St George Sustainable General Practice Solution

General Practice Solution

Developing a Sustainable General Practice Solution for the community of St George

General Practices across Australia are struggling, particularly in rural and remote locations.

St George is not exempt from these pressures, and it is imperative that GP services in St George can continue to meet the needs of the community in a sustainable way.

Local Health parties South West Hospital & Health Service, Western Queensland Primary Health Network, the St George Medical Centre, along with Balonne Shire Council have come together to explore and identify possible options for a sustainable GP service in St George.

A number of community consultation activities will occur over the coming period to allow the community to have their say on developing sustainable GP services in St George.

COMMUNITY CONSULTATION

  • Community Stakeholder Forum - On 1 May 2024, hosted a Community Forum with a range of key community members and stakeholders to explore options for the best path forward to maintain the sustainability of GP services in St George.
    • Invitations were extended to representatives from groups in the field of health service providers, service clubs, local industry groups, community groups, government representatives, education providers, First Nations and consumer representatives.
  • Community Drop-in Sessions – Two Community Drop-in sessions were held on 14 & 15 May. These sessions allowed the community to talk directly to all partners involved in this. If more Community Drop-in sessions are required, they will be organised and publicised.
  • Community Survey – This survey will allow the community to have their say on the possible path forward.

For more information on this important initiative, you can contact the Balonne Shire Council on 4620 8888 or the St George Medical Centre on 4625 5344.

  • Currently, St George Medical Centre is struggling to create viability and sustainability in the provision of primary healthcare for St George and outreach services. More fit-for-purpose and modern business models are being explored to ensure the continuation of services. 

    There are a range of issues surrounding General Practices in rural and remote Australia. Our community is not exempt from these struggles. Some of these challenges include:

    • Medicare Bulk billing item numbers haven’t kept up with rising overheads and aren’t enough to cover costs in rural and remote areas. General Practice is not viable if Medicare is the only source of funding;
    • Private ownership means there is limited access to a lot of grants funds, block funding, corporate donations, or sponsorship;
    • Smaller population meaning economies of scales can’t be achieved and the practice provides care for every demographic of the population;
    • Recruiting and retaining health professionals requires local support and partnerships to make St George and attractive place to live and work;
    • Providing equitable and comparable employment packages to public and block-funded services;
    • High infrastructure requirements and costs to deliver quality multidisciplinary care needs innovative funding solutions, a local plan and pooled funding to retain services locally.
  • Current Health Service Model in St George

    As rural communities struggle to maintain or expand access to primary healthcare services locally there are a number of options developing across Australia. Below is an outline of the current service model for St George.

    MEDICAL SERVICES

    Private Practice - Percentage Based

    This is model most used to recruit senior GPs. Currently there are two senior GPs working in St George being paid as a percentage of their practice billing.

    Private practice employed (Registrars)

    There is currently 1 FTE GP Registrar working at the practice but there would be the potential to accommodate 2 registrar positions.

    HHS Employed (Agreement)

    Currently there are 6 GPs working at St George Medical Centre Practice under an agreement with SWHHS. The sessions are roster based with most being 3 hours in the morning. There is only limited continuity with allocation of Senior Medical Officers and rostering.

    HHS part time or Right of Private Practice

    There is an option to adapt to these positions as the capacity of the practice to support senior salary or percentage billing increases.

    Single employer HHS

    This model is currently in planning for some of Queensland but not in operation in St George. This would be an extension of the employment agreement model.

    Locums / Interns / Medical Students

    Locums are not often used in St George Medical Centre but will be required to cover leave if an additional GP or Registrar cannot be recruited.

     

    Interns do not currently work in St George Medical Centre but would be an ideal addition to support services within the General Practice and experience working in Rural Primary Care.

     

    Medical Students work across St George Medical Centre and St George Hospital.

    OTHER PRIMARY CARE SERVICES IN ST GEORGE

    Allied Health Services

    Allied Health services are provided privately through Vital Health services, and solo practitioners co-located with St George Medical Centre. Public allied health services are provided by a team located at the St George Hospital and provide inpatient and outpatient services.

    Mental Health

    Mental Health co-ordination services are funded through the PHN to St George Medical Centre with services provided through the Medical Centre, other local non-government providers, private practitioners, and through the Mental Health team based at St George Hospital.

    Aged Care Services

    Aged Care services are provided in the community by Non-government Organisations and with the Residential Aged Care facility Warrawee (25 beds operated by the Churches of Christ, Queensland). St George Medical Centre provides weekly and 24 hour on call services to the residential aged care facility.

    Early Intervention

    Early Intervention is provided at St George Medical Centre through the provision of Health Assessment. There is currently an active program to provide health assessment to Aboriginal patients but there is potential to increase this to older patients, and diabetic patients and those age 45 to 49 years.

