The latest funding promise in the hotly contested Queensland election is for 50 new bulk-billing clinics.
Working out how to bump up GP bulk-billing rates may have stumped successive federal governments, but Queensland Labor is confident it has found the solution in a plan to establish 50 bulk bill-only clinics.
Under the proposal put forward by current premier Steven Miles, $365 million will go toward setting up 50 GP clinics across the state.
While Queensland Labor is calling it an “unprecedented move to fix primary care”, AMA Queensland said it was “a fundamental misunderstanding of the pressures facing existing practices”.
Polling in the state opened today, with election day set for Saturday 26 October.
It’s unclear whether the clinics would have ongoing state-administered grant funding and how the bulk-billing component would be enforced.
AMA Queensland president Dr Nick Yim told The Medical Republic that while it was “commendable” that a state government was trying to fix general practice, the problem with bulk billing did not stem from a lack of clinics.
“This funding announcement was more predominantly for infrastructure and initial setup costs, but one of the challenges in general practice is the ongoing costs associated with running a GP practice,” he said.
It’s not much good building shiny new clinics if there are no doctors to staff them, after all.
There’s also the risk that a bulk bill-only clinic would potentially undercut existing practices.
“General practices need a workforce that includes GPs, nurses and administration staff,” Dr Yim said.
“[Introducing] additional clinics runs the risk of splitting our existing workforce, especially in areas where another GP might be directly competing with a 100% bulk billing clinic.”
Dr Yim also pointed out that it would take time to build those new centres, which would also only be of benefit from people in the specific areas they are going to be set up in.
“Most patients have GPs who they already know and trust, and governments should fund them to access their trusted GP and practice staff who know them and have been caring for them,” Dr Yim said.
Neither the AMAQ nor the RACGP were consulted about the policy prior to it being announced.
“We really don’t know any of the details, and I guess that’s our concern,” immediate past RACGP Queensland chair Dr Bruce Willett told TMR.
“We … have had seemingly contradictory comments from the health minister and the premier about whether or not these will be new sites or whether there’s an availability for existing clinics to be involved in this as well.”
No locations for the 50 hypothetical clinics have been set thus far, but Mr Miles confirmed they would be placed in areas of the state with the lowest bulk billing rates.
According to the latest Medicare statistics, the Primary Health Network with the lowest bulk billing is Brisbane North, at 68%.
The next-lowest bulk-billing regions were Sunshine Coast, Wide Bay and Central Queensland at 74% and Brisbane South at 76%.
These areas, excluding some parts of central Queensland, are predominantly metropolitan; along with the Gold Coast, the three PHNs contain the entirety of the state’s non-designated priority area GP catchments.
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Rural areas of the state, meanwhile, tend to have higher bulk billing rates and have historically struggled to attract and retain a GP workforce.
“The next question is: what problem are we trying to solve here?” Dr Willett said.
“The bulk-billing rate is just shy of 80%, so it’s still very high.
“I challenge anyone to identify another industry where people accept less than half their fee in a time when there’s a [labour] shortage.”
“It speaks to the compassion of GPs … my own bulk billing rate is in excess of 80%, and I know that if I were to bulk bill I would still be fully booked.”
Other promises from Queensland Labor this election cycle include legislating an exemption for payroll tax on contractor GPs – something that the LNP has also pledged – and making the pharmacist prescribing trial permanent without an evaluation.
