‘Not the time to point fingers’: GPs push back against hospital ramping blame

Jolyon Attwooll

19/05/2022 5:01:18 PM

Queensland’s Deputy Premier has said the hospital crisis is being exacerbated due to ‘GPs declining to see people with respiratory illnesses’.

Steven Miles
Queensland Deputy Premier Steven Miles says GPs are contributing to ambulance ramping at the state’s hospitals. (Image: AAP)

Prominent RACGP figures have strongly contested a claim made by the Queensland Deputy Premier Steven Miles that GPs are contributing to ambulance ramping at the state’s hospitals.
Mr Miles, who previously worked as the state’s health minister, this week said there had been ‘an absolute collapse in primary healthcare’.
‘[There are] lots and lots of people who can’t get to see a GP [and] even if they have a regular GP, many GPs are declining to see people with respiratory illnesses, sometimes before they get a COVID test, sometimes not at all, and that is driving lots and lots more people to our emergency departments,’ he told reporters on Wednesday.
He said that delays in obtaining care are causing many people to develop more acute illness and then go to over-stretched emergency departments as a result.
However, RACGP Rural Chair Dr Michael Clements, who practises in Townsville, said it is not the first time that the State Government has looked to shift blame for significant hospital ramping and overcrowded emergency departments.
‘The issue of ambulance ramping is not new,’ he told newsGP. ‘It has been happening, and getting worse over several years, including before the pandemic began.’  
Last year, GPs were also forced to defend themselves against similar attacks from Queensland’s then Chief Health Officer Dr Jeanette Young, as well as claims made by Victorian Liberal Democrat MP David Limbrick.
But with the pandemic still raging and Queensland averaging roughly 6000 new COVID cases each day, Dr Clements says health professionals need to work together and blaming primary care is unhelpful.
‘Now is the time for Queensland Health to work with GPs that have been supporting the hospitals during their shutdowns, and not to point fingers and blame them for not working hard enough,’ he said.
RACGP President Adjunct Professor Karen Price is of the same view.
‘Never before has the family doctor been so important, and yet we are facing a future where the long-term sustainability of general practice care is in jeopardy and GPs are being blamed for an over-stretched hospital system,’ she said. 
‘Now is not the time to throw blame at GPs and general practice teams, we are doing our best in very challenging circumstances and need the full support of all levels of government.’
Dr Clements also highlighted a Queensland Health inquiry report on primary healthcare released earlier this year, saying 40 of the 44 recommendations blamed the Federal Government for current healthcare challenges.
‘There were lots of submissions for the inquiry giving options to Queensland Health for help, including the RACGP submission suggesting how they could work with GPs better,’ he said.
Dr Clements said GPs are doing their best to deal with a rising number of upper respiratory tract infections and COVID-19 cases, alongside other tasks such as vaccination and looking after patients who are unable to be seen in hospital clinics.
‘General practices are dealing with things over the phone wherever possible to keep the waiting rooms safe for those vulnerable patients who need face to face [care],’ he said.
‘Most coughs and colds do not need antibiotics and so GPs have been able to manage these symptoms well remotely.
‘We are seeing patients with upper respiratory tract infections face-to-face where possible after triage.
‘Some practices are not well set up for this though, and neither federal nor state governments have given any extra support for PPE and the costs of making sure everyone stays as safe as possible.’
He also said many patients are finding GPs charging out-of-pocket fees as the Medicare rebate is no longer accepted by an increasing number of practices.
‘Our members have been reporting patients walking out after finding out about new fees and choosing to wait in ED for free rather than pay a gap,’ he said.
The state’s current Health Minister Yvette D’Ath warned on Wednesday that Queensland is likely to see its worst flu season in a decade.
Queensland Health separately confirmed to newsGP that 475 patients had been admitted to hospitals in the state due to influenza since the beginning of April, with 30 of those going to ICU.

Back in 2019 there were 68,148 confirmed cases of the disease in the state with 264 deaths.
According to the Department of Health, there were 511 COVID patients in Queensland hospitals at the time of publication on 19 May, including 16 in ICU.

