Latest / 360 with Katie Woolf / Royal College of General Practitioners NT Chair Dr Sam Heard is encouraging Territorians to shop around for a doctor amid claims some practices are no longer bulk billing

Transcript

Royal College of General Practitioners NT Chair Dr Sam Heard is encouraging Territorians to shop around for a doctor amid claims some practices are no longer bulk billing · 360 with Katie Woolf

• 0:00
  Speaker 1: Now we've been contacted by a number of listeners raising
• 0:03
  Speaker 1: concerns over recent days and weeks about being charged to
• 0:06
  Speaker 1: go to the doctors when they normally wouldn't be as
• 0:09
  Speaker 1: pensioners and concession holders. It is another strain on people's budgets.
• 0:13
  Speaker 1: With Christmas just around the corner. Joining me on the
• 0:16
  Speaker 1: line right now is doctor Sam Hurd, who is indeed
• 0:19
  Speaker 1: from the Royal College of General Practitioners, the Northern Territory Chair.
• 0:24
  Speaker 1: Good morning to you, doctor Herd. Hello, Hello, thanks so
• 0:30
  Speaker 1: much for your time this morning. Now, doctor, do you
• 0:34
  Speaker 1: know there are women there? Obviously is some occasions where
• 0:38
  Speaker 1: concession card holders and pensioners are all of a sudden
• 0:40
  Speaker 1: being charged to see a doctor in Darwin. Is that
• 0:45
  Speaker 1: Is that happening from your perspective, Yeah.
• 0:49
  Speaker 2: I guess it's rare. Most practices would bill a bulk
• 0:56
  Speaker 2: bill group generally, and you do get you do get
• 1:04
  Speaker 2: an extra bolt building fee to do that, Yeah, ten
• 1:08
  Speaker 2: dollars or so eleven dollars, So it's there's a little
• 1:12
  Speaker 2: bit of incentive to bolt build that group. So I
• 1:15
  Speaker 2: think the main change, honestly is not in that group.
• 1:18
  Speaker 2: It's in the people that don't have those cards probably
• 1:21
  Speaker 2: where the big change has been I think, yeah.
• 1:24
  Speaker 1: Right, So talk us through that change and why it
• 1:27
  Speaker 1: has come into play.
• 1:30
  Speaker 2: So you know, historically in Darwin, if we go back
• 1:35
  Speaker 2: twenty years that the main people will bolt build if
• 1:39
  Speaker 2: they were confession cardholders, elderly children, they were the groups
• 1:44
  Speaker 2: that were and that's that's the group now that have
• 1:46
  Speaker 2: a bit of an incentive to do that. What happened
• 1:50
  Speaker 2: then was we've got bolt building clinics in Darwin. So
• 1:52
  Speaker 2: that's a new disruptive thing that happened all over the
• 1:55
  Speaker 2: country and they would see most of the light is stuff.
• 2:01
  Speaker 2: People who are sicker might go there, or they might
• 2:04
  Speaker 2: choose to go to general practitioner that was working in
• 2:08
  Speaker 2: a billing practice. And the doctors who came in were
• 2:13
  Speaker 2: in training. A lot of them they weren't qualified GPS,
• 2:18
  Speaker 2: and they I guess had a high throughput and made
• 2:22
  Speaker 2: quite a lot of money by having a high throughput.
• 2:24
  Speaker 2: As that's sort of change. People have now done their
• 2:28
  Speaker 2: training specialized taking on more complex things. I think just
• 2:33
  Speaker 2: generally as a standard list, you can't deal with things
• 2:37
  Speaker 2: in five or ten minutes. You've got to actually do things.
• 2:40
  Speaker 2: Stop leaves and tests off and see what's going on.
• 2:43
  Speaker 2: So that group are now I guess, seeking to build
• 2:49
  Speaker 2: people because Medicare, which was frozen to ten years, I think,
• 2:52
  Speaker 2: you know, just can't cover the costs for a practice.
