Guild takes aim at GPs who favour wealthy, healthy patients

NSW president says pharmacists are ready to help those who are excluded from general practice

The Pharmacy Guild has accused corporate GP practices of favouring healthy patients over poor patients with chronic conditions.

Guild takes aim at GPs who favour wealthy, healthy patients

The Guild’s NSW president David Heffernan launched an attack on “five-minute medicine turnstile operations” to underpin his argument that legislators needed to allow pharmacists to treat minor ailments.

Gone are the days where a GP would “turn up on your doorstep in their dressing gown and doctor’s bag”, he wrote in the NSW Pharmacy Guild’s February bulletin.

Modern practices preferred to work normal business hours and have their books filled, he said.

Further, the business model in corporate medical centres was designed to attract wealthier and healthier patients who typically needed short appointments.

This enabled bulk-billing GPs to earn more than $400 an hour, he claimed.

“The unfortunate side effect is when GP books are filled with easier clients, the poorer and more in need of healthcare are marginalised, forced into the public system of emergency wards,” Mr Heffernan wrote.

While the AMA has called for rebate increases to fix the problem, Mr Heffernan said this would be a “disaster” for an already-struggling MBS and would not fix the problem of “cream skimming”.

“Instead, increased funding to GPs will only incentivise five-minute medicine and blow out an already out-of-control GP and hospital spend.

“A solution is there for our legislators. Allowing pharmacists to practice in the full minor ailment space is a simple legislative change with the potential for huge savings.

“There are a litany of minor ailments that could be addressed immediately by a community pharmacist — if the law permitted. The ability to treat UTIs, impetigo, migraine, to name a few, has the opportunity to save taxpayers billions, along with continuing supply of medicines and pharmacist prescribing.”

Mr Heffernan told Pharmacy News his column was designed to initiate discussion on the rising cost of living and cream skimming, and the impact they were having on patients.

He said it wasn’t his intention to tar all doctors with the same brush but to highlight emerging business models in general practices.

The guild would always look to collaborate with doctors and other groups, Mr Heffernan said, , adding that he stood by his article.
 

Extract from Dr Heffernan’s column

Gone are the days where a GP would turn up on your doorstep in their dressing gown and doctor’s bag.

The contemporary GP surgery likes to open normal business hours and prefers to have their books filled. Walk-ins are becoming rarer.

You will find in the corporate GP practices, business models that appear to encourage 5-minute medicine turnstile operations which encourage patients to come in for short visits and often.

More and more, healthier patients with low morbidity conditions fill GP time slots. Healthier and wealthier patients are financially more attractive to business models that put profits before patients (a GP practising 5-minute medicine can earn over $400 an hour in a bulk billing practice).

This phenomenon, called ‘cream skimming’, is where financially more attractive — wealthier/healthier patients with low-morbidity conditions — are given preference over high morbidity patients.

High-morbidity patients take longer to treat and are not as lucrative.

Michael Marmot’s social determinants of health defines the correlation between the sickest and poorest. The unfortunate side effect is when GP books are filled with ‘easier’ clients, the poorer and more in need of healthcare are marginalised, forced into the public system of emergency wards.

The productivity commission has recently reported that there were three million avoidable hospital admissions last year by patients who should have seen a GP instead. Could they see a pharmacist instead?

It is a simple fact: if the pharmacist is not permitted to help you and the surgery is closed, there is no choice but the emergency department.

Further, in 2018 the AIHW (Australian Institute of Health and Welfare) reported that up to 7% of Australians either delayed or avoided purchasing medicines, and more than a million people have put off seeing a GP because they could not afford it – out of pocket expenses for doctors’ visits continue to rise.

There is a significant market failure in our health system when those who access medical services are only those who can afford it.