After Mr Miles’ remarks, Ms D’Ath made a more conciliatory reference to primary care, highlighting how GPs are ‘working tirelessly’ to Nine Newspapers.
She said staff shortages due to COVID infections are having an impact on an already stretched hospital system. There are reportedly more than 1600 staff currently isolating.
A GP shortage in the state is also contributing to the problem, she said, suggesting that retiring GPs could leave aged care residents without proper access to primary care.
‘So what do they do?’ Ms D’Ath said. ‘The staff pick up the phone to the Queensland Ambulance Service and ask for an ambulance to take that person to hospital because they don’t have qualified staff and they no longer are being serviced by GPs in their area.’
She said there were 520 long-stay patients in Queensland hospitals who did not need treatment but required an NDIS or aged care package.
Dr Clements said the Australasian College for Emergency Medicine (ACEM) as well as the Australian Medical Association Queensland are clear that hospital underfunding is at the root of the current issues.
Last year, an ACEM statement directly addressed the suggestion that primary care was contributing to a worsening situation at hospitals.
‘These pressures are also not the result of “GP type” patients presenting to the ED, which is a public narrative still being frustratingly peddled,’ they said.
‘Such patients presenting to emergency departments are relatively straightforward to treat and do not require significant resources nor admission to hospital.’
Instead, ACEM called for urgent investment in beds and staffing, a plea reiterated this week.
‘The current hospital crisis has not been caused by COVID-19. COVID merely exposed and worsened existing issues,’ a spokesperson said.
‘The system pressures that lead to ambulance ramping, emergency department overcrowding, bed block and worsening health outcomes have been growing for decades. We have been calling for help with these issues for just as long.’
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Dr Dhara Prathmesh Contractor   20/05/2022 10:47:05 AM

GP practices have modified to accommodate to help. We are at our breaking points. With such comments from political platforms and entitling patients to free visits and free medical everything!
Medicare bulk bill SIMPLY pays for DR ADVICE is the only thing Medicare pays for. Never covered for the payroll for reception, electricity, IT , medical stocks, cleaning rooms, premises leases. It’s all the medical business owners expenses. Hospital health care works and GP practices team are all getting burnout due to overwork and targeting.
Why is the media not focusing on free electricity, free water, free premises for running a medical centre. And help towards getting the expenses down for Dr’s and Nurses working hard through all this time. Or government funded free dental, Or free accountants. Or at least free builders ( plumbers, electricians..) for flood affected homes. How many times did a cafe or petrol pump give free amenities to healthcare workers. No tax to healthcare workers!

Dr Campbell Robert Crilly   20/05/2022 10:50:32 AM

Mr Steven Miles has to blame someone and why not GP's. Another egregious example of the shabby treatment given to GP's. GP's are underpaid, overworked and yes older GP's are retiring after forty plus years of work. Mr Miles has no understanding of the cost pressures on general practice and that is why patients are being charged a fee for service. Until a GP is no longer available in the community the politicians and public do not care.

Dr James Courts   20/05/2022 11:03:36 AM

No surprise from ignorant and incompetent ministers, blaming front line facing staff trying to keep practices afloat on almost 10 years of below inflation Medicare rebate increases, whilst they sit back in their offices pickpocketing the public purse with year on year pay rises and expense claims.

The EDs are suffering from an increase across all sectors of illness and disease. GP workload has also increased exponentially.

Also it doesn’t take a rocket scientist to work out if you attract a large amount of interstate migration of predominantly older persons, then you may need to increase healthcare provision accordingly.

Dr Mileham Geoffrey Hayes   20/05/2022 11:22:40 AM

I am so sick of these "Kentucky Colonels" (who bought the title but 'never went to war') Thy have never been self-employed, know every scam in the book, are supported by an incredible retinue of public servants and never, never, never accept responsibility let alone practise clinical medicine. General Practice has been, and is, being screwed for 50 years by these Politicians and non-clinical "Doctors" and they wonder why no graduates want to go into General Practice, They are the cause.

Dr Carmelo Poli   20/05/2022 11:27:18 AM

GPs are not causing ramping due to not seeing patients with chest issues. However they are indeed contributing to ramping here in WA. I have been a GP from 1982 to 2021.
I now work as a triage physician with our ambulance provider and deal with calls for ambulances. I regret that our local GPs could do a lot more to reduce stress on ambulance service and the scale of ramping. I am not say they are the total cause but one of the contributing factors. If the RACGP wish they have my details, I would be happy to explore this with them further.

