GP workforce problem in all states.

We are in Brisbane, but we know that the GP workforce problem is acute in many urban areas in other states: the Sydney Morning Herald recently highlighted the seriousness of the problem in both Sydney and in Victoria.

If we ask you "Is there a GP workforce shortage in your own area?", how would you respond? Please let us know: email us at brisbanegp@gmail.com with your response.

To: The Divisions.

The following email has been sent to the over fifty urban Divisions of General Practice around the country.

Dear Colleagues,

You may be aware of the national coverage of the GP workforce issue in the Prime Minister’s own electorate of Griffith over the last week. My practice is one of those at the centre of the publicity. In summary, both this and a neighbouring practice are facing closure in the relatively near future due to our inability to find doctors eligible for employment in our inner metropolitan area. I am sixty years of age, with no succession plan for the practice. In the shorter term we will not meet accreditation standards when we are reviewed next March, unless we can find another doctor.

A local campaign was started by a concerned patient several weeks ago and has been received with great enthusiasm by the community. It has received attention from television, radio, local and national newspapers. The first batch of petition signatures has been handed in to Kevin Rudd’s Griffith electorate office; a second batch will follow shortly.

We know that many of you in urban areas in other states are in a similar situation. We believe the problem can be solved, if there is a will to do so. We have some practical ideas and suggestions which we have already forwarded to the Prime Minister and to the Minister for Health (although we have not to date received any response other than the formulaic one.)

We have started a blog at http://needmoregps.blogspot.com/ to publicise the campaign and act as a focus for the debate we have to have if this problem is to be solved. We do not need or want any more analysis of the problem. We welcome your suggestions and comments.

Yours sincerely,

Dr Janet Clarkson.
Logan Road General Practice
Stones Corner
Brisbane
3394 3622
0417 718 375

The Financial Review.

Doctor's jab sullies watershed moment.

Laura Tingle of The Australian Financial Review has seen fit to comment on our grass roots campaign; the article is in the Opinion section, page 83, in today's edition. Here is an extract:

"Not everyone in Australia loves Kevin Rudd at the moment. At home in his seat of Griffith, a grass roots campaign has begun to try to get some action on a chronic shortage of doctors.

Local patients and GPs have started a website called needmoregps.blogspot.com/ because shortages of doctors-and difficulties experienced by local clinics with the bureaucracy in hiring overseas trained doctors – are claimed to threaten two clinics, leaving 7,500 patients without a doctor.

This isn’t some remote part of Australia but suburban Brisbane in the spotlight, and the PM’s own electorate to boot.

The locals have been underwhelmed with the response from Rudd so far.

In a week in which the Prime Minister is setting off around the world to establish his credentials as a middle-power statesman, and hosting a significant Council of Australian Governments meeting why are we so concerned about doctor shortages in Griffith?

Because in a ‘six degrees of separation’ way, they show how all international and federal politics – and all that talk that seems to be going on – can ultimately rebound locally.

Australia’s reputation abroad after last year’s Haneef affair has made it hard to attract over seas trained doctors to Queensland.

Even the ones who are here and determined to stay are being driven made by bureaucratic processes in which states don’t seem to have had adequate records of who has worked where and, even if they have, require different qualifications for registration in other states.

There is also the issue of which areas are declared as areas of medical workforce shortage – areas that get precedence in the placement of overseas trained doctors. The electorate of Griffith isn’t one of them, so even overseas trained doctors who live in the area have to go and work in areas of designated shortage in the bush."

An Invitation.

We invite you to join in the Need More GPs Solution Discussion.

We do not need any more data to find out how bad the problem is.

We do not need any more statements about how bad the problem is.

We do not need any more whingeing about whose fault it is.

We need some solutions.

We invite you all to use both halves of your brain, to throw the correctly coloured hat onto the discussion table, to think out of the box, out of left field, out of desperation, and join in the discussion.

Towards this end, and in an attempt to open up the debate, we offer some ideas for discussion. We hope that, with your input, this list will grow.

