Concern closure of GP clinics would put more pressure on already overstretched hospital system

This article is more than 5 months old

This article is more than 5 months old

Smaller doctor-owned general practices are on the brink of financial collapse due to revenue losses from Covid-19, prompting fears more patients will be unnecessarily pushed into an already overstretched hospital system.

Peak medical bodies and the health minster, Greg Hunt, on Thursday urged Australians to continue seeing their GPs, saying Covid-19 should not mean people “ignore the doctor” or their ordinary health needs.

GP clinics across the country are reporting a major drop in patient numbers due to the pandemic, either because of Covid-19 fears or problems transitioning to telehealth services.

The peak body for GP-owned clinics, the Australian General Practitioners Alliance, said the reductions were delivering a “brutal” hit to many clinics already operating on razor-thin margins.

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It fears practices will begin closing down within weeks, something that would have dire consequences for Australia’s broader healthcare system.

“Our problem is that we’ve got a primary healthcare system that relies on these small businesses to deliver it,” Richard Hart, an administrator with the AGPA secretariat, said.

“And the small businesses are marginally viable at the best of times. Right now they are not financially viable. Therefore, your delivery system is about to collapse.”

A survey of 175 GPs conducted by specialist health publication The Medical Republic found about half had lost more than 30% of their revenue. Roughly one-third reported losses of less than 30%.

Hart said those numbers accorded with the experience of the alliance’s members, one of whom had reported a revenue loss as high as 75%, an issue the alliance says is compounded by new rules requiring GPs to bulk-bill 50-80% of their telehealth consultations.

The changes undermined the viability of GP-owned clinics, which traditionally had low liquidity.

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“Most practices run with maybe two to four weeks of cash and we’re three weeks into this,” Hart said. “So we think that within six weeks we could see some of them closing their doors.”

Richard Nguyen, a general practitioner in Sydney’s Sutherland shire, said he’d seen patient numbers drop dramatically since lockdown laws came into place.

“Basically, when all of the isolation measures became more strict, my patient numbers dropped by more than 50%, and certainly in our GP groups people are seeing drops of up to 80%,” he said.

“The flu shot has made that a little bit different in that people are coming in for that [but] I would imagine that once that dies down it will go back to being quiet. Obviously people are worried about going out so they are putting off the minor things they would usually come in for. But then all those routine things like skin cancer checks and mental health plans I think people are also putting off.”

The Royal Australian College of General Practitioners is also hearing reports of “significant” reductions in patient numbers, both those presenting to practices and those using phone services.

“The general public should know that general practice is still very much open for business and patients should not neglect their health and wellbeing and usual medical care,” the RACGP president, Dr Harry Nespolon, said.

Hunt appeared alongside the RACGP and the Australian Medical Association on Wednesday to urge all Australians to see their GPs and continue the normal management of their health.

“That means – call the doctor. See the doctor if that’s a face-to-face consultation that’s required,” Hunt said. “But don’t ignore the doctor. For all of these health conditions, we want Australians to continue to focus on their ordinary health as well as the coronavirus management.”

He said 2.5m telehealth consultations had already been conducted.

The federal government drastically overhauled telehealth arrangements late last month, expanding Medicare-subsidised telehealth services to create a system of “universal telehealth”, a move welcomed by the RACGP.

It also doubled the incentive for GPs to bulk-bill and introduced a new incentive payment to help GP clinics stay open as part of a $500m package.

Dr Maria Boulton, a Brisbane-based GP and AGPA director, said her clinic was now being forced to bulk-bill 80% of its patients due to the changes, something its business model is not set up to cope with.

At the same time, it has experienced a dramatic loss of patients. The practice was usually 110% booked out on any given day, but that was now at 70% and had dipped to 50% last week.

To break even, she and her business partner have stopped paying themselves an income, even with the government’s various incentive payments factored in.

“For us and for many, many practices like ours, it’s going to hit us hardest, and I think it’s going to be a shame to lose us,” she told the Guardian.

“We’re already stressed enough. We’re putting our lives at risk, and this is not fair for us either.”

The concerns about GP financial viability come as emergency doctors urge people to continue to seek treatment from primary healthcare practitioners where possible.

The Australian College for Emergency Medicine president, Dr John Bonning, said failing to seek treatment for mild to moderate health issues would later place a greater burden on hospitals “at as time when it is unclear precisely when Covid-19 will peak”.

“In the ongoing response to the pandemic, it is important for people to know that our hospital emergency departments remain open to treat and care for severely unwell patients, and that staff are there to help,” Bonning said. “Primary care is also still there for your routine and chronic healthcare needs.”

While the Australian Health Practitioner Regulation Agency has begun mobilising thousands of retired doctors to help tackle the increasing load on the health system, Nguyen wonders why GPs aren’t being asked to do more.

“I certainly think, not so much from a financial view but to make use of me and my skills, that it would make sense for GPs to be called on,” he said.

Nguyen is now working one day a week at a Covid-19 clinic and says more GPs should be called on do that, if they are healthy and willing.

“I think that’s better than using retired doctors and nurses who are the ones most vulnerable to this virus if they get sick.”