Who believes the next government will give general practice any more than it takes away?
As the election nears, I find myself needing some thinking time. There are significant decisions we need to make in regards to how we practise medicine over the next few months.
So I’ve decided to head to the Northern Territory and spend some time wandering, thinking, taking in the ancient surrounds and cultures.
I’ll end up making some decisions for the practice, but, alas, more than likely return home as usual, feeling distressed, disappointed, and demoralised after seeing once again the appalling state of healthcare and health inequities – arguably some of the worst health outcomes on the planet.
The healthcare gaps in the Top End remain a national shame and don’t look like closing any time soon.
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The lately announced health policies and debates, particularly regarding the major parties’ Medicare package, seem to have no likelihood of improving the health outcomes of those in our community who are most vulnerable.
I’d like the lies and truth-stretching to stop.
“Nine out of 10 GP visits will be bulk billed.”
While the current rebates remain at such an inadequate level to provide quality healthcare and keep practices financially viable, this will not eventuate. Providing continuous holistic healthcare takes time during consultations and regular follow-up. There is no incentive to practice this way in the package – if anything, the package disincentivises quality healthcare and encourages six-minute factory medicine, which, we are all aware, leads to poor outcomes and increased reliance on hospital emergency departments.
“GP salaries will be over $400,000 if the practices commit to bulk billing.”
Yeah, sure, if I see 79 people per day at six minutes per visit, but that is poor-quality medicine to my mind. (Apparently for regulators bad medicine only starts if I see 80 people per day.)
Where is the honesty that billings do not equate to salaries? With my mystical $400K I need to pay staff wages, super, rent and electricity, consumables, phone bills and insurance etc.
Where also is the honesty that these magical numbers, for over a quarter of the practices in my area, are only guaranteed for nine months?
Why, when the minister and shadow minister comment about these funding increases, do they never mention that the unaccredited practices will only get access to the 12.5% bulk billing incentive in second-quarter 2026 and that it will be removed in fourth-quarter 2026?
Where is the caveat that the $400K drops by 12.5% for at least 60 to 70 practices in southwest Sydney, not to mention the rest of the country?
Then there’s the budget announcement about increasing workforce shortage districts of need to include the suburb where I practise, Campbelltown, to become a partial DPA region. After months of asking we have finally been informed that part of the area will be reclassified as a DPA area of need. Unfortunately, this area is bushland. There is no infrastructure and it borders the army barracks with areas of unexploded ordinance.
These two maps show the generously rezoned area:
The whole package has nothing to improve workforce maldistribution. The budget solution was to allow, or so we were led to believe, more overseas-trained GPs to work in the local area (75% of our GPs already are overseas-trained) – but the small print shows that they will be working in uninhabitable scrubland.
How will the Medicare-strengthening package increase GP salaries, when three months from now, before the package even kicks in, Medicare is planning to remove funding for item numbers involving chronic healthcare planning and mental health?
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It’s looking likely that the package will be a break-even exercise at best, as we will no longer be able to bill chronic healthcare reviews, and some mental health reviews and other chronic health assessment items. Both major parties are claiming they will increase funding with the new $8.5 billion package in November, but while they giveth with one hand they will taketh away an unspecified amount with the other.
I’m also at a loss that two years into the MyMedicare debacle it proves to have been all talk and nothing but talk.
Another excellent local PHN/LHD program designed to assist people with chronic health conditions and keep them out of hospital has just lost its funding because the promise of MyMedicare payments for keeping so-called frequent flyers out of hospitals has not yet materialised.
So my decisions are probably already made for me in that any change to bulk bill more patients will most likely lead to a reduction in income as seen in the explanations above, meaning the unaffordability of primary healthcare and increasing out-of-pocket fees will continue, with the subsequent poor health outcomes for the most vulnerable in our community.
I guess on the positive side both major parties’ housing policies will do very little but increase the value of existing houses and, as one ex-prime minister has said, “no one ever complained about the value of their home going up”.
