The AMA has put out its Collaborative Arrangements:

There is much speculation surrounding this document; yes there are parts of it that make me cringe.... however it must be equally difficult for the AMA, not that any midwife wants to hear that;
Collaborative Arrangements what you need to know? the irony of this document has to make you laugh or cry:

"Working with other health professionals is an everyday feature of clinical practice for a modern medical practitioner. Effective teamwork can improve patient outcomes, create new opportunities for learning,and build a shared understanding of the skills that each person brings to the care of a patient."

Oh yes everyone is a patient even the well woman = this equals paternalism at its best; yes our medical colleagues are great at being paternalistic they feel they have the right to make that decision for the woman because they believe they know what is best; consequently, if the vulnerable woman is not able to make decisions or is not in a position to do so they are often coerced or made to feel fearful therefore making the decision the doctor wants.

“In a sense, this statutory requirement reflects the planned team care arrangements that have set parameters for collaboration in areas where doctors, midwives and nurses have always worked together - our hospitals.”

If we examine this statement they do say that it is “planned team care” and the word ‘collaboration’ means working together – not the GP/Obstetrician is in charge – it means a two way street. It will be interesting to see this work! because the doctors have the power and the money.... and automatically think they are in charge.

For me there are four main points that are important:

If we do not embrace these changes, then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place. This would risk fragmentation of care to the detriment of patients.

This is the most telling statement of all.... this means the AMA is seriously concerned that if they the doctors do not collaborate then changes will be made......this is in our favour.

Yes they are correct in saying that

“Some doctors will be challenged by the Government’s reforms, which will fund new models of patient care.”

This is clearly an understatement, we as midwives are certainly challenging them and if this collaborative framework does not work it will be changed; The doctors are back pedaling, they are fearful of losing money... so they are picking up stumps and are not going to play.

What should you do when a patient does not want to follow agreed clinical guidelines?

This may place you in a difficult situation.
The AMA believes that the best way of handling this is to ensure that your written collaborative arrangement clearly states that you will only provide care in accordance with accepted medical practice and within accepted clinical guidelines.
It should also clarify what will occur in circumstances where a patient declines to
follow these guidelines. If this occurs and you decide you cannot provide ongoing care for that patient, you will need to ensure that you advise the patient and the midwife/ nurse practitioner so that an alternative arrangement can be put in place by the nurse practitioner/midwife.
How you will address this issue if it occurs needs to be agreed prospectively in order to avoid a situation where you are forced to continue care because of a lack of
alternative arrangements.

This is nothing new, this is how the AMA works in every day practice, so this is no surprise....the only thing that is different is that they are blatant about and it is in writing.... there is no such thing as the clients right to choose the type of care they want or the right to refuse treatment.

Lastly I would like to be able to check the credentials of the doctors...what are their statistics, are they registered? how many women are not happy with their care etc? we should be able to check their register; that would be fair and just, equality.

Despite these issues I do think that we need to push forward, these are challenges put in our way and in time it will seem like a storm in a tea cup.

My vision is that all women will have the choice of continuity of midwifery care with a midwife and the right to claim a Medicare Rebate for fee for services;
Whilst I do not like the wording in this Determination I can see that this is still a historic time for midwifery....Opportunity is knocking..... walk through and make it work...if it doesn't you can always reject it.... but if we don't try we will never know it will always be a speculation