GP Consult Update: Supporting the Vulnerable
The CBD practice owned by former AMA SA President Dr Jill Maxwell is demonstrating the rewards – and costs – of providing care to vulnerable patients, writes Dr Jess Donaghue.
By Dr Jess Donaghue, AMA SA Committee for General Practice.
A philosophy grounded in the belief that every person is entitled to excellent physical, mental and emotional care is the foundation of Adelaide City General Practice’s efforts to provide services to vulnerable people. The Adelaide PHN recognised this work in 2024 in by awarding Adelaide City General Practice a Health Equity Award.
As a GP at this practice, owned by former AMA SA President Dr Jill Maxwell OAM, I’ve been proud to support the efforts of Jill and everyone at Adelaide City to reach people and groups that so often have limited access to care.
Jill’s philosophy is shared by all of us at the practice, motivating us to welcome and support people of all ages, socio-economic and cultural backgrounds. And it’s not new – Jill has been providing care to people with disabilities since the 1990s, and in 2011 expanded her services for the vulnerable when she responded to a call to support patients from refugee and asylum seeker backgrounds.
Adelaide City General Practice’s involvement with large numbers of patients from refugee and asylum-seeker backgrounds began in 2011. In 2023, the practice provided 781 interpreter-supported consultations, among which 599 involved on-site interpreters and 182 phone interpreters.
In 2015, the practice responded to a request for GPs interested in providing services at the Hutt Street Centre for Homeless People, and since then has run a weekly GP clinic at what is now the Hutt Street Centre. During 2023, the practice provided 247 consultations to patients at the Centre.
For 20 years, the practice has run two clinics each week for people with severe disabilities in residential aged care – with more than 650 consultations in 2023 – in addition to caring for people with disabilities at our accessible clinic. In recent years the practice has established a relationship with Lifetime Support Authority (LSA), which supports people with significant and long-term acquired disabilities as a result of motor vehicle accidents.
More recently, I’ve joined the practice, adding my interest in caring for members of trans, gender diverse and non-binary communities. My aim is to provide holistic care to a demographic of people who have a range of healthcare needs, and who have often struggled to access care in our current health system. I knew the philosophy of the practice would fit with my own when I approached them, and my patient cohort has been welcomed.
Unfortunately, Medicare doesn’t offer much to relieve the pressure on practices like ours that want to do right by vulnerable patients, most of whom have complex needs and require long consultations. It’s not easy to obtain the information we need and to make a difference in anything less than 30 minutes. With that timeframe, we receive $43.70 in bulk-billing incentives for an hour, compared to more than $130 in bulk-billing incentives for a GP seeing six bulk-billed patients an hour.
Practices such as Adelaide City General Practice rely on many patients paying private fees, well above the Medicare rebates, to enable the practice to continue to provide much-needed services to vulnerable populations with complex needs. A policy of significantly increasing Medicare rebates, rather than just the bulk billing incentives, for all consultations would benefit all patients, including those who are, and will continue to be billed privately. These patients have received very little increase in their rebates for many years.
In the meantime, the practice has been very fortunate to be supported by Adelaide PHN for a 12-month project to improve access to primary health services for people experiencing homelessness. This will enable the practice to increase the number of clinics provided at Hutt Street Centre and to employ a nurse to support our GPs. A significant focus of this project will be to address chronic condition management and increase access to Medicare-funded allied health services – which is exactly the model the AMA is calling for to increase access to primary care.
- Dr Jess Donaghue is a member of the AMA SA Committee of General Practice.