• 2:56
  Speaker 2: It's got to cover the cost of receptionist running the
• 3:00
  Speaker 2: practice doing you know, it's not just going to the
• 3:03
  Speaker 2: doctor when you get thirty five dollar bill, it's going
• 3:05
  Speaker 2: to the whole system that's running that. You can imagine
• 3:12
  Speaker 2: in most practices that will be thirty or forty percent
• 3:14
  Speaker 2: of the overhead. It include your dressing to get on
• 3:17
  Speaker 2: all that sort of thing. The rest goes to the GP.
• 3:20
  Speaker 2: So forty percent of thirty five dollars, quarter of an
• 3:24
  Speaker 2: hour times four to work that out, it's not you know,
• 3:27
  Speaker 2: it's maybe eighty dollars an hour or something like that.
• 3:31
  Speaker 2: And I know that I think four people are now.
• 3:34
  Speaker 1: I know that there has been some some more serious discussion,
• 3:37
  Speaker 1: I guess, about the way in which Medicare works. Over
• 3:39
  Speaker 1: the last couple of days, there was that review from
• 3:42
  Speaker 1: the Gratten Institute yesterday that found that Medicare needs an
• 3:45
  Speaker 1: urgent overhaul. They're saying a complete change needed to the
• 3:50
  Speaker 1: way that practitioner practitioners work and get paid. What are
• 3:54
  Speaker 1: your thoughts on those findings from the Gratten Institute report
• 3:59
  Speaker 1: and the why in which Medicare does work.
• 4:03
  Speaker 2: Okay, so I actually went over to the UK and
• 4:06
  Speaker 2: train to Mandi between theres a long while ago. Came
• 4:09
  Speaker 2: back to Darwin thirty years ago and over there they
• 4:13
  Speaker 2: fought to get some FIFA service. There's no FEAFA services,
• 4:17
  Speaker 2: just to a capital payment, and they fought very hard
• 4:19
  Speaker 2: to get a fee for serve and now they're really
• 4:22
  Speaker 2: struggling because people are coming nine or ten times a
• 4:26
  Speaker 2: year instead of three, which was thirty years ago. And
• 4:30
  Speaker 2: so that's thinking under the no fee for service arrangements.
• 4:34
  Speaker 2: The important thing to recognize is we need various funding
• 4:39
  Speaker 2: to do this job properly, not just feef for service.
• 4:42
  Speaker 2: We don't just have fee for service. Now we get
• 4:45
  Speaker 2: as much as forty percent of the practice income comes
• 4:48
  Speaker 2: through channels like support for nurses and other things that
• 4:52
  Speaker 2: Medicare needs reform. There's no doubt about that. The Gratton Institute,
• 4:57
  Speaker 2: they didn't talk to a College of GPS about that report,
• 5:01
  Speaker 2: but didn't ask anybody. You know, it's just kind of
• 5:04
  Speaker 2: madness to come out with the revolutionary, high profile news
• 5:10
  Speaker 2: kind of aimed at things without doing a job properly.
• 5:13
  Speaker 2: So I'm just very skeptical about that. If we're not
• 5:16
  Speaker 2: going to make sure GPS get carried along in this reform,
• 5:21
  Speaker 2: then you know everybody's going to be in a mess.
• 5:24
  Speaker 2: People will say, you know, having a physiotherapy, you're having
• 5:27
  Speaker 2: this access to all these things. I agree, it's great,
• 5:30
  Speaker 2: but you've still got to have something at the heart
• 5:33
  Speaker 2: of it. You know, if you take your ankle to
• 5:35
  Speaker 2: the physiotherapist and it's gout, they can't help you at all.
• 5:39
  Speaker 2: I heard a lot it feels like your ankle problem.
• 5:41
  Speaker 2: But you know you've got to have a medical heart
• 5:44
  Speaker 2: of primary care being a generous and primary care is tough.
• 5:48
  Speaker 2: You know, it's really demanding a knowledge basis high. So
• 5:53
  Speaker 2: you know, we'd be saying, yes, change things, but let's
• 5:56
  Speaker 2: get more resources into primary care so most care can happen.
• 6:00
  Speaker 2: That's where ninety five percent of care can have an
• 6:03
  Speaker 2: in primary care forget it right.
