What do GPs really think of the $8.5b Medicare investment?

Few healthcare announcements have been as widely anticipated as the one made by Prime Minister Anthony Albanese in Tasmania on Sunday.
 
The Australian Labor Party pledge of an $8.5 billion funding injection into Medicare – which was matched the same day by the Coalition – is likely to be of far-reaching significance to general practice.
 
The commitment includes significant funding set aside to boost the GP workforce, including an increase in training places and measures to attract more medical students into the profession.
 
It also includes details of an expansion of bulk-billing incentives and a new Bulk Billing Practice Incentive Program from 1 November this year.
 
According to the Labor Party, this investment will improve the financial position for around 4800 practices, if they adopt universal bulk billing.
 
‘Our plan will mean more bulk billing, in every part of our country because our Government wants nine out of 10 visits to the GP to be free,’ the Prime Minister said.
 
In response, RACGP President Dr Michael Wright said this promise to invest in Medicare is ‘well overdue’ and acknowledged the bipartisan commitment, describing the boost to the general practice workforce as ‘amazing’.
 
However, he said the focus on universal bulk billing was ‘certainly not the RACGP’s policy direction’, saying that it instead had wanted a focus on Medicare funding for longer consults for people to spend more time with their GP.
 
‘The additional investment into general practice is a positive thing but we’ve got to make sure that it’s targeted to the people who need it most and the GPs who are looking after them,’ Dr Wright told newsGP.
 
‘Just because these bulk-billing incentives are available to everyone doesn’t mean everyone’s going to have access to bulk billing, because GPs are still able to set their fees, and the college will completely support that going forward.’
 
‘I’ve heard a range of views about what the impact these of measures might be, and we will continue to update members as we get more details.’
 
To follow up the initial announcement, newsGP has sought views of GPs around the country on the proposal and whether it will change their approach to billing. Here are the responses received, with GPs all commenting in an individual capacity:
 
Associate Professor Magdalena Simonis, Victoria 
Although this injection of funds into general practice makes good sense after such a long period of neglect from governments, we need to ensure that patients with complex and chronic care needs are better supported, as well as the practices that provide their care.  
 
As a full-time GP who squeezes so much into every consultation, running constantly overtime to save my patients money and the inconvenience of repeat visits at my expense, this should help lighten the load on both sides but it’s only part of the solution to the bigger problem. 
 
GPs have been partially heard finally, and we have been at the bottom of the funding barrel for so long that every aspect of the system is now feeling the pressure. 
 
It’s general practice where prevention occurs, and fragmenting primary care is so risky and I fear, once done, the levels of continuity of care will decline, adding more pressure on a strained system. 
 
I think I’ll be more inclined to bulk bill only for the review visits.    
 
Dr Andrew Leech, Western Australia 
This is a clever announcement by the Government as it makes them look good by increasing funding but puts the pressure back on us GPs to bulk bill ‘because every consult is now free’.  
 
Those who don’t get bulk billed will be frustrated, and we will be left having to explain that even with the incentive, the costs of running a modern-day high-quality GP clinic are still not covered.  
 
I would much prefer that they increase rebates to match inflation and even more so for long appointments, complex care, chronic disease and mental health, where the gap is bigger than a Level B consult.
 
Dr Edwin Kruys, Queensland 
A much-needed boost to general practice. 
 
There is an urgent need to optimise access to general practice, especially for vulnerable groups.  
 
This large investment will go a long way towards facilitating access and supporting practice viability for those who choose to bulk bill.
 
Dr Mariam Tokhi, Victoria (edited extract from The Guardian)  
There are many things to celebrate here: an investment in primary care and particularly the commitment to support for junior doctors entering the GP workforce.  
 
I, and many, have tried (and failed) to run completely Medicare-funded quality bulk-billing GP practices for the underprivileged. It is an extremely difficult, almost impossible, endeavour. This change will make it easier for those bulk-billing clinics that have been running in the red, especially if they have been doing a lot of short consultations.  
 
But there are some downsides.
 
Albanese’s reform entrenches the notion that a quick consult is a good one. There is still more detail to be revealed about funding measures for chronic disease management and practice payments. But it appears that Medicare might still incentivise ‘throughput’ over ‘quality’. And these quality consultations are what I (and many in ‘deep-end GP clinics’) have been advocating for. 
 
Associate Professor Michael Clements, Queensland  
A disappointing consequence is that it will incentivise short medicine and disadvantage patients with complex and chronic disease and the clinicians who care for them. 
 
The messaging about nine out of 10 consults will be bulk billed from the Government is harmful and feels like a deliberate effort to push the criticism and hard conversations about underfunded healthcare to the GPs as patients will expect to be bulk billed because of the messaging. 
 
It’s very encouraging to see the GP registrar pay and conditions recognised as a priority, and this is as a direct result of multiple advocacy groups being aligned on this key measure. 
 
This is going to be impactful in remote communities and some rural communities, but we are still likely to see a mix of practices move to bulk billing and those who stay with existing policies 
 
This is great for Aboriginal Community Controlled Health Organisations (ACCHOs) and clinics who work with the most vulnerable who are already bulk billing.
 
