomplice here, did GPs a great disservice.

Andy

State Labor is in trouble and federal Labor is looking to follow. Rudd/Roxon/Swan are slowing showing that they can talk well but they have very little substance.

John Hill

I'm looking for an anti Labor slogan in preparation for the trench warfare just around the corner. Maybe "BOXON ROXON is pure evil TOXON". Any other suggestions?