What's in it for Canberra? A GP Super Clinic!

Just sit back and watch the Labor Govt stuff this one up too…. 🙁

Sorry to come late to this, but agree with all those who say $15 million is ridiculous. And some of the alternative ideas are very good.

Belconnen already has two decent-sized one-stop shop clinics – Ginninderra practice and the West Belconnen Health Coop. One was built with private money and cost the government nothing more than grief over a tree (now dead); the other is a community-led initiative that cost the government less than $1 million in capital grants. Why not use a model that works and costs less?

JumpingTurkey said :

…If they expanded the number of GP registrars in Canberra by increasing incentives for GPs in Canberra to take on more trainee doctors in their surgeries then there would be greater chance that they will stay on in Canberra…i.e. cost of offering each registar $10,000 each year, plus 12 free return flights per year plus taxi vouchers would be something like $15000 each year.

If you attracted say extra 40 registars each year (20 each from Sydney and Melbourne), then this would cost $600,000 a year. This would take a huge burden off GP shortage in Canberra, not to mention that 2 years later some of these registrars may decide to stay on.

….This would be a far more cost effective solution than spending $10 million on building a whopping big building for a super clinic.

Now THAT sounds like a plan.

Well, we have a system that ‘locks in’ overseas trained doctors (OTD) entering into general practice in Australia into ‘area of need’. Number of years varies but generally 10 years. There are several practices in Canberra that are able to employ these area of need doctors.
However there are a couple of issues with this:

a) while many OTDs are competent, many aren’t. The proportion of incompetent doctors is far higher for OTDs. This is due to the fact that their communication skills are problematic; and also many OTDs simply did not receive first class training; and many OTDs are also older and often trained as a specialist in a country that has no established system of general practice (e.g. in middle east or subcontinent where people just go straight to a specialist doctor). So you get a situation where you have inadequate doctors working in areas that need good doctors the most (e.g. in areas of existing doctor shortages where patients cannot get second opinions).

(b) This system is a bit inhumane. Forcing people stay in country towns, often away from their family in major cities for many years is a bit slack. But this may not be a problem in a large city like Canberra where the entire family can easily move here and enjoy the benefits of city living and education.

In terms of imposing geographic restrictions on provider numbers to even local graduates – this could work, and something similar to this is happening with rural students. For example students from rural regions can enter Med school with a lower mark provided that they sign a contract restricting them to practicing in rural regions for X number of years after they finish their medical training. In addition, med students can also receive scholarships to help them financially during their study, but in return they may have to sign a contract once again bonding them to rural practice for X number of years on graduation. Problem with these approaches is that often students are willing to sign such contracts, but they are often young and naive when they do so, so may not understanding the implications in what they are signing; and secondly they often change their minds while spending 6 years studying at a major city – they often get used to the lifestyle of a big city, and wish to remain in the city.

I think a far better solution is to have geographic limits on provider numbers, AND provide training in the actual area that you want them to practice. And this is why ANU getting a medical school is so vitally important. Local Canberra students who train at the ANU are likely to remain in Canberra.

Another solution to workforce shortage of GPs is to expand the number of GP registrars – doctors who have finished internship and residency in the hospitals and who are undergoing on the job training as GPs. If they expanded the number of GP registrars in Canberra by increasing incentives for GPs in Canberra to take on more trainee doctors in their surgeries then there would be greater chance that they will stay on in Canberra after their training. In order to do this you need to snatch GP registrars away from Sydney and Melbourne – and one way of doing this is by offering them incentives to come to Canberra for the duration of their training by offering them additional money, but perhaps more importantly I reckon offering them generous number of free flights each year so that they can easily visit their friends in the big cities.

i.e. cost of offering each registar $10,000 each year, plus 12 free return flights per year plus taxi vouchers would be something like $15000 each year. If you attracted say extra 40 registars each year (20 each from Sydney and Melbourne), then this would cost $600,000 a year. This would take a huge burden off GP shortage in Canberra, not to mention that 2 years later some of these registrars may decide to stay on.

This would be a far more cost effective solution than spending $10 million on building a whopping big building for a super clinic. All this would is to get GPs who are practicing in their private practice to sell their practice or pack away their gear and just move into this new building. How does this help anyone (but of course it helps the government in getting reelected)???

@JumpingTurkey

I agree with you wholeheartedly on point #1.

Regarding point #2, what do you think is required to lure more GPs to Canberra and other inland cities -or what keeps them away? If it is purely a financial issue, what form of financial incentive would be the most attractive in your view? If it is not a purely financial issue, what else would work?

What do you think about imposing geographic limits on Provider Numbers, as I believe they do with foreign-trained doctors?

I think Jumping Turkey hit the nail on the head when its comes to bulkbilling. Start blaming the Government and not the doctors.

Besides, most people who post on here could quite easily afford to pay a doctor.

Leave the doctors who bulk bill for people who genuinely can’t afford to see a doctor. (and all those other bludgers on the dole)

As an existing GP I have a few comments.

1. Building a huge builing to the tune of several million dollars is going to do absolutely nothing to address the GP shortage in Canberra. GPs are not going to be suddenly lured to Canberra to work in these new super clinics.

2. Issue of how to get GPs to work in Canberra is complex. I think it has to do with the fact that GPs generally don’t stick around in cities and places that they did not train in or grew up in. Until very recently, Canberra did not have their own medical school, except for students who rotated from Sydney Uni. Hopefully when ANU starts pumping out graduates, (and they are now) then this will address some of these issues.

3. You say that there are incentives for GPs to work in Canberra. I’ve never heard any details of these incentives. And I read through most medical newspapers / journals regularly. If it does exist then the government is not doing a good job of promoting this, are they?

