Controversial bulk-billing clinics slated for mid-2027

‘Incredibly unfair and hurtful.’
 
That is how RACGP NSW Chair Dr Rebekah Hoffman labels a Federal Government plan to rollout a series of fully funded bulk-billing clinics in regional NSW, as more details emerged on Tuesday.
 
A $25.3 million cash injection over three years will go towards the opening of six new clinics in the Central Coast, Newcastle, Lake Macquarie and Hunter regions by mid-2027, Federal Health and Ageing Minister Mark Butler confirmed.
 
According to the Government, the regions were chosen because of their ‘persistently low bulk-billing rates for GP services’ with the Newcastle and Lake Macquarie areas averaging 66.6% compared to a national average of 81.4%.
 
Minister Butler has repeatedly said the Government would intervene in the market if bulk-billing rates in the area do not increase.
 
The Hunter New England and Central Coast Primary Health Network has now been tasked with determining the locations and operators for the new clinics, which are expected to provide 150,000 bulk-billed visits annually.
 
For Dr Hoffman, the move betrays a lack of government understanding about the value of GP care.
 
‘They really continue to not understand general practice,’ she told newsGP. 
 
‘They don’t understand the complexities around having a complex patient cohort.
 
‘They don’t understand that this is a small business and that by putting competition into these towns that it will actually mean that these small businesses may close, that they may suffer and the people that have looked after these towns quite often for decades might be out of work.
 
‘That really seems incredibly unfair and hurtful to the GPs that have put their lives into these small communities.’
 
Visiting a Charlestown practice on Tuesday, Minister Butler said comparatively few clinics in the areas had signed up to full bulk billing following the huge expansion of incentives introduced last November.
 
‘The number of fully bulk-billing practices, 100% bulk billing, in this region is half the New South Wales average, and there’s simply no rationale for that,’ he said.
 
‘It is not more expensive to run a general practice in this region than it is in Sydney. Arguably, it’s cheaper … these practices now have access to doctors in the way they didn’t before.
 
‘There is simply a cultural issue in general practice in this region, and we’re determined to change that culture.’
 
However, Dr Max Mollenkopf, whose clinic is in the Newcastle area, warns the move may not help patients access better healthcare.
 
He said he and his colleagues locally ‘provide a certain quality of practice that we stand by’.
 
‘The clinicians in the Newcastle area have chosen to practice medicine in a way that doesn’t fit six-minute medicine, and that would be the cultural shift that general practitioners locally would be quite proud of,’ he told newsGP.
 
‘The Government choosing to provide millions of dollars in funding for these clinics represents the fact that bulk billing is not a sustainable business model and that extra funding is needed to actually service consumers with complex health needs.
 
‘I would absolutely welcome additional government funding to target consumers who need more care.
 
‘But simply ramming bulk billing down everyone’s throat doesn’t change the fact that that style of medicine doesn’t suit all consumers.’
 
Dr Mollenkopf views access to healthcare versus access to quality healthcare as ‘two completely separate conversations,’ with his colleagues and other practice owners in the area preferring to offer ‘comprehensive and quality care’.
 
‘The fact that the Minister continues to attack that is disappointing,’ he said.
 
‘As a business owner and a clinician, competing with a local service that has significant amounts of additional funding that is not accessible to me, but presenting us as the same option, it’s not a position anyone wants to be in.’
 
Another doctor affected by the move is Dr George Shehata, a GP in the Central Coast area who is not a clinic owner.
 
He points to an ageing demographic, as well as an unhelpful Modified Monash 1 (MM 1) classification for the area as significant factors.
 
‘In my opinion, intervening in the market, we are putting stress on the current practices on the Central Coast, especially as not every practice is mixed billing or private billing,’ he told newsGP.
 
‘The patient on the Central Coast is different from the demographic in Sydney and other areas in New South Wales.
 
‘We have a lot of elderly people, we have a lot of people with a disability.
 
‘We have a lot of people who need longer consultations and everyone is aware the rebate is not enough for that.’
 
The MM 1 classification draws smaller bulk-billing incentives, while Dr Shehata also points out that many GPs in training are unable to stay as they need to work in areas with a more remote classification.
 
He also fears that any new bulk-billing clinics will disrupt patient care, as they are exposed to further funding reforms that could mean they change their business model in a few years.
 
‘It’s a big challenge,’ he said. ‘I’m not happy with that intervention.’
 
The funding for the bulk-billing clinics was first announced in this month’s Federal Budget, with this week’s announcement providing more detail on the timings and process.
 
‘As a practice owner, my heart just really goes out to the doctors that will be impacted by this,’ Dr Hoffman said. 
 
‘Competition is fair when it’s another GP down the road and there’s no additional grants or subsidies and there’s no leg up from the government to be able to do things at different or lower costs.’
 
She believes the funding should not prop up new bulk-billing clinics, pointing to research that suggests increasing rebates for long consultations would have the biggest impact.
 
‘Our own studies we’ve done with Deloitte have shown it would reduce out-of-pocket costs down to as little as $20 for patients to be able to be seen by their usual care provider and we actually feel that would be far more equitable, far more effective in areas where we know there’s increased complexity, such as with ageing populations,’ she said.
 
‘We should be giving that [$25.3 million funding] to the GPs who already live and work in those communities and see what they can then do to their costs.
 
‘That’s the exact dollar figure that the Government has told us that it takes to provide bulk billing.
 
‘Then why aren’t they actually providing that to the community as an alternative?’
 
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