In no particular order, we propose:

1. To assist the urban crisis: a short moratorium (say, 6-12 months) on the provider number restriction, with some other conditions: only Australian residents or citizens who are fully registered and have a demonstrable urban commitment. This could allow an uptake of OTDs into urban practices at risk of closing, without causing an exodus from the bush

2. A reduction of the time-limit on OTDs obtaining unrestricted provider numbers from ten to three years. Three years seems reasonable to demonstrate a commitment to the country. Three years is short enough to make upskilling not too much of an issue for OTDs who have not found work in Australia for whatever reason. We also suggest that a three-year requirement is less intimidating than a ten-year one - might this increase the number of doctors prepared to consider going to the bush?

3. To encourage doctors to work in rural and remote areas:

(i) They receive a Medicare rebate of 100% of the scheduled fee.

4. To encourage doctors who have left the workforce prematurely to return to practice: (i) A ‘Welcome Back’ package, along the lines of the ‘Golden Hello’ offered to GPs in the UK between 2001-2005. The cost of this would be far less than training a replacement GP.

(ii) An upskilling and mentoring program to assist their return to work.

5. Temporary assistance to female GPs who wish to work part-time while their children are under-school age, in the form of a subsidy of their medical indemnity cost, to be repaid (as is the student HECS bill) when their working hours increase substantially. There is strong anecdotal evidence that the very high cost of medical indemnity in relation to a part-time income is a contributory factor in women leaving the GP workforce for this reason. A short period of time out of the profession increases the likelihood of the practitioner not returning to it at all due to loss of confidence and de-skilling.

Please leave your comments directly, using the comments link below, or email us at brisbanegp@gmail.com

From the Local Newspaper ....

STONES CORNER, March 26: "When it comes to improving Australia's health system, as Prime Minister, the buck will stop with me.''

Those were the words Prime Minister Kevin Rudd used in the lead-up to last year's Federal election to convince voters he was the best person to tackle the country's health system.
Four months after being elected, the Member for Griffith has dodged questions on his plans for fixing a shortage of General Practitioners in his own electorate.

Read the remainder of the article HERE.

OPSO Media Release.

We have been advised by Val French, President of Older People Speak Out (OPSO) that the following media release has been sent out.

Media Release by OPSO

OPSO supports the patients in the Prime Minister’s electorate in their fight to keep their medical practice alive.

OPSO president Val French said the shortage of general practitioners in that electorate was reflected across Australia.

“This is partly the result of insufficient graduates to replace those retiring through age or moving to less stressful areas of medicine, but in inner city areas it is compounded by regulations making over -seas trained doctors ineligible for a Medicare Provider number for day-time practice.

“A suggested six month moratorium on these regulations would solve immediate problems.

“Long term the recommendation from Stones Corner General Practice Dr Janet Clarkson that there be new legislation to allow doctors who have practised for three years in rural Australia unrestricted provider privileges has a great deal of merit."

Val French,
President Older People Speak Out.
0419020924

Medical Observer observes.

Workforce Crisis hits home for Rudd.
Desi Corbett

KEVIN Rudd is feeling the sharp end of the GP workforce crisis with his own electorate in Queensland calling on him to relax rules governing the placement of overseas doctors.

Locals have warned the situation in the Prime Minister’s inner Brisbane electorate of Griffith will reach “flash-point” this month when the fifth practice in a two-kilometre radius closes and the Logan Road General Practice loses a doctor, leaving up to 8000 patients without a GP.

Griffith is one of many inner metropolitan areas facing GP shortages, but practices in these areas are unable to employ international medical graduates (IMGs) because federal laws only allow them to work in designated Districts of Workforce Shortage.

Inner metropolitan areas are not eligible for District of Workforce Shortage status.

Dr Janet Clarkson, principal of the Logan Road practice, said three GPs from Canada, New Zealand and China were willing to work but she was unable to take them on.

Patients and GPs in the area called on the government to lift the ban on IMGs working in inner-metro areas with a known medical workforce shortage.

Dr Clarkson, 60, threw down the gauntlet for the government to tell her patients where to go for treatment if she retired.

AMA Queensland president Dr Ross Cartmill said the situation showed the workforce shortage was not only affecting rural areas.

Mr Rudd’s office did not respond to MO’s requests for comment in time for deadline.

The Petition Continues ....

Another patient signs the petition at Logan Road General Practice ....

“After-Hours”

An open letter to the Hon. Nicola Roxon, Federal Health Minister.

