GP Snapshot Survey
Accepting new patients and bulk billing in Canberra General Practice
Report by Dr Marjan Kljakovic
The Canberra GP task force undertook an audit survey of general practices in the Canberra region in June 2009. The aim was to gather data that could inform health service questions including what proportion of general practices in the ACT were taking on new patients? Which group of patients continued to be bulk billed by practices? How many practices had practice nurses working there? And did practices have GPs who would visit local residential aged care facilities?
The task force complied a list of 100 names and telephone numbers of general practices in the ACT region of which 16 were not contacted for the survey. Two were individual GPs who were part of larger practices; three had closed in 2009, and 11 offered specialised services that were outside the scope of general practice (E.g. sports clinics, youth services, skin clinics etc).
Each practice was asked a set of seven questions listed in Table 1. Analyses were done to determine responses to questions in terms of the size of a practice. All data were entered into SPSS and analysed in the usual manner. Ethical approval was not obtained because the project involved an anonymous audit of information that was publicly available. No identifying information was collected, nor reported.
Among the 84 general practices that could be contacted by telephone, 80 practices responded (95% response rate). Among the four non-responding practices two practices were too busy to answer questions and two practices did not answer the calls despite four attempts at different times of day and different days of week.
There were 74 receptionists (92%) who gave information about the practice, four practice managers, one practice nurse, and one GP. The responses to the questions are listed in Table 1.
The distribution of GPs working within general practices varied across the ACT. A small practice was defined as having 1 to 3 GPs working there (n= 40 practices, 50%); A medium practice was defined as having 4 to 10 GPs working there (n=35 practices, 44%); A large practice was defined as having 11 or more GPs working there (n= 5 practices, 6%).
There were 35 part-time practice nurses and 25 full-time practice nurses working in the ACT. The mean (SE) part-time practice nurses per practice was 1.9 (0.207) (range 1 to 6). The mean (SE) full-time practice nurses per practice was 1.16 (0.095) (range 1 to 3).
Increasing numbers of GPs within a practice was associated with having a practice nurse within the practice: 48% of small practices had at least one practice nurse compared to 91% of medium sized practices and 100% of large practices. (Chi squared =18.905, df=2, p=0.000). There was no relationship between the number of GPs in a practice and the practice taking on new patients, their bulk billing policies, and the likelihood of GPs visiting a local aged care facility.
There were 22 practices (28%) that accepted any new patient into the practice and 28 practices (35%) that accepted new patients under certain conditions as described in Table 1. The most common conditions for taking new patients was either to accept particular patient groups (e.g. only accepting university students), or that some GPs within the practice were taking new patients.
There were 45 practices (56%) that had GPs who visited residential aged care facilities and nine practices (11%) that had GPs who visited aged patients who were part of the practice and lived close by. The mean (SE) number of residential aged care facilities per ACT practice was 3.88 (0.366) (range 1 to 8).
There was a complex relationship between practices accepting new patients and practices that had GPs who visited their local residential aged care facilities. More practices had GPs visiting local aged care facilities if the practice was not accepting any new patients (n=22, 76%), compared to practices that had conditions for accepting new patients (n=16, 57%), or were accepting any new patients (n=7, 31%) (Chi squared = 9.90, df=2 p=0.007). There was no relationship between the practice accepting new patients, their bulk billing policies, and the presence of a practice nurse in the practice.
There were seven practices (9%) that bulked billed all patients for consultations and 51 practices (64%) that bulked billed under certain conditions as described in Table 1. There were 14 practices (17%) that bulk billed for children under 16, 21 practices (26%) that bulk billed for the Healthcare Card, and 21 practices (26%) bulk billed for the Pension Card. The most common condition on bulk billing was the GP choosing to bulk bill on a case-by-case basis. There was no relationship between practices' bulk billing policies, and all the previously mentioned practice characteristics.
Ninety five percent of general practices in the ACT were willing to inform the GP taskforce on how their practice operated. The majority of practices were providing considerable primary health care to the Canberra community: About a third of practices were taking on new patients; two-thirds of practices bulk billed patients in some form; two-thirds of practices had at least one practice nurse working in the practice; and just over half the practices had GPs who would visit their local aged-care facilities.
There were unique and paradoxical patterns of service provision across the ACT. Small practices were less likely to have a practice nurse working on the premises even though half of all practices in the ACT had small numbers of GPs. A small proportion of practices in the ACT (about a third) were not accepting any new patients, yet these practices were more likely to visit local aged care facilities compared to the practices that had open books. These paradoxes are evident because of a workforce shortage of both GPs and practice nurses across the ACT.
Responses to survey questions
A table containing answers to the questions asked of 82 general practices in Canberra about accepting new patients, eligibility for bulk billing a consultation, the frequency of GP visits to local aged care facilities, and the presence of practice nurses can be downloaded below: