EMPHN Insights Feature: Primary care features in the election

Written by Dr Stephen Duckett AM

02/05/2025

Primary care reform is coming. Whoever wins the current election, the shape of primary care will change. There may be some difference in the detail, but the underlying driving forces for change – such as the epidemiological transition – create an inevitability that whoever forms government will need to address. There is a stack of reports – all pointing in the same direction – that an incoming minister will have to deal with. The big changes that need to happen, e.g., proper funding for multidisciplinary teams in primary care and ensuring all health professionals can work to their full scope of practice, have not featured in the election at all so far. But two other issues, both important, have attracted significant funding commitments.

The first of these is bulk billing. Early in the campaign, Labor promised increased incentives for bulk billing, a promise quickly matched by the Opposition. In brief, the policy dramatically increases the current bulk billing incentive and expands it from a targeted incentive to a universal one, significantly increasing the number of people who are eligible for the incentive. As an additional carrot, practices which achieve 100% bulk billing will get an additional payment of 12.5% on top. However, only practices which have signed up for MyMedicare will be eligible for this latter payment, creating an important incentive for signup supplementing the current quite weak incentives to sign up. The government has predicted that this new policy will lead to about 90% of all GP attendances being bulk billed, up from the current 75%. I think they will achieve that target.

There are three factors which will affect a practice’s choice about how it responds to the new incentives when they are introduced. Firstly, the ideological orientation of the practice owner and the general practitioners in the practice. Some practice owners are opposed to bulk billing and won’t take up the new incentive because of that. Secondly, a practice’s current level of out-of-pocket payments. The higher the current out-of-pocket, the less likely the increase in incentive payments will cover the gap in revenue if the practice swaps. It is worth recalling though, that shifting to bulk billing also yields payroll tax savings. Thirdly, the higher the current rate of bulk billing, the more likely the 12.5% supplementary payment will be sufficient for a practice to shift.

In my view, the government should offer some further sweeteners, in particular to legislate automatic indexation of the rebate and the bulk billing incentive so that there is no longer an on-again off-again approach to policy which makes it so hard for practices to plan. Legislating indexing also protects – albeit imperfectly – against a change of government.

A second big announcement was about expansion of urgent care centres. Labor has promised an additional 50 Urgent Care Centres, including two in EMPHN’s catchment (Diamond Creek and Lilydale). This policy has not been matched by the Coalition but they have promised an additional Urgent Care Centre in Healesville.

Urgent Care Centres are contentious and not universally welcomed by the medical profession. They are, however, very popular with consumers. It is early days in terms of the evaluation of Urgent Care Centres, but it looks like they do reduce demand for emergency department care, and do cost less than an emergency department attendance. However, they cost more than the average general practice visit, which is the crux of the medical professions argument.

I support the expansion of Urgent Care Centres, but I think more also needs to be done to support the role of GPs in after-hours care, including restructuring the rebates for care in unsociable hours.

The bulk billing and Urgent Care Centre changes are just the start of some of the changes which will transform primary care over the next few years.

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