THE decision by a Gunnedah doctor to offer a fee-jumping queue has created controversy in northern medical circles.
It has been revealed that Dr Chris Gittoes has written to locals, effectively selling priority positions “on the books” to 1000 patients for a $140 upfront fee.
The proposal caught the Gunnedah Rural Health Centre board by surprise and outraged some in the community who donated toward getting the centre built.
The board of Gunnedah Rural Health has moved quickly to “dissociate itself from the priority patient plans being proposed by Dr Gittoes”, while Dr Grahame Deane, who has been part of the efforts to build the centre for the past seven years, said he was concerned other doctors would be “tarred with the same brush”.
“This is a decision by one individual doctor,” Dr Deane said.
“At this point, I am concerned this will create a negative impression of the rural health centre.”
But Dr Gittoes stands by his proposal to sell “priority patient plans” for $140 every two years, to be paid upfront, as well as his decision to only allow patients who purchase the plan onto his books.
About a fortnight ago, patients and prospective patients of Dr Gittoes began receiving letters “thanking them for the opportunity to become you regular doctor”.
In the letter, Dr Gittoes explained there was a critical shortage of doctors in Gunnedah “and patients often find it difficult to see a regular doctor”.
“I intend to book up to two weeks in advance,” he wrote.
“I am happy to see any patient; however, while I cannot guarantee you will get a timely appointment every time, I will endeavour to give priority appointments to my regular patients.”
But, in order to become a “regular patient”, Dr Gittoes will charge an upfront fee of $140 every two years.
“Please understand, I have more than enough patients and I am in no way trying to expand my practice,” he wrote.
“In fact, I intend to reduce the number of regular patients on my books to those who want and value a preventative health care approach.
“This is similar to when you board an aeroplane and the pilot has a checksheet to prevent the plane from crashing. Your healthcare is no different.
“The fee for your investment in your health will be $140. Unfortunately, Medicare will only pay for a GP management plan specific for a chronic disease. Please understand you will have to pay for (my) preventative health care plan yourself.”
Dr Gittoes said he would “of course see other patients as time permits” and “I am happy to continue treating you on that basis whenever I can fit you in”.
But some medical leaders have questioned the move.
Dr Deane, who was involved in the GRHC from the first committee meeting on July 28, 2005, said the proposal was in conflict with the GRHC’s objectives of equitable and timely access for all patients in this community-owned, not-for-profit centre.
“The community raised a lot of money towards the centre,” he said.
“Speaking only for myself, I always have and will continue, to bulk-bill the financially disadvantaged in the community.”
Centre practice manager Helene Walsh confirmed most consultations at the GRHC were bulk-billed.
“As a snapshot, exactly 64 per cent of all consultations over the past month were bulk-billed,” Ms Walsh said.
“What has been splashed around over the past several days is only half the story.”
Gunnedah Rural Health Board chairwoman Penny Crawford said the Gittoes letter, which was printed on GRHC letterhead “has not been endorsed by the board and does not have its support”.
She said the board was only made aware of Dr Gittoes’ approach, when a patient who received the letter complained.
“The board wishes to emphasise that this contravenes both GRH policy and the Federal government’s GP Super Clinic objectives of accessible and affordable services,” Ms Crawford said.
“This doctor is an independent medical contractor and is not an employee of the Gunnedah Rural Health
“While health care prevention schemes are a laudable initiative, this particular proposal remains the individual initiative of Dr Gittoes.”
Ms Crawford said Dr Gittoes’ proposal made a mockery of the intents of the Gunnedah Rural Health Centre.
“We are concerned that it will exclude members of the community who are struggling already to cover medical costs,” Ms Crawford said.
“As a GP super clinic, we received $4.3 million in funding from the Federal government. That funding was also granted because we were able to demonstrate a strong level of community support.
“A third of the project cost was raised within the community of Gunnedah – and the people and business organisations within this town have a right to feel they have worked hard towards achieving affordable, accessible health care.
“Additional fees for services, which are within the normal scope of services provided by a GP, make a mockery of those objectives.”
Dr Gittoes had originally agreed to speak to the Namoi Valley Independent last Thursday; however, he postponed and has since been unavailable for comment.
He did tell the Sydney Morning Herald at the weekend, doctors were entitled to some incentives to live in communities which did not have the services and comforts offered by larger towns.
He said he could not make a living from bulk-billing patients.
‘’If I bulk-billed, I’d be earning less than a 24-year-old driving a truck at one of the local mines,” he told the SMH.
-----------------------------------------------------------------------------------------------------------------------NOT SANCTIONED BY GUNNEDAH RURAL HEALTH CENTRE
By Wendy Spooner
NEW England Medicare Local chief executive officer Graeme Kershaw said yesteday he was not aware of the Gittoes proposal.
“In this region, I’m not aware of any instances like this, but I think there’s been some other instances of it ... in Western Australia,” Mr Kershaw said.
“It’s the first time I’ve heard of it in this region.”
Questioned about the preference for most people to be with one doctor for continuity of care, he said a monetary incentive was unnecessary.
“I think most people would like to have continuity of care,” he said.
But he said this was not always the case, depending on people’s circumstances.
“Often people will have more than one doctor they will see,” Mr Kershaw said.
“Not only is there a shortage (of doctors), but people will go and see different
doctors at different times.”
Gunnedah Rural Health Centre chairwoman Penny Crawford said the problem, from the board’s perspective, was that it hadn’t approved the three-page letter, which had been written on GRHC
letterhead and would lead people to think that the board had somehow sanctioned it.
Mrs Crawford said all the doctors at the centre were “individual medical contractors, so they’re not employed by us”.
“The GRHC encourages preventative health. We have not condoned the thought or sanctioned being a private patient (like what Dr Gittoes is proposing).
“A lot of people cannot afford the $140 to become a regular patient – I suppose there are some (who could, but not everyone could).
Dr Gittoes did not return The Leader’s call.