GPs who are dissatisfied with current or planned changes within the NHS, may find a comparison with the Australian Medicare-based system encouraging.
The Australian Medicare is often conceptualised as the ‘antipodean NHS’ but there are quite a few major philosophical and practical differences between the two systems. The biggest practical difference is in GP payments: under the Medicare system, doctors are paid per consultation, as opposed to the NHS system of capitation payments. The other major differences are:
- Unlike the NHS, Medicare has no out-of-hours care requirement and working out of hours is completely voluntary
- On a philosophical level, the Medicare system tends toward greater doctor and patient freedom, and encourages GPs to be more entrepreneurial
- Patients choose their own practice and doctor and can move between practices as they wish, regardless of their location; similarly, doctors are not required to see any particular patient or patients
Medicare vs the NHS, in Broad Strokes
In very broad strokes, Medicare gives more freedom both to doctors and patients. Medicare’s fee-for-service model, in particular, allows doctors to give extra care to patients as necessary, being appropriately compensated for doing so, and without then having to work longer hours to try to see the rest of the patients in their catchment. The difference in the remuneration system in Medicare compared to the NHS is the most significant structural difference, and gives both doctors and patients greater flexibility. Anecdotally, both Australian GPs and Australian patients seem to be much more satisfied with Medicare than with the NHS (certainly true if online practice reviews are anything to go by!).
Ultimately, the difference between Medicare and the NHS in practical terms comes down to respect: respect for doctors’ time and training, and respect for patient autonomy and their desire to choose their own GP.
NHS vs Medicare for GPs: Key Differences
Both systems provide access to health care services, but differ in their funding and payment mechanisms for general practice.
| Category | NHS in the UK | Medicare in Australia |
|---|---|---|
| Healthcare model | Public healthcare system providing NHS-funded services | Universal health insurance scheme that subsidises eligible healthcare services |
| GP payment | GP practices receive funding through contractual arrangements, with additional payments linked to schemes such as the Quality and Outcomes Framework | Medicare payments are generally linked to services billed under the Medicare Benefits Schedule (MBS), with practices also able to use different billing arrangements |
| Patient registration | Patients generally register with a GP practice and are recorded on practice patient lists | Patients can generally choose which GP they visit. Australia also offers MyMedicare, a voluntary registration programme that allows patients to formally register with their preferred general practice and GP. |
| Billing | Patients generally do not pay for standard NHS GP appointments | GPs may bulk bill eligible services or charge private fees, with Medicare providing a rebate for eligible services |
| Practice income | Practice income is influenced by NHS contractual funding, patient registrations and incentive programs | Practice income can be influenced by consultation volumes, MBS items, billing arrangements, patient demographics and practice location |
| After-hours care | Out-of-hours arrangements can vary and may involve GP practices, NHS services and other providers | After-hours services may be provided through general practices, medical centres and dedicated after-hours providers |
| Practice ownership | GP partnerships and other practice structures are common within NHS general practice | Australian practices operate under different ownership and employment structures, including practices where GPs work as employees, contractors or practice owners |
The NHS and Medicare are not directly equivalent systems.
The NHS is the publicly funded health system in the United Kingdom and Medicare is the universal health insurance system in Australia.
Medicare pays for a variety of medical services, for which the services and benefits are defined in the Medicare Benefits Schedule (MBS).
One of the biggest distinctions for GPs is that of funding and billing. In Australia, a GP may bulk bill an eligible service, meaning the Medicare benefit is accepted as full payment, or may privately bill the patient depending on the service and practice’s billing approach.
Australian Government guidance also confirms that different billing arrangements can apply to services provided during the same consultation in certain circumstances.
GP practices in England are under NHS contractual agreements, and may also receive extra income via incentive schemes, such as the Quality and Outcomes Framework (QOF).
Patients also generally register with a GP practice, creating a different relationship between practices and their patient populations compared with Australia’s Medicare system.
These differences are significant for a GP trained in the UK to consider prior to taking up a job in Australia. The amount of money you can make, your work hours, what you do during the day and the nature of your employment can vary based on the individual practice, location, patient population, billing model and employment structure, not just whether you’re working under Medicare versus the NHS.
UK GPs Practising in Australia
There is a large and growing community of expat GPs in Australia, due in no small part to ongoing and increasing frustrations with the NHS. If you are interested in practising in Australia, or considering the move, you may be interested in reading some comments from some of the GPs we’ve placed over the years. We also post vacancies on our website, for example see here for listings for current GP jobs in Melbourne, Sydney, Perth, and Brisbane.
How GPs are Paid by the NHS Compared to Medicare
Unlike the NHS, Medicare pays practices themselves very little, and instead pays GPs directly per patient visit, with the amount dependent on the type of service provided. The practice then takes a percentage of the GP salary (usually 35%) to cover running costs. The most common “item number” (the code associated with a particular service per the Medicare Benefits Schedule, or MBS) is an Item 23: a standard 15 minute consultation. GPs may choose either to charge for consultations by “bulk-billing” or privately billing the patient. Bulk-billing involves sending the bill directly to Medicare and accepting the Medicare-determined schedule payment as the total fee for service. On the other hand, privately billing consultations involves collecting a fee from the patient, generally determined by the practice (with GP-input), with the patient collecting the Medicare contribution directly from Medicare as partial reimbursement. Currently, Medicare is paying $36.30 for an Item 23, and many practices are charging private billing patients approximately $70 for the same (figures correct as at April, 2014). There are both mixed- and bulk-billing practices in Australia.
