6 NEWS
6 NEWS
14 JULY 2023 ausdoc . com . au
GPs and the specialty ’ s payroll tax fightback
Dr Matt Young .
PAGE 5
The image provoked a little laughter , but the point was made .
Mr Ryan even mentioned the potential importance of changing the words on the practice website .
So Dr Blogs should no longer be described as one of the clinic ’ s doctors ( with the implication they were employees ) but as ‘ your doctor ’, with the implication that the arrangement is between the GP and the patient . Some practices are already doing
Optimal dosing opt in to life . * 1-5
the edits apparently .
But the issue for both lawyers and accountants is simply that greater legal clarity is required to guide the actual responses of GP practice owners .
Given the Thomas and Naaz structures weren ’ t typical — a product of a business seeing a need to apply a heavy hand to the doings of the GPs — another test case is needed , a practice owner willing to seek a court judgement on a structure more reflective of the wider reality .
lets your PEI patients
*
Optimal dosing of Creon ® can lead to an improved quality of life . 1 – 5 Creon ® can optimise nutritional status and normalise digestion , pain , and bowel movements , which may improve QoL in patients with PEI . 5 , 6
Suggested adult maintenance dosing : 1 , 5 ® ®
PEI , pancreatic exocrine insufficiency ; QoL , quality of life .
PBS Information : Creon is listed on the PBS as a digestive enzyme preparation ( 10 repeats ). Restricted benefit : for cystic fibrosis patients under a GP Management Plan or Team Care Arrangement ( 21 repeats ).
Before prescribing please review the full product information available on request from Viatris or telephone 1800 314 527
That is a big ask : time , money and not least the immense stress that can be involved .
After the lawyers and the accountants , Dr Aaron Chambers took to the podium to talk about his entanglements with the taxman and his practice , Growlife Medical in Brisbane .
He says he got the first tax office letter in February last year . He knew something of what was coming . He had watched on as a solo contractor himself when the practice
MINIMUM PRODUCT INFORMATION : CREON ® CAPSULES ( pancreatic extract 10,000 , 20,000 * 25,000 , 35,000 , 40,000 * BP ) CREON ® MICRO enteric coated granules ( Pancreatic Extract ) INDICATIONS : Pancreatic enzyme replacement in paediatric and adult patients with pancreatic exocrine insufficiency ( PEI ). PEI is often associated with , but not limited to cystic fibrosis , chronic pancreatitis , pancreatic surgery , gastrointestinal bypass surgery ( eg . Bilroth II gastroenterostomy ), ductal obstruction of the pancreas or common bile duct ( e . g . from neoplasm ) CONTRAINDICATIONS : Hypersensitivity to porcine protein or any of the ingredients . PRECAUTIONS : Fibrosing Colonopathy , Pregnancy , Lactation . INTERACTIONS WITH OTHER MEDICINES : Antacids : Antacids should not be taken at the same as time as with Creon . If necessary , it is recommended that at least one hour should elapse between use . ADVERSE EFFECTS : The most commonly reported adverse reactions were gastrointestinal disorders and were primarily mild or moderate in severity . Common adverse reactions included , nausea , vomiting , constipation , diarrhoea , abdominal distention , rash , pruritus , urticaria , abdominal pain . Some of these adverse events are similar to the symptoms associated with PEI and underlying conditions . DOSAGE AND ADMINISTRATION : The capsules : Capsules should be swallowed without crushing or chewing , with enough fluid during meals . If unable to swallow capsules , open and add minimicrospheres to acidic soft foods and consume immediately . Do not chew or crush minimicrospheres . Ensure that none is retained in mouth . The dosage should be individually titrated and depends on the severity of the disease and the composition of food . Cystic fibrosis : 1,000 lipase units / kg / meal for children less than four years old ; 500 lipase units / kg / meal for those over age four . For adult patients with PEI associated with other conditions , initiate at 25,000 to 40,000 BP units of lipase per meal and half of that dose for snacks . If required , 80,000 BP units of lipase per meal and half of that dose for snacks . Max dose 10,000 units lipase / kg body weight . The granules : Can be added to acidic soft food . The scoop provides 100 mg or 5,000 units of lipase . Any mixture of the granules with food or liquids should be used immediately . The dose is adjusted to the fat content of the meal and the severity of the disease . Cystic fibrosis : 1,000 lipase units / kg / meal for children less than four years old ; 500 lipase units / kg / meal for those over age four . Most patients should remain below 10,000 lipase units / kg body weight per day or 4,000 lipase units / gram fat intake . * Not currently marketed in Australia . Minimum PI updated : 21 April 2021 .
