The details released so far suggest they have been poorly thought out, and will fail and cause other GP clinics to fail.
Recently the NSW and Victorian premiers announced plans for the provision of urgent care clinics (UCCs) to help ease pressures on emergency departments and give people access to GPs for free – i.e. to bulk-billing GPs.
While some details are yet to be released, there are fears that this will be more of the same, with the emphasis on bulk billing patients being the main concern.
As reported by The Medical Republic, “The NSW and Victorian governments will only cover the additional practice operating costs for UCCs, with the GPs staffing them expected to bulk bill only.”
It seems GPs will be taken on as contractors, not employees, and will be expected to see patients in addition to their own daytime practice, opening for up to 16 hours a day, while bulk billing everyone seen at the UCCs.
Understandably, these terms have not inspired much confidence in the UCCs, which look destined to fail. Why?
For a start, taking on someone as a contractor means you cannot direct them on how they do the job; i.e. you cannot direct them to only bulk bill, because you can only direct an employee, to do what is deemed reasonable for the purposes of a business (yes, some practice owners do insist GPs bulk bill, but often these are IMGs with little power to say no). And if one is hired as an employee and expected to carry out all reasonable directions, one is also entitled to a fair hourly wage, with superannuation and all leave entitlements.
Then, say a GP practice accepts the terms as they stands, and agrees to run a UCC adjacent to its own clinic, which may charge a gap to see patients. What is to stop patients who don’t want to pay a gap just showing up at the UCC after hours instead? To say nothing of the nearby non-UCC clinics that are charging a gap to survive.
Then, at what level of subsidy would this arrangement actually be appealing to a specialist GP? Maybe if the government offered to fund ALL running costs of the UCC, including staff wages, overheads, infrastructure etc., and its contractors GPs were allowed to keep 100% of the patient rebate as full payment – maybe that would be acceptable.
And where are the checks and balances? What is to stop UCCs taking the rebates and sending patients on to nearby EDs anyway?
I cannot help but feel this has been poorly thought out so far.
How would I fix it?
While it seems tempting to simply build 100 new UCCs, and set up more GPs to offer extra hours AFTER hours at these sites to see people for free at point of care, with an estimated 300 people per week per UCC, it would make better sense to do the following:
- Acknowledge that the Medicare set up in 1984 is no longer fit for purpose and has not been for at least a decade, if not twice as long.
- Acknowledge that unless the government does something to redistribute the patient’s Medicare rebate – e.g. raise it to some degree for all to reduce gap fees, and raise the rebate for those on pension cards etc. to an AMA rate equivalent so they are not out of pocket AND their GPs are not financially disadvantaged – bulk billing is dead and we need to let go of our unhealthy attachment to it.
- Recognise that most GPs are already working more than is safe for them and their patients, under stressful conditions, for a fraction of the income their non-GP colleagues charge and earn, and that expecting us to work after hours for a pittance is not only ridiculous but insulting and would be in breach of Fair Work if we were employees.
- Fund these UCCs in a way that will have FRACGPs wanting to work for the government: employ them like hospital VMOs at similar rates and/or with leave and super entitlements.
- Require all junior doctors as part of internship to do at least one term in a UCC so they get some exposure to community medicine, with a supervisor who is not so rushed that they don’t have time to teach, as can often happen in general practice.
- Finally, and likely the best case scenario: instead of funding these UCCs, just fund existing general practices properly. We know our patients, especially those with complex histories and needs, and we are best placed to provide care for them, instead of further fragmenting care. What we need help with is funding to enable all this, not only in-hours but also out-of-hours. Pay us better, provide us with funding to be able to do so, including after hours, in a way that will enable us to provide the best care to our regular patients while not going under ourselves.
It won’t be easy, it will require some work and some difficult changes, but it is entirely possible. The current plan means continuing to throw money at strategies that are designed to fail and turning young people away from the speciality in droves.
It’s not too late, but someone in government needs to wake up, pay attention and make the hard decisions.