In response to the local publicity on the GP shortage in the Stones Corner/Greenslopes area you were reported as pointing out that OTDs can in fact work in designated ‘Inner Metropolitan’ areas – provided that they work after-hours (i.e 6 pm to 8 am).

This response, Ms. Roxon, is unsatisfactory. It is clearly the response provided to you by your advisors. It is patronising and unhelpful. It serves only to highlight the abyss that gapes between GPs working at the coal-face and bureaucrats working from their ivory towers.

I one wants to find out about knitting, one does not ask a carpenter. May I respectfully suggest that if you want to find out what is really happening in general practice on a day-to-day basis, that you do not ask a bureaucrat.

I offer the following comments, which I would be grateful if you would pass on to your Departmental advisors during your next discussion.

1. If you are suggesting that each individual practice could solve their workforce problem by employing an OTD after-hours, could you please explain how this would assist a practice which cannot find a doctor to fill the morning shift from Monday to Friday to meet their accreditation requirement (based on the RACGP Standards) to have a doctor available during office hours (8 am to 6 pm)? As you are aware, practice accreditation is linked with remuneration, and hence financial survival.

2. In any case, to suggest that every small individual practice could afford to employ an after-hours doctor is ludicrous. It would necessitate the employment of after-hours administration and security staff, which would be financially impossible for every practice I know. Some of the large corporate practices tried this in Brisbane some years ago, but even with their economies of scale, they were not able to make it a viable business proposition. There may be two remaining 24 hour practices left in Brisbane.

3. Inner metropolitan practices do in fact employ OTDs ‘after-hours’ – but most do it via a subscription to the commercial After-hours service.

4. This ‘solution’ is equally unnacceptable to the community if it is offered as a substitute for availability during office hours. A mother of an infant is not going to want to take her child for routine vaccination at 9 at night because the practice does not have a doctor available at another time, nor is a frail elderly lady going to venture out on her own late at night to get her blood pressure checked.

I look forward to your response.

Yours sincerely,

Dr Janet Clarkson

Logan Road General Practice.

Thoughts on Super Clinics.

An open letter to Mr. Rudd and Ms. Roxon, from a GP at the coal-face.

Dear Mr. Rudd and Ms. Roxon,

I would like to make the following comments in regard to the Super Clinics which you have offered as a solution to the GP shortage.

1. Unless there is a net increase in the total number of GPs, this simply represents people-moving.

2. These Super Clinics are apparently to be staffed by the large number of GPs that you 'hope’ will result from the increased number of medical students currently attending our universities.

(i) Assuming that this increased cohort does eventuate, it will not be for nearly a decade. Do you have any strategies for our survival in the meanwhile?

(ii) One quarter of the current Year 1 students at the University of Queensland School of Medicine are overseas students, who will not be allowed to stay in the country after they graduate.

(iii) Of the remaining 303 Australian first-year students, assuming that they all complete their course, is it not a fantasy that a large number will become GPs given that:

(a) it is acknowledged that the popularity of the general practice as a career choice has been declining world-wide for years.

(b) this has been reflected in a decreasing number of applicants for each general practice training place for a number of years. We understand that in the late 1990’s there were three applicants per place, compared to 1.1 applicants per place in 2005.

(c) there are said to be sufficient training places in specialist colleges that every student could access one of these, making it theoretically possible that there could be no applicants at all for the general practice progam.

To build a concept of Super Clinics based on what can only be called optimism of the highest order can surely not qualify as a strategy, can it?

3. The Super Clinics are apparently going to attract these mythical graduates on account of the state-of-the art facilities that they will offer. This sort of statement, Mr. Rudd and Ms Roxon, is, quite frankly, an insult to future and current practitioners.

4. The Super Clinics are to be subsidised by governement. Will not this represent unfair competition to GPs who have struggled to maintain their community practices for years? I do not know if it is unconstitutional. I do not know if it breaches the Trade Practices Act. I do know that it is unfair.

5. And finally, in your reply to our letters regarding the local problem you described the planned Super Clinic concept. As, by your own definition, Super Clinics will be set up in Districts of Workforce Shortage, and, by your own definition, this area (Stones Corner and Greenslopes) is not a District of Workforce Shortage, can you please explain how this will help solve the local area problem?

