Thread by @KarenMagraith

Excellent thread from @mariamtokhi about access to primary health care for people in disadvantaged communities.

GPs working in disadvantaged and rural areas report that it is increasingly difficult to provide care for their patients. Worse since Covid.

My thoughts:

https://twitter.com/mariamtokhi/status/1438665368424255489

All Australians deserve to have access to quality GP services that provide the time and care that they need. Especially if they have complex health problems or mental health care concerns.

Even in areas that are not disadvantaged, providing GP services for the Medicare ‘bulk billing’ rate is very difficult. Funding does not cover the cost of providing the service, and over the years has not kept up with inflation or operating costs, eg nursing and admin staffing.

As a result, GPs often rely on ‘chronic disease’ item numbers which were designed to improve care but in effect are used to cross-subsidise the cost of GP consults. GPs have to think about item numbers and billing instead of just providing care to the patient in front of them.

There are inherent rewards in caring for disadvantaged communities and @mariamtokhi has described them beautifully. I take my hat off to Mariam and many colleagues who do this work.
But these rewards are not always enough.

GPs also have to consider their own circumstances and their families. GPs doing this work often feel exhausted and overwhelmed. Young newly trained GPs are not necessarily going to take this work on just because we want them to.

It’s difficult to have conversations in public about GP incomes and practice viability because it brings out the calls of ‘greedy GPs’. But when patients struggle to access GP services you have to ask why, and what can be done about it.

Currently the optimal amount of time for a GP to spend with a patient, from the income point of view, is 6 minutes. A GP who spend 18 minutes with each patient receives a third of the income of a GP who spends 6 minutes, if they bulk bill. (No wonder patients can feel rushed!)

Increasing Medicare rebates for patients having longer consults will help, because access to long consults is one way of improving care. Longer consults allow time to listen and address the issues properly. Why should GP income go down with the longer they spend with a patient?

I think there is a role for a salaried or hybrid model in some areas. This would help to maintain practice viability (eg in rural) and access. GPs currently spend 14% of their time on non-billable work (eg coordinating care). Funding this would help. www1.racgp.org.au/ajgp/2021/sept…

Multidisciplinary care is very important. General practice works best when we are part of a team, rather than just sitting in an office seeing one patient after another. I would also love participate in ‘GP ward rounds’ which I believe would improve the quality of care.

Finally, GPs and practices dealing with Covid patients need support and resources right now so that their patients get the care they need. I’m not an expert on what is needed but GPs on the ground need to be listened to.