In the last few months I have spoken a great deal about payroll tax. Why is it an issue for General Practices? The answer is financial viability. Most GPs are contractors. Traditionally the payments to GPs from patients have been exempt from payroll tax. A new application of the law means that these payments will now be treated as wages. General Practices do not have sufficient margins to absorb the cost, and it will be passed on to patients.
What we see on the surface of general practice rarely reflects the incredible work that goes into ensuring that we keep patients healthy and safe.
We need to have sufficient administrative staff to manage urgent issues, test results, correspondence from other clinicians, phone calls, all of the paperwork (even when it comes electronically). These are the reception staff that know that your child had croup three times last winter, and that it was scary, and that your GP will want to know straight away so we can fit them in for review.
We need to be able to work with the highly skilled practice nurses who triage our patients, assist us with procedures, care for patient wounds, provide immunisations, check blood pressure, set up our ECGS. Our nurses also chat to our patients who are lonely, let us know if they need extra services like meals or cleaning. They know our veterans who get a bit sad in winter, and send flowers to people when their beloved dog passes away.
There is so much in the consult room that is invisible to everyone except the patient and their GP. The grief that is lessened by being shared, the conversations about end of life care and someone’s wishes. The hope and happiness of planning for a pregnancy. The celebration when someone reaches a milestone and their cancer treatment ends. It is hard to measure the diabetes or kidney disease that is prevented with a discussion about diet and exercise, the depression that gets better because someone was available to listen.
No one sees the conversations we have with our non-GP specialist colleagues that happen every day. The advice obtained, the advocacy for urgent issues to be seen. The generosity that comes with collegiality, and the patient time and money that is saved by a good plan and not needing a hospital admission to achieve it.
General practice remains the most efficient part of the health system. However we are not funded to support it.
Decades ago the gap between the cost of delivering the service and the medicare rebate was modest. Over time that gap has grown wider and wider. In order to keep practicing GPs moved from bulk billing most patients, to bulk billing half to patients, to billing billing a few patients. Many can no longer afford to bulk bill anyone at all. The $41.20 that we receive when we bulk bill a standard consult covers the GP, the nurse, the sutures, dressings and sterilising equipment, the admin staff, the IT systems, the rent, the heating. It is no wonder so many practices are losing GPs, and sometimes having to close their doors altogether. The bulk billing incentives are available for some patients, but not all, and even then the gap between cost and rebate remains too high.
The ACT Government agreed to not audit practices and send retrospective bills. We are asking for exemption for general practices. We are asking for more time to prepare the practices for the cost. We are asking for real investment in General Practice so we can retain the doctors we have, attract the next generation to training, and keep the practices in Canberra viable.
Please sign our petition https://epetitions.parliament.act.gov.au/details/e-pet-024-23
Dr Kerrie Aust 