Two hours of unpaid paperwork per day? Welcome to general practice’s Next Big Problem.
One of the bigger surprises to come out of last week’s Health of the Nation report was that managing income did not top the list of challenges facing general practice.
Instead, a third of the GPs who completed the annual RACGP survey selected managing workload and compliance as the most important challenge to the profession going forward.
Maintaining income got only 20% of the vote.
By college president Adjunct Professor Karen Price’s telling, the picture couldn’t be any clearer.
“The fact that managing workload overtook managing income as the biggest challenge reported by GPs is a massive shift,” she tells The Medical Republic.
“I can’t stress enough the importance of cutting red tape so that GPs can get on with what they do best: providing high-quality care to patients.”
At yesterday’s crisis summit in Canberra, Professor Price said reducing the admin burden was a priority right alongside Medicare rebate hikes.
“We also need to reduce the amount of red tape, because it’s really strangling general practice and causing people to undercharge or do the work and not be paid for it,” she said.
Given that Medicare is designed to only fund the time spent face-to-face (or screen-to-screen) with a patient, administrative burden is also inextricably linked with remuneration.
Sydney GP Dr Brad McKay estimates that he spends at least two hours at the end of each clinic day doing paperwork.
“I previously was working in the clinic until 7pm, seeing patients, and then I’d be there until like 9pm doing paperwork,” he tells TMR.
“Now I’ve changed my hours to finishing [with patients] at 5pm and I leave at 7pm.
“What’s the next step? Do I finish at 3pm so I can get out the door by 5pm?”
Often, Dr McKay says, patients will arrive with a lengthy form like an NDIS access request which needs to be completed by a doctor, and cheerily inform him that he can just go through and complete it in his “spare time”.
An access request form is 28 pages long, with 13 pages that can only be completed by a treating health professional.
It requires the healthcare professional to answer detailed questions on the patient’s “functional capacity” across six domains: mobility, communication, socialising, learning, self-care and self-management.
Each domain then has three internal questions around what specific home modifications, assistive equipment or assistance from other persons the NDIS applicant might need.
“The other day I had a patient came in with their support worker, the support worker had already filled out a lot of the information that was necessary on the form,” Dr McKay says.
“And then it still took more than 40 minutes to go through everything with the patient, and [that is] with the support worker helping me through the process.”
It’s not just the NDIS forms, either.
The process just to get to the GP referral form to access PHN-subsidised psychological support services through the Central and Eastern Sydney PHN can only be described as byzantine.
You go to the PHN homepage and embark from there on a clicking odyssey of General Practice / mental health / mental health services funded by CESPHN / moderate intensity services / psychological support services / GP referral forms.
Once the form is actually in front of him, Dr McKay estimates that it takes a further 20 minutes to complete. Even then, it’s not necessarily simple.
“The forms like start off with ‘is your patient eligible? Did they earn under this amount of money?’” he says. “And I don’t know – I don’t see their tax invoices!”
Dr McKay expresses empathy for the fact that these patients are in difficult financial situations, but he also questioned how much the endless form-filling actually helps patients.
“It just ends up blowing time out considerably,” Dr McKay says.
“How much of that is really benefiting the patient in the end, let alone the doctor?”
What’s more, the Darlinghurst GP is convinced that it’s getting worse. A few years ago, he says, it would only amount to about an hour at the end of each day.
“We’ve got less people on the ground at the moment for different reasons, and then if you’ve got less appointment times you’ve also got patients needing stuff done urgently,” he says.
“That’s why you sort of get dumped with a lot of urgent stuff that needs to be done by the end of the day.”
Professor Price says the burden of regulatory and compliance measures are of “greater concern than ever before”.
“It comes at a time when we have an enormous load on our plate managing patients in the fallout of the pandemic, including those who delayed or avoided screenings as well as people with mental health concerns,” she tells TMR.
“The paperwork involved in supporting patient access to programs such as the NDIS is extensive and can require co-ordination with other non-GP specialists.
“Patients don’t always receive financial support when their GP assists with these requests, so GPs are often not remunerated for doing this work.”
