‘This is the limit’: GPs’ personal plea as tax devastation grows

The Bridgeview Medical Practice is a hub of its local community.
 
With 10,000 patients on its books, many of them from disadvantaged and traumatic backgrounds, the busy western Sydney clinic is home to nine bulk-billing doctors offering comprehensive general practice care to an often marginalised population.
 
But despite being located in an area of great need, the looming spectre of payroll tax has forced its owners, Drs Shanthini and Thava Seelan, to consider whether they can keep their doors open.
 
‘If payroll tax comes into effect, then I don’t think we can afford to bulk bill our patients and then it’s going to be downhill from there,’ Shanthini told newsGP.
 
‘We built this practice from scratch. We promised top-grade, top-notch quality care and affordable care. The Medicare bonus has been a godsend and the recent incentives have been really helpful for us, but payroll tax could diminish all this good work.
 
‘Being GPs, we’ve made a lot of sacrifices over these years, and we’ve been asked [to do] quite a lot, but I think this is the limit.’
 
The pleas for change were issued against a backdrop of new Federal Government data suggesting that last November’s bulk billing initiatives are helping to improve access to care for vulnerable patients.
 
However, Federal Health and Aged Care Minister Mark Butler has cautioned that these gains could be reversed by payroll tax liabilities, and urged his state counterparts to ‘listen closely’ to GPs.
 
Many practices across the nation are currently facing crippling tax bills – some in excess of $5 million – as state governments avoid making long-term commitments for change.
 
Most pressingly, a South Australian amnesty ends on 30 June this year, while in Victoria, GPs can only request ex gratia relief with no amnesty period on offer.
 
Meanwhile, having sparked the payroll tax furore, the NSW Government rolled out its own year-long amnesty last August, saying it ‘continues to engage with GPs and stakeholders as it finds a solution to payroll tax issues’.
 
But as Thava told newsGP, a combination of this long-term tax uncertainty and cost of living pressures has left him feeling as if ‘there is no balance at all’.
 
‘It’s so difficult for us to not start privately billing our patients and we don’t want to do that, but if the payroll tax comes in then I suppose we’ll have no choice, and our patients will be affected by that,’ he said.
 
‘It’s very hard to pass on the cost to this demographic of patients who can’t afford it, but the other option is we would actually have to close down.
 
‘It’s not fair because we have to be trying to do our best to the community and then the [NSW] Government is not looking after us.’
 
With a high culturally and linguistically diverse (CALD) community, the Seelan’s clinic operates within a suburb where non-English languages are spoken in more than 60% of households.
 
‘We have a huge CALD population, a lot of first-time arrivals finding their feet, struggling, and we service a lot of them coming from countries where there have a lot of violence and trauma,’ Shanthini said.
 
‘We have a lot of complex consultations and high rates of chronic disease, and we do a lot of work on that, and we spend a lot of time with the patients.
 
‘We are determined to continue giving our care and we’ve got a standard of healthcare that we are actually keeping up and we want to continue that, but it’s becoming harder to offer the same services without private billing and we don’t want to do that.’
 
In 2013, the Bridgeview Medical Practice was named RACGP’s New South Wales General Practice of the Year for its ‘invaluable primary healthcare service’.
 
But if nothing changes, its future could be at risk.
 
Now, Drs Shanthini and Thava Seelan are pleading for help, and for change.
 
‘Our Medicare rebates were frozen for years. We put up with it because the patient comes first. We’re doing everything we can … be fair, or at least listen to what we’re doing,’ Shanthini said.
 
‘We are working in an area that has high health need, we are an almost extinct practice, we are still bulk bulling.
 
‘We are putting our patients first, we are trying to give that high quality care, we are bulk billing, so the Government just needs to be fair, to look after us, and we will look after your people.’
 
GPs and patients can sign an RACGP petition calling for the tax to be scrapped, which has so far received almost 12,000 signatures.
 
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