An ABC News survey of more than 800 GPs combined with exclusive data from the Royal College of General Practitioners (RACGP) has cast doubt on whether the signature health policy of this election campaign can be fully delivered.<\/p>\n
More than 90 per cent of doctors who contacted ABC News said they won’t move to full bulk-billing under changes promised by both major parties.<\/p>\n
The findings align with a similar survey by the RACGP, released exclusively to ABC News, which found two-thirds of respondents don’t intend to bulk-bill more patients, let alone all of them.<\/p>\n
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Many GPs told us they thought the policy would incentivise shorter consultations and reward getting more patients through the door.\u00a0 (ABC NEWS: Billy Cooper)<\/p>\n
Labor’s cornerstone election promise<\/a> is to make nine out of 10 visits to the GP free by the end of the decade. It says this will be achieved through an $8.5 billion scheme that gives doctors an incentive payment to bulk-bill all patients, not just pensioners and concession card holders.<\/p>\n The Coalition has promised to match the package<\/a> dollar for dollar.<\/p>\n But many doctors told ABC News the policy showed a lack of understanding of how general practice works. They said it would incentivise shorter consultations and could compromise quality care.<\/p>\n Politicians are throwing more money at GPs, so why are they unhappy?<\/a><\/p>\n We heard from hundreds of GPs across the country and here’s why many are saying they won’t expand their bulk-billing practices beyond concession patients.<\/p>\n Doctors who already bulk-bill in large numbers said the commitment would make a difference and one of Australia’s biggest bulk-billing providers said it will bulk-bill millions of extra appointments each year.<\/p>\n But that hinges on whether the GPs who work at those clinics agree to do so.<\/p>\n ABC News ran a week-long survey of doctors online.<\/p>\n More than 840 GPs responded; 92.4 per cent stated they would not start exclusively bulk-billing when the changes came into effect while 7.6 per cent said they would.<\/p>\n See how we used these responses to help develop this story<\/a>.<\/p>\n Loading<\/p>\n Last month, the RACGP briefed 283 GPs on the proposed changes and presented the government’s own modelling<\/a> which suggests most GPs would be better off under the changes. The doctors were then asked how this would affect their billing.<\/p>\n Six per cent said they would shift to fully bulk-billing; 10 per cent said they would increase bulk-billing; and 66 per cent said they would not change their bulk-billing rates at all, with 6 per cent within that group intending to increase private fees.<\/p>\n Patient frustration expected<\/p>\n In the NSW central west town of Mudgee there are too many patients and not enough doctors.<\/p>\n Two medical practices service an area covering more than 26,000 residents.<\/p>\n Both doctors’ practices in Mudgee have closed their books to new patients.<\/p>\n At the Mudgee Medical Centre, practice manager Colleen Best said the billions of dollars being promised by both sides won’t change their rates.<\/p>\n Every morning, patients queue outside the medical centre to secure last-minute appointments.<\/p>\n Colleen Best says the pledges won\u2019t make the Mudgee Medical Centre change its rates. (ABC NEWS: Billy Cooper)<\/p>\n On the morning ABC News visited, there were more than 20 people waiting for the doors to open at 8:30am and the practice was fully booked for the day within 10 minutes of opening.<\/p>\n Loading<\/p>\n Ms Best estimates 65 per cent of patients are bulk-billed and the rest pay $108 for a private consultation.<\/p>\n Under the government’s plans if the practice went to total bulk-billing, the centre would receive a rebate of $87 per visit, which would be a loss of $21 on every patient.<\/p>\n “That’s the bottom line\u2026 there is an expense to running a practice that we can’t afford if we bulk-billed everybody,” Ms Best said.<\/p>\n “Every month it’s a battle to make this place earn more than we spend.”<\/p><\/blockquote>\n Patients queue outside every morning to secure last-minute appointments. (ABC NEWS: Billy Cooper)<\/p>\n Ms Best said the practice would continue to only bulk-bill pensioners, health card holders and some under 16s. She expects patients to become frustrated when they learn the centre is not making all appointments free, putting more stress on staff.<\/p>\n “They’ve just made our problem worse, because now we’re going to be listening to people whingeing about not being able to get into a doctor, and then people whingeing about not being bulk-billed,”<\/p><\/blockquote>\n she said.<\/p>\n “My poor reception staff, I’m just going to have to put armour on them soon, I think, to deal with all the complaints and it’s not their fault.”<\/p>\n Colleen Best says clinic staff do the best they can in difficult situations. (ABC NEWS: Billy Cooper)<\/p>\n What does the government modelling show?<\/p>\n The government incentives will be higher for doctors in regional or remote areas.<\/p>\n RACGP president Dr Michael Wright said that’s likely where the biggest difference will be felt.<\/p>\n “That’s important as often in those areas, general practice is the only health care that people can access in those communities,” he said.<\/p>\n But there are concerns that clinics in the city, where overhead costs are higher, will be less likely to bulk-bill more patients, according to the Australian General Practice Alliance, which represents GP-owned businesses.<\/p>\n “There are plenty of people doing it tough in metropolitan areas but there’s a disincentive for urban GPs to bulk-bill. It shouldn’t be a postcode lottery,”<\/p><\/blockquote>\n chair of AGPA Dr John Deery said. Michael Wright says GPs across the country have concerns. (ABC NEWS: John Gunn)<\/p>\n Many doctors told ABC News their main concern was that the new scheme would encourage short consultations because the incentive is a flat rate that doesn’t increase for longer appointments typically required for complex cases and women’s health<\/p>\n “I’ve had a lot of concerns, particularly from female GPs, who spend more time with their patients on average, that they are going to be more disadvantaged,” Dr Wright said.<\/p>\n The government said it had calculated that 4,800 practices, that’s about three quarters of clinics in Australia, would be better off moving to full bulk-billing.<\/p>\n “A full bulk-billing GP two years ago earned about $280,000 a year \u2026 after November that rate will be more than $400,000. That’s a $125,000 increase in salary,” Health Minister Mark Butler said.<\/p>\n “After November they will be earning more than a mixed billing GP.”<\/p>\n Read more about health and the federal election:<\/p>\n GPs told ABC News those figures include unrealistic numbers of patients seen and don’t properly account for insurance and other practice costs.<\/p>\n Mr Butler said it was up to GPs to decide whether or not they took up the incentives as the government couldn’t make it a mandatory scheme.<\/p>\n “I can’t make them do that \u2026 but I’m confident we have designed this in a way that’s in their interests to do this as well as obviously in the interest of patients.”<\/p><\/blockquote>\n What the big GP operators think<\/p>\n ABC News spoke to five of the large corporate groups that run GP clinics across Australia and only one said they would be able to significantly ramp up bulk-billing.<\/p>\n ForHealth owns and operates around 70 GP clinics across Australia and anticipates their overall bulk-billing rate would increase from 77 per cent to 90 per cent.<\/p>\n “We’re expecting six in every 10 practices will bulk-bill versus one in every 10 practices that do so today. So it’s a six-fold increase and we’re expecting that on day one,” CEO Andrew Cohen said.<\/p>\n<\/p>\n
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