Associate Professor Louise Stone, Canberra (edited extract from LinkedIn)
We need a generalist at the front, seeing the patient first. Our superpower is as diagnosticians, which is why we spend 11 years learning our trade.
 
We are best placed to pick the one meningitis in a sea of viral infections. We don’t always get it right, but we are best placed. But only if governments don’t optimise Medicare for six minutes.
 
At the moment, a 6-minute consult brings in $7 per minute ($10 in the new world order).
 
One of my complex patients, the ones women see more often, who needs 40 minutes, brings in $2 per minute ($2.20 in the new world order). This is why we have a gender pay gap and women GPs are leaving. They can’t make it pay.
 
 It makes no sense. GPs don’t want six-minute medicine. Patients don’t want six-minute medicine. Why optimise that sort of consultation? 
 
Dr Tim Senior, New South Wales 
It’s worth welcoming any significant investment in general practice. The workforce measures are welcome, and we’ll need to ensure that the increased number of GPs that result are distributed to where the workforce is required, to underserved areas.  
 
The bulk-billing incentives will benefit practices and services who are already bulk billing, especially those who are bulk billing everyone. 
 
This is particularly welcome in ACCHOs and other Aboriginal Medical Services, as well as other practices serving socioeconomically disadvantaged communities, where many people can’t afford co-payments. This will relieve some pressure in communities where general practice has become economically unviable.  
 
However, there is still more of an incentive for high throughput medicine, rather than quality medicine, and we should continue advocating for increased rebates for longer consultations that manage complexity and mental health and keep an eye out for the effect just on high throughput medicine. 
 
Dr Cathy Andronis, Victoria 
It’s a ‘return to the future’: short-term gains for longer-term pain.  
 
Autonomy is one of the cornerstones of happiness and wellbeing. GPs have invested at great costs in their careers and want to be valued for their dedication and caring for patients so it’s disheartening to be at the beck and call of ever-changing government policies.  
 
I’ve long accepted my individual best fit for my practice style which is person-centred mixed billing.
 
Dr Ken McCroary, New South Wales 
I’m grateful for any primary care funding initiative but weary of the philosophy that Band-Aids are ever actually going to solve underlying systemic problems. 
 
GPs being the only doctors who can’t access the highest available Medicare rebate (unlike every other specialty) unless signing mandated bulk billing will not attract anyone to general practice. 
 
Not having rebates equal to what it costs to run a practice will not attract the poor souls who actually do general practice to work in areas of need as they get paid more, see less patients, more healthier patients in more affluent areas.
 
Dr Tim Jones, Tasmania 
My strongest reflection is that this is a positive voice from Government on scope of practice reforms. They do still see that general practice is the best and most cost-effective way to deliver primary care and they are willing to put up big money provided equity of access improves. 
 
This is huge support for training and future workforce development, and I hope that we can bolster the training and supervision arms of general practice to deliver this.  
 
The bulk billing incentive will greatly assist practices in rural and remote areas to attract doctors and remain viable. The situation is less clear with urban practices where practice costs can be much higher. 
 
This reduces the pressure to have to charge a gap fee when patients are clearly under financial duress. I already try and deliver as much bulk-billed care to kids and vulnerable populations as I can so I think this will consolidate my position to try and offer this as much as I can (within the limits of practice viability).
 
Dr Rod Omond, Victoria 
As others have stated, this is a good start to the task of refinancing Medicare and therefore supporting patients to get the high-quality care they deserve. 
  
It reverses to some extent the funding drought over the last 15 years. 
 
I think there was a missed opportunity to selectively fund longer consults, which are more common in the rural context, and support patients with more complex health needs. 
  
My billing is supported by the Northern Territory Department of Health (remote Indigenous consults), so there will be no change for me. However, I do feel the changes will support Aboriginal Medical Service funding.
 
Associate Professor Vicki Kotsirilos, Melbourne 
The proposal is great news for bulk-billing clinics and for helping patients with financial issues. I charge above the proposed rebate increase so it would put me in a lower financial position. It would not make me stop charging patients, especially for longer consultations. 
 
I am barely covering costs of overheads at our practice with my current fees.
 
Dr Emil Djakic, Tasmania 
There is no doubt that further federal funds to support the Medicare insurance scheme will be very welcome to assist the low to middle income band of patients who do not have access to the triple bulk-billing incentives started in 2023.  
  
The second component of a 12.5% practice incentive for a commitment to 100% bulk billing seems to conflict with the knowledge that the majority of independent contractor doctors are entitled to set their own fee.  
 
Will this be a proposal that will require the Australian Competition and Consumer Commission to make a ruling on to allow practices to establish the fee policy? 
 
Dr Mukesh Haikerwal, Victoria
Why have they not worked out that the rebate already is skewed to not favour necessary long consults for complex care and then compound that with a fixed rate bulk billing incentive which further erodes the rebate complex patient care brings with it?
 
An Independent Pricing Authority came out of the National Health and Hospitals Reform commission in 2009 but did not include GP/community rebates. 
 
There is a precedent for a pricing authority and applying it to GP consults would set a fair rate that could not be eroded by political expediency.
 
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