General News
8 February, 2023
Greater support needed for GPs
TERANG Medical Clinic staff hold hopes new additions and impending federal action can ease the pressure after the clinic joined the list of GPs pushed to introduce out-of-pocket costs to patients last year.
TERANG Medical Clinic staff hold hopes new additions and impending federal action can ease the pressure after the clinic joined the list of GPs pushed to introduce out-of-pocket costs to patients last year.
The introduction of direct costs to cover the funding gaps and supplement Medicare rebates has become a national issue as more Australian practices adopt the model.
Terang Medical Clinic announced out-of-pocket costs to patients would be in place from July last year, citing the rising disparity between the costs of medical practice and stagnating Medicare rebates.
A Terang Medical Clinic spokesperson, who issued a joint statement on behalf of clinic staff in response to questions, said the decision to introduce direct costs to patients had been a last resort.
“General practice holds a unique position in the community, on one hand operating as a private business but on the other it is a true vocation,” the spokesperson said.
“It is difficult to reconcile this with the vulgarity of requesting payment.
“For some time during the darkest days of lockdowns, we bulk billed all patients, recognising the extraordinary and unpredictable stressors within our community.
“However, it became clear this was not going to be sustainable.”
Since introducing out-of-pocket costs staff has seen discussion with patients on how general practitioners are paid become increasingly common.
“When Medicare was first introduced, the rebate was designed to remunerate patients for 85 per cent of the cost of a consultation,” the spokesperson said.
“If a doctor bulk billed, they agreed to accept the rebate as their whole payment, writing off the additional 15 per cent of their fee on the understanding many patients were unable to afford to pay the full amount.”
Practices writing off the funding difference if accepting bulk billing was legislated under the Health Insurance Act 1973.
The at-the-time 15 per cent gap was manageable but blowout costs, inflation and modern practice are among the causes which have made writing off the costs untenable.
“With successive rebate freezes, as well as rebates increasing at a rate far less than inflation, patients are repaid somewhere around 50 per cent of the real cost of the consultation,” the spokesperson said.
“It is also rare now to see a patient who only has one issue on their list.
“Patients visit the doctor after waiting several weeks for an appointment, often with a list of complex issues.
“The medicine we do now is slow and complex, and we are actively disincentivised to practice the type of medicine our patients need because of the way we are paid.”
The issue extended beyond funding support as Terang Medical Clinic faced another common regional situation.
In November 2020, Dr Neil Jackson of Civic Medical announced his retirement and the closure of his Terang-based practice after 15-years.
“The truth is having a single clinic in a town the size of Terang is the norm rather than the exception,” the spokesperson said.
“Dr Neil Jackson had some 3000 patients on his books.
“The amount of demand that has been placed on our availability is considerable, but that’s not the only reason people can’t get an appointment.
“General practice medicine is getting more complex, and thus slower; patients are sicker and need more frequent care.”
The spokesperson acknowledged easing the pressure would be a gradual process, short of another clinic opening in town or an influx of new GPs.
The latter of which has begun, with Dr Alish McLeod and Dr Tej Chollangi joining the clinic from this week.
In addition two new administrative staff and third-year Deakin University medical student, Alex Wulff, have also joined the team.
Ms Wulff joined Terang Medical Clinic as part of Deakin’s Rural Community Clinical School program while studying a Doctor of Medicine, and will learn under Dr Tim Fitzpatrick through this year.
She said she already loved the peace and quiet of Terang, having spent the last eight years between Geelong, Melbourne and Torquay.
“It’s very relaxing compared to other places I’ve been,” Ms Wulff said.
“Everyone has been so friendly.”
Dr Tej Chollangi is a first-year registrar who will spend the next year with Terang Medical Clinic, but hopes she can build a long-term future in the area.
“What struck me is the way the clinic is so community focussed,” she said.
“I was hearing about how some of the staff go to the pharmacy and deliver medications to patients who can’t access it another way – that’s something unheard of to me.
“It just seems like such a local, wholesome practice.”
Warrnambool’s Dr Alisha McLeod is no stranger to town, having completed her Medical School Placement at Terang Medical Clinic in 2018.
“It’s exciting to come back – stick with what you know,” she said.
“I’m now in my first year as a GP registrar.
“Everyone at the clinic has been really supportive and happy to help wherever possible.”
While additional staff was a step in the right direction, the diverse role Terang Medical Clinic GPs play in the community meant more would need to be done before a shift in current circumstances,
such as getting waiting times down, occurred.
“All the general practitioners working at Terang Medical Clinic have additional interests that we fit in around consulting times,” the spokesperson said.
“Currently this includes aged care visits, skin surgery, gynaecological procedures, medical education, emergency/urgent care work and anaesthetics.
“These additional skills make us better able to serve the whole town, but they can make it difficult to find an appointment on any given day.”
The issues pushing clinics to abandon bulk billing has not been isolated to Terang, and became a priority issue for voters ahead of the 2022 Federal Election.
In the days prior to the election, eventual-Prime Minister Anthony Albanese pledged a $970 million investment in Medicare and general practice, saying GPs were “the cornerstone of the Australian health system”.
The pitch included a $750 million commitment over the forward estimates to strengthen Medicare, beginning at $250 million annually from 2023-24.
The remaining $220 million was to be delivered under the Strengthening Medicare GP Grants Program to invest in GP practices; with smaller practices able to apply for up to $25,000 in funding.
In addition, the federal government’s Strengthening Medicare Taskforce released its report last week with recommendations on how to improve primary health care for Australians.
The Terang Medical Clinic spokesperson said there was uncertainty surrounding how the recommendations will be implemented, and what impact those changes will ultimately have.
The spokesperson also noted in the Strengthening Medicare Taskforce report that increasing Medicare rebates had been all but ruled out by federal Minister for Health and Aged Care Mark Butler.
“A lot of us are worried that such a change might harm the direct patient-GP relationship which we so passionately defend,” the spokesperson said.
“Any change must privilege the primary role of GPs in the health system, and we hope that it does lead to the recognition of general practice as a specialty in itself.”
But there is also a sense of optimism, with various associations supporting GPs urging the government to take the opportunity to modernise Medicare.
The concept of modernising Medicare was a point Mr Albanese made last month while slamming a Medicare system inherited from the former Liberal government as “struggling to keep up”.
The idea of modernising the system to suit contemporary practice was something Terang Medical Clinic staff agree with if it can better reflect the role general practitioners play in health today.
“Medicare is a good system,” the spokesperson said.
“It has done a mighty job for many Australians over many decades. However, the way we see general practice within that system needs to change.
“Any change must privilege the primary role of GPs in the health system, and we hope that it does lead to the recognition of general practice as a specialty in itself.
“At Terang Medical Clinic, we love the work we do, we are passionate about general practice and our community, but if you wouldn’t ask your cardiologist to bulk bill, please don’t ask us just because we are GPs.”
