Existing practices ‘shutout’ of funded bulk-billing clinics: RACGP

A blueprint has been released for new fully funded bulk-billing clinics rolling out in New South Wales, with the Federal Government coming good on its promise to ‘intervene in the market’.
 
The Hunter New England and Central Coast Primary Health Network (HNECC PHN), which has been commissioned to deliver the initiative, has unveiled the requirements providers must meet to establish and operate the clinics.
 
It forms part of the Government’s bulk-billing expansion agenda, with $25.3 million allocated to open six clinics in the Central Coast, Newcastle, Lake Macquarie and Hunter regions, and make healthcare ‘cheaper and more accessible’.
 
Under the newly released Expression of Interest documents, each clinic must be a newly established practice, bulk bill all eligible services, achieve RACGP accreditation, and recruit a multidisciplinary workforce that includes at least 10 GPs.
 
The HNECC PHN also confirmed the funding cannot be used to purchase, acquire or convert an existing general practice, with applicants required to demonstrate they will create additional capacity rather than simply redistribute patients or practitioners.
 
But it’s an initiative which has drawn the ire of many GPs, both local and further afield, with RACGP President Dr Michael Wright saying the latest details raise significant concerns about the precedent it sets.
 
‘This is creating an uneven playing field: funding new big practices very generously and shutting out existing practices from participating,’ he told newsGP.
 
‘It’s really showing a deliberate policy preference for these big business corporate practices at the expense of GP-owned small businesses.
 
‘Rather than increasing competition this looks potentially anti-competitive by excluding existing practices from the tender. 
 
‘This is really worrying for the people of Hunter.’
 
Sharnna Graves, HNECC PHN’s Bulk Billing Initiatives Manager, said the initiative is designed to deliver new services in areas of greatest need.
 
‘This initiative is not intended to fund the purchase, acquisition, or conversion of an existing general practice or simply relocate or rebrand an existing service,’ she said.
 
‘Applicants must not use recruitment approaches that intentionally target, incentivise, or induce GPs currently practising within the HNECC PHN to leave their existing clinic.
 
‘We are seeking new service capacity rather than moving the existing capacity around the region.’
 
But for Newcastle GP and practice owner Dr Max Mollenkopf, he holds concerns the Federal Government’s plan is a ‘threat to local practices’.
 
‘It’s the equivalent of, if I run a coffee shop and the Government thinks I charge too much for my coffees, they pay someone else to set up next door to me, but they pay them $10 a cup just in background funding, so they can offer consumers $1 cups,’ he told newsGP.
 
‘How do you expect me to deliver all those services when you have to pay someone else so much money to do it?


‘They could help me with my recruitment, and I will bring more GPs online, and I will deliver more services, but that doesn’t fit the narrative.’
 
Dr Wright added that existing practices have spent years establishing services and setting fees based on the cost of caring for their communities.
 
‘Practices have been working in this area for many years and have set their fees based on the costs of providing care to that community,’ he said.
 
‘Selectively funding just some practices and only new practices does more than just distort the market, it’s potentially destructive to the market.
 
‘The Minister needs to guarantee that local patients aren’t going to have their existing local practice shut down because of the effects of this intervention.’
 
According to the PHN, funding can be used for clinic fit-outs, medical equipment, digital health infrastructure, GP attraction and relocation costs, employment of non-clinical staff, and continuing professional development activities focused on priority populations.
 
Ms Graves said providers will be assessed on their ability to improve equitable access to affordable care.
 
‘Fundamentally, we’ll be looking for a strong commitment to increasing equitable access through the delivery of bulk-billed services,’ she said.
 
‘The framework seeks to improve access to affordable primary care for populations who may be disproportionately impacted by out-of-pocket costs, poor health outcomes, or limited healthcare options.’
 
Dr Mollenkopf appreciates that lower socioeconomic regions and those with vulnerable populations will be prioritised.
 
‘There are a large group of consumers out there who struggle with the costs of primary care, and if we can genuinely use these styles of clinics to help those people to access care, that is a net positive for the consumers in the region,’ he said.

‘But at the same time, it would be greatly appreciated if some of that money could be redirected into existing practices so we too can participate in trying to deliver more care for more consumers at a lower cost at the point of access.’
 
Detailing the rollout earlier this year, Federal Health and Ageing Minister Mark Butler said these regions were selected because of their ‘persistently low bulk-billing rates for GP services’.
 
‘The Albanese Government wants all Australians to get the healthcare they need when they need it, and we’re committed to supporting more bulk billing GPs in the Hunter and Central Coast regions,’ he said.
 
‘The Hunter and Central Coast regions have had issues with bulk billing for a long time.
 
‘Having six new fully bulk-billing GP clinics will help make healthcare cheaper and more accessible for many in the community.’
 
Expressions of interest close on 14 September, with the current implementation timeframe seeing the clinics established and operating between April and June 2027.
 
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