The government’s bulk-billing push is coming for independent mixed-billing GPs, funded by your taxes and delivered at scale by private equity. Max Mollenkopf’s answer is to stop pretending it isn’t happening and think harder.
Dr Max Mollenkopf is a Newcastle GP who tells jokes to kids, runs his own practice, sits on medical software platform boards, and thinks harder about the business of general practice than almost anyone in the country.
He is not angry.
He is not a victim.
He is, however, deeply clear-eyed about what is happening to independent mixed-billing general practice in Australia right now, and his message to his colleagues is blunt: this is not Kansas anymore, and clicking your heels three times and wishing for 2008 is not a strategy.
Max’s practice, White Bridge Medical Centre, was, by his own description, “dying in the messy middle”.
Patients who were being bulk-billed were sitting in the same waiting room as patients paying a gap, and everyone was annoyed about it for different reasons. The GPs were in constant tension about who to charge. The practice was trying to be everything to everyone and succeeding at neither.
So Max did something that the panel host at this week’s Digital Health Festival in Melbourne described as “ballsy”: he formally split the practice in two.
White Bridge Express is the bulk-billing arm. Walk in, check yourself in on a kiosk, sit in a separate and subtly less salubrious waiting area, see a GP in a shorter appointment, get what you need, leave. No follow-up. No frills.
The service, as Max puts it with characteristic directness, “reflects the cost of providing it”.
The premium side of the practice is the opposite: longer appointments, dedicated reception engagement, follow up, continuity of care, and a gap fee that reflects what that actually costs to deliver.
(Hmmm … maybe a big comfy snow white MCM couch with an exotic tropical fish aquarium featuring Nemo and an angry french crab too, Max? ).
“We made a conscious decision,” Max told this week’s Digital Health Festival audience. “In my mind, what we do is reflecting what the true system looks like.”
He’s right. The true system is considerably more uncomfortable than most people in general practice want to acknowledge. Including, the RACGP, which isn’t getting it entirely so far.
How we got here
The story of bulk billing’s collapse and engineered revival is one of the more instructive political dramas in recent Australian health policy.
In late 2021, then RACGP president Dr Karen Price said, in effect, that all bets were off. The government was not genuinely behind general practice. The Medicare rebate had been frozen for years while practice costs rose. GPs who kept bulk billing every patient were subsidising the system with their own income.
One by one, practices that had always bulk billed started charging gaps. Patients noticed. Access became an issue and it took almost no time for it to become a major political battleground. .
When the Albanese government came to power in 2022 it made the decline in general practice a priority to fix. But how it started doing it was always going to have a political endgame attached to it and ramifications for all GPs.
It was definitely a case for the RACGP and its members at the time of – ironically the College had done a great job of lobbying in this election – be careful what you wish for.
At the 2025 election, Labor launched a campaign that positioned the Medicare card as, in the words of the Prime Minister, a ‘free green credit card for healthcare’.
That should have sent chills down the spines of most GPs for what that potentially meant was coming.
More money sure. But with some very hairy string.
Labor committed a very large amount of new funding to general practice – heavily skewed toward making bulk billing more financially viable for practices that returned to it – or not.
The government published numbers purporting to show that bulk billing was now more profitable for practices that had left it. Independent analysis suggested the numbers did not quite stack up for most mixed-billing practices once you factored in the true costs of providing care.
But the political commitment was made, and it has been pursued since, with considerable zeal. The government needed a way to pressure those mixed billing practices who didn’t want to revert.
One instrument of that pursuit is the new bulk-billing clinic program: direct government funding to establish new bulk-billing practices in areas the government has identified as underserved.
Canberra, for years one of the worst-performing cities in the country for bulk billing, has been an early target. Three new bulk-billing GP clinics are planned to open in the ACT next month, in addition to the existing Medicare Urgent Care Clinic network across the territory. Similar programs are rolling out nationally.
Newcastle has now been targeted. And that is where Max’s story becomes everyone’s story.
The Bunnings problem
The government does not build these new bulk-billing clinics itself. It funds other organisations to build them. And the organisations best positioned to win those contracts are the ones with the scale, the capital, the management infrastructure, and the operational track record to execute at speed.
This means, in large part, corporates, now often PE-funded corporates, and yes, one organisation stands out above all others – not because it’s bad or evil which is a bit of a PE branding problem, because ForHealth is just a smart operation meeting both the government’s needs and that of consumers.
Related
ForHealth, led by CEO Andrew Cohen, is one of the largest bulk-billing general practice providers in the country, serving more than eight million patient visits every year across a network of more than 85 large-scale medical centres.