• 6:05
  Speaker 1: And so do you think that's what does need to
• 6:07
  Speaker 1: be happening, that there does need to be more resources
• 6:10
  Speaker 1: into primary care or how do you think things could
• 6:13
  Speaker 1: be shaken up a little bit?
• 6:16
  Speaker 2: I think so, you know, if you look in Denmark,
• 6:18
  Speaker 2: it's turned on its head really that primary care gets
• 6:22
  Speaker 2: the majority of funding and deals with most things. So
• 6:26
  Speaker 2: you know, we may or may not be quite ready
• 6:28
  Speaker 2: for that, but we know emergency department is not the
• 6:31
  Speaker 2: place to have your primary care. It's free ambulances whatever,
• 6:36
  Speaker 2: so there's no barriers to using their ethnics at waiting time,
• 6:40
  Speaker 2: but it's a really bad place to get your primary care.
• 6:43
  Speaker 2: You're not going to get good care in an emergency
• 6:46
  Speaker 2: department unless you're very sick. You're seeing young people without
• 6:50
  Speaker 2: training dealing with just the very superficial symptoms you're coming
• 6:55
  Speaker 2: with most of the time.
• 6:57
  Speaker 1: And so doctor Hurd, when you talk about that, when
• 6:59
  Speaker 1: you're talk talk about then people sort of presenting to
• 7:02
  Speaker 1: the emergency ward on things that they could be going
• 7:04
  Speaker 1: to their GP on or you know about obviously that
• 7:09
  Speaker 1: cost factor is what comes into play sometimes. And do
• 7:12
  Speaker 1: you think that we're going to see more people presenting
• 7:15
  Speaker 1: to emergency because they can't afford to go and see
• 7:18
  Speaker 1: a GP.
• 7:20
  Speaker 2: I think that's quite possible. I think you know that
• 7:23
  Speaker 2: there's always going to be a gap. The private thing
• 7:26
  Speaker 2: isn't very expensive. I think you know we've had a
• 7:31
  Speaker 2: culture where a government everyone's been trying to get everyone
• 7:34
  Speaker 2: bolt filled. They've frozen Medicare and that's been their way
• 7:36
  Speaker 2: of getting the cost of healthcare down. So now we've
• 7:39
  Speaker 2: got an underfunded primary care environment. The result is inevitably
• 7:46
  Speaker 2: practically going to look to the users to fund that more. So,
• 7:50
  Speaker 2: you know it's got to be about So yes is
• 7:52
  Speaker 2: the answer to your question. But you know, I think
• 7:55
  Speaker 2: the way Medicare is set up, you would expect to
• 7:58
  Speaker 2: pay something to go and see your primary care service.
• 8:02
  Speaker 2: In New Zealand where it's very so there's a fifty
• 8:05
  Speaker 2: dollars kind of notion every time you go to a
• 8:08
  Speaker 2: primary care doctor for example, that can be waived by
• 8:13
  Speaker 2: the doctor. And you know, general practitioners generally don't go
• 8:17
  Speaker 2: on charging people for getting their results back or whatever.
• 8:21
  Speaker 2: They don't, you know, charge you every time. I do.
• 8:24
  Speaker 2: And some do a very very good job and charge
• 8:28
  Speaker 2: for it because they have to be able to do that.
• 8:31
  Speaker 2: But the majority will charge you the first time you
• 8:33
  Speaker 2: go and then see you with the results and things,
• 8:36
  Speaker 2: and not doing you the second time and you can
• 8:39
  Speaker 2: ask about it. I mean, it's very interesting that there
• 8:43
  Speaker 2: doesn't seem to be any relationship from my experience between
• 8:46
  Speaker 2: how well off somebody is and whether they expect to
• 8:48
  Speaker 2: be bulk built or not.
• 8:51
  Speaker 1: So you mean it doesn't matter, like even if they
• 8:53
  Speaker 1: are hired, they still expect to.
• 8:55
  Speaker 2: Be bulk built. It's just that rage at some people
• 8:59
  Speaker 2: that you and then they'll be a plumber of something
• 9:01
  Speaker 2: and they'll charge you like a wounded bullets. You have
• 9:04
  Speaker 2: to get to call them out.
