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‘Deeply troubling’: At least 184 general practices lost in a year


Jolyon Attwooll


15/09/2023 3:17:37 PM

New clinics have offset the closures to a degree, but the figures represent a net loss of at least 55 practices – and incomplete data means the number could be much higher.

Closed sign.
At least 184 general practices have closed around Australia in the space of a year.

At least 184 general practices have closed around Australia in the space of a year, with the rate of new openings falling significantly short of making up the difference.
 
That is according to information supplied to newsGP by 17 Primary Health Network (PHNs), slightly more than half of the 31 organisations tasked with improving patient care across the country’s different regions.
 
While the picture is partial and in many cases lacking detail, the finding suggests the impact of the economic and workforce pressures faced by general practices could be even more acute than previously understood.
 
The incomplete figure is already significantly more than the 60 closures in four years identified by in-house RACGP research earlier this year.
 
PHNs that responded to newsGP on this occasion reported a total of 110 new general practices opening in the past financial year, or the most recent 12-month period. With one PHN confirming the number of closures but unable to provide a figure for new practices, the net loss of 55 is calculated from the 16 PHNs that supplied details of both.
 
The remaining PHNs were either unwilling or unable to supply statistics for their own area, making a detailed picture across the country difficult to assess.
 
‘This may not be the full picture, but these figures are still deeply troubling,’ RACGP President Dr Nicole Higgins told newsGP.  
 
‘It’s a reminder of how urgent it is to get funding and supports for general practices right, and to allow us to get on with our job and keep our patients safe and out of hospital.
 
‘What is also concerning is that almost half of the PHNs were unable to give a clear idea of what is happening in their area.
 
‘It is essential that we get an accurate and reliable picture of how general practices have been affected, and continue to be impacted, by previous years of neglect, COVID-19, the burden of chronic disease, and other challenges they have faced.
 
‘It also makes it crystal clear how the threat of payroll tax on independent practitioners, which places even greater pressure on general practices and the communities they serve, is so counterproductive and short-sighted.
 
‘It can’t stop soon enough.’
 
In response to a newsGP inquiry, a Department of Health and Aged Care (DoH) spokesperson said it could not supply more detail to fill the gaps.
 
‘The DoH does not have a longitudinal dataset on openings and closings of general practices and does not consider the “net loss” analysis, based on partial data provided without a consistent methodology, to be sound,’ they stated.
 
‘General practices are private businesses that make their own decisions about whether and how to operate in local markets, based on a whole range of factors and circumstances.’
 
They also said general practices vary significantly and that the opening or closure of an individual practice ‘may have no net impact on access to care for patients’.
 
The spokesperson said the DoH has offered to work with the RACGP on a sound methodology for data collection and analysis on general practice business health and sustainability.

General-practice-closures-article-1.jpgHealth economist Professor Anthony Scott says tracking the number and location of general practices is an essential part of ensuring they are located in the areas of highest population need.
 
One PHN communications advisor, speaking on background, told newsGP that their PHN had historically only kept ‘real time’ data and had not attempted to track ‘legacy’ openings and closures until recently. 
 
Another acknowledged that the information requested was too difficult to supply.
 
In many cases, the type of practices that opened or closed was unclear, so it is uncertain to what extent the closures are affecting solo private GPs, small-to-medium sized practices or larger-scale corporates.
 
The trends behind the closures are also hard to define, with some PHNs unable to give precise reasons. Broad factors including financial pressures, retirement and mergers were cited.
 
Workforce concerns
One PHN drew attention to workforce supply issues, noting that practices could remain open but with fewer GPs.
 
A spokesperson for the Nepean Blue Mountains PHN in NSW said the decreasing number of GPs is ‘a real concern’.
 
‘Practices are not so much closing, as operating with fewer GPs, making appointment availability difficult for patients and putting pressure on the remaining GPs,’ they told newsGP.
 
Lizz Reay, CEO of Wentworth Healthcare – the PHN for the Nepean Blue Mountains region – said she has seen a steady decline in GPs in recent years, with varied, complex factors at play.
 
‘There are many reasons why we are experiencing a GP workforce shortage, not just in our region but nationally,’ she told newsGP.
 
‘Previous under investment in primary care, fewer medical students choosing to go into general practice, complexity of recruiting overseas doctors, changes to Distribution Priority Areas, and the impacts of COVID-19 have all contributed.’
 
According to their figures, there were 429 GPs working across the PHN in June 2023 compared to 502 in June 2019, a drop of 73 GPs (15%). In the meantime, their figures show the estimated population of the area has increased by almost 7000 residents from 2019 up to 2022.
 
Other responses highlighted particular pressure on rural areas.
 
