The Department of Health, Disability and Ageing has given a partial explanation for its decision to tie GP training funding to clinics participating in its new PIP program.
The idea behind prioritising GP registrar placements into universal bulk billing clinics is to “help develop the primary care workforce required to support patients to access the services they need”, according to the Department of Health, Disability and Ageing.
On Monday, The Medical Republic broke the news that the grant opportunity guidelines for the Australian General Practice Training program now specify that the RACGP and ACRRM must prioritise registrar placements into practices participating in the Bulk Billing Practice Incentive Program (BBPIP).
The BBPIP kicks off in November this year.
Participating practices receive an additional 12.5% incentive payment on every $1 of MBS benefit they bulk bill – the only catch is that the entire practice must commit to universal bulk billing.
DoHDA modelling suggests that around three in four general practices will take up the BBPIP, tripling the number of universal bulk billing GP clinics in Australia.
The fact that the department would direct the colleges to preference bulk billing clinics came as a shock to some RACGP and ACRRM members.
AMA Queensland president and specialist GP Dr Nick Yim said the policy had the potential to backfire in terms of workforce distribution.
“It is harder for practices that 100% bulk bill to operate in smaller centres, particularly in a decentralised state like Queensland,” he said.
“Each practice will have different structures, along with different staffing requirements and hence different expenses.
“This guideline could see deserving clinics that offer high quality training and supervision, including a broad scope of practice for trainee GPs, miss out on being able to develop that critical relationship with new doctors.”
TMR asked DoHDA how it would ensure regions with low GPs per capita and low bulk billing rates – specifically Tasmania and the Australian Capital Territory – received an equitable number of registrars.
“A key objective of the AGPT program is to increase the number of GP and rural generalist trainees working and remaining in high need communities,” a department spokesperson said.
“This requires a balanced approach to ensure the distribution of training placements meets community needs and supports quality training outcomes.”
Indeed, some of the key performance indicator measures included in the grant opportunity documents include ensuring that every trainee spends a specified amount of time in an MM2-7 region and that the colleges ensure a target number of registrars are sent to certain regions.
None of the key performance indicator measures mention the prioritisation of training in a universal bulk billing context.
The RACGP told TMR that it was unable to discuss a current grant opportunity, but that it was working with DoHDA to prioritise placing GPs in quality training environments.
ACRRM president Dr Rod Martin said it was essential that training policies support, rather than limit, access to the full range of rural generalist experiences and the college was engaging with the department to ensure the AGPT program recognises the diversity of rural practice.
“All ACRRM training takes place in accredited training posts with approved supervisors who support registrars through comprehensive, community-based rural generalist training,” Dr Martin told TMR.
“To ensure we deliver high quality and effective training, registrar placement decisions take account of a range of factors including the registrars’ individual training needs, scope of practice and future career plans.”
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When asked for comment on why the new grant opportunity guidelines prioritise BBPIP practices when the move was unlikely to be popular with many GPs, the DoHDA spokesperson said the government was committed to continuing to strengthen Medicare through bulk billing and through training a new generation of GPs.
“This is reflected in the Government’s 2025-26 budget investment of over $606 million to boost the GP workforce, which includes funding for more GP and rural generalist training places (growing to over 2,000 registrars commencing per year from 2028), and new salary incentive and leave payments for GP registrars,” they said.
“The prioritisation of AGPT placements in practices participating in the Bulk Billing Practice Incentive Program will help develop the primary care workforce required to support patients to access the services they need.”
Since 2023, when training was handed back to the profession, the two GP colleges have jointly administered the AGPT program using funding from the commonwealth delivered via grant.
The next grant will fund GP training between 2026 and 2030.
It’s a closed, non-competitive grant. The only eligible organisations are the RACGP and ACRRM.
DoHDA did not appear to be concerned that anger among GPs over the prioritisation of bulk billing practices would affect the grant process.
“The department consulted with the GP training sector in the development of the grant opportunity and the department has no concern regarding the continuation of college-led training under the new grant agreement,” the DoHDA spokesperson said.
The colleges have until 1 August to apply.
