Hunter GPs raise concerns about financial loss of participating in COVID vaccine rollout

Financial modelling by the Australian Association of Practice Management shows some practices stand to lose about $310 per day per vaccinator when Phase 1b of the rollout begins from March 22.

"Once the practices who have signed up figure out it's going to cost them money, I think there is going to be a mass exodus," Dr Allan Kirkpatrick, of Cardiff General Practice, said. "I doodled some sums on the back of an envelope... then I saw the modelling done by the practice manager's association which shows it to be a losing proposition.

"A lot of doctors aren't business people. I think a lot of them are there for the public good and doing it for the community. But the penny might slowly drop that they could lose money from this."

Dr Kirkpatrick's practice was one of 280 across the Hunter New England and Central Coast Primary Health Network deemed eligible to begin delivering the AstraZeneca vaccine later this month. His practice had been approved to administer 100 shots a week - double what most had been given. But they may not proceed because the numbers "just don't stack up".

Doctors would receive about $31 for the first jab, and $27.55 for the second. But the practice - which needed to employ extra staff including a "vaccine concierge" - would only receive 30-to-40 per cent of that. There was a $10 "practice incentive payment" that relied on both doses of the vaccine being administered, which would take "months" to be paid.

"I'm starting to question whether this is going to be viable," Dr Kirkpatrick said. "This could fall over before it has even begun for GPs.

"But I also think a lot of general practices would probably rather lose money than be considered to be not fighting the good fight.

"I'm trying to do everyone a favour here. If all of a sudden the penny drops and general practices just drop it like a hot potato, then the whole thing could fall over."

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Dr John Goswell, the vice-chair of Hunter General Practitioners Association, expects some practices will "think twice" and may decide not to vaccinate due to the risk of making a financial loss. The association had already heard from several concerned local GPs. At least one practice had already withdrawn from Phase 1b.

"Some practices have expressed that they are considering not vaccinating," Dr Goswell said. "Practices have only recently been told their allocated vaccine numbers. For many, this is well below what they offered to do. This makes a considerable difference in terms of finances because it limits the number of extra staff - registered nurses, receptionists, extra doctors, they can afford to employ."

He said the figures shown in the modelling by the practice manager's association looked to be correct, but each practice would need to do their own calculations.

"When we were asked to submit an expression of interest to vaccinate, we did not have many details as to how the vaccination clinics would work," Dr Goswell said. "Details like how many staff members would be needed were essential to calculating the viability."

Time and space requirements were also a factor. He said successive governments had not honoured the commitment to index the Medicare rebates, and the four-year rebate freeze had taken a toll on general practice.

"Freezing the rebates means that they remain lower forever, as there is never any catch-up," he said. "Practice costs have still risen with inflation. The result is that as small businesses, general practices do not have capacity to sustain losses.

"In some clinics, 10 vaccinations will take an hour, in other clinics with low staff numbers, it might take 2.5 hours. GPs are going to have to work an extra hour or more per day for the next 32 weeks in order to see Australia vaccinated. But the GPs are very keen to see their patients vaccinated, and many clinics will run the risk of making a loss in order to see this goal achieved."

Newcastle GP Dr Lee Fong said given the small volumes of vaccine currently available, minimising financial losses would be a "substantial challenge" for many practices unable to use economies of scale. He could see the federal government was trying to strike a balance between a rapid but safe rollout, while managing the budget.

"It's by no means an ideal situation, but it is what it is," Dr Fong said.

"We are very fortunate that our health system is not in the grip of a COVID-19 crisis, unlike many other places around the globe - so a slow roll-out might be a bit frustrating, but it is very unlikely to have any material consequences as far as health goes.

"A bit of patience may be required, but we can literally lean back in a chair at our local café, sip a cappuccino, and wait our turn. Which is an amazing privilege so many of our friends overseas do not have."

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