    Prevention Programs

    Prevention programs are available through the St George Medical Centre and provided opportunistically and through structured care. There is an option to provide more active prevention and early intervention programs.

    Health Promotion

    Health Promotion is provided through provision of patient information and opportunistically during appointments both at St George Medical Centre and St George Hospital. With more integration there will be the option to actively promote community awareness and targeted local screening programs.

  • Other Models/Solutions for Rural Communities

    As rural communities struggle to maintain or expand access to primary healthcare services locally there are a number of options developing across Australia. Below are a number of examples from other regional communities have used to deal with this important issue.

    MODEL

    SOLUTION

    Social Enterprise

    Emerald GP Clinic - Developed as a result of Commonwealth Infrastructure development of $5million dollars and a partnership with an existing practice – Emerald Medical Group to relocate. Land is a long term lease from Central Highlands Regional Council. Now extended to include additional GP services, onsite pharmacy, café, allied health, University Hub, visiting specialists and potential to continue to expand services to include a day procedures facility in the future.

    Mareeba Medical Centre - Developed to prevent the imminent failure of General Practice, with development funded through NQPHN. Now managed locally in a rented facility, increase from 3 to 5 FTE GPs, partnership with Mareeba Hospital for Registrar positions, outreach services and actively planning relocation with infrastructure grants to allow continued growth. Also actively seeking grants and fundraising to support access to Mental Health services for the community.

    Clermont for Doctors - Funded through Glencore mines to advocate for Medical Services in Clermont. Re-opened the General Practice co-located with Clermont Multi-purpose Health Service and working to establish a social enterprise management model to ensure long-term sustainability for services in the community.

    Eden NSW - Established social enterprise group that has taken on management of the local general practice but is currently unable to recruit enough GPs to maintain services.

    Corporate Ownership

    Heart of Australia – Private business with specific purpose and significant government and private investment to support the delivery of cardiac services in rural and remote communities. Specific vision and leadership from a single provider.

    Independent Practitioner Networks is a large GP corporate which operates in urban and regional communities with practices of six GPs or more and specialist workplace medicals providers (Sonic Health)

    GP Entrepreneur Groups have established in Urban and some rural communities and operate a number of General Practices usually larger practices and centralise some operations of the practices.

    Ochre Health is more focused on regional and rural services but relies on a strong viability model with practices located in communities over 10,000. Ochre also operates a recruitment and locum model.

    Charitable Management

    Charitable Management for General Practice does exist in Australia.

    RHMS Rural Health Management Services is Queensland based charity and provides practice management services predominantly to HHS operated practices and relies on a partnership with HHS providers for Medical Recruitment, currently operating in Wide Bay, Central Queensland and Townsville HHS catchments.

    RaRMS Rural and Remote Medical Services, now Healthy Communities is based in other states and operates a variety of medical and health service models with subsidies from State and Local governments and Commonwealth Government support in some communities. The services are based on a charity model and easy entry and exit for GPs working RaRMS practices, which are now reduced to 2 practices.

    Health & Hospital Services

    Health and Hospital Services by default becomes the sole Primary Care provider when General Practice fails, Southwest Health and Hospital Services and Central West Health and Hospital Services have taken on the operation of General Practices and provide Rural Generalist Senior Medical Officers to staff small hospitals and General Practices. If they cannot provide Senior Medical Officers locum replacements are sourced. This is often at significant expense for the HHS’s.

    Local Government Operated

    Julia Creek Shire currently partially funds and employed GP and also totally funds a community nurse and two houses for Medical staff. They have also funded a General Practice facility in the past.

    Cloncurry Shire provides a vehicle for outreach services and an accommodation subsidy to the General Practice.

    Mission Beach – Cassowary Coast Shire has secured the General Practice Facility to lease to a General Practitioner.

    Bogan Shire Medical Centre in Nyngan is operated by the Bogan Shire Council and was partially funded through the Commonwealth Regional Development funds.

    Nebo – Isaac Shire sourced State Development funding to establish and fit out the Medical Centre in a Council owned building. Services are provided by a visiting GP who operates the practice, and a local community group supports the clinic through local fund raising.

  • Potential General Practice solutions for St George

    There are pros and cons with all these solutions and barriers and enablers which have made the models successful. It is important for the community to review these and identify what options will work for their community. This will involve the development of a summary document and/or discussions with representatives from the different communities.

    MODEL

    GENERAL PRACTICE MANAGEMENT

    INFRASTRUCTURE

    WORKFORCE

    POSITIVE ASPECTS

    NEGATIVE ASPECTS

    GP Owner Solution

    Based on experience

    Must generate a return on investment

    Difficult without support

    This is the traditional model for General Practice and generates strong local commitment and links to the community. Services are designed to meet the needs of the patients and development of services to meet those needs. Gives continuity to services

    This model is no longer financially viable unless the practice is large enough to generate a return on investment (10 or more FTE GPs). Investment in infrastructure does not generate return and has limited resale options in rural communities.

