My response to an invitation in today’s mail to attend a dinner with the Health Minister and friends

Dear Mr Seselja & Mr Hanson

Thank your for the kind invite I received in the mail to attend a dinner, at $ 495 pp, with the Minister of Health to discuss the recent announcements and changes

As a longstanding Coalition voter I am afraid that I must decline the invitation – I did consider typing “respectfully decline” but, to be honest, I don’t feel particularly respectful towards the people I have helped to vote in.

Others have explained at length to you how it affects our patients – I agree with all of those Commentators so let me instead explain to you how your changes affect my life and that of my family as a small business owner:
I have been a self-employed GP in Australia for fourteen years – the last eight of those in Charnwood which, as you should know, is one of the poorest suburbs in the City
When my wife and I opened our clinic there were no other doctors around this part of Canberra and we were flooded by desperate people seeking a good GP.
At every step of the way life was made hell by Territory and Federal regulations and red-tape – not just medically but in generally just running a small business. Insurance, rates, wages, superannuation and all the paperwork surrounding these issues were and remain a day to day nightmare

My wife and I risked every single possession that we had and borrowed over a million dollars to set up a Clinic – despite the Clinic being extremely busy and having extensive waitinglists we are, eight years later, still in the red. I am lucky if I work anything less than 80h a week and my wife does no less than 40h a week. Our taxable income is currently less than what it was when we started our clinic in 2006 and yet we are working harder each year.

The practical realities of being self-employed in a service industry is that there is no income when I or my wife are sick – this week I was at home with pneumonia – staff and bills had to be paid but I could not risk making my patients sick so the overdraft copped it yet again. My wife and I have not had anything more than a long weekend’s break in over a decade! Small suburban clinics cannot afford the luxury of a locum doctor who, at $ 1,500 – $2,000 a day demands more than what we gross in a day and we cannot afford shutting down for an extended period – neither can our patients.

Why would this be you ask? It is simple – a compassionate GP cannot be a hard-nosed businessman. As simple as that. If you want pure bloody-minded business go to one of Ed Bateman’s bulkbilling emporiums where you get six min and a handful of scripts without even being examined. We look after our patients and when you have just spent 30min dealing with an elderly person with a long list of serious health issues it would be fairly mercenary to then turn around and charge them a full private fee – this means that we usually bulkbill around 40% of our work and significantly reduce the fees for most of the rest.

OK – so Medicare has ample remuneration for GP work – or does it?
Government after government have allowed the MBS rebate to slowly erode year after year. What other profession is expected to accept $36 for up to 20min work (the current rebate) not to mention the sizeable group of non-vocationally registered GPs whose rebate has been stuck at a paltry $21 for a 25min consult for over a decade ! Please do understand that this is also not what these highly skilled professionals actually take home – this is what the business entity earns.
GPs working at a practice will take around 70% of this amount home. GPs who own their practice are on the other hand lucky if they take 30% home hence the perverse incentives to churn patients through to make ends meet.

Your predecessors then a “smart idea” – care plans. extra money for GPs under the guise of improving care – and this is all it ever was. Countless large, predominantly bulkbilling, clinics churned these things through like it was going out of fashion, ignoring the MBS rules regarding who actually qualified for these plans and who should be doing them, with little if any real benefit to the actual punter.

Not only did the Commonwealth allow the MBS rebate to increase way below CPI and other indices – you also allowed the consultation rebates for GPs and Specialists to be vastly different – calling us “Specialists” when we have a FRACGP or a FACRRM yet giving us a fraction of what a “Partialist” receive from the MBS is beyond the pale.

To add insult to injury the previous Labor Government elected to put the annual indexation of the MBS on hold – this was in November 2012. The annual indexation for a standard GP consultation was usually around 70-80c pa which would round up very closely to a $ 2 increase that was due in November 2014 (had indexation continued in November). As things stand indexation was due to happen 1 July 2014 put the Minister has not mentioned this at all and I, and most of my colleagues, expect that we will once again be given short shrift and that indexation will be skipped.

So all of this was pre-budget – how did your Budget affect me?
Firstly, the Coalition Government has decided that GP services are somehow even worth less than previously thought – you decided to take $ 5 from every GP consultation rebate yet left the rebates for Specialist consultations unchanged.
You can sugarcoat it all you like but essentially this a new tax on GP income – money destined to a research fund that may or may no do some good in the distant future. Work that will probably be performed by our Specialist Colleagues yet we GPs end up footing the bill.
Every single patient will end up having to pay us this extra $5 as part of their consult as we simply cannot afford to absorb such a loss in our turnover and will keep our Fees at least at the current level – a fact that was very conveniently not highlighted by the Politicians.

Then we get to the Co-payment issue – suffice to again remind you about the fact that there will simply be patients where we cannot charge this money. Not only will we in the process forfeit $ 5 on the rebate but if they are a Concessional patient we will also lose the Bulkbilling incentive which currently amounts to $ 9.10 a visit.
This changes the current income for such a 5-20min consultation from $45 to  $ 31 – a reduction in income of 31%
Many of the larger clinics employ non-vocationally registered doctors – these doctors currently earn $30 for  5-25min consult – this is reduced to a mere $16 – a 47% reduction !

How can you expect a  business or a Professional to spend time with a patient for this remuneration ?
I would suggest Minister Dutton need a refresher course in basic accounting – a $2 “windfall” can in no way make up for such cuts to income. This “windfall” is anyway simply a catching up of the indexation.

Off course the Minister did have an answer – we should see our chronically unwell and poor patients on “Care plans” as these are excluded from the Co-payment. This does make one wonder if the Minister has even bothered to familiarise himself with the MBS because if he had done so he would realise how ridiculous this suggestion is – please Minister just go and read your own “rulebook” and then think again before making such a suggestion. Any GP who follows the Minister’s advice would be breaking the law as routine consultations cannot be replaced by a Care plan regardless of how many illnesses or complaints a patient might have.

To add further insult to injury the Minister then chucked another curveball this weekend – in order to claim a Care plan item number the details has to be uploaded to the PCEHR (or MyHR) as it is going to be called
– Australia card anyone ?

Your changes are bad for my business on so many levels Minister – Bad financially. Bad logistically in terms of chasing down demented nursing home patients’ relatives for seven dollars. Bad for my staff in terms of an extra workload and a security risk with the cash we will have on the premises. Bad ethically and morally where many GPs will be forced to stop attending nursing homes or giving vaccinations as they simply cannot afford to do it at the new rebates yet know the patients cannot afford the Co-payment

I will lastly add my voice to the many who will tell you that these changes are very bad for the most vulnerable and disadvantaged of our patients. The reasons have been clearly expressed by others who explained it very eloquently

So thanks for the invite but I will not be attending even if I was not asked money to do so.

Yours truly
Thinus van Rensburg

(Dr FM Janse van Rensburg BSc MBChB FRACGP FACRRM)

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