25 June 2019 | Australian GPs, Clinic Owners and Practice Managers, UK/Ireland GPs | 4 minutes read
The Death of Bulk Billing
Recent changes for GPs could reduce the access to bulk billing GP services across the country and because of this we predict that the majority of clinics will move away from bulk billing within 2-3 years.
Due to changes such as the Visas for GPs program and PEP, Australia stands to lose a cohort of well-trained GPs – rather than retaining them to work in areas that are not so popular for unrestricted GPs.
Our reasons for this statement are varied, but it is a well-established fact that most bulk billing practices are staffed by GPs that have come from overseas and they would not survive without an overseas trained workforce which the government is trying to reduce. We have seen the release of several policies designed to restrict the number of GPs and the Department of Health has clearly indicated that they wish to reduce GP numbers by 355 in the next 12 months.
While the policies are an attempt to solve the workforce shortage in rural and regional areas, they also actively reduce the number of GPs able to work in inner and outer metropolitan areas – the areas where most people live.
Why will bulk billing disappear?
There are a range of reasons why we believe bulk billing will disappear however the following are issues solely related to workforce:
Bulk billing practices are usually found in lower-socioeconomic areas. Most unrestricted GPs prefer to work close to CBD areas and sway towards the idea of mixed billing.
These practices rely heavily on OTDs. If the practices can’t access enough GPs, they will be forced to leave the bulk billing model to recruit GPs – as patient demand will outstrip the supply of consultations. This will also push up GP remuneration and make bulk billing clinics unviable. One clinic owner told us recently that they have only 20% private billing in their clinic, but that is their only source of profits.
The visa changes mean that overseas GPs that are already in Australia, but not yet permanent residents, will find themselves unable to change jobs unless they move to regional area (this affects both VR and Non-VR GPs). Many of these GPs have children in private schools and will not be willing to move to a regional area (if their current role becomes unsuitable). Once they become permanent residents they will have more freedom, however with the DWS changes expected in July they will be back to the same set of options – move to a regional area, return to their home country, or stay with their employer for the balance of their 10 year moratorium.
As this flow of well-trained GPs stops, and existing GPs find themselves at retirement age, the supply of GPs across the country will fall. We are predicting a drop of at least 500 GPs in the next 12 months due to these factors alone.
The RACGP program changes that will come into effect from September attempt to push GPs to regional (MMM2+) regions – these changes will also stem the flow of well-trained GPs to Australia. DWS will change, and we know these changes to be in the same vein – pushing OTDs to MMM2+ regions. So GPs that have in good faith relocated and resettled their family to Australia will be faced with a very difficult decision – if they wish to change jobs for any reason: Move to a regional centre (which the vast majority will not do) or head home.
The net effect of these factors will be that bulk billing practices will slowly lose their GPs, and not be able to replace them. This will achieve the Government’s objective of reducing the number of GPs in Australia in order to reduce the growth in Medicare spending – at the cost of low-income Australians that will struggle to afford access to primary healthcare.
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