‘Devastated’: Clinic closures spark funding debate

There are fears vulnerable patients are increasingly falling through the cracks, as Tasmania becomes the latest jurisdiction to cut funding.
 
The Tasmanian Government has ended its funding to a mobile GP program which provides no-cost care to vulnerable and hard-to-reach populations.
 
It’s ‘the real pointy end’ of healthcare, explains Rob Moreton, managing director of Moreton Group Medical Services which runs the mobile clinics.
 
‘We’re not frontline; we’re in front of the front line,’ he tells newsGP.
 
‘We do most things that can be done in GP rooms, but we go out to sheltered accommodation, out on the street, and to community housing and provide no-cost healthcare to the patient.’
 
An after-hours service has been running for the past decade under Commonwealth support through Primary Health Tasmania, allowing for statewide outreach clinics at night.
 
In an expanded offering, the Tasmanian Government picked up the tab two years ago to enable the program to offer daytime clinics across the state’s south.
 
However, the State Government opted to cease funding to the day clinics in its recent Budget.
 
The move has left GPs and their primary care colleagues ‘devastated’.
 
‘Our GPs put their heart and soul into supporting vulnerable Tasmanians. It’s not big money for them to do this work,’ Mr Moreton said.
 
‘They do it because they understand that it’s worthwhile, they can see the importance of the work, and they can see the success of people transitioning from our service to our bricks and mortar practice.
 
‘They’re devastated that the hard work that they’re putting in could be ripped out from under them.’
 
Losing the day service removes care opportunities for a key group of vulnerable people in the community, Mr Moreton adds.
 
‘The important thing about these daytime clinics is that they disproportionately affect women, children, the elderly, and people who identify as Aboriginal or Torres Strait Islander,’ he explains.
 
‘And we get higher patient numbers per hour during the day than we do in the evenings, so the majority of our patient load won’t be able to see us at these places.’
 
The clinics are funded to see 16 patients a day, but this can go as high as 25 on a busy day.
 
RACGP Tasmania Chair Dr Toby Gardner said these sorts of funding changes often leave practices and programs scrambling as they ‘come at the 11th hour’.
 
‘They have to try and work out how you’re going to fund and keep the doors open,’ he told newsGP.
 
‘It’s tough, it’s hard, and so I understand the pressures that these small operators face when they’re trying to do something to keep people out of hospital.’
 
Underlying the funding withdrawals is a State and Federal government divide over who should fund primary care services.
 
Tasmanian Health Minister Bridget Archer said, ‘we cannot keep picking up the tab on services that should be funded by the Commonwealth’.
 
‘While GPs are the responsibility of the Federal Government, our Government has been continually stepping in to support primary care initiatives in Tasmania,’ she told newsGP.
 
Minister Archer adds that she is happy to sit down with stakeholders to discuss transitional arrangements, and ‘work is underway as we speak’.
 
The loss of services targeted at vulnerable people is something that has been felt in other states, with Victorian-based cohealth also facing challenges to providing care in a sustainable way to patients in need.
 
One of Canberra’s last fully bulk-billing clinics was also facing closure last year after struggling to cover costs and attract enough GPs – it has since received Federal funding to remain open.
 
Another Tasmanian service to lose funding in recent days is an after-hours service in Cygnet in the state’s south, which will shut down at the end of the financial year after its $250,000 in annual funding ceased.
 
‘They worked out that if they weren’t there, the cost in ambulance transfers to the Royal Hobart Hospital would be about $1 million a year, so that’s a bit sad,’ Dr Gardner said.
 
‘I guess the way the Government is justifying this is that there is a Medicare urgent care clinic that’s just been set up in Kingston, which is about 30 minutes away from Cygnat, and they think that will be able to step in and stop people needing to be transferred to the Royal Hobart.’
 
Now, Mr Moreton is urging the Government to reconsider – taking his cause to State Parliament on Wednesday to seek support.
 
‘I’m just going to yell and scream and advocate for people who don’t have a voice, who deserve access to healthcare,’ he says.
 
‘At the moment the rhetoric is that primary healthcare is a federal problem, and that’s how it should be funded, and we 100% agree that the Federal Government is responsible for primary healthcare.
 
‘But the implications of primary healthcare not being supported by the State Government is that the people that we support will end up presenting at the hospitals, and when they present at the hospitals, the state picks up the bill.’

The Cygnet Family Practice Urgent and After-Hours Service has also called on community support to raise awareness and to help keep the service in operation. 
 
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Medicare mobile clinics outreach Tasmania vulnerable populations