Transcript - ABC Radio - GP membership models

Transcript: AMA Queensland Vice President, Dr Nick Yim, ABC Queensland, Drive with Annie Gaffney, Tuesday 22 August 2023

Subjects: Membership models for GPs, satellite hospitals

ANNIE GAFFNEY:   If you’ve got a sick child, it’s often hard to get in to see your GP on the same day to have them checked out. Sometimes appointments can be a couple of weeks out and if you’re lucky enough to get an appointment elsewhere, it’s not with the doctor who’s seen your child before. But would you pay to get priority access, by paying for membership of a GP clinic, if it meant that you could get in to see the doctor of your choice on the same day or soon after? A Brisbane-based clinic has just opened its doors, offering subscriptions for a daily fee of $1.50 for adults or $45 per month, plus $10 for every dependent child in the family. Now, there's other perks associated with using their practice app too, like being able to contact your doctor of choice with questions and even the ability to renew scripts. So is this model of care a good idea and where does it fit in within the overall landscape of getting good timely access to your GP?

Dr Nick Yim is the Vice President of the Australian Medical Association Queensland. He's a GP from Hervey Bay. Nick, great to have you back with us this afternoon. I've never heard of a subscription-based GP practice before. How long has this model of care been around for?

DR NICK YIM:   Well, what we've been seeing over a period of some years with the reduction of Medicare rebates, many GP practices around the country are designing new innovative models of care to help service their community because Medicare rebates haven't kept up with time. The model that you speak of, something similar popped up in Canberra a couple of years ago called the National Health Co-op, where they charged an annual fee and then bulk billed their members. However, they went into administration a couple of years later, which was quite unfortunate.

ANNIE GAFFNEY:   It sounds like a pretty good model to me, particularly for parents, as I mentioned, who might be really struggling to get their child seen by a GP on the day of their illness. What do you see as the strengths of this kind of practice?

DR NICK YIM:   Definitely innovation. What we're hearing from the community is that access to their GP, to a medical centre is difficult and the cost of living is hurting the patients and the parents. So innovation is key, but we don't want to see fragmentation of care. We want to see that patients can see their doctors.

ANNIE GAFFNEY:   So what's your understanding, Nick, of whether a subscription-type GP practice can also offer bulk billing? Is that the standard, that you pay for to subscribe and then get bulk billed as well?

DR NICK YIM:   Yeah. It's a little bit unclear whether GPs can charge a membership fee and still bulk bill, so we are seeking clarification from the federal government. Like I did say earlier with the Canberra group, that one there unfortunately did go to administration in 2021. So the key thing is with any model of care, we need to ensure that it is sustainable. We want to ensure that general practices remain viable. And what we've been calling for from both state and federal governments is to ensure that primary care is adequately funded for now and into the future.

ANNIE GAFFNEY:   I mean, this kind of model is great if you can afford to pay an upfront subscription. But what about for those who can't? Where does it leave them?

DR NICK YIM:   Yeah, this is always challenging. We've always had the private sector and the public health sector But ultimately patients, parents and the community, have to do that research and find that GP and the general practice clinic that's suitable for them.

ANNIE GAFFNEY:   What about in terms of the overall GP sector? Where does this model fit? Could it actually take some pressure off the existing GPs that we have in working in a community?

DR NICK YIM:   Yeah, without a doubt, I think the innovative models of general practice care is definitely a positive for the community, but we do need to ensure that the standard of care is the most important thing, that we continue delivering good medical care to our patients and the community. And at the same time, we need to ensure that general practice and primary care continues to be viable.

ANNIE GAFFNEY:   Is this something, as a GP yourself, Nick, that you would be interested in setting up, a subscription service?

DR NICK YIM:   I think with all different services, different models of care, it comes down to risks and benefits and it comes down to the practice viability. We do know that unfortunately the Medicare rebate, the patient’s rebate, just hasn't kept up with inflation and we h out-of-pocket expenses have increased. So that's what we want to see, to ensure funding for patient rebate increases over a period of time.

ANNIE GAFFNEY:   And Nick, I don't know if you can comment on this, but the state’s first satellite hospital in Caboolture apparently has made a lot of people who have gone there on Monday quite cranky. They are expecting, I guess, more of a hospital setting, but walked in - The Courier-Mail is reporting today - to find only one doctor working there and hours-long wait times. It's not far from the actual main Caboolture Hospital itself. What are your thoughts around that?

DR NICK YIM:   It's a bit challenging for me to comment because I don't have the details on that, but what AMA Queensland has been calling for is, while it's great to have infrastructure, workforce is really important. It's great having big buildings, but obviously the workforce - the doctors, the nurses, allied health, the wardies, all the people within that healthcare facility - they need to be there managing the patients, seeing the patients, because without that workforce it just won't function.

ANNIE GAFFNEY:   The Opposition has pointed out the fact that these satellite hospitals don't have the capacity for you to stay in overnight, so they shouldn't really be called hospitals. What are your thoughts around that?

DR NICK YIM:   I think it's a facility that can definitely help with the community. But at the same time, we do need transparency for that community and that's where the future workforce plan is going to be really important. It's not just about public hospitals. It's also about general practice, it's about pharmacy, aged care facilities, allied health. What workforce do we actually need for Queenslanders?

ANNIE GAFFNEY:   Dr Nick Yim, always good to hear from you. Thank you.