Charlotte Varcoe
Doctors at the region’s only Urgent Care Clinic (UCC) are worried about further pressure put on its system with the general practitioner payroll tax coming into effect.
While the Mount Gambier Urgent Care Clinic itself is exempt, operator Doctor Richard Try is concerned that the tax will see clinics increase their fees, sending more people to their door.
While general practices have always paid payroll tax on the salaries of reception staff, nurses, allied health professionals and salaried staff such as GP registrars, the payment made to a GP was not considered to be eligible for payroll tax, but now clinics will need to pay payroll tax on their GPs as well.
Bulk-billing medical offices and centres with wages totalling less than $1.5 million are exempt.
Dr Try said his main concern was if practices increase their prices, more patients would attend the UCC due to not being able to afford basic healthcare.
“We will then have more patients coming to the Urgent Care Clinic and as it stands, the clinic should be taking the pressure off the emergency department by seeing some of the things which are emergencies but could be done outside the hospital,” Dr Try said.
“What we are finding is there is a huge unmet need in Mount Gambier and a lot of people will not seek medical care because of fears of cost but also not knowing where to go.”
He said although he had been told the clinic was making a difference on the pressure at the Mount Gambier and Districts Hospital emergency department, the clinic still had a number of patients who simply did not have a general practitioner or could not afford an appointment.
“If the costs go up more people are going to be deterred from going to a general practitioner and more people might come to us,” Dr Try said.
“We are already really busy to the point where we are turning people away because they are not meeting the criteria for the clinic.
“We do not like doing that but we are not allowed to do certain things such as repeat prescriptions or routine general practitioner work, checking blood pressure and those sorts of things.”
He said despite the clinic being contracted to perform urgent yet non-life-threatening treatment, some patients were claiming they were unable to secure a general practitioner appointment for about six months.
“There is a bigger crisis here in the lower South East which is the lack of general practitioners and it has just gotten worse,” Dr Try said.
“A lot of general practitioners come to this country and leave and what we have ended up with is an increasing crisis that has led to not enough doctors to do the work for the population.
“Then we end up with poorly treated conditions and people have not had the care they need so their condition gets worse and what was not an urgent problem becomes one.”
Dr Try said it had become increasingly common for the clinic to turn patients away not only due to patients not meeting the criteria but also due to the clinic being overwhelmed.
“There comes a point where we just cannot fit anyone else in and we have got a defined opening and closing hours which the emergency department does not have, so people go up there and sit and wait whereas there comes a point for us where we just cannot see people anymore,” Dr Try said.
“Otherwise, rather than closing when we are supposed to, we would be open forever because that is how great the demand is.”
He said many of the general practitioners working at the clinic were opting to work through their lunch breaks to ensure all patients receive the care they need.
“It gets to a point where we tell them they have to take a break because if they do that for a couple of weeks, they are exhausted and have to have a week off,” Dr Try said.
“Then we have a reduced service again so it is really difficult mainly because the expected demand on the service was much lower than what it actually is.”
Rural Doctors Association South Australia president Bill Geyer said regional and metropolitan practices were going to find it hard after the payroll tax with the “bottom line” being greatly affected.
He acknowledged the state was “desperately short” of general practitioners in the city and regional areas and said those which stay open would have to look at their fee structure.
He said he thought it was a “terrible shame” the payroll tax had rolled out across the country with the ideal thing being for general practices to be exempt.
“I think the state governments have done what they can in terms of initiating a delay before it is imposed and that is given some practices an opportunity to look at the legal and accounting issues because there might be ways they can restructure their business so there are those doctors who have been contractors in the past,” he said.
“It has been a kick in the guts that general practice could have done without.”
State Treasurer Stephen Mulligan said the government was cutting payroll tax for general practitioners on the wages earned providing bulk-billed consultations to patients.
“Federal Government data shows three quarters of all general practitioner consultations are bulk billed, so the vast majority of GP consultations will benefit from this cut,” Mr Mulligan said.
“This will ensure there is no further pressure on emergency departments.
“South Australia’s legislated scheme will be the most generous in the country. It is backed by the Royal College of General Practitioners, which we have been working closely with for many months to ensure we get the balance right.”
He said many general practitioners fell well below the threshold of $1.5m following the bulk-billing dedication.
