LATE last month our health reporter Anita Beaumont broke the news that GP Access, which runs a long-standing after hours medical service in the Hunter, was about to shut its operation at the Calvary Mater and trim some hours from its other operations.
It's not the first time we've run stories about GP Access needing more money.
I've written my share over the years, but when I started talking to people this time around, I realised that things were not as cut and dried as I'd thought.
We've often described the Newcastle after-hours service as the model for a national roll-out, and described its occasional funding disputes as a simple tussle with government.
What I hadn't considered was the role that private after-hours providers play in this story.
All of them, GP Access included, are known officially as "deputising services".
They "deputise" for local GP practices when their offices are shut. In theory, anyway.
One of the leading private firms is Newcastle After-Hours Medical Service (NAHMS), part-owned by (non-doctor) Peter Court.
Court is not entirely critical of GP Access.
He says if it's the "Rolls Royce service", his is like "the NRMA patching you up until tomorrow".
He says that "about half" of the Hunter's GP surgeries switch their phones through to GP Access, and the other half through to NAHMS.
His partner in NAHMS is the entrepreneurial Dr Andrew Walker, who took his medical degree at the University of Newcastle. Walker and the Mayfield-born Glenn Keys, an engineering graduate, went on to form Aspen Medical, which has grown to become a global provider of healthcare services to governments and defence services, as well as the resources and humanitarian sectors.
Court reels off a string of complaints about the difficulties the various regulatory bodies and doctors' colleges create for his roster of mostly overseas doctors, and he says the modern-day GP doesn't want to work the sort of hours that the doctors of previous generation accepted as part of the price of the job.
Dr Annette Carruthers, a Lake Macquarie GP who has been with GP Access from the start, has similar things to say about younger doctors, even if she phrases them a bit more diplomatically than Court, who says, simply, that most doctors nowadays "are lazy".
Carruthers blames student fees.
As someone who studied medicine under a Commonwealth Scholarship, Carruthers said it left her with an ethic of giving to the community. Today's students paying fees of $250,000 or tend to have a more profit-oriented outlook, she says.
Whatever the reasons, GP Access is finding it harder to recruit doctors to its service, with its numbers down to 190 from about 250 a decade ago.
Carruthers says Greater Newcastle has about 600 GPs.
Court says he was already in the after-hours game when when Maitland GP Arn Sprogis came up with the GP Access idea.
He says GP Access has made various promises over the years to become "self-funding" - which in this case means existing entirely from Medicare rebates.
Prominent Newcastle lawyer Richard Anicich, who chairs Hunter Primary Care, says he is unaware of any such pledge.
Regardless, it's the model the government wants, as Carruthers acknowledges.
Hunter Primary Care has a new annual report due soon, but its 2020 report puts the funding at $7.74million. Dr Lee Fong, who is GP Access clinical director, president of the GP Deputising Association and secretary of the Hunter General Practitioners Association, says about $4million of this is in dedicated or block funding, with more than $3million in rebates.
Carruthers confirmed that the doctors on shift kept 70 per cent of the Medicare rebates, with GP Access taking the other 30 per cent.
I'm told that's more generous than most private practices: Court says his doctors get 65 per cent.
In a 46-page study - The Rise of Medical Deputising Services - produced in 2016 for the Hunter GP Association, Fong says the evidence from detailed Medicare rebate statistics "appears to show" that direct marketed after-hours home visit services" were diverting patients out of daytime GP appointments into the after-hours period, earning per-visit Medicare rebates that were almost four times the size of a standard payment.
The study found "no clear evidence" that the for-profits were helping to reduce emergency department attendances, one of the stated rationale for GP Access.
Court, unsurprisingly, begs to differ.
RECENT GP ACCESS REPORTING:
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Support for GP Access grows with Claydon petition
- Report holds concerns for Hunter GP Access funding
- Carruthers calls for 'proper' funding
- Claydon weighs in on funding
The private operators, through their peak body, the National Association of Medical Deputing Services, had their own research in 2016 by Deloitte Access Economics.
This 70-page study acknowledges big increases in Medicare payments to after-hours services but blames the growth on changes in government policy, rather than being the fault of the after-hours services.
There's more analysis out in the ether but I'm out of space.
Governments don't mind providing services but no-one likes paying for them.
If GP Access wants to retain all of its funding, it's going to have to fight.
