In 2014 the then ACT Health Minister proudly announced the introduction of a new medical service to the ACT. The media showed her spruiking the arrival of the National Home Doctor Service and how this was going to be a bulkbilling service that would remove the pressure from the Emergency Departments and improve the care of Canberrans.
Sounds wonderful until one looks a bit closer.
So how does this work?
Patient’s start calling a 1300 number in the late afternoon and book a visit. There is no pre-requisite as to what the underlying problem is – it can be anything and the commitment is to attend, free of charge to the patient, sometime that evening.
So who are the doctors attending? – the organisation claims to be employing about 600 doctors across Australia and has provided over a million services since they started so one would assume that these are all fully qualified General Practitioners.
Think again – this type of organisation functions as a deputising service which means their doctors can be anything from a full qualified GP to a moonlighting Surgical trainee to an overseas trained doctor with the most basic Australian registration.
This variable skill set is reflected in the type of care that patients receive – in our practice, and reported by others, we have seen a massive over-use of antibiotics and in the most inappropriate settings.
In many ways this could be expected – we have moved from a situation where we have discouraged patients from attending their GPs with colds and flus to one where they can sit at home and have someone attend them there at no costs to the patient at all.
One example that springs to mind is a recent case where a mother called the doctor to look at her toddler – the child had absolutely no concerning features and (unusually) the doctor correctly did not prescribe any antibiotics. This did not stop the mother from calling for another review for the next two nights in a row – the child was seen three times to re-assure mother that it was a mild cold and not a concern. At no cost to the mother.
So who then do pay for all of this? You and I do, the tax-payer. You see, the Government, of both Political persuasions, has frozen normal GP rebates – it has stayed below CPI for decades. At the same time they have allowed organisations such as NHD to see patients at home and, regardless of the nature of the illness, charge an emergency after hours consultation fee to the Government. These item numbers generate nearly four times the amount that a standard GP consultation would generate. If one considers that these organisations do not have the costs of running accredited Consultation rooms, multiple staff members and do not follow up on these consults it is money for jam.
In Canberra alone the number of after hours consultation items have quadrupled since the NHD opened up – assuming that the great majority of their item numbers billed to the Government are the after hours emergency numbers a basic bit of maths would show us that the organisation has cost the tax payer at least $ 150, 000, 000 since it started operating.
So why do the Government and the peak Medical bodies allow this to happen?
I was particularly curious about this when I attended the peak GP training conference in Hobart this week (GPTEC2015) and discovered that NHD had an advertising booth there promoting their services.
This led to me doing a bit of digging – finding out who was behind this organisation was an eye opener. Their CEO is an active senior NSW Labor politician. Their Medical Governance team involves current and past RACGP Faculty Board Members, past State AMA Presidents and current and past Division of GP/Medicare local Directors.
Even more concerning is the fact that some of the doctors involved in the NHD does not openly disclose their involvement – locally in the ACT their Medical Governance is under the care of a member of the RACGP standing committee on Quality care and a current NSW/ACT Faculty Board Member – this fact is not disclosed in any easily accessible location anywhere.
Thus we have an organisation being run by the leaders in General Practice – decision makers, policy deciders and people who end up calling the shots within the AMA and the RACGP in some form or fashion. And their non-medical allies are Politicians. Openly.
This really makes me very pessimistic. There is a lot of talk in the medical media in recent times about how the various medical organisations do not have “the GP’s back anymore”.
My research on the NHD can only make me say “et tu Brute ?”
I may have it all wrong so here is my open challenge to the NHD. In a public forum such as this I would like you to answer:
a. How many of your 600 doctors are fully qualified GPs?
b. How many of you 1, 000, 000 consultations were billed to Medicare as Emergency after hours consultations?
c. What was the diagnoses of those patients (you are coding every visit so this information is a mouse click away) Where they truly emergencies that could not wait?
If the NHD is above reproach they should have no problem in releasing this information – I am however not holding my breath.