Collapse of bulk-billing GPs has health system ‘on its knees’

Royal Australian College of GPs Vice President Dr Bruce Willett says the federal budget’s bulk billing incentive is “very welcome” because it helps people who need it the most. “The Medicare rebates have been eroded dramatically over the last couple of decades by both sides of politics, so it’s essentially worth half of what it was before,” Mr Willett told Sky News Australia. “The bulk billing incentive allows GPs to bulk bill people, essentially vulnerable patients and under 16-year-olds. “It’s an additional payment and that’s what’s been increased, so it’s not a tripling of the rebate, it’s a tripling of this top-up payment but very welcome because it’s directed to the people who need it the most.”

There has been a surge in children under 14 presenting with “imminent” or “potentially” life-threatening conditions at multiple hospitals in regional Queensland including in Bundaberg, Dysart, Beaudesert, Maryborough, Ayr, Cooktown, Gympie, Hervey Bay, and Sarina.

In Mackay numbers have more than doubled from January to March 2023 compared to the same time last year.

SCROLL DOWN: FULL LIST OF WHO BULK BILLS

Mackay Hospital and Health Services acting chief executive Dr Charles Pain said the Mackay Base Hospital was also dealing with “more acutely unwell people” and more patients arriving by ambulance.

“For many, a trip to the ED is the first time they have seen a doctor in a long time and they are often more unwell than they would have been if they had earlier intervention and diagnosis,” Dr Pain said.

“We believe one reason for this is that some people may be reluctant to see a general practitioner because they can’t find a bulk billing practice within our region.”

The 2023 Cleanbill Health of the Nation Report revealed the federal electorate of Dawson – where MBH is located – only had three remaining clinics that offered comprehensive bulk billing, as did the electorates of Brisbane, Capricornia and Groom.

Fairfax was worse still with no remaining full bulk billing clinics with Leichardt only slightly better with two.

Australian College of Rural and Remote Medicine president Dr Dan Halliday said the federal government’s decade-long resistance to thawing the freeze on Medicare rebates had forced the hand of many GPs to ditch bulk-billing, including to children and pensioners.

He said it was a misconception that all GPs bulk-billed children 16 and under, with this decision entirely up to each individual practice or GP.

“We know that if you do provide good quality primary care, that you actually reduce the presentations and admissions to the emergency departments,” Dr Halliday said.

“Bulk-billing in certain areas is on its knees, and in some areas that it’s ceased altogether, which is an absolute shame.”

An argument against lifting the Medicare rebate in line with inflation is the cost to the federal coffers, and therefore the taxpayers.

For GPs to bulk bill a standard consult at today’s rates, the federal government would have to reimburse about $70-120 per appointment. It currently reimburses $39.75 but will rise to $41.40 by the end of 2023 after the budget revealed two increases to the standard patient rebate this year.

Royal Australian College of General Practitioners president Dr Nicole Higgins said GPs had “sacrificed for years” to maintain healthcare services for their “most vulnerable patients”.

The Mackay-based doctor said GP practices could no longer afford to cover that gap – with wages, utilities and insurance to pay – citing the 60 practices that had shut across Australia since 2019.

Federal health minister Mark Butler did not address this publication’s question concerning the economic crisis, but said the Albanese Government was making Medicare “stronger for all Australians”.

“Our historic investments in Medicare will triple the bulk-billing incentive – the largest increase to the incentive in the 40-year history of Medicare,” Mr Butler said.

Mr Butler said the “game-changer” move would help GPs nationwide “maintain and even shift back to bulk billing”, a move that has been welcomed by the ACRRM, RACGP and newly-minted Queensland health minister Shannon Fentiman.

But with a national population of 26 million people, GPs still have to treat more than 12 million people not applicable for the tripled incentive that comes into effect on November 1.

Mr Butler said the government was also introducing Medicare Urgent Care Clinics, “taking pressure off overwhelmed emergency departments”.

It will spend $358.5m over the next five years establishing the 58 Medicare UCCs at GP clinics, community health centres, and Aboriginal community Controlled Health Services across Australia.

The clinics can bulk-bill, stay open after normal business hours and accept walk-in patients for conditions that do not require hospital admission.

Ms Fentiman said the state government was committed to collaborating with the federal government to provide “world-class free healthcare to all Queenslanders” which included ensuring access to a doctor in every community.

But she did not address questions about whether she was concerned about the drop in the number of bulk-billing practices, or how the government was supporting public hospitals to deal with an increase in ED presentations.

Requests for both levels of government o provide a definitive list of bulk-billing practices in Queensland were not provided to this publication.

This was despite Mr Butler telling other media earlier this year that all bulk-billing data would be made public by February 20.

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