‘Immeasurable loss’: Confirmed closure of 60 practices in four years

Matt Woodley

3/04/2023 3:55:22 PM

Underfunding and workforce shortages have seen scores of general practices close since the pandemic. Vulnerable patients are likely to suffer most.

GP practice closing
Funding freezes have increased pressures on general practices in recent years.

More than 60 general practices have been forced to close nationwide over the past four years, with the RACGP identifying years of government neglect as the root cause.
The in-house analysis, based on member and media reports, shows that the closures have occurred in metropolitan and rural areas alike, but that remote (MM 3–6) communities have been disproportionately impacted.
According to the college, the correspondence suggests most of the closures have been due to inadequate Medicare rebates and the related inability to recruit enough GPs.
South-western Sydney clinic Ingleburn GP represents just one of the recent closures, with patients told they would need to find a new practice due to a lack of GPs and financial viability concerns.
Practice owner Dr Tom Lieng told newsGP the current level B rebate of around $40 had made it impossible to keep the doors open in a low-socioeconomic area whose patients relied almost entirely on bulk billed care.
‘It’s really tough out here as we don’t get any support,’ he said.
‘I just spoke to a friend who recently Fellowed in general practice and decided to go back to training for orthopaedics. He said if he knew how tough it was, he wouldn’t have bothered with GP training. 
‘As a practice owner, I can’t continue running a practice with all the costs we have.’
Dr Lieng says while most of his personal practice is in occupational health, for which he charges the AMA rate, the general practice part of his business is ‘dying’ and currently being subsidised by his own earnings.
He believes higher Medicare rebates – especially for longer consultations – and increased bulk billing incentives are needed to protect healthcare delivery for those who need it most.
‘[For example], aged pensioners do not have an income and rely solely on social benefit for living expenses,’ he said.
‘They have to pay for medication and other things – we could ask for payment too, but we are going to kill them if they cut down on medical reviews to save money.
‘There should not be a disincentive to have a health review.’
Former Ingleburn GP patient Rebecca Cade, a nurse with a complex autoimmune disease, has been looking for a new GP since the practice closed – an ongoing process that has so far lasted two months and proved stressful.
‘Just the thought of trying to bring someone up to speed on 13 years of complex medical history is overwhelming,’ she said.
‘I’ve been looking around for a new GP, looking on patient notice boards for who people recommend, but many are not taking on new patients. I’ve seen half a dozen or so not taking new patients.’
Ms Cade also said she is finding it harder to manage the increasing out-pocket-costs for healthcare services.
‘The GP I was seeing was bulk billing, but they changed it towards the end to try to keep the practice going and started charging a gap fee of $20,’ she said.
‘I earn enough so I don’t qualify for a healthcare card, so by the time I see the specialist and pay for medications, I have nothing left from my pay. Any extra expenses I have to find money from elsewhere.’
Meanwhile, RACGP President Dr Nicole Higgins says the closure of so many practices represents an ‘immeasurable loss’ for the Australian healthcare system.
‘GPs are the lifeblood of our communities. Everyone needs access to high-quality GP care, when they’re sick, and to help them stay well,’ she said.
‘The closure of so many clinics means an increasing number of Australians will struggle to find a GP – particularly in areas where practices are at capacity and can’t take on new patients.
‘So much is lost that can’t be measured when a community loses a practice and patients have to find another clinic. You can move health records, but not the relationship a patient had with their GP or the trust and knowledge that GP gained over years of consultations.’
Like Dr Lieng, the RACGP President is calling on the Federal Government to provide an immediate funding injection in the upcoming Budget to increase patient rebates, while she has also warned state and territory governments to not place an additional ‘sick tax’ on already struggling practices.
‘We are in this situation because for decades our elected officials have chosen to strip funding from general practice care and patients’ Medicare rebates,’ Dr Higgins said.
‘It is hurting those who are most disadvantaged, including people on low incomes who can’t afford rising out-of-pocket costs.
‘Serious reform and funding is needed to ensure everyone can get the care they need from a GP. And so GPs can keep doing the job we love – making a meaningful difference for our patients and communities.’ 
In the meantime, Dr Lieng says he has another typical day ahead, with his next patient being an elderly pensioner with a list of complex healthcare issues requiring more time and care than can possibly be sustained by current Medicare rebates.
‘It’s 4–5 consultations in one … for a standard consult plus 10990, it’s simply not enough,’ he said.
‘The practice can’t survive with the cost of maintaining high standard care with such low margins. Add extra 5% payroll tax and we’re all dead.’
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