Uralla Medical Centre will lock its doors at close of business on Friday 7th June, not to be reopened until another GP can be found.
After a number of previous threats, Dr Riccardo Alkhourie seems certain that he will close, but not sell, his sole practitioner medical centre in Uralla. The closure of the medical centre leaves an anxious wait for patients to find another practice able to take on new clientele. However, with a number of new doctors coming in to Armidale in the last 12 months, the situation is not as dire as it was the last time he claimed to be forced to close to avoid bankruptcy.
Claims the system is stacked
In an address to the patients and Uralla community via Facebook and YouTube on Sunday 12th May, Dr Alkhourie claimed some disadvantages to operating a rural General Practice, compared to metropolitan counterparts.
“So you think doctors are making money, but not in the country when you have only a solo practitioner,” said Dr Alkhourie.
Dr Alkhourie cited many reasons for his decision to close the practice, including what he claims are city-centric Medicare bulk billing incentives, changes to medical student training and ongoing and ever increasing cost of practice accreditation.
“If you go to any bulk billing Clinic in the city, the maximum length of consultation is ten minutes. This means the doctors see at least six patients per hour,” said Dr Alkhourie.
It is unclear what Dr Alkhourie believes is the advantage paid to city general practitioners, but he certainly will not be paid as much at his new position in Brisbane as he receives from Medicare for seeing a patient in Uralla. As a town with less than 5000 residents, Uralla is classified as MM 5 under the Modified Monash Model, attracting a long list of incentives, funding, grants, and other measures to support operation of a medical practice. All Medicare bulk billing rates paid to a clinic in an MM 5 area are 170%, or almost twice, the rate paid to a clinic in Sydney or Brisbane.
Dr Alkhourie incorrectly claimed the bulk billing incentive was attached to standard consultations, but did not include mental health consultations, NDIS Management Plan consults, or chronic disease management.
“I count mostly on management plans so I would be lucky to see more than three patients an hour. At least one of those would be management plan or management plan review, or long mental health consultation, so the face-to-face consultations I get Medicare incentive on would only be two per hour.”
Bulk billing incentives are an additional payment made to assist doctors in not charging up front fees to vulnerable groups, specifically children under 16 and anyone with a concession card. Like the standard bulk billing rates, incentives paid to a clinic in Uralla are 170% the rate paid to the city. Bulk billing incentives are paid on chronic health and mental health management plans, however, the already higher incentive for these items was not tripled as the incentive for general appointments was last year.
Dr Alkhourie caused great alarm in the community last year when his clinic had its accreditation revoked, resulting in a loss of funding. He blamed the system and demanded political intervention, but it later appeared it was his own lack of understanding of requirements rather than any failure of bureaucracy that led to the crisis for the small centre. Then, in a nearly five hour long Facebook live, he demanded the Uralla Shire Council build him a new clinic, and revealed that his primary driver was wealth, wanting, among other things, to not pay tax for five years and go on more overseas holidays with his family.
Patients do have options
While this centre closes its doors, it is not the only doctor in Uralla. The Uralla Clinic, which has operated for 50 years in Bridge Street, has been forced to differentiate itself from the Uralla Medical Centre and assure people they have no plans to close a number of times. The two doctors at the Uralla Clinic are making every possible effort to support the elderly residents within the community.
“We are doing our best to take new patients, however we are already overextended as both our doctors only work here part time,” said Uralla Clinic Practice Manager, Dannielle Batt.
“This has been a surprise to us so we are trying to work out what we can do at the moment.”
“We have taken on a number of elderly Uralla residents already, but we have had to stop accepting new patients until we can come up with a plan for going forward. It is important to have the capacity to look after our existing patients.”
Availability of GPs in the area has improved from the intense situation of early last year, but Dr Michelle Guppy from the New England Division of General Practice says the situation is still critical.
“Yes, some clinics are taking new patients and we’ve had several new doctors start in Armidale in the last 12 months, but waiting lists to see a GP are still very long.”
“We’re working really hard for our community to try and find solutions to this.”
Concern about McMaugh Gardens
Of great concern within the Uralla community is the support of residents of the not-for-profit Aged Care facility, McMaugh Gardens. This facility is fully accredited by the Commonwealth Government and is operated by the Uralla Shire Council.
“Council values the important role general practitioners play in small communities such as ours, and we thank Dr Riccardo for his contribution to Uralla Shire over the last 12 years,” said Mr Mick Raby, acting General Manager of Uralla Shire Council.
“Local GP services are an important part of the overall care plan for our residents and the loss of the GP services to McMaugh Gardens means that we will need to adapt the way in which we deliver quality aged care.”
“Whilst we are optimistic that a new GP service will establish itself, in the interim we will be implementing a range of service delivery options including the potential for telehealth and or locum GP services to ensure the continuation of quality care.”
“Overall, McMaugh Gardens preference is to restore personal GP services for our residents. We will be supporting our community in advocating for locally based medical services.”
The Hunter New England Local Health District was asked if they would be providing any additional support to the facility, but they said they have no role and the Armidale Regional Hospital would continue to support patients when they were brought to Emergency, 20 minutes drive away. (Uralla does not have a hospital.)
Broader impact on the town
President of the Uralla Shire Business Chamber, Mr David Mailler, has also reiterated the flow on effects of losing a Doctor.
“It’s not just losing a Doctor, which is a huge loss in itself, it’s also losing the four trained staff,” said Mr Mailler.
“The loss of jobs effects the livelihood of these families with the potential loss of these families from our community, which is also the loss of kids from our Schools and the loss of capital circulating through our town’s economy.”
“Losing a doctor is not just a medical issue, it’s a blow to the whole town.”
Closing but not selling?
While Dr Alkhourie is closing his Practice, he will endeavour to maintain doctor services for McMaugh Gardens residents, including any new patients. He will not be accepting new patients from other Armidale-based Aged Care facilities he works with including Bupa, Ken Thompson Lodge and Autumn Lodge.
“I’m actually not selling the Medical Centre,” said Dr Alkhourie.
“I’m leaving the clinic fully equipped for not less than one year. I’m not selling anything in it, so this gives a chance for the community to find a solution.”
He is selling patient records, charging $25 per patient, $10 for concession card holders, to provide people with a copy of their medical history. Patients wishing to obtain their medical records can contact the centre by email at office@urallamc.com.au.
Like what you’re reading? Support The New England Times by making a small donation today and help us keep delivering local news paywall-free. Donate now