Medicare’s fee-for-service approach encourages a more entrepreneurial approach from GPs who, on the one hand, may earn very little if they see very few patients, but who, on the other hand, may significantly increase their earnings by seeing more patients, and performing more complex services such as creating Health Plans or doing excisions. There are billing incentives attached to preventive health checks, as well as the management of chronic disease.
Read here for more information about what the average GP earns
Conversely, the NHS system of capitation payments is quite involved and complex — one Department of Health report on the system of weighted capitation payments and the formulas for the same came in at 107 pages! In broad terms, however, the NHS pays practices according to the number of patients on their list, and the number of patients in their catchment. There is a capped amount on the number of visits for which a practice may be paid per patient per year, and most NHS GPs are on salaries, with or without incentive payments. For patients, there is no fee-for-service charge.
After-Hours Requirements, in the NHS Compared to Medicare
Because Medicare has adopted a fee-for-service model, there is no obligation for GPs to provide out of hours care, and no financial disincentives should they choose not to. Some MBS items, such as those for home and nursing-home visits, as well as visits after 8pm, do attract a higher Medicare payment rate, if GPs choose to perform them. Similarly, the overwhelming majority of patients in Australia do not expect their doctor to be available in the late evenings, or on Sundays and public holidays, although many practices do open on Saturday morning, and generally request that their doctors work on a rotating roster for those Saturday morning sessions.
Most after-hours primary care in Australia is handled by independent after-hours locum organisations whose doctors send through visit notes to the patient’s nominated primary GP after their consultation.
On the other hand, in the NHS, GPs’ salaries are calculated according to whether or not they have opted out of the provision of after-hours services. It has also been traditional in the UK, and is still the case for some GPs, that GPs are personally responsible for providing care to all patients on their list, 24 hours per day, 7 days per week, all year round. There can also be something of an expectation on the part of the public that patients’ GPs be personally available to them regardless of the day or time. Dr Eric Rose has done an excellent write-up of the history of after-hours under the NHS here, and Dr Peter Holden has responded to increasingly burdensome patient expectations of his availability and rate of pay here.
Patient Selection and GP Autonomy
GPs in Australia are not required to see any patient they do not wish to, discriminatory practices in patient and appointment selection withstanding. So, while under the NHS GPs have an obligation to take on any patient within their catchment, and to become singularly responsible for the year-round healthcare of that patient, in Australia doctors may choose their patients, and may see as many or as few patients per year as they deem appropriate. Although Australia, like the rest of the industrialised world, has a fairly tightly regulated medical field, and increasing government oversight, UK GPs who have moved to Australia have conveyed to us a feeling that Medicare is less prescriptive with treatment practices and grants more autonomy to GPs.
Moving From the NHS to Medicare
If UK GPs wish to work in Australia, they will need to be registered with the Australian medical board, and the route they take will vary according to their qualifications, GP training, specialist recognition and background.
The Australian Health Practitioner Regulation Agency (AHPRA) oversees the registration process for the Medical Board of Australia, while the Royal Australian College of General Practitioners (RACGP) is involved in the assessment and fellowship process for overseas-trained GPs. The Australian Medical Council (AMC) also assesses international medical graduates’ primary medical qualifications.
Registration for UK-Trained GPs
Each GP in the UK has a unique pathway to registration. Your path is dependent on your personal competence and training level. Depending on your situation, possible registration pathways for GPs trained in the UK may include the AHPRA Expedited Specialist Pathway (ESP), the RACGP Practice Experience Program (PEP) Specialist Stream or the Competent Authority Pathway (CAP).
The Expedited Specialist Pathway might be suitable for UK GPs who have a Certificate of Completion of Training (CCT) and hold MRCGP. This pathway may offer a more direct pathway for specialist registration than some traditional pathways, though eligibility is based on specific requirements.
The RACGP pathway can also be used to assess the competence of GPs who hold a specialist qualification in a different country, including the PEP Specialist Stream for doctors whose qualifications are assessed as substantially or partially comparable to Australian standards. Doctors trained in other countries may be eligible for the Competent Authority Pathway if they meet the necessary requirements. However, this pathway leads to general registration rather than specialist GP registration.
Do UK GPs Need Australian Fellowship?
Fellowship of the Royal Australian College of General Practitioners (FRACGP) is a relevant qualification for doctors who are undertaking GP training in Australia as well as for some overseas-trained GPs aiming for fellowship in Australia.
But UK GPs should not think that the training path taken by an Australian medical graduate is necessarily the path they will need to follow. It may be possible for some overseas-trained GPs to be registered as a specialist under the Expedited Specialist Pathway without obtaining FRACGP, or to undertake supervised practice and other requirements via an appropriate RACGP pathway.
Find Your GP Registration Pathway
You should check your eligibility before applying for jobs or making relocation plans as requirements may differ between doctors educated in the UK and others. The GP Registration Pathway in Australia may be dependent on Primary Medical Qualification, MRCGP, CCT, Specialist Recognition and Country of training.
International GPs can use our GP Eligibility Pathway Tool to help determine which registration pathway might apply to their individual circumstances. The tool outlines the main routes overseas-trained GPs generally go down and offers a point of reference for the next steps.