References : 1 . Smith RC , et al . Australasian guidelines for the management of pancreatic exocrine insufficiency . Australasian Pancreatic Club , October 2015 . Available at : https :// www . pancreas . org . au / resources [ Accessed January 2023 ]. 2 . Sikkens EC et al . J Gastrointest Surg 2012 ; 16:1487-92 . 3 . Kuhlmann L et al . JOP J Pancreas ( Online ) 2018 ; 19 ( 4 ): 183-89 . 4 . Keller J et al . Gut 2005 ; 54 ( Suppl VI ): vi1-vi28 . 5 . Creon ® Product Information . 24 January 2022 . 6 . Ramesh H et al . Pancreatology 2013 ; 13 ( 2 ): 133-39 .
Creon ® is a Viatris company trademark . Copyright © 2023 Viatris Inc . All rights reserved . Viatris Pty Ltd . Level 1 , 30 – 34 Hickson Rd , Millers Point , NSW 2000 , Australia . ABN : 29 601 608 771 . Call : 1800 314 527 . Date of preparation : January 2023 . CRE-2022-1126 . MYL0752 .
he was working at faced a tax demand and it nearly went broke .
“ So when this letter landed in our inbox , we were relatively confident despite the anxiety , obviously , with the Thomas and Naaz case . We had everything set up correctly . We were told we were in about as good a place as it gets .”
They were initially given two weeks to respond . Their accountant was undergoing chemo . But with much effort collecting the accounts information covering five years of the practice ’ s finances , they put together a detailed response . They were told the revenue office would get back to them in a couple of months .
When that eventually happened , they realised their efforts were in vain . The bill was substantial .
“ For us , it basically swallowed any profit [ we had ] made [ in ] the last three years , and of course , there [ was ] some anxiety . We were surprised because we only got one paragraph to explain their reasoning and that paragraph said because it just is .”
He says he is now going through the payroll tax objection process , which sounds like a particularly dark and menacing wormhole . The inspirational element in his story was his next decision — the decision to get political .
It started with him contacting staff at AMA Queensland ( led by Dr Maria Boulton ) and the RACGP ’ s Queensland faculty ( led by Dr Bruce Willett ). “ I then arranged a chat with our local member . And by August last year , we had drawn up a letter documenting what was happening to us .
“ The crux of this letter was [ that payroll tax demands ] will essentially mean the collapse of general practice in Queensland given that the average margin was reported at 3 % or 4 % of billings and the tax is nearly 5 % of billings .
“ Really , it doesn ’ t take rocket science to realise that nearly every practice [ that ] is subject to payroll tax will be insolvent …
“ It didn ’ t seem to make any sense to me that , on one hand , the Treasury is taking money and , the other hand , health is trying to work closer with us and they ’ ll get more effort out to general practice .
He also went before the media .
“ I was pretty nervous . And to be honest , my family and my trusted mentor said , ‘ Look , I don ’ t think that ’ s a good idea , Aaron . You ’ ve got to put yourself out there . Your neck will be on the chopping block .’
“ And apart from anything else , at a personal level , the embarrassment and shame come with this stuff …
“ But it was through having this conversation that I ’ ve realised actually there ’ s no reason