As non-profit community health clinic Cohealth prepares to scale back GP services, its GPs ask: who will care for the most vulnerable?
If the state or federal government does not step in, some 12,500 patients in central Melbourne will soon be without a GP, doctors with Cohealth clinics are warning.
Last week, Cohealth – a non-profit which operates a number of community health clinics across Melbourne and Tasmania – announced that it would be closing its Collingwood clinic entirely and cutting GP services from its Fitzroy and Kensington clinics from December.
While Cohealth is a non-profit, it operates on a mixed billing model and its GPs are salaried.
“These clinics serve people with multiple, intersecting challenges – chronic illness, trauma, mental illness, homelessness, addiction, or refugee experiences,” Cohealth GPs wrote in a co-signed statement.
“Many of our patients can’t fit into short, simple consultations that keep most bulk-billing clinics financially afloat.
“They need time, patience, and continuity – and that’s exactly what Cohealth’s salaried GPs have provided.”
The GPs are now directly calling on state and federal governments to urgently identify a funding solution.
What’s more, Cohealth’s GPs have been blunt about what they see as the root cause of the clinic’s failure.
“This is not about inefficient management,” they said.
“It’s about a Medicare system that simply doesn’t fund the care that complex patients require.
“Our community health model allows doctors to focus on care, not on billing targets. But when care for the most vulnerable becomes financially unsustainable, the system is broken.”
For years, they said, Cohealth had been absorbing financial losses in the interest of keeping the service running.
“The loss extends beyond patients. It deprives future doctors of the chance to train in ‘deep-end medicine’ – the challenging, messy, deeply human work that reminds us why we became doctors,” the Cohealth GPs said.
“Once these services close, that pathway disappears.
“This is more than a financial decision.
“It is a decision about what kind of society we want to be. Do we turn away from those who are hardest to help, or do we invest in them because that’s what fairness looks like?”
Cohealth GP Dr Wilding told TMR that the incoming bulk billing incentives and PIP would be unlikely to change its fortunes.
“I think [the financial team] said [the incentives] helped by about $250,000 – but it’s $4 million [we need], that’s our problem,” he said.
Part of the problem, Dr Wilding explained, was that around 95% of the patients at Cohealth were higher complexity and had higher care needs.
Even though these patients may be technically eligible for higher-value MBS items like chronic condition care plans, it was not always that simple.
“To say to someone who’s homeless, who can’t afford their medications, and is living an itinerant lifestyle ‘oh, just for the sake of billing, can you tell me your goals for health?’ … they just look at you like they want to punch you and say, ‘I just want to have a house’,” he said.
“That’s not my jurisdiction, and it’s quite an offensive thing to do at times.”
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As a result, around 75% of Cohealth’s income comes from the time-based consult item set, which disincentivises long consults.
“[It is all well and good to say] ‘that patient was worth an extra $600 if you had just come up with a care plan for them’, but that side of things doesn’t gel with our patients,” Dr Wilding said.
“A government person can say, ‘well, you just need to make it gel’, but it’s very, very hard to try and make a high complexity patient fit MBS items, and on a schedule that suits me as a doctor trying to stay financially viable.”
The co-signed statement follows advocacy from the RACGP, AMA Victoria, the Australian Nursing and Midwifery Federation and the Doctors Reform Society.
Doctors Reform Society president Dr Tim Woodruff called Cohealth’s struggles “an appalling sign of a lack of concern by both State and Federal Governments about the health of some of the most disadvantaged Australians”.
“Now the usual game will be played by the State and Federal Governments,” he said.
“’It is not our fault’, each will say.
“This is a pathetic response to a potential life-threatening crisis in access to care.
“The respective health ministers need to be locked in a room and kept there until they come up with a solution.
“Sadly, nothing remotely like that will happen. Patients will die or suffer.
“Governments will pretend they did what they could.”
