Saturday, October 9, 2010

Examples of lack of collegiality by some doctors

In preparation for the implementation of Medicare reforms, commencing 1 November, midwives and maternity consumers have been asked to record evidence of any obstruction to collaboration.

The following message has been received from a midwife in Melbourne:

"A number of my clients have been advised by the GP, when going to their office requesting blood tests, ultrasounds etc, that if they are having a midwife attended home-birth then the GP does not want to be involved in their care beacuse of the lack of insurance for midwives in private practice. This is a major barrier to collaboration in my opinion. I have been searching RACGP websites for some confirmation of this issue and have found some. The attached document (the RACGP submission to government) states:
"What are the workforce barriers to integrated models of care?
• Insurance
As stated previously the RACGP finds the present unavailable of insurance for
privately employed midwives a deterrent. Some GPs want to access midwives on a
sessional basis as they do for other doctors, but find this not possible in the current

"Do any of the Midwives/clients have it in writing that GP's are refusing to collaborate already? I have personally found this to be a frustrating and potentially negilgent treatment of women. They [the women] ask for a simple test and the GP refuses - what if there IS an undetected problem because of the GP's refusal to provide care?"

The Australian Medical Association has published a document Collaborative Arrangements: What you need to know in preparation for the inclusion of eligible midwives and nurse practitioners in Medicare funding from 1 November 2010.
This guide is intended to provide you with guidance on important information to consider when entering into a collaborative arrangement with a midwife or nurse practitioner.
  • The legislation
  • Effective collaboration is good for patients
  • What is a collaborative arrangement?
  • Does the midwife/nurse practitioner meet the relevant MBS/PBS requirements?
  • Indemnity insurance
  • Is there any obligation to participate in a collaborative arrangement?
  • Are there any restrictions on which medical practitioners can participate in a collaborative arrangement?
  • Can more than one medical practitioner be a party to a collaborative arrangement?
  • Is a collaborative arrangement required for every patient?
  • Do you have confidence in the midwife or nurse practitioner?
  • Remuneration
  • Should you insist on a written agreement?
  • Clinical settings where services will be provided
  • What matters should be included in a collaborative arrangement?
  • Best practice guidelines
  • What should you do when a patient does not want to follow agreed clinical guidelines?
  • What happens if things do not work out?
  • Where can you obtain more information about relevant MBS and PBS arrangements?

Link to Medicare information: Midwives and Nurse Practitioners