Could they make it any harder to be a good GP?

Even without the covid circus, visits to aged care homes are so poorly compensated they effectively depend on altruism.

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Talk about an exercise in frustration. 

I’d been contacted by a local nursing home, one of my elderly patients had had an unwitnessed fall and, although she seemed ok could I please check her out? 

Maybe it was because I had to squeeze the visit in to an already packed day, or the fact that the visit was likely to be just a formality, but I do admit I was probably not in the right frame of mind going to the aged care facility which is about a 15-minute drive away from the surgery. 

It’s always a bit of a rigmarole getting into this facility as you have to buzz to get in, log in electronically and get a sticker, but covid has added yet another hurdle to overcome. 

They have introduced an obligatory RAT for all visitors, done on arrival and necessitating a 15-minute wait outside until the negative result is in. Great!

All up more than 30 minutes had passed before I even made it past the front desk. 

Then there were all the usual frustrations – find the nurse who knows what the issue is, find the notes, find the patient (who was always cranky but whose dementia now makes her positively hostile), back to the notes, log on to the computer to check medications (so much better than paper med charts – not), sign out of the facility and drive back to surgery and write up notes there! 

There’s close to an hour of my life that I won’t get back.

I have always believed visits to aged care facilities (and home visits for that matter) are an important part of general practice. But seriously, it seems to me, it is becoming harder and harder to honour this commitment. 

Honestly, I get why more and more GPs, especially the newer ones are refusing to visit aged care facilities. What an incredible amount of wasted time. 

Obviously the addition of the RAT was a bridge too far, and that’s not really the facility’s fault. They are just trying to the best thing by their residents, but couldn’t someone have given some thought to streamlining this process for visiting medical staff? Could they perhaps accept a negative RAT done at the surgery earlier that day? It just feels that the GP’s time is of little value.

I know, I know this pandemic will pass. We will not be swabbing and PPE’ing forever, but this latest complication has just opened a bit of a festering sore.

There seems so little incentive for GPs to continue to visit aged care facilities. 

It’s not just that the remuneration is inadequate – you are actually penalised by expanding your aged care practice. I could have seen four patients in the surgery in that time. Four level Bs. And yet, if I’d seen more than one patient in the nursing home I’d get a reduced rebate for that second consult. What a joke! 

This is not a new issue. The aged care sector, the AMA and the GP colleges have been complaining forever that GPs attending aged care residents were a dying breed. They have been warning authorities that without GPs there will be more acute care, more hospitalisations, and poorer overall health for aged care residents.

Lots of things need changing if GPs are going to continue to regularly see patients in nursing homes as part of their general practice. 

There should be a better way than having to keep two sets of notes (one at the facility and one at the surgery). And there is the problem that most places have nowhere to properly examine the patient. But one of the most concrete and readily doable changes has to be remuneration. As they say in the classics, it’s not rocket surgery.

Last year the government announced its latest solution to the remuneration problem. A (rather complicated) increased practice incentive payment program. Basically GPs were to be better rewarded for seeing aged care residents with a lump sum payment, the value of which depends on how many such visits are conducted in a financial year.

While the headlines sounded enticing – GPs can get an extra $10,000 a year for visiting patients in aged care – the reality is you need to make more than 180 aged care patient visits a year to get that. Doctors who visit between 60-99 patients a year will be eligible for only $2000 a year. 

I know it is better than nothing, but remember it is capped, so as soon as you see 180 patients in that financial year you will get the maximum amount and no incentive after that. 

It’s complicated. Just trying to get information on this new incentive is tricky – the website info is confusing, the helpline just kept referring me back to the website and even online aged care support groups have experienced GPs expressing different opinions and information on how this new program works and how it should work.

These bureaucratic hoops feel like the government’s way of putting doctors off even applying for these incentives. It’s as though you need to earn it twice. 

Couldn’t they just increase the aged care rebate? Couldn’t they just once come close to paying us what we are worth? 

As it stands the incentive program is, I believe, unlikely to incentivise anyone, especially those who only have a handful of patients in nursing homes. 

It’s not just about the money, but the lack of decent remuneration is reflective of just how undervalued GP care in aged care actually is. 

This is an issue that is only likely to get worse as the population ages, and if things don’t change this very vulnerable population will struggle to get access to timely and appropriate medical care. Governments cannot rely on GP altruism forever.

We deserve better.