Nurses in line of fire

Looming changes to general practitioner rebate amounts could result in nurse job losses and cuts to services at Latrobe Valley clinics, a Moe doctor has warned.

From 19 January, GP clinics will receive about $20 less for consultations which are shorter than 10 minutes, which, according to the Australian Medical Association, is more than a quarter of all consultations.

Tanjil Place Medical GP Dr Robert Birks has warned this change would see a clinic’s capacity to provide chronic care curtail as it would no longer be able to afford to employ practice nurses.

Dr Birks said clinics received no direct funding for the work of highly-skilled practice nurses, whose duties include wound care, diabetes education and immunisations.

He said the nurses’ work was subsidised by GP rebates, where GPs bill for a full consultation when they might be required for the initial inspection, but the specialised nurse carried out the work.

“Let’s say you come over and you’ve split your skin. A nurse will do that work and that gets paid for (under the current arrangements),” Dr Birks said.

“All our nurses’ work with patients would no longer attract the rebate.”

Dr Birks said the loss in revenue would force clinics to either pass on the cost to patients for all visits of less than 10 minutes or cut services and staff.

“We have two nurses on duty at most times… there are 10 nurses we employ in total,” Dr Birks said.

“Our only way to keep our nurses would be to pass costs on to patients, but realistically this would be difficult.

“The exact fee hasn’t yet been decided, but it may need to be at least $30 per visit to cover lost income, and most patients using the nurses in our clinic are aged care pensioners, often coming for regular visits.

“These patients simply would not be able to afford this.”

On Thursday in Sydney, AMA president Dr Brian Owler said the rebate structure was “quite different” to the current situation, which is based on complexity.

“…these changes are insulting to GPs, many of whom are experienced and can provide good quality care within eight or nine minutes,” Dr Owler said.

“Quality is not necessarily about time. Quality is about the nature of the care that’s provided.

“These changes haven’t been debated by Parliament, many people are unaware of the changes, and it’s a terrible time of year to institute such far-reaching changes to general practice.”

The Federal Government said the changes were made to “streamline Medicare and improve quality outcomes” in a statement released on 9 December 2014, when Prime Minister Tony Abbott announced the $5 effective fee for most GP visits and scrapped the $7 co-payment.

“This change will ensure that Medicare expenditure more accurately reflects the time a GP spends with a patient,” a previous government statement read.

“It encourages a shift away from ‘six minute medicine’ so that appropriate, comprehensive care is better rewarded over patient throughput.”

Federal Health Minister Sussan Ley’s office did not respond to requests for comment by time of print.