Our after hours contract with the state government was easy to understand and five pages long. It said when we had to be open and how much funding we would receive, and it worked fine.
Now Medicare Locals have taken over the funding. We are still providing the same service but the contract has grown to 37 pages! Our management team had to engage a lawyer to make sense of it.
Let’s have a close look at (yet) another contract Medicare Locals have recently sent to GP practices. This is the one for practice incentive payments. These so-called PIP payments will be paid by Medicare Locals if practices meet certain targets, e.g. providing an x-amount of after hours care, using electronic health records, or providing asthma & diabetes services.
I have picked four clauses from the contract, but there’s plenty more. Here we go:
It is a requirement that 30% of patients are bulk billed (after hours). If this target is not met, no bulk billing payment will be made (Appendix)
Many practices cannot afford to bulk bill, even the government-funded super clinics have acknowledged this. The value of Medicare rebates is dropping and the government will not increase the rebate this year. I wonder how Medicare Locals expect GPs, nurses and receptionists to work cheaper after hours, especially under the current Fair Work act. Try to get a plumber after hours for less than in-hours fees…
The ML may at any time require the Contractor to remove any of its Personnel from performing any of the Services (5.3)
I had to read this twice. The Medicare Local wants the authority to make us fire our GPs, nurses, receptionists or managers from providing services to our patients? Please leave the responsibility for providing the service with health care providers, and let Medicare Locals provide the funding.
Where the ML determines that an amendment to this agreement is necessary (…) the Contractor will be deemed to have agreed to such amendment to this agreement (19.6 )
In other words, if the Medicare Local wants to change to contract or the fees they can do so, and GPs will have to accept this? Talking about a one-sided contract…
The contractor must not publish any publication or otherwise make any public communication in relation to the Services without the prior written approval of the ML (17.3( 2))
Contracts like this are dangerous because they have many negative consequences. Here are three reasons why:
- They increase distrust
- They increase costs (practice managers time, lawyers fees, Medicare Local staff, more reports etc)
- They are a risk to the viability of GP services to the community
To move forward I suggest that Medicare Locals withdraw the contracts and offer us a simple, understandable and fair 5-page document instead. Busy doctors and nurses really haven’t got time for this.