    Social Enterprise

    Need to develop

    Eligible for Government Grants, Philanthropic and Corporate Support

    Difficult without local support

    Local leadership and investment in community-based services. Capacity to provide extended primary care services. Eligible for charity status and many State and Federal grants programs. Ability to deliver services specific to the needs of the community.

    Not all communities will have, or can establish, a group with the capacity to operate a social enterprise. Groups will need support to develop to full potential.

    Corporate Ownership

    Management based on return to owner

    Need a return on investment

    Needs to be cost neutral

    Capacity to grow services in areas of high populations and return on investment.

    St George is not attractive to Corporate Ownership as there is limited opportunity to provide return on investment.

    Charitable Management

    Management based on ‘not for loss’

    Usually do not purchase

    Difficult without support

    Ability to work within communities and with State and Federal government funders. Experienced practice management and delivery of State and Federal grants.

    Primary care returns need to provide a break even on investment or be grant funded.

    Health & Hospital Services

    Have developed practice management expertise.

    Usually co-located

    Is employed by HHS and provides care for the acute service and the General Practice.

    Provider of default (patients will attend hospital if there are no other options).  Provides accredited GP service.

    Funded in part by the state government.

    Local Government

    Not a usual service model

    Eligible for Grants - Capacity to manage

    Difficult without support

    Limited experience in managing primary care services.

    Ability to provide infrastructure management and community leadership.

  • Frequently Asked Questions

    Are we about to lose the private GP service in St George?

    Currently, St George Medical Centre is struggling to create viability and sustainability in the provision of primary healthcare for St George and outreach services. More fit-for-purpose and modern business models are being explored to ensure the continuation of services.

     

    Why do we need to change what we already have?

    The traditional segregated small business models for Primary Health Care (Medical and Allied Health) leave services vulnerable to ongoing workforce shortages and ever-increasing operating costs.

    The end result is often closure of services which results in a situation where community access to services is reduced and total investment in health services in rural and remote communities decrease.

    Funding for the provision of Primary Health Care rest predominantly with the Commonwealth Government and Medicare, but services are also funded by the Queensland Government, Fee for service from individuals, NDIS, Workplaces and other funded service provision programs through Local, State and Federal Governments.

    Services traditionally focus on one funding source and often only one aspect of Primary Care which is very limiting in rural areas where the service numbers are lower and service delivery costs are often higher.

     

    Aren’t private GP services and public hospital services just the same thing?

    No, the health services provided by a public hospital provider and a General Practice service are very different and although both provide some similar health services, they deliver very different care through different systems.

    All health services are provided to support the patient and the quality of these services are not in question. There are different systems to support ongoing primary care, which is traditionally provided through a General Practice and allows the patient to choose a Doctor and continue to access the same Doctor, or another Doctor at the practice who can follow on with that care.

    Hospitals are more focused on delivering acute and inpatient care, when the patient is very unwell and needs immediate care or longer-term specific hospital care.

    In some areas General Practices have been set up as part of the hospital services when there is no other local General Practice.

     

    Is this change because the current management is failing to deliver a viable service?

    Over the last decade there are many factors that have affected General Practice nationally. St George Medical is not exempt from these, and like many other practices in Australia, has felt the affects of difficulties recruiting Doctors, increasing costs and the falling value of Medicare.

    Margins in private general practice are very tight with litle to no profit margin for most private practices. Nationally many practices are either being taken over by corporate owners to create economies of scale, defaulting to public services, increasing fees and going to 100% private billing, moving to fast medicine that lacks quality, or closing.

    St George Medical Centre currently has 2800 active patients (an active patient is one that has been to the practice 3 or more times in the last 2 years). Unlike practices in larger towns the medial centre is tasked with a population approach. This means bulk billing those that can’t pay, providing the highest quality of service possible and recruiting additional services and employees to service the complex needs of a community.

    Now there is an opportunity to work together as a community to develop a local solution to provide the General Practice services the community needs.

     

    How are the State and Federal Governments helping to provide GeneralPractice and Primary Care?

    As a private General Practice, the St George Medical Centre needs to adhere to funding models provided to health services from State and Federal governments, which may suit areas with a higher population, but in areas with a low population base, many private GP Practices across Australia are finding it difficult to remain sustainable without help.

    The major income stream for St George Medical Centre is through Medicare and Fee-for-service income with some additional funding through grants with WQPHN and from SWHHS through health workforce staff support.

    All levels of government recognise that communities need access to Primary Care (General Practice and Allied Health). The local solutions process will allow the community to work with Governments, Hospital and Health Services, the Primary Health Network and others to deliver services that meet the needs of the community.

