Health Minister Mark Butler says the decision to split the upcoming 12.5% Bulk Billing Practice Incentive Program payment 50/50 between practices and GPs came after much consultation – but not everyone’s buying it…

Starting 1 November, the new PIP will be available for practices that universally bulk bill all patients.

But the Government’s choice to require doctors and practices to evenly split the incentive has proved unpopular with many – including 58% of 946 GPs who responded to a Healthed poll Tuesday night, who said they disagreed with the decision.

GPs who are practice owners view the decision more favourably than other GPs, Healthed’s survey suggests – with 53% saying they agree with the 50/50 split, compared with 39% of non-practice owner GPs.

Regardless, most GPs think the government should not get to decide how the payment is split. In a separate poll two weeks ago, 64% of more than 1500 GPs said the choice over how to split the incentive should be left to individual practices and doctors to decide for themselves. Just 36% agreed the government should decide.

Should it all go to GPs?

Around 350 GPs commented on the rationale behind their frustration, or support, for the government’s mandated split. The most common perspective expressed was that GPs should get 100% of the Bulk Billing PIP payment.

“GPs are doing the work, not the practice,” reflected a common sentiment.

“I think most, if not all, of the bulk billing incentive program benefits should go to the person earning money for the clinic, which is the doctor,” one GP commented.

“The GPs are the reason patients access the practice. The practice already takes their cut of the GP gross earning, so it will be unfair to award them equal incentive for the work that the GP were solely responsible for,” another said.

Double dipping concerns

Many GPs were concerned that practices would benefit twice since GPs already pay service fees.

“GPs pay a management fee to the Practice. So the 50% given to GP will also be levied by the practice at 30-40%,” one GP worried.

“GPs pay high amount of service charge to the practices. With 50-50 split, the practice will have more benefit, not the individual doctor.” – GP in Healthed’s survey

“I am paid on a 50% commission basis on all my billing takings, so the bulk billing PIP payment would be split 50-50 with the practice anyway, but this way, I will only end up with 25% of the payment,” another GP commented.

AMA President Dr Danielle McMullen has said the 50/50 split was confusing, and that more flexibility was preferable, particularly given that it differs from many existing service agreements.

Several GPs in Healthed’s survey said the existing arrangements that practices and GPs have already established should apply to the incentive too, with many noting that a 70/30 split might be more appropriate.

“Currently GPs get 60-70% of billings, and this should be reflected,” was a common sentiment.

“There are existing percentage splits between all GPs and practices already; just follow the same split,” one GP said.

’50/50 split is fair’

Those who agree with the government’s decision were represented in the qualitative comments too.

“Both benefit, and practices certainly do need to have a share,” one GP who supports the 50/50 split commented. “Shared risks, shared benefits,” another said.

“The practice has shouldered the costs of bulk billing more than the employed GPs for a very long time and financially suffered more accordingly,” one GP-practice owner said.

Still, many GPs acknowledged that the cost of running a practice is increasing, and many clinics are struggling to remain viable.

“Practice infrastructure needs funding too,” is how one GP put it.

“Practices are struggling to survive,” another summed up.

What your colleagues are saying

“All practices funding models are not the same, and there may prove to be systemic distortions. I am unsure whether this will best target the funds to the most needy areas.”

“50/50 split may not adequately reflect the increased workload, clinical responsibility, and financial pressures faced by GPs.”

“Disappointingly, small increase, and this is a gift for the corporates.”

“If the practice owner decides to bulk bill because of the incentive then the contractor might be coerced to bulk bill as well… What the government doesn’t seem to realise is that there is an undersupply of GPs and an unhappy contractor will simply move to another practice where he /she can privately bill…”

“Since GP is affected most for the billings, the percentage should be 70/30 or 100%, why is practice getting 50% when GP is self-employed and doing all the work and bulk billing patients affecting our income.”

“It should be split according to arrangements for payment of GPs, and not 50/50.”

“GPs should get 100% of this meagre offering by the government.”