Yours sincerely,

Dr Janet Clarkson,

Logan Road General Practice.

UPDATE, 27 March, 2008

Proposal to pay incentives to doctors to work at Super Clinics; read the Medical Observer Article.

Some Workforce Recommendations.

There are three groups of doctors that can help us out of this plight.

1. Overseas-trained doctors (OTDs)
2. Australian-trained doctors who are not currently practicing.
3. Future doctors – the medical students still in training.

We need to consider how each of these might help the workforce crisis, as each group has a different perspective and presents a different set of issues.

The most obvious obstruction for most of us seeking to employ a doctor in our practices is the provider number legislation. The provider number legislation was enacted to ‘encourage’ OTDs to work in rural areas, by restricting the allocation of a provider number to those prepared to work in a “District of Workforce Shortage”. There is great reluctance (refusal) to withdraw this legislation for fear that it will worsen the rural workforce crisis. We believe, and hope to demonstrate, that the legislation is, however, causing a net loss of doctors from the system. Anything that causes a net loss of doctors will not help the rural segment at all.

In order to open up the debate, we suggest the following ideas for discussion:

1. A short moratorium (say, 6-12 months) on the provider number restriction, with some other conditions: only Australian residents or citizens who are fully registered and have a demonstrable urban commitment. This could allow an uptake of OTDs into urban practices at risk of closing, without causing an exodus from the bush.

2. A reduction of the time-limit on OTDs obtaining unrestricted provider numbers from ten to three years. Three years seems reasonable to demonstrate a commitment to the country. Three years is short enough to make upskilling not too much of an issue for OTDs who have not found work in Australia for whatever reason. We also suggest that a three-year requirement is less intimidating than a ten-year one - might this increase the number of doctors prepared to consider going to the bush?

If some respite can be found for those of us tired of struggling with the issue, so that our practices can remain open, it might buy some time for the underlying issues to be addressed.

We have specifically considered the rural health issue, the issues of medical student intake and GP training, and the under-utilisation of the home-trained doctor, and will present our ideas in future posts.

We welcome your input: please leave your comments, or alternatively email us via the address in the sidebar.

Mr. Rudd's Response ....

Mr. Rudd did indeed get back to us in response to our letter. Here is the text of his reply, dated 11 March 2008.

"Thankyou for your correspondence of 15 and 27 February regarding the level of medical services and resources available in the Griffith electorate.

As you indicated, ‘Districts of Workforce Shortage’ are classified by the Department of Health and Ageing according to a range of criteria including the supply of General Practitioners in the broader area and the population need.

I understand that the area is not currently classified as a ‘District of Workforce Shortage’ by the Department of Health and Ageing. I understand the difficulties family practices have trying to attract GPs, and I have asked the minister for Health and Ageing, the Hon Nicola Roxon, MP, to examine why the Greenslopes Family Practice has not been classified as having ‘District of Workforce Shortage’ status.

Please be assured that as soon as further information becomes available my Electorate Office staff will be in contact with you.

The Federal Government will seek to invest %220 million in the health system to establish GP Super Clinics in local communities – bolstering frontline health care for Australian familiies. This investment will ensure more Australian families have access to doctors in their local community.

Over the next few yearrs, our government’s GP Super Clinics policy will also help to encourage the large number of doctors who will be graduating from our medical schools to work in general practice. GP Super Clinics will provide attractive environments for new medical school graduates to work in so we hope to see more doctors interested in becoming GPs as a result.

Further information regarding the Federal Government’s outline for GP Super Clinics may be obtained by visiting:
http://www.alp.org.au/download/now/new_directions_for_australias_health_gp_super_clinics_final.pdf

As you are aware, I recently announced the establishment of the Health and Hospital Reform Commission.

The Commission is developing its own website which will be available in the near future.

Should you wish to contact the Commission with suggestions for health and hospital reform, you may contact 1800 017 533 or email hhrc@health.gov.au

Given your interest in this matter, I have enclosed a brief outline of the Health and Hospital Reform Commissions’ objectives to further address your concerns.

Thankyou for taking the time to write to me on this most important concern. I trust this information will be of assistance to you.

