I am concerned that the recent recommendations of the GPSC, who were charged with the task of strengthening family practice, have weakened the incentive to continue with an important responsibility of GP work.
At present a number of GPs do more than their proportional share of nursing home care because some GPs have opted out of most nursing home work. They don’t like it or it doesn’t pay. A care coordinator for a home who cannot get GPs to accept care because of the inadequate fee confirmed this.
Most of our patients who go into nursing homes cannot choose to go to a particular nursing home so may move to an area inconvenient for their GP to visit, so most homes have a “house” doctor. For this 00114 we get paid two-thirds what we would get paid if the patients came to the office. There is still the same overhead for our MOA and rent in that time. The concept that there is no overhead is so obviously wrong. We also have to travel to the home and write notes there and keep records in the office. We spend more time to provide care for less than two-thirds the fee. The fee schedule accepts that care of older people is more complex, but for some reason only if it’s in the office!
The proposal is to reduce the 00114 to every 4 weeks from 2 weeks. If a visit is required before 4 weeks a “comment” will need to be written. This is ridiculous because the extra time spent “commenting” will make the payment worse. (Commenting also results in a delay in payment.) My practice is to only see patients that the nurses want me to see or who need follow-up from a previous visit. We don’t need to comment in the office for the same situation.
GPs have already dropped out of hospital work because of being fiscally abused, only to see the hospitalists get paid a fairer income. We should be getting paid the same rate as an office visit and be allowed to see people when needed—as applies to the office.
The proposals were intended to strengthen full-service GP work and maybe penalize the walk-in type of practice. This will do the opposite.
—David Brough, MD
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