OK, let's talk about the measures in the budget to increase bulk billing.
A quick thread...
The measures are OK, and the increased funding for care for vulnerable people is welcome.
However, it's not tripling the amount GPs get.
And it's not made "Free GP care" widely available. Here's what happened.
When you see a GP, the GP charges you whatever amount they deem that service costs (which will include their income, practice costs, staff pay etc).
You get back a rebate from Medicare depending on what service(s) you received.

It's #IWD2023 so let's have a chat about the gender pay gap in Australian general practice.
For every hour worked today a female GP will earn on average $11 per hour less than their male colleagues.
(Yes, per hour, so this isn't part time work, maternity leave etc.) "But how can this be?" I hear you ask. "Medicare rebates don't discriminate."
Well, they do....

Let's talk about some specific Medicare item number billing.
I regularly discuss prevention of heart disease with people, and calculate absolute CVD risk.
There's a specific item number for this - item 699
www9.health.gov.au/mbs/fullDispla… Though I regularly perform this activity, I've *never* billed it, because I have to take over 20 minutes on *just this one* activity.
If I see someone for over 20 minutes, we've discussed this AND the thing(s) they're worried about, other preventive health, medications etc.

The real story here is not one of rorting Medicare.
The real story is of GPs trying to provide care to patients while Medicare makes it harder and harder. For a while now, Medicare has been sending nudge letters to GPs to suggest they might be claiming inappropriately, despite the fact that there's no evidence they are claiming inappropriately.
For example...
www1.racgp.org.au/newsgp/profess…

GP To Do list - 2022 - a thread...
1. Manage the multiple conditions that we've always been managing, including complex multimorbidity. 2. Manage hundreds of patients in the community with COVID, many of whom have had no PCR, so aren't known to State health services.
- Monitor for severe illness
- Advise on isolation and testing requirements
- Manage pre-existing conditions (while isolating)

With PCR testing for COVID stretched to capacity, with massive queues, with people being turned away from testing, we know that 12,000+ number of cases is an undercount.
But that also will have clinical consequences... All of the clinical guidelines assume a positive PCR, all the pathways for initial risk management (eg other chronic conditions), getting more unwell, release from isolation depend on a positive PCR test.

Anyway, I'm so glad that in NSW we don't have rules, we just take personal responsibility.
(A short and totally untrue thread) In NSW there are no laws against speeding. Other drivers and pedestrians take personal responsibility for avoiding speedsters.

Complex mix of feelings right now, with anger and sadness very high up in the mix.
Let me tell you why...
🧵 We are on the brink of a potentially devastating outbreak of COVID in NSW Aboriginal communities...

Let me tell you about some of the common problems I see in my clinic every day.... People not being able to afford specialist care, medication, medical devices...

Here's a scary thread.
HT @kedwardbear who sent it to me.
Now, I'll tell you why I find it particularly scary in Australia....
(1/n)

https://twitter.com/Yascha_Mounk/status/1237731864233807872

@kedwardbear This thread is all about setting criteria for access to intensive care in an overwhelmed health system. It's happening in Italy. That is scary enough. But there's a but....
(2/n)

https://twitter.com/Yascha_Mounk/status/1237731864233807872

I am reading over the PM's #ClosingtheGap speech, and I have some thoughts.
Would you like to hear them.
(Speech here in case you want your own thoughts not mine. pm.gov.au/media/address-…) Here, the PM makes all the right noises about working in partnership. If he really means this, then that is really good.
Do you sense a "But..." coming?
There's "But..."
#ClosingTheGap

I feel a thread coming on....

Do you trust the Department of Human Services? Today we learnt that the Department of Human Services (DHS) sent a letter on behalf of a research institute to people who had been prescribed lithium on the PBS, assuming they had bipolar.

1.25 million new jobs.
Presumably tax cuts mean none of these jobs will be doctors, nurses, police, armed forces, teachers, public service... Will we see strategies to improve Indigenous participation in the workforce as part of those 1.25 million jobs?
(I'm not holding my breath)

Peter Dutton has done a pretty disgusting thing in raising mental health as an issue for Roman Quaedvlieg - a quick thread.... Dutton can make a good case just by saying the dates in Quaedvlieg's letter don't add up. But he had to take a swipe at the man on his way through, using mental health....