We all know house calls are under-remunerated pains in the bum. But don’t blame the reluctant GPs.
Who will look after our poor old home visit patients when we retire?
That was how our “debrief” session started after one of our fairly standard full-on days at the surgery last week.
My friend, colleague and fellow GP is set to retire at the end of the year after over 30 years at the practice. Often – on a Wednesday evening – after the doors are locked and the receptionists have all long gone – we are left checking results, completing notes and doing reports. Just before we finally escape, it has become our habit to simply have a real conversation (as opposed to the 15-minute consultations we’ve been doing all day). You can probably tell how much I value it.
Anyway, this particular Wednesday, my colleague – let’s call him Trevor (because that’s his name) – had had a particularly harrowing day where he’d been on a fairly routine house call and found a situation that needed emergency attention – a surprise to both Trevor and the patient. And it had taken some convincing to get an ambulance and get the matter dealt with ASAP. It all turned out okay – the patient was admitted and was receiving appropriate care.
But what if Trevor hadn’t gone to this patient’s place? That’s the really scary thing.
At our practice, of the seven doctors working there only three of us do house calls – and we’re the three old ones. And God knows, I don’t do many.
This sounds accusatory but it is not meant to be. I totally get it. House calls are a pain in the bum. We all know they are a long way from being worthwhile financially, and, I am the first to admit it, the medicine practised tends to be substandard. Even with the best will in the world it is hard to feel at the top of your game when it takes 10 minutes to get the front door open, the light is a 40W globe on a bedside table and you’re left watching the midday movie while the patient needs a “quick” bathroom break!!
But, by the same token, who will take care of these patients when there are no GPs willing and available to check on them at home. There is no way my 99-year-old veteran, my darling 94-year-old carer-dependent widow or my arthritic, dementing 90-year-old can get to the surgery. So where will they go?
I know this problem is not unique to our practice. MBS data from Services Australia shows the number of item 24 consults (the standard home visit item number) claimed over 2022-23 was less than half claimed a decade ago. Less than half!
But what can be done? We cannot change the nature of house calls. There will always be the issue of travel, parking, yappy dogs, poor lighting and awkward furniture.
The only thing that can change – and should change – is incentives!
How is it that the NDIS, the aged care services and even the veterans will happily shell out more than twice the going rate for services such as cleaners and carers, and yet GPs are expected to claim the Medicare-subsidised piddly rebate – no travel time, no parking allowance, no IT support grants.
I don’t blame younger doctors for not taking on house calls. I do blame government for making it such an easy decision. If I was starting out in general practice, I wouldn’t take it on.
It is so short-sighted of government. There is a wealth of evidence that shows regular GP visits keep patients out of very expensive hospitals, and yet you can feel their reservation. You just know they think an increase in the home-visit rebate will lead to a blow-out in costs and an exploitation of the system.
Maybe the new MyMedicare enrolment will be a way of getting around this fear of exploitation. Just give higher rebates for home visits to those patients enrolled in the practice as part of the MyMedicare program.
Who knows? They’ll probably use all the money up on promoting the MyMedicare program! Nonetheless something needs to be done. We can’t just abandon these poor house-bound patients.
No wonder my soon-to-be-retired colleague Trevor is worried. He has been, and always will be a quality GP with the best interests of his patient at heart – he has earned the right to a guilt-free retirement. He should be able to handover these house call patients!
