When will we we stop framing access and quality as opposing goals?
I want every patient to see a GP without worrying about the cost — but I also want to preserve time, quality, and independence in how we practice medicine.
In Australia, it seems you can’t have both.
And that’s the real tragedy.
The uneasy question
I haven’t made up my mind. It’s a question that has sat uneasily with me for months.
I would love to be part of a story where every patient can see a GP with no out-of-pocket cost.
And I’d also love to be part of a story that celebrates high-quality general practice — where time, skill, and continuity are valued.
But the more I look at the numbers, the more I realise: in our system, you can’t do both.
To achieve one, you must compromise the other.
The new incentives: a sweetener or a trap?
The new bulk-billing incentives have made things interesting.
They lift practice income and GP earnings — not dramatically, but not insignificantly either.
For many practices, this new money has been a relief. Patients would receive fully subsidised care.
So why not just go all-in and bulk bill everyone? Isn’t it foolish not to?
Then comes the uncomfortable thought … is this a trap? What happens in three years, when incentives shift or governments change? Are we becoming part of a system designed for throughput, not thoughtful, relational care?
Each new “carrot” seems to come with multiple bureaucratic handbrakes:
- Upload more data.
- Share more information.
- Tick more boxes.
Slowly but surely, private GP businesses are being pulled into government orbit — losing the flexibility and independence that once defined our sector.
Not about blaming government
This isn’t about blaming government.
They fund the system. They have limits. They want accountability and control — fair enough.
Related
Governments are splashing funds to gain influence. They genuinely believe stronger central control will improve outcomes by increasing access and reducing cost.
Quality, however, often feels like an afterthought.
What worries me more is trust.
Most of the colleagues I speak with — including those who plan to move to full bulk billing — admit they don’t fully trust this initiative.
They’re not embracing it out of faith; they’re making the most of a temporary cash injection.
Many feel this is a short-term gain, not a long-term ground-breaking reform. And perhaps they’re right.
The government tends to speak more openly with corporates than with colleges or practitioner groups.
Their logic seems to be that if they can control the item numbers, they can curate people’s health outcomes — an idea that looks good on paper but is far from the reality of day-to-day general practice.
Between a rock and a hard place
We all want a strong, accessible, well-resourced primary care sector. But we’re stuck in bad politics and worse advocacy.
Government wants control to manage cost and data.
Practices and colleges want more funding but resist the strings that come with it.
It leaves GPs — and our patients — caught between ideals and realities.
My uneasy conclusion
Bulk billing as a measure of quality never sat right with me. Expecting increased public funding without oversight is unrealistic.
And trust — between government and primary care — remains fragile on both sides.
So, should I switch to full bulk billing? I still don’t know.
But until we stop framing access and quality as opposing goals, we’ll keep asking the same question — and never find an answer that feels right.
I don’t have the answers. But I think it’s time we start asking better questions — not just about how we fund general practice, but what kind of care we actually value as a country.
Associate Professor Alam Yoosuff is a rural generalist GP, a board director for the Murrumbidgee LHD and Murrumbidgee PHN. He is a clinical academic at the University of Notre Dame.
This article was first published on Professor Yoosuff’s substack. Read the original here.