If there are any other Federal Government matters with which I may be of assistance to you, please do not hesitate to contace my office on 3899 4031. "

Yours sincerely,

The Honourable Kevin Rudd, MP
Prime Minister of Australia
Federal Member for Griffith.

Dear Mr.Rudd ....

15 February, 2008

Dear Mr. Rudd,

I wish to bring to your notice the problem concerning the impending closure of a yet another general medical practice in your electorate.

It was reported recently in the South-East Advertiser (local newspaper) that another general practice, namely Logan Road General Practice, 329 Logan Road, Stones Corner, Brisbane, is likely to close in the near future as they are unable to employ suitable doctors to join the practice.

This is not the first medical practice in this area to be closed in recent times. Greenslopes Family Practice is in the process of closing and recently at least three medical practices that I know of, in the close vicinity of Stones Corner, have closed. All experienced the same problem – inability to employ overseas trained doctors (OTDs).

This is not because there are no doctors interested in joining them. It is due to the federal government’s policy with regard to overseas trained doctors. The area serviced by the Logan Road General Practice and the other medical centres that have closed is not classed as a ‘district of workforce shortage’ (DWS), therefore overseas trained doctors cannot be employed as they are not eligible for provider numbers for work in this region.

This is a region of high density population which includes a significant number of aged people, a migrant population, and pockets of people of low socio-economic background, as well as the young families that are moving into the area. I know that the Logan Road General Practice serves the community well as they work with interpreters and other support groups.

There is a public hospital in this area (The Princess Alexandra Hospital) that may be able to service some of the people’s medical needs, but this would be an added burden to the already stretched public hospital system.

So this inner city, high density area is not classed as a DWS. In light of the fact that several medical practices have already closed and others are about to close, and the fact that most existing medical centres in the area have closed their books to new patients, where will people go for medical care?

Will the Princess Alexandra Hospital and the Mater public services and existing GP services in the area be able to service the needs of this population? I think not. Already the hospitals are overburdened and existing medical services have closed their books. I was told by a local chemist that some people have had to go as far afield as Springwood to find a doctor who would be able to attend to them.

The closure of these medical centres therefore pushes local people further afield to find medical care. This is not a viable, let alone easy, option for elderly or chronically ill people.

This region may appear to have a good doctor to population ratio. A check of the Yellow Pages however, indicates that many of the doctors listed for this area are specialists or GPs specialising in particular areas, e.g. mole clinics, weight loss clinics, etc. This, together with the fact that many clinics have closed their books to new patients would indicate that this is not so.

As it is well acknowledged that primary health care is the cheapest overall approach to health care, it seems to me that it is in the interests of the community, the hospital system and the economy, to help sustain GP medical centres such as Logan Road General Practice.

In a good GP clinic, as opposed to the proposed ‘super clinics’, patients with chronic illnesses, age related illnesses and certain psychiatric conditions, are monitored and treated. This often means that people are treated before they reach the stage of hospitalisation. This requires time, building a relationship between patient and doctor and enough doctors to make this primary care viable.

I do not know the criteria for determining whether a region is a ‘district of workforce shortage’, however, perhaps the criteria need to be reviewed in the light of demographic conditions that would indicate potential medical needs of people in the region.

The situation in regard to medical care that this area is facing is dire. It would seem to me that there are two aspects to a solution: the short term and the long term.

The long term solution is being attended to by government through increased medical places at university.

In the short term is it possible to:

• ease the placement requirements for certain overseas trained doctors? For example, if an overseas trained doctor comes to Australia with her spouse who is on transfer, because of federal policy, she is unable to take work in a local area so that she can remain with her family. Her skills are lost to the profession, the community, and the economy.
• make access to re-skilling easier for doctors who have left the workforce for various reasons and who may be induced to return? This would include help with medical indemnity and cost of re-skilling.
• give support and incentives to doctors who would prefer to work part time?
• make bulk billing more attractive for GPs? (In this electorate the bulk billing rate is 10% below the national average.)

The most recent edition of the South-East Advertiser the federal health minister, Ms. Nicola Roxon is quoted as playing down the concerns about health services in this region and ‘said because the area was classified as “inner metropolitan”, it was not entitled to employ OTDs to work conventional hours’. This is unrealistic as it does not take into account zoning laws and people’s actual needs. Should we plan to visit our GP at 10.00 p.m. or midnight?

