Taking $3.5 billion out of general practice is going to hurt. The government must reverse its catastrophic co-payment plan, the 4-year Medicare rebate freeze and the changes to the duration of a standard consultation. There are other, better ways to save health dollars.
Here are some great examples of messages and letters to politicians, written by GPs. Send your letter, or the templates from the RACGP or AMA to Tony Abbott, Sussan Ley (firstname.lastname@example.org) or your local member. To find the address of your local MP click here.
Posted with permission of the authors.
Dr Ash Broomfield
We met with our local member and highlighted the following points:
- GPs have been shown by evidence to be the most efficient part of the health care system
- Cuts to rebates and times will affect viability of practices and even fee paying practices will suffer (as often bulk bill lots of non concessional patients like palliative care)
- Patients will be more out-of-pocket
- Costs will increase in tertiary care
- Any decision regarding cuts needs to be made in consultation with the profession as we have an inherent understanding of where exorbitant waste occurs
- Any further cuts needs to be based on evidence
- This devalues general practice and is a disincentive for GP training
We encouraged him to take the RACGP recent statement to the Health Minister and call for a moratorium until further consultation occurs. It was very satisfying to tell an MP and we gave him real life examples of patients who will be affected and cost comparisons of GP compared to state health funding for hospitals etc. We encourage you all to do the same.
Dr Ian Kamerman
Dear Mr. Coulton,
Thank you for getting back to me. Six minute medicine is an interesting term. I don’t agree that all consultations under ten minutes are valueless in fact the whole direction of primary care has been to engage in team based care. In one swoop this makes the practice nurse at $40+ an hour an unaffordable proposition.
Gone will be immunisation clinics, nurse led Pap smear clinics, anti coagulation clinics and most importantly wound care. How can patients or I be asked to pay the gap for thrice weekly wound dressings?
Many rural doctors are planning to retrench nursing staff along with receptionists. Whilst it might be arguable that patients could benefit from longer consultations where is the evidence that ten minutes becomes a value proposition? The short consults are often used for review of short-term illnesses or reviews of results. These will in essence be gone. How do I convince a patient to return for a review with a significant gap? Furthermore I’m busy enough now to suggest I extend my consults to ten minutes means patient access worsens.
Mark, the problem is the health system is complex. These changes will have significant and I presume unintended consequences. What is needed is genuine reform. I’d be happy to meet with you any time you are in Tamworth. Come have a few hours seeing how a training practice works.
Dr Andrew Rees
Dear Senator Macdonald,
Thank you for responding to my earlier eMail. I noted your comment about ‘suggestions for improvements.’ I declare my interests – I am a private billing GP, that is my patients (other than DVA) rarely escape without paying an out-of-pocket ‘gap’. These ideas and comments are my own, although I have listened to my colleagues and I have incorporated some things from what they have been saying. I hold no office, I am a member both of the RACGP and the AMA.
There appear to me to be a few areas where improvements could be made:
- High throughput bulk-billing
- Demand for unnecessary services
- Appropriate rebates
High throughput bulk-billing
These clinics provide the 6-minute medicine that everyone is (quite rightly) concerned about. Patients are rushed through – sufficient complexity of consult to satisfy the medicare requirements for a category B consult and the patient is sent away, often with unnecessary a)antibiotics b)pathology referral and/or c)X-ray or ultrasound referral. The practitioners in these clinics, working to the tight time frames often provide poor value services at high expense to the community.
These clinics are often owned by non-medical people or companies and their existence and activities are profit centred. This is the kind of GP practice that should be dealt with by an efficient and effective audit system using intelligence practices such as are used in law enforcement rather than based on mere statistical analysis. We all know the 80/20 rule, so the practice managers just send the doctors home at patient 79, thus dodging the Medicare radar. I cannot conceive how 79 even half-way decent GP consults could be fitted into a day.
Perhaps if, like pharmacies, GP clinics could only be owned by medical practitioners and thus hopefully governed by the ethics of our profession, the emphasis might be on patient care rather than just income.
This contrasts with what happens now in not only my own clinic [I am not the proprietor, another GP is] but also other clinics that I visit (because GPs don’t just sit in an office, we do LOTS of things).
In the clinics I visit, a patient or two will have every clinical requirement completed within six or seven minutes, then the next patient will require 16 minutes, and the next 19. All of these are billed as category B because they have sufficient complexity. This provides a degree of flexibility that permits enough time to be given to more difficult cases without having to book 30 minutes for every consult. Patients rarely if ever have any idea of how long their consult will take. I frequently navigate through eight or nine presenting problems from a single patient in about 12 minutes. I dread the patient who comes in saying “just a quick one, doc” because they are not infrequently seen leaving in an ambulance about 40 minutes later despite their insisting on being squeezed in between other booked patients when they first come in.
