Practice managers step up amid viability challenges

Doug Hendrie

9/10/2020 2:54:22 PM

It has been a challenging year for Australia’s practice managers, but peer support has provided some relief.

Downwards graph
Dropping patient numbers for some practices means viability concerns are never far away.

The COVID-19 pandemic has forced rapid and far-reaching change in general practice, with a widespread embrace of telehealth and a scramble for personal protective equipment (PPE) amid price gouging and shortages.
But the pandemic has seen practice managers stepping up, according to Riwka Hagen, a consultant, practice manager and the founder of the 5000-member social media group, Practice Managers Network.
‘Practice managers have risen to the challenge, working to the top of their scope and capability,’ Ms Hagen told newsGP.
As clinics ran out of hand sanitiser in March’s early days of the pandemic, network members set about collaborating on what would become known as the Hand Sanitiser Australia Project.
Ms Hagen, along with fellow network members Anna Davidson and Matt Gilchrist, worked to link chemical manufacturers with a supply of ethanol to produce hundreds of thousands of litres of locally produced hand sanitiser to send to health services where it was in short supply. 
Grateful practices were able to stay open due to the increased supplies, with one practice manager dubbing the sanitiser ‘liquid gold’.
‘It was a beautiful collaborative piece of work, done by the network for the network,’ Ms Hagen said.
‘We were able to ship out over 5000 units of sanitiser in the early days of COVID when there were real supply blocks.’
In response to a newsGP question posed to the network about the broad impact of the pandemic, one practice manager wrote: ‘With resilience, determination, grace, devotion, class, innovation, resourcefulness, staunchness, adaptation, humour, courage ... that is how [practice managers] have led the way.’
Another manager praised the whole primary care response: ‘The fact that we have all adapted to changes so quickly and so well speaks to how committed we are to the delivery of excellent service to our communities and to the skills and professionalism of all our staff.
‘Our practices have risen to each challenge with quiet determination, team support, hard work and commitment to our profession, despite our own personal situations and fears and with very little support from professional or government bodies.’
Others have found the year especially difficult.
‘It’s been a constant [challenge] … to keep up with the constant changes and ensuring we remain COVID-safe and compliant with all aspects of running a clinic, as well as trying to maintain the doctor’s billings and keep staff employed. It’s been a tough year for everyone,’ one manager wrote.
That sentiment is echoed by another response:
‘It’s hard to explain to staff, patients and the public how much of a financial and psychological hit this pandemic has caused – particularly in Melbourne GP practices. Significant cost of PPE, extra cleaning, signage and other infrastructure. Six months (and counting) of not being able to function normally.
‘The true toll of that is yet to be revealed.’
Another practice manager wrote: ‘I think that the PPE issue highlighted that private practices weren’t really considered by Government in pandemic planning – hopefully a lesson learned for them. Private GP clinics are the frontline – before the emergency departments.’

‘Practice managers have risen to the challenge, working to the top of their scope and capability,’ practice manager Riwka Hagen said.

The struggle for viability
Even though the threat of the virus has somewhat eased for now, repercussions continue rippling throughout general practice.
Ms Hagen said real viability challenges remains for some practices, while others may come out of it in a better position.
‘Some practices are absolutely concerned about their finances,’ she said.
‘For many, there’s been a reduction in income, as patient numbers have declined. That was offset a little bit with stimulus packages and telehealth.
‘There’s a real fear factor, especially as we are going into lower financial support.
‘That’s a really big worry for practice managers.’ 
But this issue varies across Australia and even within states, with practices in Melbourne’s near-empty CBD taking the hardest hits, according to Ms Hagen.
‘The picture is variable across the country. But the impact of COVID comes on top of already quite a financially strained situation,’ she said.
‘The funding models of primary care are just so precarious. Even prior to COVID, I was seeing quite a number of practices that were stretched or stressed. COVID has pushed them right to the brink.’
For others who were in a good position, however, changes like telehealth and other incentives have been a boon.
‘For practices that were pretty strong to start with, the fact additional funding has been made available strengthens them even further,’ Ms Hagen said. ‘These have been able to capitalise on the changes and pivot quickly to take advantage of telehealth and also embracing new ways of working and thinking about the way they are operating.
‘We’re seeing a high level of staff turnover, so there’s lots of stress and anxiety from practice managers who are trying to keep the show on the road and work in really difficult circumstances. Some good practice managers are leaving the profession, and you have a lot of new managers coming through with limited experience asking what they need to know – and realising it is a really big job.
‘That fits with the picture of what’s happening to GPs, who may also be feeling underpaid, undervalued and stressed out.’
The hardships of the year may serve to bind the profession closer, according to practice manager respondents, with the social media group playing an ‘invaluable’ role in connecting people.
‘It has felt very lonely at times (particularly early stages), and knowing others were going through the same things helped enormously,’ one practice manager wrote.
Another said the group support is what got them through.
‘A major lesson for me through this pandemic was that some days [there were just] no answers,’ they wrote.
‘It was very stressful and I had to admit to myself that I wasn’t coping and needed support and this group provided that. From answers, to humour, to chats, to admitting the same fears, this group held me together and helped me believe we would survive this.
‘Support in the future, whether it comes from government or from this group, is so very important.’
Respondent comments have been slightly edited for clarity.
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