Murray PHN in Victoria said that around half of the state’s 153 GP catchments are experiencing ‘moderate-to-high’ GP workforce need, with the greatest issues ‘all located in rural Victoria’.
 
Matt Jones, Murray PHN CEO, said any solution will need collaboration between all levels of government and health services.
 
‘For those of us working in rural and regional areas, it is clear that we need more tailored and nuanced models of general practice funding,’ Mr Jones told newsGP.
 
‘Instead of simple fee-for-service funding models, we need long-term planning and support for communities to grow their own workforce and build systems and structures that provide high-quality healthcare as close to home as possible.
 
‘We also need to support our medical professionals so they can work in satisfying and sustainable jobs.’
 
Professor Anthony Scott, the Director of Monash University’s Centre for Health Economics, told newsGP he finds the data researched, and the omissions, ‘very concerning’.
 
‘Being able to track the number and location of GP practices is essential to ensure that general practices are located in the areas of highest population need,’ he said.
 
‘Entry and exit of practices is important to help ensure local community access to healthcare.
 
‘Practice closures are especially important in rural areas where there are few alternatives.’
 
Professor Scott has previously looked into the business of general practice, having compiled a report for ANZ Bank and the Melbourne Institute, Trends in the structure and financial health of private medical practices in Australia.
 
In that report, which was published last year, he also highlighted the absence of longitudinal data on the total number of general practices in Australia – and believes the net difference in openings and closures should be publicly accessible.
 
‘PHNs need to be on top of this and these data should be part of their reporting to their communities,’ Professor Scott said.
 
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Justin Oughton   16/09/2023 6:18:35 AM

Last week my practice, which I am an associate of, has announced its closure after 43 years of service to the community. As a smaller practice with only 2 full time, and one part-time doctor and one registrar, we were unable to survive. Over the last 3 years we have been looking for new doctors, we have been cost cutting where able, and we even tried to move away from bulk billing. Unfortunately following the retirement of 2 doctors our income to overheads had become too marginal. The move towards private billing resulted in a decrease in patient visits (no doubt a win for the Government), but also meant we had to reduce our registrar training positions from two to one.
Moving forward from where we are now It appears that to be a healthy GP practice you will need a minimum of 5 full time doctor equivalents completely booked up. This means no capacity for on the day visits. Our local emergency department will now have to soak up the extra load.


Dr Michael Charles Rice   16/09/2023 7:22:15 AM

‘General practices are private businesses that make their own decisions about whether and how to operate in local markets, based on a whole range of factors and circumstances.’

Indeed.

Certainly not an essential service nor something a Government would seek to influence or control. Same as other private specialists and facilities. Glad we've cleared that up.

We're on our own, folks, Government isn't going to fix our problems. If we believe in what we're doing, we have to make it viable and appealing to a new generation.

That may not mean driving cars like cardiologists, overseas travel like orthopods or living in swish suburbs with surgeons, but it will require re-establishing respect in the medical schools and hospitals where the next generation is in preparation.

Perhaps we can do that by taking as many teaching roles as we can get our hands on and modelling what we do well. Even if we cannot (yet) model the cars, holidays and houses!


A.Prof Christopher David Hogan   16/09/2023 8:31:23 AM

The DOH spokesperson has given excuses as to the absence of available hard data about GP workforce.
It is a shame that such a major measurement of a key part of the Australian health system is either not collected or if collected, is not revealed.
I hope I am being polite in my response to such a major gap


Dr Partha Sarothi Modak   16/09/2023 8:43:39 AM

I personally feel this payroll issue is a distraction and counterproductive for our quest to dissociate general practice from bulk billing in Australia.
Rather than trying to save money practices should accept it and make sure that our clients and the Australian population know that this kind of ongoing financial pressure on our businesses is a cause of why bulk billing is incompatible with our survival and people need to be prepared to pay for GP's survices.


Dr RS   16/09/2023 10:56:25 AM

Governments both Federal and State and the community at Large do not understand the pressures facing GPs and are unwilling to Fund general practice properly The reasons are1 A mindset that GPs Should bulk bill everyone so that we have Free healthcare for all 2 The perception that GPs are not experts and the Job could easily be done by Nurses or Pharmacists 3 To Fund general practice the way it should be is too expensive so Tinkering around the edges like tripling the bulk billing incentive yet reducing rebates for Shorter consults( Note the rebate for longer consults will not be increased!) is the way to “ strengthen medicare”4 An aggressive and dominant health bureaucracy that advises the Government , creates barriers towards proper Funding and creates more and more red tape and demands on GPs5 Divergent views within general practice and various “expert committees “ and special interest groups , health economists that the government listens to( while failing to listen to GPs


Rural GP   16/09/2023 1:13:20 PM

And there is the bold truth : PHN ‘s sole duty is to implement government policy, not work with stakeholders. Kill the fee for service model and an independent profession, Break the back of General Practice and bring them to toe. What a different landscape it could be if they trusted General Practices with adequate funding (MBS) and to act professionally, where we work for patients and not the government. And YES , Of Course there is no data, every level of government is set on controlling the narrative, not fixing the problem.


