MP behind bulk-billing letters singled out for praise

An MP who wrote controversial letters to doctors encouraging them to adopt a fully bulk-billing model amid constituents’ ‘disappointment’ has been singled out for praise by the Federal Health and Ageing Minister.
 
In the regional Victorian city of Bendigo on Tuesday, Minister Mark Butler repeatedly applauded Federal member Lisa Chesters and her efforts to drive up bulk billing in the electorate.
 
He flagged a rate of ‘well over’ 80% for those without a concession card, and a big leap in rates for older patients, saying it is the second highest increase in the country, behind only Darwin.
 
‘In Bendigo and the surrounding towns, pensioners are now seeing bulk-billing rates of around 94%, when a few years ago they were down as low as 80%,’ he said.
 
‘That in such significant part is down to the way in which Lisa has advocated these reforms in this community.’
 
He added he is ‘really proud’ of Ms Chesters’ work and the resources she put into promoting the reforms.
 
Ms Chesters controversially sent the letters to local doctors earlier this year – a move leading to backlash from many GPs.
 
‘My constituents have shared their disappointment that [clinic’s name] is currently not a fully bulk-billing clinic,’ the letter read.
 
‘I encourage you to move toward a 100% bulk-billing model as it would better serve the community and your patients.’
 
On Tuesday, Ms Chesters labelled the bulk-billing take-up an ‘outstanding turnaround’.
 
‘We’ve gone from just two clinics that were bulk billing all patients under the former Liberal–National Government to now 38 clinics bulk billing all patients that come through their doors,’ she said.
 
The existence of the letter was reported in March, and in June, Senator Anne Ruston, the shadow Health Minister, labelled the approach – which was also adopted by other Federal politicians – as ‘bullying’ at a Senate Estimates hearing.
 
Mentioning the Bendigo representative’s letter, she asked why MPs would put ‘pressure on a practice by expressing great disappointment that they’re not bulk billing, when the department’s own figures suggest that 30% of practices would be worse off if they went to a full bulk-billing model’.
 
Tasmanian MP Julie Collins was also criticised earlier this year for ‘naming and shaming’ practices not bulk billing.
 
At the time, RACGP President Dr Michael Wright criticised ‘coercive tactics’ and suggested politicians wishing to understand why practices adopt a specific billing policy could talk to him for an explanation.
 
Local Bendigo GP Dr Remon Eskandar, who works as a mixed-billing GP at Strathfieldsaye Primary Health, and is the owner of Bendigo Healthy Weight Clinic, has also tried to put his perspective across.
 
He says he has attempted to meet with Ms Chesters to discuss the topic, but the meetings have been cancelled three times – twice by Ms Chesters’ office and once by him.
 
‘We acknowledge and respect that local MPs are trying to look after the people of their district and they’re trying to ensure better access for locals and other patients to their clinics – and we appreciate their efforts toward improving that access,’ he told newsGP.
 
‘We would like at the same time to have open communication, explaining why general practice at the moment is struggling from practical, logistical, and financial points of view.’
 
He says bulk billing ‘could be suitable at certain points’ but general practices are under significant strain in regional and rural areas, and that efforts to encourage access need to be balanced with business sustainability.  
 
‘There is no point having shorter-term quick access that is not going to survive downstream,’ he said.

‘That’s what I wrote in letters and emails to Ms Chesters, hoping to get that point of view discussed and hopefully being able to transfer the point of focus from quick fix to long-term general practice, high-quality care – especially in regional and rural areas where access to the hospital, access to specialised centres are very limited.’ 
 
Dr Wright reiterates that every practice should be free to make their own decisions about sustainable billing.
 
‘We’ve seen the most recent indexation of Medicare is less than CPI,’ he told newsGP.  
 
‘And we continue to see the pressures for GPs who want to provide longer consultations for their patients.
 
‘It’s either their patients or the GPs who are having to fund that extra cost.
 
‘The college continues to support practices’ autonomy to set their own billing practices.
 
‘And it’s actually in the interests of communities that GPs and practices do that – no one benefits if practices close because they’re unsustainable.’
 
Ms Chesters’ office was approached for comment.
 
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BBPIP Bendigo bulk billing Lisa Chesters