After-hours home-doctor services have begun pulling out of major regional centres as rebate cuts and advertising bans take their toll
After-hours home-doctor services are pulling out of major regional centres and warning a wave of closures will follow around the country if government reforms to the sector go ahead.
Letters were circulated this week to patients in Perth, Hobart, Townsville and Albury-Wodonga advising that their home-visit services would close imminently because of a new advertising ban and a 30% cut in the Medicare rebate for after-hours visits by non-GPs that took effect on March 1.
The step has led to questions in parliament, with Greens Leader Richard di Natale, a former GP, demanding assurances the reforms would not lead to added pressure on emergency hospital services.
The reforms will need to pass the Senate, or possibly be subject to a disallowance motion being considered by crossbenchers.
“As you can imagine, it is already difficult to get doctors to work in the after-hours period … but this Medicare cut has made recruitment and retention of doctors close to impossible,” a letter sent by National Home Doctor Service, the largest provider, said.
Under the changes, the Medicare rebate for after-hours call-out visits by GPs will remain at $129.80.
But the rate has been slashed to $100 for non-VR GPs working for medical deputising services, and will fall further to $90 next January. These doctors have accounted for an estimated 60% of the after-hours home-doctor workforce.
Providers such as NHDS face a double hit because they pay on-call doctors a base fee for their time, even if no calls come in.
A year ago, the NHDS-led industry body issued a list of more than 30 areas that it said would be first to lose services if the government changed workforce rules and cut rebates to rein-in spending on after-hours visits.
The National Association of Medical Deputising Services (NAMDS) said closures would start in areas where the viability was most fragile, including:
- VIC: Ballarat, Bendigo, Shepparton
- QLD: Bundaberg, Cairns, Coolangatta, Gladstone, Hervey Bay, Mackay, Maryborough, Toowoomba, Townsville
- NSW: Parts of Western Sydney, Armidale, Ballina, Byron Bay, Central Coast, Cessnock, Coffs Harbour, Gosford, Kiama, Lake Macquarie, Lismore, Maitland, Newcastle, Port Macquarie, Tweed Heads
- WA: Bunbury, Mandurah, Rockingham
- ACT: Canberra
- TAS: Hobart, Launceston
- NT: Darwin
Of the cities listed, only Townsville and Hobart are among the four earmarked for shutdown so far.
The industry has warned of political consequences, saying there will be a massive withdrawal of a community service under the changes.
In Queensland, Labor Health Minister Cameron Dick has gone on record defending after-hours home-doctor services in Townsville, saying the local hospital would be inundated without them.
“We talk about rural and regional communities being exempt, but under this change Albury and Townsville will both be subject to the reduction in after-hours rebates,” Senator Di Natale said in Senate estimates.
Asked whether the closures would reduce access to care, Health Deputy Secretary Mark Cormack said the MBS Review Taskforce had determined much of the after-hours workload had been diverted from daytime services.
“We need to acknowledge there are a range of other services,” he said.
Dr Nathan Pinskier, president of the rival General Practice Deputising Association, said the motivation for the announced closures might be “more about an inability to generate volume, now that advertising bans are in place, rather than issues related to workforce”.
“Although there has also been reference to potential negative impacts in rural and regional areas as a consequence of the reforms, there is a long history of GPs in these areas providing access to appropriate and comprehensive support to their patients after hours and we don’t see this changing,” Dr Pinskier said.
