Funder by the Department of Human Services Auspiced by Our Community

A CONSUMER'S GUIDE TO GENERAL PRACTITIONERS

General practitioners (GPs) are often our first point of call when we are having emotional issues or our friends have dragged us to the doctor kicking and screaming because we are distressed.


Who are GPs and what constrains them?

General practice is the cornerstone of primary care. GPs have primary responsibility as diagnosticians; they must have good practical and intuitive skills to pick up pathology as well as astute decision-making skills to decide which way to go next:

When it comes to mental health there are a number of complicating factors, some of which are shared with other types of 'illness' and some of which are not:


What we can do for ourselves - Assertive Personal Management

Some GPs are really good with people with a diagnosis of mental illness. They give us generous time. They are interested in what we need to say and will go one step further to try to meet our needs. Unfortunately they are often in demand and have long waiting lists.

There are also, regrettably, GPs who are less interested in people with 'mental illness' and less able to assist us. They may treat us as less important than other patients, using words like 'dependent', 'histrionic', 'not really mentally ill', 'just behavioural' and so on.

Below is a quote from a consumer who has found a solution to this dilemma.


The policy environment

Although the fundamentals of good primary care remain relatively constant, what does change is the policy environment in which this practice must take place.

History

The Federal Government became more active in direct health policy (and mental health policy) with the establishment of the Federal Mental Health Branch by Labor Health Minister Brian Howe in 1992.

The Commonwealth, through the First National Mental Health Strategy, began to pour money directly into both state health coffers and into direct care through programs they were funding, giving the government an unprecedented opportunity to dictate guidelines.

In the case of both mental health and primary care, successive Federal Governments tried to influence state and territory health policy by making federal money conditional on 'performance and reporting'. Unfortunately for practitioners, and indirectly, perhaps, unfortunately for us, this policy-driven money brought with it an enormous amount of reading, research and paperwork for primary care clinicians.

GPs react differently to these imposed initiatives. Some were genuinely thrilled that money was going into areas like psychological services, for example, where they had struggled for many years to find resources to help their patients. Some GPs resented this intrusion in their practice and became infuriated by the paperwork. Many GPs were also annoyed by losing (or the threat of losing) their autonomy.

As consumers, we need to understand this because it has the potential to influence both our care and our relationship with our GP.

Over time, federal intervention into health has become more blatant, with explicit programs in primary care and mental health, funded either directly through the Federal Health Department or through Medicare Locals, which have replaced Divisions of General Practice.

Recent developments

In February 2011, the Australian Government released the publication outlining quite radical changes to primary care, Improving Primary Health Care for All Australians, and in August 2011 the National Health Reform.

The reform focused on a range of things, including better relationships between states and territories and the Federal Government.

Under the National Health Reform, the Federal Government aimed to shift health services from hospitals to primary care. This applies as much to people diagnosed with 'mental illness' as it does to any other member of the community.

The components of the 2011 National Health Reform which affect those of us with a diagnosis of 'mental illness' in a generic way are:

As these changes become more familiar, consumers will start to get a better feeling about the new programs and how we will be affected by them.

ATAPS

In 2011 the Federal Government introduced legislation that would, they hoped, help to break down the mental health service impasse. They were heavily lobbied by allied health unions, particularly by the APS (Australian Psychological Association).

The result was ATAPS - Access to Allied Psychological Services. ATAPS provides Medicare funding that, for the first time in Australia, makes provision for federal money to subsidise the provision of a small number of session with a clinical psychologist or counsellor. It is complex and does not provide for the same refund for the different groups.

GPs have had a hard time getting their heads around this new scheme, as have psychologists. There are many issues.

For those of us with complex needs, often debilitating and arising from childhood trauma or 'mental illness' that requires psychotherapy, there is an item number in Medicare that enables our GP to refer us to a psychiatrist for up to 50 consultations per year.

Again, there are stringent guidelines which you should find out about if you think you might fit into this category.