     

    How can I have my say on maintaining sustainable GP services in St George?

    There are four organisations currently leading the development of sustainable General Practice services for St George. They are the South West Hospital and Health Service, the Western Queensland Primary Health Network, and the St George Medical Centre, along with Balonne Shire Council. These organisations with community members have come together to explore and identify possible options for a sustainable GP service in St George.

    There will be drop-in sessions and a Community Survey as per below to gain community feedback:

    - Community Drop-in Sessions – These sessions will allow the community to talk directly to all partners involved in this.

    • 14 May 4pm – 6pm at the Cultural Centre, 118 Victoria St, St George
    • 15 May 8am - 10am at the Cultural Centre, 118 Victoria St, St George

     

    - Community Survey – This survey will allow the community to have their say on the possible path forward.

    For more information on this important initiative, you can contact the Balonne Shire Council on 4620 8888 or the St George Medical Centre on 4625 5344.

     

    Is Balonne Shire Council taking over the management of GP services in St George?

    At this stage, Balonne Shire Council has only commited to funding a part share of this community consultation and nothing further. Any decision to ultimately provide any further funding, or support would need to be discussed and decided by Councillors.

    This consultation process is designed to provide a sustainable solution for the community of St George. To do this there needs to be expertise in all aspects of providing GP and Primary Care services. This is not an area where local government traditionally has skills. The Council is however an elected body to represent the local needs of the community and to work with others to ensure the community continues to grow and support all members of the community.

     

    Which of these service models (or a mix of models) are an option for St George?

    St George Medical Centre has established a purpose-built facility for the delivery of Primary Health Care services, which is ideal for the size of the community and centrally located, but not currently generating an income sufficient to maintain viability.

    There are several options, most of which involve investment and support of Government Infrastructure funds from State and Federal Governments (grants such as Regional Infrastructure and Building Beter Regions grants), philanthropic and local fundraising can support maintaining local infrastructure.

    The specific options include:

    Social Enterprise – This model requires local leadership, investment in community-based services with a capacity to provide extended primary care services. This model is eligible for charity status and many State and Federal grants programs. However, not all communities will have a group with the capacity to form a social enterprise. Groups will need support to develop this option to full potential.

    Corporate Ownership – This model has the capacity to grow services in areas of high populations and return on investment, however St George is not attractive to Corporate Ownership, as there is limited opportunity to provide return on investment.

    Charitable Management – This model has an ability to work within communities and with State and Federal government funders, experienced practice management and receive State and Federal grants. Primary care returns need to provide a break-even on investment or be grant funded.

    Health and Hospital Services - Provider of default (patients will attend hospital if no other options). Hospital and Health Services can provide comprehensive accredited General Practice.

    Local Government – Has an ability to provide infrastructure management and community leadership, however, has limited experience in managing small business.

     

    What are the options for ensuring access to the current St George Medical Centre infrastructure is maintained for the community?

    The current General Practice buildings in St George are privately-owned and need to generate a return on investment for the owners. This currently adds to the costs of operating the General Practice.

    Maintaining the infrastructure for the community will be one of the decisions needed to ensure sustainability of the services. These buildings provide an ideal location for a General Practice and offer opportunities to further expand access to local primary care services for the community.

    Options for maintaining these buildings could be:

    • through a social enterprise and purchase of the buildings;

    • through a foundation purchasing the buildings;

    • through Balonne Shire Council ownership or management;

    • a local benefactor purchase;

    • plus a number of other options.

     

    Is St George able to develop a local social enterprise? What support would the group require to develop and thrive? What are the other options for St George?

    There is an opportunity to establish a local organisation with membership or partnerships with individuals or organisations with General Practice skills and experience. This may be as a co- operative, association or company with or without charitable status. The final membership and structure of the social enterprise would need to be identofied by the organisation.

    Managing a General Practice with a strong business model requires a set of skills not available in many rural communities, Local Government or HHS’s. These skills are however available, and they are skills that can be developed within the organisation.

    A local organisation can ensure the General Practice is set up to ensure maximum income potential and the ability to remunerate clinicians through direct payment, bonus payments or payments to the HHS for medical services. Clinicians can be employed as an independent practitioner, on a fixed salary, or hourly wage, employed through a grant or provide services under an agreement with an existing employer.

    There are quite a few innovative workforce models emerging to support the local capacity for clinicians to provide a diversity of services under different funding models. These models are not limited by the government funding arrangements between State and Federally funded services.

    It is important for the community to maintain access to private practice, fee for services, Medicare, PHN and Qld Health Funded services to ensure the community has access to the services that meet the health needs of the community.

The below Community Survey will help to inform the health partners about community sentiment in relation to the range of options for achieving sustainable General Practitioner services (Doctors) for the community of St George.

COMMUNITY SURVEY - St George General Practice Solution