A new model of care and in‐house general practitioners for residential aged care facilities

To the Editor: We read the recent article from Haines and colleagues1 with interest and noted that it is featured on the front cover of the print version of the Journal. We agree that the Bupa model for provision of general practitioner services to residents of aged care facilities has promise, as illustrated by this study.

However, we wish to point out that, despite these promising findings, this Bupa model has been terminated. The arrangement at the time of the Haines study (2012–2014), whereby GPs were employed by the company as part of a broader care model to provide medical services to residents of Bupa aged care facilities, no longer exists — as known among GPs and in the industry.

That care model was reviewed and Bupa GPs were taken off salary when it was observed that GP Medicare billings did not match or exceeded their income. They were advised that they could continue only as contractors, with financial reimbursement being made through their Medicare billings alone. A handful of GPs apparently have remained on salary and they are those who are able to ensure that their billings cover their income.

Most GPs chose to sever their ties once the focus of the company shifted. Some remain as contractors, with the acknowledgement that their relationship within the care home has changed. The responsibilities of education, meeting attendance and audits, which are not eligible for a Medicare rebate, are no longer performed. The termination of Bupa GPs as salaried employees coincided with other changes within the care staff structure.

We interpret this to mean that promising models of practice that may improve the health of people living in residential aged care facilities can be compromised by corporate decision making that has motivations in addition to, or even at variance with, provision of good health care. Our interpretation is based on the contamination‐adjusted intention‐to‐treat analyses presented by Haines and colleagues.