Exclusive: ‘I can’t keep doing this. I need help’: Cohealth GP

On the day the final report was released, a Cohealth GP has spoken to HSD about what they’re trying to do to keep the embattled health service afloat.

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Dr Simon Wilding has been a Cohealth GP for over 20 years. He divides his time between working at the Cohealth Fitzroy and Collingwood clinics and private GP practice in Melbourne.

He notes that his patients at Cohealth are different from those at the private practice. While both have their fair share of complex medical issues, it’s the community support that the Cohealth patients lack.

“It’s a very different way of treating someone with diabetes at Cohealth than in my city clinic.

“Every clinic has a percentage of complex medical issue patients who lack social supports. It’s just that a clinic like Cohealth has very high numbers of that,” he said.

In terms of how that works in general practice, as the Cohealth independent review identified, there’s limited funding to make it work.

Which is why Dr Wilding and a handful of his colleagues have been working on another model. He’s spent the last few months looking into what the government meant by multidisciplinary model of care in the 2022 Strengthening Medicare Taskforce.

“I’ve spent maybe 50 or 60 hours of my own time just investigating that, along with a few of my colleagues. You could ask, why hasn’t Cohealth looked into that a couple of years ago?

“The reason is the model doesn’t exist, and we haven’t been funded to look into that,” he said.

“I’m already giving up dozens and dozens of hours, because I want my patients to have a better service, but I can’t keep doing this. I need help,” he said.

The premise is a multidisciplinary, team-based primary care model. Care would be delivered by a team, not just a GP.

“Instead of walking to a clinic saying I need to see my GP, the next appointments in six weeks, and then heading off to the pharmacist to get their treatment for the pill, or whatever.

“We want the model to be – the patient contacting the centre, saying ‘I need to meet with my treatment team’, and that treatment team has a GP, a registered nurse or a nurse practitioner, a clinical care coordinator, and our receptionist, who are our client services officers.

“So the patient can then contact their care team. The care team is able to work out what the needs are, and then everyone within the care team gets to work at their top of scope, which is a really important concept for primary care to embrace in Australia,” he said.

This was one of the core recommendations from the review, released today, with Cohealth recommended as the pilot model.

“Recommendation 5: We recommended the Commonwealth consider using Cohealth as a pilot for a new approach to funding multidisciplinary teams in primary medical services.

“Specifically, we recommend that:

• “The Commonwealth Minister for Health and Ageing provide a Health Program Grant to cohealth under Part IV of Health Insurance Act in lieu of Medicare rebates and the full bulk-billing incentive payments.
• “The basis for the grant would be rebates calculated according to the cost to the government if services provided by cohealth GPs were billed on Medicare. That is, services provided by cohealth would be notified to the Commonwealth as currently, with the Health Program Grant being based on those notifications.”

Cohealth was also tasked with codesigning its own single model of care for all of GP clinics that will ensure practice viability in the context of the new revenue streams.

However Dr Wilding said for it to really work, they needed government support.

“We’ve been constantly hamstrung by not really knowing whether the government’s going to do this or that.

“We’ve got a group of GPs and a clinic and an executive that’s actually quite inspired by what we understand the report and the recommendations to promote, and we’re ready to go.

“But we know that first, this particular model of care that’s reliant on Medicare does not exist yet. It exists under blended funding in AACHOs and other areas, but not purely under Medicare rebates to GPs.

“It’s like we’ve been given the designs of a house by the government, and then just a hammer,” he said.

He said they’re appreciative of what the government has done to help the clinic stay afloat.

“But we want them to come on board with our ongoing desire to build this new model of care. We know the resources up to this point haven’t proven adequate, and we want them to keep stepping in and support us in this.”

In response to the review, a government spokesperson said:

“The Commonwealth will consider all recommendations in the review, which identified the need for changes to Cohealth’s governance, management and service delivery models to support long-term sustainability of the general practices.”