• 9:05
  Speaker 1: Well, doctor, whod I suppose? So there are there are
• 9:08
  Speaker 1: quite a few people who've been in contact with us
• 9:10
  Speaker 1: in recent weeks and they are concerned about those the
• 9:13
  Speaker 1: pricing structure changing or the payment structure changing. We have
• 9:17
  Speaker 1: heard from some pensioners as well who are worried that
• 9:20
  Speaker 1: they are now being charged. So are there like, are
• 9:24
  Speaker 1: there instances in the territory where that is happening from
• 9:28
  Speaker 1: your understanding or what should the situation be?
• 9:31
  Speaker 2: I know of, but there may well be. The important
• 9:34
  Speaker 2: thing I think is if your pension and your healthcare cardholder,
• 9:37
  Speaker 2: you can ring up and let's see a doctor that
• 9:42
  Speaker 2: will bolk be you. That's pretty clear. Most practices will.
• 9:45
  Speaker 1: Say okay, right, So if you are somebody who's on
• 9:50
  Speaker 1: who is one of those cardholders, you can actually call
• 9:54
  Speaker 1: and say that you want to see a doctor who
• 9:56
  Speaker 1: will bonk bell, you'dn't.
• 9:57
  Speaker 2: See a doctor who would do And if they say,
• 9:59
  Speaker 2: well we don't do that, here, bring around you're going
• 10:01
  Speaker 2: to find the majority of practices do actually do that.
• 10:06
  Speaker 2: They might say the first time you come, you're going
• 10:09
  Speaker 2: to bitter you, because that can be quite a long
• 10:12
  Speaker 2: kind of things. And they might say, you know, just
• 10:15
  Speaker 2: to have a transfer of ca it's inevitably going to
• 10:17
  Speaker 2: be a big To do it properly is going to
• 10:19
  Speaker 2: be a big handover.
• 10:21
  Speaker 1: We did have somebody just call through to my producer
• 10:24
  Speaker 1: and saying that they were told eighty five dollars for everyone,
• 10:28
  Speaker 1: sixty five dollars for concession holder from December tenth at
• 10:32
  Speaker 1: one and local practice, and about fifty for kids. That
• 10:36
  Speaker 1: person says that he is still a lot of money
• 10:38
  Speaker 1: for them.
• 10:39
  Speaker 2: Yeah, yeah, Well there will be practices around the do that,
• 10:43
  Speaker 2: and the people that go there, I guess they're going
• 10:45
  Speaker 2: to have more money or they're going to get a
• 10:48
  Speaker 2: much better service when they go there, and it's worth it.
• 10:51
  Speaker 2: That's the pressure, you know. They are free to do that.
• 10:55
  Speaker 2: It's a commercial arrangement. The Medicare payment is actually to
• 11:00
  Speaker 2: the client not to the practice. Legally, they hand it
• 11:06
  Speaker 2: over when they go and sign it. So if you're
• 11:08
  Speaker 2: bolt doing, it's still really going via the person. If
• 11:11
  Speaker 2: you pay immediately, the money goes back into your bank.
• 11:16
  Speaker 2: You know, it's to this client.
• 11:18
  Speaker 1: What is your advice to people if they can't afford that, like,
• 11:21
  Speaker 1: if they if they are in a situation where they can't,
• 11:25
  Speaker 1: it's to.
• 11:25
  Speaker 2: Ring around and just be upfront. And if you're not
• 11:30
  Speaker 2: a healthcare card holder and you need to get a
• 11:33
  Speaker 2: relationship and have your fifty dollars or whatever ready to
• 11:37
  Speaker 2: just want you know, let's save up and go and
• 11:41
  Speaker 2: do it properly if you if you're really strying. Because
• 11:44
  Speaker 2: boat doing practices in dah and now real. I think
• 11:48
  Speaker 2: there's one in Parmesan. Still we doing. I don't know
• 11:51
  Speaker 2: that I've heard that, but it's rare.
• 11:54
  Speaker 1: Now Well, Royal College of General Practitioners NT Chair Doctor
• 11:59
  Speaker 1: Sam heard. We appreciate your time this morning. Thank you
• 12:02
  Speaker 1: for having your chat with us.
• 12:03
  Speaker 2: Thank you