A letter to Greg Hunt about disciplining GPs who do holistic care
To Greg Hunt,
I have grave concerns about the very real harm being done to GPs mental health and to the General Public by the letters being sent to GPs by the government. I think the government will be measuring the effect of them and seeing success, where I measure the effect and see a very real negative outcome.
The level of distress I am seeing amongst GPs in the online community is real, high and appears dangerous. It is interfering with their ability to work and their ability to be with their family. If one GP commits suicide over these letters I feel the government and all of our supporting bodies are complicit and should be held responsible.
When the letters for opioid prescribing came out, they failed to take into account GPs with special interest in palliative care. Falling outside the bellcurve is now a problem. What happened? GPs became scared to fall outside the bellcurve. Some likely stopped providing those services. What did the government see? Reduction in prescribing - SUCCESS. What didn’t they see? Vulnerable patient groups losing services because the few GPs trying to help them were too scared to keep going.
When the letters for risperidone prescribing came out, they failed to take into account GPs who might be seeing patients in assisted living and circumstances where it’s appropriate to prescribe. I was seeing someone with a mental health indication for risperidone. ONE patient I prescribe for ONE patient. I got a letter. I was doing home visits It was already costing me money being away from the clinic to do this extra service, it was already hard work, with lots of extra phone calls. This letter was the straw that broke the camel’s back. I quit. I don’t provide this service. Do you think I’m the only one? NO. What does the government see? SUCCESS. They ‘’fixed’’ my prescribing. What don’t they see? Reduction in services to the most vulnerable members of the community.
Now the letters are going out RE: mental health plans and 23/36 item numbers. I haven’t had one (yet). The ripples for the GPs who have are being heard already. Is it worth it? How many of these vulnerable patients with chronic disease and mental health do we keep on our books? Quite frankly they lose me money. They are often long appts. They book 30 minutes and often can’t show up. I have to do more things in the appt because I never know when they’ll show up again for their incredibly serious medical problem and their incredibly entrenched mental health issues.
It can be hard work having them as patients. But they *need* GPs who will do this for them, who will sit with them and do *all* the things. We are going to be punished. GPs with mental health interests are going to get targeted. Then what’s going to happen? GPs are going to say ‘’It’s not worth it to fall outside the bellcurve, I won’t provide this service’’. They’ll strike these patients off their books and stop seeing as many complex patients. Then the government will say SUCCESS. But what really happened? Reduction in services to the most vulnerable member of the community.
So what is the harm here:
· Increase in mental health distress to GPs
· Reduction in services to patients
· In the long term this will cause an increase cost to the government as these patients will actually have poorer health outcomes and will also have to access health services publicly
Benefits:
· Only the egos of the people who want to feel successful via these campaigns. They get to pat themselves on the back
I hope you are prepared as GPs, no longer able to mentally cope with the constant mental load of both managing patients and trying to double guess medicare’s intention, mass exit to safer careers external to medicare. Already in social media groups GPs are talking about their exit strategies and alternative career options. Please prepare for the same workforce shortage that the UK is facing.
Dr Rebecca