Dr Derek L Mitchell   16/09/2023 5:10:43 PM

It is tragic to see general practices closing at any rate, let alone what is being reported in this article.

It is cringeworthy that neither Nicole Higgins nor the PHN CEOs quoted claim to know why this is happening. Why not? What do they all do? This is almost as appalling as the clinic closures.

We all have gut feelings - mine is that the elephant in the room is bulk billing- but that’s different from actually knowing the causes, and what minimum fixes would look like.

A radical idea: Ask the outgoing practice principals or manager. A phone call might be impersonal, but with a problem this size, it’s likely the only method. At least the scotoma rate would be reduced.

The worst suggestion made was to change the remuneration model, while still not defining what this would address, or how.

This is a potentially terminal malignancy. We should not tolerate advice based on hearsay any more than in our day jobs. Accurate answers are urgent.


Dr Sarath Ransiri Wimalaratne   17/09/2023 12:17:26 PM

My Understanding is that THE MEDICAL BOARD IS USELESS
MEDICAL BOARD HAS VERY LITTLE IDEAS RE DIFFICULTIES FACING GP PRACTICES.
BEST TO SCRAP MEDICAL BOARD.
INVITE NEW LEADERS TO REPRESENT GPS
WELL EXPERIENCED LEADERS ARE BEST.
THEY HAVE THE EXPERIENCE WHICH IS CRUCIAL TO UNDERTAND
BASIC FINANCIAL & QUALITY REQUIREMENTS TO FUND ADEQUATE
/WELL RUN GP PRACTICES.
BEST REGARDS
HON DR. SARATH WIMALARATNE


Dr Sarath Ransiri Wimalaratne   17/09/2023 12:18:38 PM

WHAT BOARD ARE YOU DISCUSSING
MEDICAL BOARD WOULD BE USELESS.


Dr Sarath Ransiri Wimalaratne   17/09/2023 12:37:20 PM

MY SUGGESTION WOULD BE VERY AGGRESSIVE.
GP'S BE PAID $ 400/HOUR MINIMUM.
IMDENITY INSURERS VISIT EVERY GP PRACTICE EVERY 6 MONTHS
& ADVICE ON QUALITY CARE.
NEW MEDICAL BOARD MINIMUM 25 YEARS EXPERIENCE IN GP PRACTICE
MUST VISIT GP PRACTICES EVERY 2 YEARS& ADVICE RE QUALITY IMPROVEMENT OF PATIENT CARE & DOCUMENTATION.[ACCESS TO MEDICAL TYPISTS VIA MEDICARE.THIS WOULS RESULT IN MINIMISED SPECIALIST REFERRALS, REDUCED HOSPITAL ADMISSIONS
LESS PRESSURE ON ICU BEDS & MORE DOCTORS JOINING GP PRACTICES.


Dr Sudeer Rajbally Mahadeo   17/09/2023 12:59:43 PM

If the powers that be stopped regulating gps to within an inch of our lives we may be able to come up with some novel universally beneficial solutions. For example if patients were asked to pay an annual registration fee say of $120 per year to the practice in ret for bulk billing consultations a practice with a 1000 patients would generate 120k that could be used to provide better services and consumables eg wound dressings. AND this money doesnt come out of government coffers. Most people are happy to fund their smokes and gym memberships so why not gps. to prevent excessive charging as cap say of $20 per month can be agreed upon.
Dr M


Dr Edward Thomas Wu   21/09/2023 10:08:28 PM

Firstly we heard medical students (doctors in the pipe line) don't want to be general practitioners. Then we have under recruitment for training in general practice. Now serving general practitioners are giving up with insufficient replacement. Everyone can offer their perceived explanations. Maybe the people who are responsible to "regulate" general practice have done too good a job in "regulating" general practice out of existence? Food for thought? Maybe we don't really need general practitioners? There are countries don't have general practitioners. Do the Australian community want general practitioners?


Dr Cam Frederick James Hollows   22/11/2023 11:17:40 AM

Deeply concerning that only half of the PHN's have these data (in varying degrees of clarity/ granularity) given the amount of health funding they consume one would hope this is a minimum metric and more could be determined with not just practice numbers but FTE numbers. Even more concerning that the PHN's data are so mismatched with the RACGP's data. These organisations have as a principal part of their roles as supporting primary care / general and it appears they can't even count it... how truly disappointing.