It holds a significant share of the Medicare Urgent Care Clinic contracts, has been publicly thanked by the NSW government for its role in the state’s bulk-billing support initiative, and is now a primary vehicle through which the federal government is delivering its new bulk-billing clinic program.
Cohen is a genuinely smart operator who has understood the government’s needs, built an organisation that can meet them, and positioned ForHealth to be the beneficiary of the policy agenda. There is nothing wrong with any of that.
But here is the thing that sticks in Max’s craw, and it is hard to argue with him.
Bunnings builds new stores competing with local hardware shops using its own capital. Cohen is doing the same thing – move in, use scale and operational excellence to deliver better prices and broader range, compete the locals into submission – but with government capital to get started.
The mixed-billing GP clinic down the road from the new government-funded ForHealth bulk-billing practice did not get a grant. They were just told to compete.
Or not.
“I’d be happy tomorrow to bulk bill all my patients if the government actually covered the cost of providing that bulk billing,” Max told The Medical Republic.
“But at the moment they seem to have this approach where they find select providers with significant background funding, and then expect the rest of us to meet that same level on a totally different funding model. I don’t necessarily think it’s fair.”
Max is also, characteristically, pragmatic about it.
“I will be applying for it, because you’d be an idiot not to. Why would you leave millions of dollars of government funding on the table?”
If local patients got a vote in the process, Max might actually win one of these contracts, but as things stand, his set-up, though cool, is small and he’s not rich – not a white grand piano to be seen anywhere.
Also, these contracts are generally assessed by the local PHNs so the government can maintain an air of independence about how they are won. And Dr Mollenkopf wouldn’t be on the senior management Xmas card list of Hunter New England PHN, I’d say, based on a few of the – very logical – missives he’s written on LinkedIn over the years about the organisation.
HNEPHN, by the way, would do very well to have a good look at Dr Mollenkopf’s application carefully. He understands Newcastle people, patients and the healthcare system better than anyone I’ve ever met. He might be a good experiment for them.
This is not just about the government
Max’s analysis of what general practice is up against goes considerably beyond the ForHealth Bunnings problem, and this is where he is most valuable as a voice for the profession.
Because the government and ForHealth are only two of the new competitive threats facing an independent GP practice in 2026.
There are the digital health platforms: Eucalyptus for weight loss and women’s health, Midnight Health for after-hours telehealth, InstantScripts for fast script delivery.
These are not general practices. They are consumer healthcare businesses that have looked at the pain points in the primary care system – access, speed, after-hours coverage, specific condition management – and built elegant products around them.
Their patient acquisition is digital-first. Their user experience is built from the consumer out, not the clinician in. They are not trying to replace your GP. They are trying to make your GP irrelevant for the specific interactions where they can do it faster and cheaper.
They are automating the low-hanging fruit consult game. And in doing so taking another big chunk out of the traditional (outdated?) GP business model.
Then there are the private health insurers.
Several of the major funds are now acquiring or partnering with GP groups and offering their members free or heavily subsidised primary care access as part of their product offering.
The logic is straightforward: if you own the GP interaction, you can manage your members’ health upstream, reduce hospitalisation claims downstream, and create a vertically integrated health product that makes it much harder for members to leave.
This is not fringe activity. It is accelerating.
And then there is that small new thing called AI
At the coalface, Max sees the AI-informed patient becoming the norm.
At his clinic, in a collaboration with cloud-based practice management system MediRecords, the practice has spent 18 months building an engaged patient portal with 663 active accounts and 60 or more logins per day.
The most common uses after appointment booking are results viewing and medication information. Patients are already taking their pathology results, photographing them, and putting them into ChatGPT.
As Max told his Digital Health Festival audience, without clinical context, ChatGPT tells an elderly patient with chronic renal failure and a high creatinine that they are in acute renal failure and should go to hospital immediately.
“They freak out,” he said.
The MediRecords solution under development is AI-powered contextual pathology explanations inside the patient portal, where the AI has access to the full clinical history and can say: yes, this value is high, and it is consistent with your baseline.
That is general practice defending its clinical relationship through technology. It’s a very big other op ed that’s coming (sorry).
The prevention problem the RACGP doesn’t want to say out loud
There is a deeper policy problem running underneath all of this that Max understands and that Professor Louise Stone has articulated consistently in these pages: bulk billing, as it is currently structured, is structurally incompatible with the prevention agenda that both the Labor government and the RACGP nominally support.
The case for investing in general practice – the political case, the economic case, the system design case – rests on the idea that GPs, given the time and continuity to do it properly, can manage chronic disease, identify risk early, change behaviour, and ultimately prevent the acute episodes that fill hospitals and consume the system’s most expensive resources.
