❓ Mr Cook questions the Minister for Health about the closure of a bulk-billing general practice at Fremantle Hospital. The Minister explains the situation, citing financial viability issues and a need for a tender process.
AnsweredQoN 132Legislative Assembly
QuestionView source ↗
FREMANTLE HOSPITAL — BULK-BILLING
GENERAL PRACTICE
132. Mr R.H. COOK to the Minister for Health:
I refer to the bulk-billing general practice at Fremantle
Hospital, which will close on 3 April unless the minister intervenes to save
the service on behalf of the people of Fremantle.
(1) What did the
minister's department do to stop the clinic from closing when he was
contacted earlier in the year?
(2) If the
minister is not prepared to save this clinic, will he guarantee that a new
bulk-billing practice will replace it on 3 April?
GENERAL PRACTICE
132. Mr R.H. COOK to the Minister for Health:
I refer to the bulk-billing general practice at Fremantle
Hospital, which will close on 3 April unless the minister intervenes to save
the service on behalf of the people of Fremantle.
(1) What did the
minister's department do to stop the clinic from closing when he was
contacted earlier in the year?
(2) If the
minister is not prepared to save this clinic, will he guarantee that a new
bulk-billing practice will replace it on 3 April?
AnswerView source ↗
(1)–(2) I
have had a conversation about this. In fact, at the invitation of the member
for Fremantle, who came with me, I visited the clinic to discuss the problems
that it was having. I forget when it was. I think it was about six or eight
months ago that the member and I went down there. I sat at the table and talked
to the doctors who were practising there about the difficulties they were
having. It must be remembered that this practice operates during the daytime.
In the evening, a totally different practice takes over and does the
after-hours work at that clinic. That clinic does the same as other after-hours
practices that exist at Armadale, Rockingham and Royal Perth Hospital. The
standard practice is that they bulk-bill most patients. A $20 gap is charged
for those who have the capacity to pay, but most people, particularly
pensioners and Seniors Health Card holders, are bulk-billed.
Mr R.H. Cook : So
will it be a new bulk-billing service?
Dr K.D. HAMES : I
will get to that.
That happens at those practices, including the Fremantle
practice. One of the difficulties that practice has in being financially viable
is the time that it takes to look after the sorts of patients that practice has
there. Often there are detailed problems with psychiatric illness and the like,
and it is very hard for those practitioners, under the bulk-billing system, to
run a practice that makes a profit. We provide that space that they use free of
charge, and I think we provide cleaning services as well. So we already support
that practice. I have to say that, from my own experience of running a GP
practice, I gave them advice, because I do not think they were operating in a
sufficiently efficient manner to be able to make that practice viable. Indeed,
that is what has happened now. The practice has reached a stage at which it is
not viable and is unable to generate sufficient funds.
It is my view that we need to go to other practices,
including the one that practises there after hours, to see whether another
practice wishes to take over and provide that same standard of service. The
problem is that under the Public Sector Management Act —
Mr R.H. Cook : So
this will happen by next week?
Mr
M. McGowan : By next week?
Dr K.D. HAMES : We
had discussions with the practitioners—I did not, but my senior staff
did. They initially asked for some money to see them through the changeover, to
pay the doctors who were there and to pay the bills. Indeed, we offered to
provide some money. I forget how much it was. It was $3 000 or $4 000, or
something of that order, a week—or it could have been a month—to
assist. I am sorry; I do not know the figure. Anyway, we offered to provide
some money to help them pay the staff they had while we went through the tender
process. They declined that in the end, and obviously a campaign is being
mounted to keep that practice there. My advice is that under the Public Sector
Management Act we need to go to tender for the practice, rather than just
provide additional moneys to support a private practice that is not operating
as a part of government. The staff are not employed by us; they do not work for
us. It is a private operation. We are coming to an arrangement with a general
practice in the area—I am not sure whether it is the night-time
practice or a different group—to keep that service going while we go
through that process. It will take a couple of months, I gather, to go through
the process.
Several members interjected.
Dr K.D. HAMES : That
is what all the others do. That practice bulk-billed all the time, but my
understanding is that it has changed lately to try to generate more income, so
it has been charging that gap to those who have the capacity to pay. It is my
anticipation that whoever wins that tender, as was done under the Labor Party
when it was in government, will do the same for Royal Perth Hospital and
certainly for some of those other clinics. The then Labor government went out
to tender and it appointed general practices at hospitals. I remember that Hon Jim
McGinty coordinated that. I thought it was a good idea. Those practices have an
arrangement, which the previous Labor government put in place, that allows
those doctors to charge the $20 gap to people who have the capacity to pay.
