Valuing general practice
- On 02/10/2016
The Schwarz Family Practice has experienced dramatic growth in the last 30 years, much like the area of Camden in which it is located. Despite this evolution, maintaining a high quality of care remains at the heart of this surgery.
What strikes most visitors about ‘Historic Camden’ is just how green it is. Roughly 65 km from Sydney CBD, the area is also known as ‘Cowpastures’, so named after a herd of cattle that disappeared was rediscovered there in 1795.
Dr Matthew Gray said there still isn’t a stop light between his surgery, Schwarz Family Practice, and his home – although recent construction has slowed his commute.
In fact, the construction is probably the second thing most visitors note. After the Hume Highway turnoff, the number of diggers, bulldozers, and backhoes gives evidence to a community that is starting to swell.
Schwarz Family Practice was established in 1984 by Dr John Schwarz, who continues to work part-time. His daughter, Dr Jane Gray, joined the practice in 1998 and is a principal alongside her husband Matthew.
The clinic has expanded significantly in the last three decades – from being a single consulting room attached to the Schwarz family home – to a large, modern premise that enjoys a rural outlook.
It now has 12 permanent doctors, five GP registrars, three nurses and more than 20 support staff. In addition to medical consultations, it features an onsite pharmacy, pathology collection centre and podiatrist. Other allied providers include a visiting audiologist, clinical psychologist, an exercise physiologist and a dietician.
Its patient base includes a broad crosssection of the community, catering to the many new families moving into the area, as well as Camden’s well established senior residents, many of whom have chronic or complex care needs.
Schwarz Family Practice is a private billing general practice, but its transition to fee for service has been gradual. Dr Schwarz opened his practice the same year Medicare was launched in Australia.
“The rebate was a fair and reasonable fee when it was introduced, but there’s been a very modest indexing of the rebate since that time,” Dr Matthew Gray said. “Fifteen years down the track there was recognition that to continue to provide the quality of care for our patients it wasn’t sustainable to stick with bulk billing.”
“Towards the end of 2014 there were some proposed changes to the way general practice is funded and an expectation by the Government that we would charge a gap payment to patients. What we recognised is that whilst when Medicare was introduced the rebate was probably a fair and reasonable reflection of the costs and value of the service that general practice provides, what we’ve seen overtime is a very modest increase in the rebate and a significant increase in costs. So to be able to provide the quality of care that we desired, we recognised that a move to increased private billing was required.”
While continuing to bulk bill some concession card holders and children under 16, the practice altered its fee for service guidelines with a view to increase private billing to 60%. Dr Gray said the Government’s copayment campaign made the transition very topical.
“In fact, so many patients were coming in saying ‘what’s this mean for us, are we going to have to start paying?’ And it was quite an impetus to have the conversation with them, to say ‘yes, the rebate is not growing with inflation and for us to be able to continue to provide the quality of care that we want to provide, then we need charge a fee’.”
The actual transition to increased private billing took about a month. The practice used that time leading up to the start date to create detailed letters explaining why they considered it necessary and preparing staff to communicate the changes to patients. They placed posters around the practice and provided staff
with a cohesive message that was fairly simple and easy to explain.
When the changes were made, Dr Gray said the reaction from patients was generally one of acceptance and they didn’t see a drop in patient numbers.
Looking back at the recent transition, Dr Gray admitted there was some fear. Despite Camden being a pocket of relative affluence, the South Western region is generally socio-economically disadvantaged. There are also several other general practices in the area, some of which are 100% bulk billing.
“The obstacle for me was the fear of losing patients. And I guess as a profession and as individuals, we didn’t go into medicine to have the economics of general practice as the centre of what we do.”
However, he added, “We have to be comfortable that we’re adding value to people’s lives. And if the rebate doesn’t recognise the value of the service and the cost of providing the service then that’s a political discussion. But we need to be able to recognise the value of our service and price it at an appropriate level, while acknowledging the people who are less able to pay and giving them a discounted or bulk billed rate.”
Dr Gray predicts that the future of general practice is healthy, but GPs have to be prepared to meet the challenges that come with providing quality care.
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