Mark Butler has told the public to ‘ring around’ for bulk billing GPs and vote with their feet.
Federal Health Minister Mark Butler has shifted pressure to general practice to respond to the “very significant investment” in last year’s budget and encouraged patients to shop around for bulk billing practices.
Speaking at a press conference yesterday, Mr Butler said, “we want patients to know that if one practice in their area has changed their behaviour around bulk billing, and another hasn’t, that it’s entirely your right to vote with your feet”.
While he promised the government wouldn’t “name and shame”, he encouraged people to “ring around and ask ‘are you bulk billing a consult for my kid who’s 14? Are you bulk billing me, I’m a pensioner, I’m a concession card holder’”.
Speaking to The Medical Republic, founder of the Australian Society for General Practice Dr Chris Irwin labelled the press conference a “let them eat cake moment”, demonstrating the government’s dissociation from the reality that bulk billing is hard to find, especially for non-concession card holders.
The lack of focus on quality of care from the minister was also disappointing, added Dr Irwin.
“I’d argue that it’s far better value, for health and money, for most Australians to spend $40-50 to see a fantastic GP that can spend 15-20 minutes of time, compared to a GP who is under extreme financial pressure, and is still having to do six-minute appointments,” he said.
“You logically just can’t give patients as much when you’re so constrained by time.”
RACGP president Nicole Higgins added that it was through the neglect of successive governments that the subsidy for GPs had long ceased to match the cost of care.
“After 10 years of failing to invest in the patient’s subsidy to see their GP, there is now a gap,” she told TMR.
Dr Higgins added that it was important to remember that Medicare was never intended to fully subsidise general practice.
“We can’t be like the UK, where they’ve traded off free access to general practice for quality and safety, and they’ve now got a broken system,” she said.
“I would never expect that GPs should trade off quality and safety and devalue 10-11 years of training to become a specialist GP.”
Dr Irwin said the government’s “unfortunate” new comments played on the “greedy doctor” rhetoric, and contradicted the premise of MyMedicare, which according to Mr Butler himself in March last year is supposed to strengthen patient-medical practitioner relationships.
GPs have taken to X to speak out against this vilification of GPs.
If your GP won’t bulk bill, we will vilify them for making sure they continue to pay their receptionist and nursing staff salaries.
— Dr Marian Dover (@DoverMarian) January 29, 2024
If your GP won’t bulk bill, we will blame them for the dwindling interest in GP training, because new doctors in GP should just accept lower pay.
If something at the shop costs $85, it doesn't matter if I offer $40 or offer $60; I'm still not covering the costs and I can't expect the shop to accept it.
— QLDCountry GP (@QLDCountryGP) January 29, 2024
That's EXACTLY what you're doing to general practice.
Trying to call us greedy when the Gov is too cheap to pay the bill.
But Mr Butler touted the government’s consultation with general practice, pointing to the RACGP as a key backer of the triple bulk billing incentive.
“This was not something we designed on a blank sheet of paper, it was something that followed deep engagement with doctors’ groups, particularly the RACGP, and they said it was an important measure to re-incentivise bulk billing behaviour in general practice,” he said.
“So, we want to see a response from general practice to the very significant investment, on behalf of taxpayers, that we made last May.”
When asked why doctors weren’t universally bulk billing, Mr Butler evaded with the anecdotal benefit of the tripled incentive to the regional community.
“For regional communities where it is harder to attract doctors and always has been, the average income for a general practice consult has increased by 50% because of the measure we introduced in the May 2023 Budget,” he said.
But some rural doctors have been quick to point out that the incentives only apply to concession holders and are insufficient at that.
“We want to see a response from GP to the very significant investment [on Medicare] on behalf of taxpayers” ?
— Dr Marian Dover (@DoverMarian) January 29, 2024
Sorry but does @Mark_Butler_MP realise the rebates are less than half the cost of GP consults? That incentive 2 bulk bill isn’t for pregnant women or mental health? https://t.co/qfx0jLGKRR
Mr Butler was unable to provide data on whether more doctors have started bulk billing since the incentives were implemented, despite fortnightly reports being provided to the federal government.
According to Mr Butler, the data hasn’t been “fully pulled together” but they are “keen to get that material out as quickly as possible” after it is “analysed by regions”.
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Dr Irwin expected that the bulk billing numbers would be “static” if not reduced due to the disincentive to bulk bill those who are not eligible for the triple bulk billing incentive.
“I definitely think that we need a strong well-funded health system in which the vulnerable have access to care at little or no cost,” he noted.
“The problem that the government doesn’t understand is once a practice has spent $10,000 getting FPOS machines in, training the staff, once you’ve made that leap from being a fully bulk billing clinic to a clinic with Tyro, you can’t put the genie back in the bottle.
“I think it’s very unfortunate the Health Minister tries to put GPs in the naughty basket for just trying to receive adequate funding for service provided.
“But that’s politics, I suppose.”
Mr Butler added that concessions, which account for 60% of all activity in general practice, remained the “principal focus” of bulk billing.
“We’re hoping to have some real data to support the anecdotal feedback we’ve got that there has been a significant return to bulk billing,” he added.
