I chanced upon this article while scrolling through my LinkedIn feeds yesterday, titled Bulk-Billing Clinics ‘Turning Away’ Complex Patients.’

Everybody loves a good story and an effective journalist is skilled at capturing large audiences through the use of catchy headlines. Like other stories, this one can be told a thousand ways depending on who is telling it. So here’s my account.

In an era where everyone in health seems to be talking about person-centred care, it never ceases to amaze me how we can get our terminology so wrong. We do not have ‘complex patients’. We care for people with complex needs. Perhaps the article should more aptly be titled:

‘Overstretched clinics inadequately remunerated for meeting the complex needs of the people they serve’.

Less catchy, isn’t it?

Tracey Johnson, whom I have had the great pleasure of meeting, and who is the CEO of Inala Primary Care, had this to say.

“Our charitable GP practice bulk bills. 68% of our patients have health care or pension cards and others are under 16. In Queensland’s most disadvantaged suburb, we have seen big corporate practices relocate as they could not hold GPs nor earn sufficient revenue given the number of non-English speakers and complex patients.

We have ended up with a super complex cohort, 38% of whom see one of our team 12 or more times a year. It is hard to keep the doors open when that is your caseload and bulk billing is your revenue stream. We desperately need income supplementation to maintain services and can’t wait for the MBS review to fix the problem.”

It is quite striking to hear this perspective from one of Australia’s leading primary health clinics. Can I reiterate:

“It is hard to keep the doors open when that is your caseload and bulk billing is your revenue stream.”

The needs of our people with complex needs are not being met and those that make a genuine effort to address these needs are not being adequately remunerated.

Bulk-billing practices (those that accept their patients’ Medicare rebates as full payment for their services) are overburdened by volume. Practices that attempt to charge a gap struggle to do so when patients make the choice to access ‘free and fast’ care.

As a health system, we make the deliberate choice to invest greatly in hospitals, and continually divest in general practice. The evidence is overwhelmingly in favour of increasing our investment in primary care to drive sustainable improvements in our population’s health outcomes.

We can not simply accept a position of celebrating the end of the ‘Great Medicare Freeze’ when the costs of running a practice are spiralling upwards and the viability of high quality general practice, the most efficient and effective sector of our health system, is under threat.

The AMA Gaps poster illustrates how successive Governments have failed to index the Medicare schedule fees in line with the CPI and average weekly earnings. Accounting for the increase in the consumer price index, general practitioners now earn approximately 18% less than they did 30 years ago, whilst costs of owning, managing and running a general practice have increased substantially over that period of time.

Practically, this means either that:

1) Practices absorb the additional costs of running a practice and do so in a way that is not financially viable, threatening practice closure; or

2) Patients pay a higher gap to see their general practice team.

According to the AMA, “with year upon year of indexation that has been well below par, today there is now quite a disconnect between Medicare schedule fees and the realistic cost of providing the services.”


Health care consumers are in the best and most powerful position to advocate for funding parity in general practice.

Remember, it is your rebate that has been consistently cut, sliced and more recently, frozen. I’m angry, are you?