Grassroots GPs’ backlash against incentive split decision

GPs around the country have expressed their unhappiness at a Federal Government decision to split a new incentive evenly between general practices and GPs.
 
The weighting of the 12.5% incentive payment, which will be tied to clinics that bulk bill all their patients from 1 November, has been the subject of speculation for months.
 
A decision announced last Friday by the Federal Health and Ageing Minister Mark Butler to split the payments 50:50 was immediately described as ‘disappointing’ by RACGP President Dr Michael Wright, who said the Government had not listened to college feedback.
 
Only 9% of respondents to a previous survey supported an even split of the incentive between clinics and GPs, with 71% saying it should be fully paid to GPs.
 
More than 75% of respondents to a newsGP poll this week have so far said they do not support the decision.
 
Among those who disagree is Dr Joseph Fernando, who works in a small GP-run clinic in the northern suburbs of Melbourne.
 
‘I have been a GP for 16 years,’ he told newsGP.
 
‘Why is the Government asking only GPs to adopt universal bulk billing? Why are they not asking other specialists, such as psychiatrists, to do the same?
 
‘This seems to be a strategy to gain votes from the public. General practice has become part of the political agenda.’
 
He said that since he and three colleagues in his suburban clinic adopted a mixed-billing system a few years ago, the GPs are ‘much happier’.
 
Dr Fernando said he will not return to universal bulk billing, describing the clinical style of practice as ‘exhausting’, although he will continue to bulk bill healthcare card holders and children.
 
‘GPs have to see patients every 10 minutes, which is risky and leads to little satisfaction,’ he said.
 
‘What we want is for the Medicare rebate for item numbers 23 and 36 to be increased so that we can reduce our gap fees.
 
‘However, this does not seem favourable for [Minister] Butler, even though it would benefit both patients and GPs.
 
‘We now have more time to spend with patients, and the business is viable.’
 
Dr Simon Holliday, a GP in regional New South Wales, believes the changes are likely to squeeze mixed billing.
 
‘Practices may well have to decide to become fully private billing or fully bulk billing,’ he said.

‘If the latter, there will be a natural commercial imperative to practice six-minute Medicare, rather than medicine.
 
‘Avoiding complexity will further dumb-down general practice and legitimately allow more powerful craft groups to expand their scope of practice.’
 
Corporate advantage
Many more GPs said the new policies were more likely to benefit larger, corporate general practices rather than smaller GP-owned businesses.
 
When Mr Butler announced the decision to split the incentive evenly, he did so from a clinic belonging to ForHealth, described as the largest bulk-billing provider in the country. 
 
ForHealth CEO Andrew Cohen said the majority of the clinics will become 100% bulk billing by 1 November, while his colleague expressed excitement about the incentives, particularly for their likely impact on urgent care.  
 
Minister Butler said doctors and practices are making the shift ‘because they know it is good for patients, and it is good for their bottom line’.

‘We know this investment will work,’ he said. ‘Because it has already worked for the patients the incentive already applies to – pensioners, concession card holders, and families with kids.’
 
However, several GPs expressed concern at the influence of corporate practices, with one Queensland GP lamenting that more general practices are not GP owned.
 
Another GP from the same state, who did not wish to be named, believes the policy will incentivise practice owners to shape doctors’ billing practices, and said practices’ income will benefit more than individual GPs proportionally if they sign up to full bulk billing.
 
‘Applying the 50:50 split of the practice incentive payment, owing to the way gross billings are divided (a 70:30 doctor:practice split), the payment stands to increase doctor revenue by a relative 9%, while the practice benefits at a relative 20% rate,’ they told newsGP. 
 
‘As such there is financial incentive now, for the first time in the history of Medicare, for practice owners to issue an ultimatum to their sub-contracting GPs: “Bulk bill or be replaced”.’ 
 
They also point out that the policy is vulnerable to the same indexation issues such as the Medicare freeze that prompted bulk-billing rates to fall in the first place.
 
Another commenter highlighted the principle enshrined in the Health Insurance Act that gives doctors the right to set their own fees.
 
They described the recent bulk-billing incentives as ‘at odds with this principle’.
 
Dr Sara Tahsin, a GP in Melbourne’s south-eastern suburbs, also expressed concerns about the weighting, describing herself as ‘deeply disappointed’ by the decision to split the bulk-billing incentive loading.
 
‘Many practices – particularly large corporate groups operating multiple clinics nationwide – already generate substantial profits by employing 10 to 15 GPs per location,’ she said.
 
‘These clinics typically operate under a bulk-billing model, where GPs receive only 60% of their total billings.

‘If practice owners are entitled to 50% of the bulk-billing loading, they stand to benefit significantly, while GPs continue to be undervalued for their work.’
 
Dr Tahsin also called for clarity on the way the split will work.

‘Should the 50% incentive allocated to GPs be subject to further deductions by practice owners, based on the agreed contractual percentage, it would result in a substantial financial disadvantage for the GPs,’ she told newsGP.
 
‘I would greatly appreciate further clarification on this matter.’
 
For Dr Wright, the frustration expressed by many GPs does not come as a surprise.
 
‘We’ve been clear with the Government and the Department of Health that most GPs want this incentive to go directly to GPs,’ he told newsGP.
 
‘That would have been the simplest way to roll out the program, and also the way to maximise GP interest in the program.  
 
‘This program needs to be simple, and support the GPs treating patients, doing the work that is generating this income.
 
‘It’s really disappointing that the Government has not chosen the model that GPs have said would be the best model for them and their patients.’
 
Dr Wright emphasised that general practice needs to be financially viable.
 
‘GPs should be able to set fees that cover the cost of care – that’s in the interest of our practices and our patients,’ he said.  
 
‘If these new Government incentives don’t cover costs of providing care or if they have too many strings attached, then GPs and practices won’t take them up.’
 
Dr Wright said the college will ‘continue to fight for increased Medicare rebates, particularly for longer consults, and to support practices regardless of whether they take up the current incentives’.
 
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