So, in the light of general practice closures, the inability of many existing medical centres to take on new patients, and a high density of population, I ask for a review of the criteria for the placement of OTDs so that existing practices are able to continue to serve the community.

Should this review not be possible, give the patients of these clinics directions as to where they will be able to receive their primary health care within a reasonable distance of their residence.

Finally, Mr. Rudd, I offer you my heartfelt congratulations on your election victory.

Yours faithfully,

Dr. Barbara Reynolds-Hutchinson, Ph.D.

7 Rowland Street,
Coorparoo Qld. 4151

Cc:

The Hon Nicola Roxon MP,
Minister for Health and Ageing.

Senator the Hon. Jan McLucas,
Parliamentary Secretary to the Minister for Health and Ageing.

The Hon. Anna Bligh,
Member for South Brisbane

The Hon Stephen Robertson,
Minister for Health,

The Hon. Gary Fenlon,
Member for Greenslopes

AMA Federal Secretariat

AMAQ

RACGP College House

National Seniors

Comments from Patients.

As a long-standing patient I was horrified to learn that the Logan Road General Practice is in danger of closing due to a shortage of doctors. Janet Clarkson has been my GP for 15 years and has seen me through a number of quite complicated medical procedures and conditions. Should the practice close I wonder what will happen to my medical records.

My concerns are replicated by hundreds of the practice’s patients and I for one have decided to join the campaign to save the practice.

Beverley Miller
Coorparoo

I read the article in the SouthEast Advertiser about the GP situation in the electorate of Griffith. At my next appointment with Dr. Janet Clarkson we talked about the situation and how dire it is not only for the Logan Road General Practice but for GPs generally. I offered to write to Kevin Rudd, member for Griffith and Prime Minister. So this campaign got underway.

I have sat in the waiting room of the Logan Road General Practice often and have watched the diversity of people who are cared for in this practice, including immigrants and the elderly. These doctors serve the community around Greenslopes as well as a wider demographic.

Barbara Reynolds-Hutchinson
Coorparoo

The Story Begins.

This story began for me on the day that my staff showed me the above article in the local community newspaper. I am ashamed to admit that my first reaction was purely selfish – I did not want to cope with the overflow of patients from this adjacent clinic, particularly in view of the fact that we are going to lose a doctor from our own practice in the first week of April. The anxiety was sufficient to put me firmly into denial mode.

I have just celebrated my 60^th birthday. I do not have a succession plan for my practice. I have found some fine doctors over the years, but all have been overseas-trained, and are therefore unemployable by us as we are not classified as a District of Workforce Shortage. I admit to having completely given up on the problem.

A few years ago there were four practices within a few hundred metres of each other in this inner suburban shopping precinct, representing about eight full time practitioners. We are the only practice left, and when we lose one of our doctors, we will be down to slightly less than 2 FTEs. We service the local community, including a significant number of refugees, as well as a large number of commuters from the outer metropolitan area. I truly do not know where these patients will go if we close.

I was humbled out of my denial by the response of patients of the practice when they read the follow-up article which explained our own plight. One of those patients has started a petition, and the first batch of signatures has been handed in to the office of our local member – Mr. Kevin Rudd.

All of us working at the coal-face in general practice are tired of the same assurances and promises. We are certainly tired of the workforce issue being analysed. There have been at least four large workforce studies since 1996. Every time the figures are done the sitution is worse. Any further data-collecting exercises must be seen as an excuse for real action on the part of the Government.

I have always felt that General Practice is the most creative form of medicine: so many of our patients do not fit any mould, and so many are sent back to us when all specialist solutions are exhausted, yet we must keep coming up with ideas and assistance. I do not believe that this problem is insoluble, if we generate a true spirit of discussion.

Mr. Rudd wants to fix the Health System.
We want to fix the Health System.
Our patients definitely want us to fix the Health System.

At the risk of sounding like an old cynic, it seems that our joint adversary is the Bureaucracy.

We must find some solutions that do not frighten the bureaucrats.
We must find some solutions that do not worsen the bottom line.
We must simultaneously address the Rural Health problem.