Not rural enough: Practices fear for the future under incentive cuts

Practices already struggling to survive in country towns and city outskirts could “become unviable” under a planned restructure of rural incentives, a GP says.

From January, the PIP incentive covering practice nurses is being combined with an incentive for rural practices into a single “workforce incentive program” accessible only in rural areas. Tasmanian GP Dr Donald Rose says dozens of practices around the state are facing cuts of up $25,000 to their Practice Incentives Program (PIP) payments after being reclassified as “less rural” by the Department of Health. 

The department is also changing the map it uses to determine which practices can access rural loadings on their PIP payments as part of a revamp of the program.

It says the system, known as the Modified Monash Model, is completely objective in determining whether a practice is metropolitan, regional, rural or remote, based on the latest data from the Australian Bureau of Statistics. But Dr Rose, who is a partner in a Launceston practice, says he knows up to 30 practices around his area that will lose out despite being in rural locations.

“These practices will just have to look at their viability now that they are going to lose yet another payment,” he says. 

“It is just another hit on top of all the other hits we’ve had to absorb in the last few years and the final straw for a lot of practices.” 

money cut

Besides practices around Launceston, practices in areas around Hobart will also lose out on rural PIP loadings under the redrawn map.

Dr Rose says the new model has “forgotten about the Bass Strait”, which makes accessing health services of the major cities, such as Melbourne and Sydney, more difficult and expensive. 

He argues Tasmania should be treated differently to the mainland, pointing out the state has been classified as rural and received exemptions in the past.

“[The model] is going to affect parts all over Australia, but it is particularly going to hurt Tasmania,” Dr Rose says.

“The majority of practices in the north of Tasmania are going to suffer this hit and a certain number of country towns in the south – and we are already struggling because we have a much higher aged population and much poorer health services.

“General practice does much more in Tasmania because we just haven’t got the resources that the other states have. We have the worst health system in the country as it is and to scrap more money out is just bizarre.”

Other inconsistencies Dr Rose points out include Launceston being categorised the same as Hobart despite the state’s capital having a large tertiary hospital with many more specialists and services. 

He also says Launceston is “sufficiently rural” to receive bulk-billing loading but not rural enough for the Practice Nurse Incentive Payment. 

“Many of our patients are on healthcare cards and pensions, so there is a small group paying the gaps,” Dr Rose says.

“Can they absorb another gap increase so we can reclaim the staff we have, or do we have to let invaluable nurses go? That’s the position we will be forced into.”

Meanwhile, a practice in the Gold Coast hinterland has gathered more than 2000 signatures from the community appealing the proposed changes to its classification. 

Tamborine Mountain Medical Practice will be classified as a “major city” because of its proximity to the “growing Gold Coast”, according to the Department of Health.

But the practice’s principal, Dr Leeann Carr-Brown, says the model has failed to take into account the difficult terrain surrounding the town and lack of public transport, making it difficult for elderly and vulnerable patients with complex conditions to access services if they cannot drive.

The local doctors also argue that the town should be considered rural because it has no town water, sewerage system or street lighting, just one local ambulance service and the nearest hospital is 40km away.

Dr Carr-Brown says nursing home visits, palliative care and after-hours could all be affected under the changes, which are important services considering Tamborine Mountain’s ageing demographic. 

The loss of IMG doctors due to the replacement of the District of Workforce Shortage would also make it “almost impossible” for the town to recruit doctors because they will be expected to work after-hours on call, she says.

The 2000 petitioners make up a third of the town’s adult population, while federal MP Scott Bucholz — who is assistant minister for Road Safety and Freight Transport — is also advocating on behalf of the community.

However, a Department of Health spokesperson told Australian Doctor that the model was an “impartial mechanism” and the department could not make discretionary changes.

This article first appeared in Australian Doctor 

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