St George Sustainable General Practice Solution

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.

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.

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.

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.