This week the Grattan Institute got some good coverage in the media for Stephen Duckett’s latest report Controlling Costly Care: A billion dollar hospital opportunity (http://grattan.edu.au/home/health).  In this report the authors argue that activity based funding by which hospitals are paid, could be made more efficient by removing outlying inefficient performers in determining the average costs.  Many people in the RACP would be aware that there is growing attention to the issue of ‘medical waste’.  One of the more interesting approaches has been to involve clinicians themselves in identifying ineffective treatments.  Programs in the USA and the UK have been established in which evidence and expert opinion are called upon to determine ineffective services which are then discouraged.  With the new Government starting to float policy directions for health surely it can only be a matter of time before medical waste comes onto the agenda, and why not? It seems a sensible approach to me.  If so, is this an area the RACP could play a role?

As I phone and email people to canvas views on the future the College it is clear that the role of the College and how it functions are issues of concern.  I spoke to someone in private practice, who is involved in some innovative health businesses, who does not think the health of Australia is business for the College.  He thinks that the College should stick to matters that directly affect the practice of members and their patients.  He agreed however that the future roles of our members in the health workforce of the future was important, and a good subject for discussion.  Another person I spoke to, from one of the Faculties was concerned that the management of the College had become too centralised, with insufficient support and budget for decentralised activities by the various groups that make up the College.

Caught up with Elaine Siggins, CEO of the Gastroenterology Society of Australia the other day.  She said that there is a lot of discussion in GESA about the issue of nurses undertaking endoscopy.  Some members are in favour and others are not.  Even the pro camp is divided:  some think this would best be done by nurse practitioners, who work autonomously and others think that it would be better to have practice nurses who work under supervision.  I recall presenting on UK nurse endoscopists at the GESA conference in 2005 or 2006, so it is good to know the conversation continues.  A comment I often hear is that most Fellows of the College devote most of their collective energies to their specialist societies.  However health workforce reconfiguration, such as the introduction of nurse endoscopists, is an issue common to many specialties.  Perhaps we should be coming together to have a broader debate, say on physician assistants.

Is this an example of where our College could be greater than the sum of its parts?

Recently I spoke to Paul Zimmett, a leading expert in diabetes in Australia and the rest of the world, and a Fellow.  As many of you will know he is very active in the creation of policy in this area at both State and Federal Government levels. I got the impression from him that the RACP was not currently an active player in this area.  Surely we have a lot to offer.  We have members who are doing research in this area, clinical experts – in both paediatric and adult medicine, public health experts in the promotion of healthy eating and physical activity, clinical experts in the management of the consequential diseases.

Is this an example of where our College could be greater than the sum of its parts?