When it is supported by other funding sources, of course.
A few weeks ago, federal health minister Mark Butler revealed that some 3700 practices had signed on to receive the bulk billing practice incentive payment (BB PIP), putting it just 1100 clinics shy of its 2030 goal.
But those final 1100 clinics may prove elusive, given that a sizeable portion of the practices which have signed up so far don’t necessarily represent traditional general practice.
While it’s true that all the clinics registered for the BB PIP bulk bill all GP non-referred attendances, it is not true that all BB PIP clinics subsist entirely off these earnings.
Technically, any practice which is providing GP NRA services, which may complement other onsite care including mental health, is eligible to participate in the BB PIP.
There are multiple Aboriginal Community Controlled Health Organisations, like the Redfern Aboriginal Medical Service and Armajun Aboriginal Health Service, signed up for the BB PIP.
While these clinics run a general practice-type model, they also receive grant funding under the Indigenous Australians’ Health Programme.
There are also clinics on the BB PIP which receive other funding, such as Geeveston Medical Centre in Tasmania, which is supported by the Huon Valley Council, and the Tuggeranong Family Medical Centre (formerly known as Interchange Health Co-op), which received $3.8 million in federal grant funding to prevent it from closing completely.
The DoHDA map of bulk billing clinics also includes the Indian Ocean Territories Health Service, located on Christmas Island, which is run by the Department of Infrastructure, Transport, Regional Development, Communications, Sport and the Arts and the Western Australian Department of Health.
Related
But the most puzzling aspect of the BB PIP is the presence of some Headspace clinics, such as Headspace Collingwood.
Headspace is predominantly funded by the Department of Health, Disability and Ageing, alongside other grants.
Professor Louise Stone has conducted a thorough investigation into the clinics listed on the DoHDA bulk billing website. Stay tuned for her op-ed, which we will be publishing on Saturday morning.
The Medical Republic is not questioning whether these clinics need or deserve the additional funding which is coming from the BB PIP. But it is worth examining the narrative that it is now easier or more viable for practices to survive under a universal bulk billing model.
The key to the Headspace puzzle lies in the fact that the Department of Health, Disability and Ageing defines general practice differently to how the RACGP – and, consequently, most GPs – define it.
Under the BB PIP program guidelines, a “general practice” is defined as any clinic providing “patient-centred, continuing, comprehensive, coordinated primary health care to individuals, families and communities within a fixed, physical location”.
The RACGP definition of general practice for the purposes of accreditation states that general practices must provide comprehensive, patient-centred, whole-person and continuous care and that its services must be predominantly of a general practice nature.
Because the DoHDA doesn’t have that requirement for most of the activity to be general practice-related, it opens the way for clinic types like Headspace to become BB PIP practices.
GP and researcher Professor Louise Stone, who has taken an interest in the clinics on the BB PIP, told The Medical Republic it was clear that universal bulk billing alone was not supporting general practice.
“The implication of the discourse around all this is that if general practices universally bulk bill, then they’ll be able to support themselves, and they’ll do well,” she said.
“[Minister Butler said] … in the in the original announcement that the goal of this program was to design the MBS so it supports all Australians to access high quality and cost-effective professional services.
“The implication is that the MBS is the mechanism by which those services will be delivered. Right? … It’s misleading.”
A follow up to this story, featuring further research from Professor Stone, will be published on Saturday.