Mr R.H. Cook : So
there will be a practice there next week?
Dr K.D. HAMES : I
do not know whether that practice will stay there, but it is our intention to
have a practice operating there during the day. It is of great benefit to us at
the hospital. The Deputy Leader of the Opposition will have seen the comments
of the nurse who works there, and I agree with them totally. It is a great
service, and patients who would otherwise take up a lot of time in the
emergency department are being well managed there. I think this practice has
done a very good job and has provided an excellent service. Sadly, it is not
able to continue in a viable manner without government help. If the government
provides help, there is a requirement for it to go to tender to get the best
value for money for the taxpayer and to get the highest quality standard of
service that it can.
have had a conversation about this. In fact, at the invitation of the member
for Fremantle, who came with me, I visited the clinic to discuss the problems
that it was having. I forget when it was. I think it was about six or eight
months ago that the member and I went down there. I sat at the table and talked
to the doctors who were practising there about the difficulties they were
having. It must be remembered that this practice operates during the daytime.
In the evening, a totally different practice takes over and does the
after-hours work at that clinic. That clinic does the same as other after-hours
practices that exist at Armadale, Rockingham and Royal Perth Hospital. The
standard practice is that they bulk-bill most patients. A $20 gap is charged
for those who have the capacity to pay, but most people, particularly
pensioners and Seniors Health Card holders, are bulk-billed.
Mr R.H. Cook : So
will it be a new bulk-billing service?
Dr K.D. HAMES : I
will get to that.
That happens at those practices, including the Fremantle
practice. One of the difficulties that practice has in being financially viable
is the time that it takes to look after the sorts of patients that practice has
there. Often there are detailed problems with psychiatric illness and the like,
and it is very hard for those practitioners, under the bulk-billing system, to
run a practice that makes a profit. We provide that space that they use free of
charge, and I think we provide cleaning services as well. So we already support
that practice. I have to say that, from my own experience of running a GP
practice, I gave them advice, because I do not think they were operating in a
sufficiently efficient manner to be able to make that practice viable. Indeed,
that is what has happened now. The practice has reached a stage at which it is
not viable and is unable to generate sufficient funds.
It is my view that we need to go to other practices,
including the one that practises there after hours, to see whether another
practice wishes to take over and provide that same standard of service. The
problem is that under the Public Sector Management Act —
Mr R.H. Cook : So
this will happen by next week?
Mr
M. McGowan : By next week?
Dr K.D. HAMES : We
had discussions with the practitioners—I did not, but my senior staff
did. They initially asked for some money to see them through the changeover, to
pay the doctors who were there and to pay the bills. Indeed, we offered to
provide some money. I forget how much it was. It was $3 000 or $4 000, or
something of that order, a week—or it could have been a month—to
assist. I am sorry; I do not know the figure. Anyway, we offered to provide
some money to help them pay the staff they had while we went through the tender
process. They declined that in the end, and obviously a campaign is being
mounted to keep that practice there. My advice is that under the Public Sector
Management Act we need to go to tender for the practice, rather than just
provide additional moneys to support a private practice that is not operating
as a part of government. The staff are not employed by us; they do not work for
us. It is a private operation. We are coming to an arrangement with a general
practice in the area—I am not sure whether it is the night-time
practice or a different group—to keep that service going while we go
through that process. It will take a couple of months, I gather, to go through
the process.
Several members interjected.
Dr K.D. HAMES : That
is what all the others do. That practice bulk-billed all the time, but my
understanding is that it has changed lately to try to generate more income, so
it has been charging that gap to those who have the capacity to pay. It is my
anticipation that whoever wins that tender, as was done under the Labor Party
when it was in government, will do the same for Royal Perth Hospital and
certainly for some of those other clinics. The then Labor government went out
to tender and it appointed general practices at hospitals. I remember that Hon Jim
McGinty coordinated that. I thought it was a good idea. Those practices have an
arrangement, which the previous Labor government put in place, that allows
those doctors to charge the $20 gap to people who have the capacity to pay.
Mr R.H. Cook : So
there will be a practice there next week?
Dr K.D. HAMES : I
do not know whether that practice will stay there, but it is our intention to
have a practice operating there during the day. It is of great benefit to us at
the hospital. The Deputy Leader of the Opposition will have seen the comments
of the nurse who works there, and I agree with them totally. It is a great
service, and patients who would otherwise take up a lot of time in the
emergency department are being well managed there. I think this practice has
done a very good job and has provided an excellent service. Sadly, it is not
able to continue in a viable manner without government help. If the government
provides help, there is a requirement for it to go to tender to get the best
value for money for the taxpayer and to get the highest quality standard of
service that it can.
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