4. You’ve got to stop blaming GPs for not bulk billing, but blame the government for not increasing medicare rebates. If you are an intern or a resident in the hospital contemplating your next career move – whether to specialise or enter GP training, and if you know that the government pays specialists double or more compared to GPs, and if you know that the training time for most specialties is only 2-3 years more compared to General Practice (and of course you earn an income as a trainee too, so its not as if you are paid nothing), then why would you enter general practice?
If you feel that your GP bills too much, then do you feel that your accountant who spent 3 years at Uni, followed by 2 years doing his CPA (compared to your GP who spends 10-12 years studying and training), charges you too much? What about your lawyer who charges you $50 for a couple of phone calls?
As a GP I’ve never dreamt of charging people for phone calls that I make to them, or bill them for the time it takes me to check their blood results or pathology results as they come through, or to call and talk to specialists or hospitals to discuss a patient’s case.
The money that you pay GPs need to pay for the surgery expenses, including rent, including electricity, phone bills, staff wages, and all sorts of expenses needed to keep the equipment sterilised, and also for medical indemnity insurance that protects you as a patient in case anything goes wrong (its not that we try to practice dodgily, but we are humans too and you’ve gotta be deluded to think that we never make mistakes).
The fact is that what medicare covers seems to rise in the order of 1% of less per year. Compare this to your electricity charges, or even the inflation that goes up at 3-4% per year. Or even your own salaries and wages that goes up by at least that amount per year.

5. Many GPs that I know will bulk bill patients who are in genuine financial difficulties. For instance, I bulk bill some of my patients – e.g. those with mental health issues, because I need to follow them up closely, and I don’t want money to be a barrier in them coming to see me frequently. Also we bulk bill those folks in nursing homes who are extremely fragile and often in the last few months to years of their lives.

6. I think having nurses working with GPs is a great idea. However you’ve gotta be kidding me if you think that nurses can replace GPs or do 80-90% of their work. What even makes you think / or what qualifies you to think that this is the case? As a GP, I can confidently tell you that 20-30% of my work is routine – i.e. coughs and colds, and issuing scripts and so forth. Around 40% are intermediate – they are things like people presenting for scripts but they actually need to be properly reviewed to make sure everything is okay – e.g. people who ‘thinks’ that they can come in asking for more scripts for diabetes tablets, without realising that they did not have a blood test for that in 12 months, or had their blood pressure checked, or does not realise that the sensation in their foot is slowly dying off due to diabetes, or their vision is silently going etc. That’s when I have to actually tell them that its not a simple matter of giving them scripts, but I have a responsibility to make sure that they are properly assessed again.
The other 30% of my work are diagnostic dilemmas. e.g. funny skin rash, or abdominal pains, headaches that persist, or dizziness etc etc. These are not ‘simple’ things and they need extensive history taking, examination and investigations to get to the bottom of things.

Now, I think a well trained nurse would be able to do the routine things. They might be able to do parts of the intermediate things, but they will always need a doctor to check to ensure that nothing was missed. Often during the course of routine BP check, I often discover things like a mole, or funny irregular heart beats. And this kind of stuff only comes with years of medical training, not years of nursing training.
There is no way that nurses can deal with diagnostic dilemmas or the harder cases.

The fact of the matter is that nurses are NOT trained to be diagnosticians. Diagnosis is the most difficult part of health care. The rest – how to get you better – is easy – you just look up a book. For instance, if you KNOW that what you have is a skin cancer – treatment is easy – cut it out or burn it out (depending on the type). But getting to that point is difficult and requires specific training.
Nurses are good at ‘nursing’ people to health. Once they have a diagnosis, they are very good at taking good care of them, and monitoring their recovery to ensure that they are back to their health. With further training they become good at technical tasks – e.g. as scrub nurses who assist surgeons, or ICU nurses who are very good at looking after patients in critical conditions and become good at protocol-driven management of people’s airway, breathing and circulation issues.
However nurses are not trained to be diagnosticians and will never become good at this because they lack the broad medical training.
Remember 20 years experience as a nurse is not the same as even 2 years experience as a doctor, given that what you are doing is so different. this is same as thinking that a dental assistant working for 20 years will be able to do the job of a dentist – although they spend a lot of time looking after patients, they are simply not involved in making diagnosis or taking on the heavy responsibility of patient’s care – so how do you expect them to be the same???

re 13 – I thought Canberra (or South canberra) actually was an ‘area of need’ for GPs?

We have the lowest level of bulk billing in auastralia, and I thought we had the second lowest level of GPs per capita?

which is why it was very bizarre that we didn’t get a GP super clinic the first time around. It will be interesting to see how this model goes in Canberra. If it is supposed to be an after hours clinic, they may expect customers who have got sick after hours – but with the difficulty in seeing a GP without 3 days notice in Canberra, they will probably find they get people treating them as their local GP.

Anyway – more doctors in Canberra can only be a good thing. I hope they can find some.

How much if this comes back to the strength and influence of the doctors’ union and the medical establishment? The AMA has worked hard to ensure that GP’s retain, in effect, a monopoly over such basics as prescriptions and medical certificates. Argument usually runs that quality of service will fall if anyone but AMA endorsed-professionals are allowed to provide these services. This imposes higher costs (eg GP salary vs Nurse Practitioner salary) on the delivery of many services.

Where will the staff come from for the new clinic?
Is it just me, or are all these new ventures simply shuffling existing resources from one place to another without adding anyone new?
I think most people want local GPs, because that provides the best quality of service.
Clinics are good too, but only if they’re additional, not if they come at the expense of small GP practises.

Why can’t the government run a review of why GPs are reluctant to work in Canberra, or why there is a shortage, and make the results public so we can then push for real solutions? Like massive increases to funding of training young doctors linked to obligatory working where they’re needed for their first 5 years as doctors? Plus short-term increases of overseas doctors.