The new 10 minute minimum requirement removes a significant component of this present flexibility. Because the costs of providing 9 minutes of care are no different from providing 19 minutes of care, patients are likely to find themselves with an out of pocket expense of $50 if their relatively complex consult finishes before 10 minutes. Asking a doctor to take this hit consult after consult will rapidly make General Practice non-viable. On average a GP seeing 32 patients a day (a very usual load) is going to suffer a financial loss of $150 per day, or > $30,000 per annum. We will have to pass these costs on.
Demand for unnecessary services
One of the other things that happens in universal bulk billing clinics is that there is a demand for unnecessary services. In particular, I refer to the phenomenon known as GANFYD “Get a Note From Your Doctor”. Employers, having had a worker off sick, insist that the worker attend a doctor to get a note to attest to their fitness for work. Now, I know that this is not something covered by Medicare, but employers have gotten used to this means of escaping liability if the worker is subsequently injured.
An appropriate audit system that ensured that these medical reports were not (unlawfully) funded by Medicare but rather by the employer/employee would substantially reduce the number of unnecessary services.
Governments of both persuasions keep on freezing rebates. They constantly speak of the ‘increasing costs’ of healthcare, but Medicare pays no more, per head of population, now than it did in 1998. Yes, the cost is going up (as it does with (almost) all things in our economy) but the Government is requiring the tax-payer to bear the increased cost, rather than making any real difference itself. So as far as “more sustainable” is concerned, saying such things is intellectually dishonest (but then, everyone that’s in power – Labor or Liberal – does it).
We know, and we can prove (because our profession collects, collates and analyses the evidence) that General Practice is the most cost efficient component of the health system. Done well, it is also the most challenging of all the medical specialities. As a GP I need a working understanding of medicine, surgery, psychiatry and their various sub-specialties. In a day I will see cardiology, dermatology, gynaecology, infectious diseases, mood disturbances and psychoses and often so much more. There will be acute trauma and chronic disease. GPs are usually the first doctor to see a case and make the first diagnosis. This means we want to attract the best and brightest to General Practice, not to have them go to Plastics or Orthopaedics or Dermatology.
Failing to support (or in the case of the LNP declaring outright hostility towards) General Practice is a very unwise thing to do. As I watch the Government fiddle about with a system that it clearly does not understand, I see a parallel with the young boy who, having been given a pocket knife for Christmas has decided to use it to see if he can fix the meowing noises made by his sister’s cat. It is all going to end in tears, mummy and daddy (the Australian public) are not going to be pleased.
There are 44,000 GPs seeing perhaps as many as one million patients a day between them. The LNP policy represents a threat to both the patients’ health and the doctors’ business interests. Our patients like us, they trust us. To paraphrase Sir Humphrey “the present approach is certainly courageous”. This is courage on the same scale as the Charge of the Light Brigade. Glorious, foolhardy and ultimately destined to be a disaster.
However, I believe you to be a ‘wise head’, a long-standing servant of your electorate and a representative not afraid to show some leadership.
Dr Stuart Anderson
Very comprehensive letter to Darren Chester MP.
Dr Sally Cockburn (Open letter)
Dear Mr Abbott and Mr Dutton,
All Australians understand we have a problem funding Medicare and need to manage this, but why do you expect GPs to subsidise the shortfall?
You’ve exempted the most vulnerable from your Medicare cut, and that’s excellent, but people struggling financially aren’t all on welfare and $5 will make a difference to them.
Most GPs and many other specialists already charge fees below what is recommended and often just the rebate (bulk bill) for those suffering hardship. We absorb this reduced fee for one reason: we care about our patients. If any doctors are rorting the system, weed them out. Don’t make Middle Australia and decent GPs pay for others’ wrong doings.
Imagine this common scenario: a tightly-budgeted, self-funded retiree or someone at risk of being retrenched consults you about being anxious and depressed about their dire financial situation. You then expect us to choose between slugging those folk $5 for their troubles or not?
I realise you’ve probably been advised that GPs are a soft touch. You know we will put our patients first. It’s the other specialists who are good at lobbying around money. Don’t paint GPs as if we are wealthy or have our snouts in government troughs. Look elsewhere for that.
Your government is taking advantage of GP benevolence with your cut to Medicare rebates. We’re sick of been kicked around. While most of my colleagues are too busy looking after patients to play political games, this time I think you may have woken a sleeping giant.
Surely a more logical (but maybe less politically palatable) solution to your Medicare problem would be to increase the Medicare levy so we share the load; everyone pays their fair share to help the system, look after those who can’t afford to pay and provide the health care we deserve.
Medicare doesn’t pay doctors – that’s political spin; Medicare reimburses patients the amount you think they’re worth – and now, it seems, in the eyes of your government the health of some Australians is worth less than others.
Please think again.
Dr Charlotte Wright
Excellent interview in the Sydney Morning Herald: ‘Be a barista’: GP fears for profession after Medicare changes.