Dr Christopher Francis Boyle   20/05/2022 1:00:52 PM

Appalling! He blames GPs but we are not the problem. The politicians have caused the problem by making GP unattractive to young graduates- poor pay being a major contributor to the lack of GP workforce.

Dr Ian   20/05/2022 2:57:51 PM

You need hospital grade or respiratory clinic grade PPE and well ventilated surgeries with fresh air or Triage Tents .
Basically more general practices given the supplies could do this .
Also many doctors and GP staff would feel it is right to choose to be up to date with vaccines and that is dose 4 even if younger than 65 and healthy as the antibody surge for two months gives protection.
Then there is the question of it being two years to build bigger more Covid safe health spaces which is a Government initiative .
By all means seminars of general practice and emergency medical staff would be good to work on a protocol to see if more more Respiratory Infections can be seen in the community .
It can be done - but with children you do need special procedures as in diagnosing urine infections .Telehealth between Emergency Medicine and General Practice would be good .
It is done for Rural and Remote .

Dr Michael Lucas Bailey   20/05/2022 3:09:59 PM

As a GP a big part of the problem is Queensland Health itself. It’s easy to point the finger and say ramping is because of not enough GPs. But look at the problems caused by Queenland Health that waste GP resources and lead to underfunding of general practice. Queensland Health tries to use the MBS to fund outpatients. If this didn’t happen there would be more funding for general practice and more GPs. With the pandemic most Queensland Health outpatient departments have gone to telehealth only. Paediatricians do phone consults and ask children to attend GPs to measure their height and weight for example. That is more egregious than GPs not seeing a patient with a respiratory illness face to face. Queensland Hospitals send patients back to GPs to get ECGs for their cardiologists or pre-op clinics. Surely they could do that themselves especially since the ECG rebate for GPs got cut. Central referrals reject valid referrals. The problem is Queensland Health!

Dr Jason Matthew Bament   20/05/2022 5:56:24 PM

I work as a Rural Generalist across ED and Anaesthetics within a Rural Local Health Network as well as Clinical Director of a large rural ED.

Alleviating ramping is directly related to whole of Hospital patient flow. This means maximising patient flow strategies such as: use of patient discharge lounges; well resourced out of hospital care (e.g. Hospital in the Home); diagnosis led discharges; patient referrals between senior clinicians; use of telemedicine; ED Consultant led decisions to Admit; KPIs for discharges before 1100hrs each morning; 7 day Inpatient Consultant staffing (not 5 day with Junior Registrar only onsite over the weekend) etc etc. These strategies need to be agreed to with targets backed by regular audits and accountability for adherence.

Low Triage Priority patients (Category 4 and 5 "See and Treat" patients) do not significantly contribute to ED access block and ED ramping, primarily because they do not occupy ED cubicles for significant times (or often at all).

Dr Susan Margaret McDonald   20/05/2022 6:24:56 PM

How dare he blame GP's. We see or do telehealth for all our patients and if they have chest infections and are Covid negative we see them in person.
We try to keep patients away from the hospital at all costs as if admitted they will contract Covid in there!!
QH does no forward planning and grey nomads are out in force now in their caravans.
Traffic is terrible in Cairns at present. Many of them have chronic diseases and even if quadrupled vaccinated they have other medical emergencies so the already overloaded hospital can't cope.
QHealth and politicians stop kicking the underdog. They might revolt and bite you badly!

Dr Vincent Edwin Russell   20/05/2022 9:00:47 PM

As both a GP and an emergency physician I agree with the above comments that ED crowding is a hospital issue relating to patient flow, as well as the difficult logistics of managing an acute respiratory illness without adequate resources. However we must not forget the immense pressure placed upon ED doctors and nurses due to current overwhelming demand. We cannot close our doors or take no more bookings to stem the tide. I would desperately implore my GP colleagues to only send patients to the ED who require ED services. I have lately been dismayed and despondent about some of the GP referrals we have had to manage, with no prior call, and for chronic conditions that are actually poorly managed in the ED setting. Respectfully, I wonder if this is the result of “corporatised” medicine that promotes shorter consultations? We all know that Medicare doesn’t reward GPs for spending an appropriate time with more difficult patients.