This is the pivot. This is the whole theory of change. And it requires long consultations, longitudinal relationships, and the cognitive bandwidth to think about the whole patient rather than the presenting problem.
Fee-for-service bulk billing, optimised for throughput, does the opposite. It incentivises short consults. It rewards churn. It penalises the GP who spends 40 minutes with a complex patient over the one who sees four patients in the same time.
There is also a well-documented gender dimension: female GPs are on average more empathetic, spend more time with patients, and in a fee-for-service model are therefore systematically paid less than male colleagues for the same quality of care. The system does not just fail to support prevention. It actively penalises the behaviours most associated with it.
The government, to its credit, is aware of this tension. But the political logic of “free healthcare” is enormously powerful, particularly in the cost-of-living environment that has dominated the last several years.
Bulk billing is popular. Nobody wants to say publicly that free healthcare is bad. But pretending that there are no trade-offs – no corners being cut, no complexity being skipped, no chronic disease going less well managed in a 10-minute bulk-billed consult than in a 30-minute properly funded one – is a form of political dishonesty that the health system is already paying for and will pay for increasingly in hospital beds and avoidable acute episodes.
What Max is actually doing
Dr Mollenkopf’s response to all of this is not to complain and wait for the cavalry – whoever that would be.
The RACGP, though much more agile than the past, is still largely living in a world where the ideal model of general practice is the corner family practice from the 1970s and 1980s – the GP that Mum knows, the longitudinal relationship, the community anchor.
It’s a board and governance problem.
There isn’t enough diversity there so things don’t actually change that much in terms of getting close to the picture of what is really going on at the coal face of members. How do you recognise a problem when you have a group of GPs running an whose members face such a diverse set of new challenges when most of them were brought up trusting one old model of care they loved and want to defend.
The RACGP board model existed in a world with regulatory capture, information asymmetry, and no competitive alternatives. None of those conditions exist anymore.
Dr Mollenkopf’s argument to independent GPs generally, is not that the traditional model is wrong or that it is going to entirely disappear.
It is that it is now one option among several, and that GPs who want to survive in the emerging environment need to think like business owners who happen to be clinicians rather than clinicians who reluctantly have a business.
That means mapping exactly who your patients are and what they actually want from you.
It means understanding which of the new competitive models is actually threatening your specific patient population and which ones are not. It means being honest about whether you are trying to serve the complex elderly patient who needs longitudinal care, the young consumer who wants fast and frictionless, or both – and if both, having the architecture to serve each properly.
His answer at White Bridge is to do both — but to stop pretending they are the same service.
The express service competes where he cannot win on cost anyway, captures the patients he would otherwise lose entirely, and does so with an honest acknowledgement of what they are getting.
The premium service builds the loyal patient base, uses technology to deepen the clinical relationship and extend it into the digital spaces where patients are already operating, and delivers the longitudinal care that he believes is both better medicine and a genuinely defensible competitive position.
The threats to the old ways are very real now.
The government is funding competitors directly.
ForHealth is executing brilliantly with government money. Telehealth platforms are picking off the easy transactions. Private health funds are building vertically integrated products. AI is making patients simultaneously better informed and more anxious.
This is not only not going away the whole dynamic is gathering momentum and AI is going to put a rocket under the whole show.
The GPs who are going to thrive are the ones who have looked clearly at the landscape, decided what they want to do, and either build their practice accordingly or pick one of the many new and diverse employment options opening up for them.
I’m a head-in-sand kind of person when it comes to anything existentially threatening. I mean, I run a media business whose business model is still in the 80s. But I’ve survived and I’m having some fun and making a bit of money. You can do it.
Being a GP is still a great career and it’s maybe even going to be better going forward.
But it is not a passive one anymore.
As Max puts it: the government is not going to change its policy, at least for a while. ForHealth is not going away. The new models are not going away. You can adapt, you can go part time and get a job at ForHealth or Ochre, or you can keep pretending it is not happening.
He has made his choice.
He thinks you should make yours.
Note: While Dr Max Mollenkopf is a member of the editorial board of The Medical Republic we did not consult him one little bit about writing this article (which we might regret soon). He’s reading it at the same time you are.
If you want to meet Dr Mollenkopf or perhaps Andrew Cohen and dive a bit deeper into the topic of this article – essentially the future of GPs and how to get there having a bit more fun along the way – please try to come to Burning GP on September 26 at Noosa this year. You can get a 20% discount on the current early bird ticket price by using this code: TMRreader and applying it HERE.
Once you’ve got your ticket, or before, get your accommodation as its school holidays. There is plenty there but not so much left at the event or main street Noosa. Hope to see you there.
