![Dr Ayman Shenouda is calling on the federal government to provide more support to GPs as the healthcare crisis worsens across the region. File picture Dr Ayman Shenouda is calling on the federal government to provide more support to GPs as the healthcare crisis worsens across the region. File picture](/images/transform/v1/crop/frm/172474527/cfdbe3b0-7585-46b7-ba57-ba77ef65f1a6.jpg/r0_0_1200_675_w1200_h678_fmax.jpg)
Bulk billing services are becoming harder and harder to come by across the Riverina, according to a new report as a Wagga GP calls for greater government support.
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A national bulk billing study conducted by primary health care support service Cleanbill, has found the region has experienced a decline in bulk billing services this financial year, despite the recent federal government funding overhaul.
According to the 2024 Blue Report, the bulk-billing rate across the federal Riverina electorate has fallen from 28.2 per cent in 2022/23 to just 25 per cent the following year.
The Riverina had a bulk billing rate below the national average of 32.4 per cent - across all federal electorates - in 2022/23.
But in a strange twist, even though the Riverina's bulk rates have fallen to just 25 per cent for the 23/24FY, the national bulk billing rate has fallen faster to 22 per cent, meaning the Riverina is now above the national average by 3 per cent.
In practical terms, for Riverina residents, the average out of pocket cost for standard consultation 22/23FY was $39.43, while in 23/24FY it has risen to $41.78, meaning an average out of pocket cost increase of $2.35.
In November 2023, the federal government tripled incentives to $31.95 for Wagga GPs who bulk bill children under 16, pensioners and healthcare card holders.
At the time, Glenrock Country Practice owner Ayman Shenouda welcomed the support boost, which added to the standard GP rebates for bulk billing consults, which benefited more than half of his patients.
But in light of the latest data, Dr Shenouda is now calling on the federal government to do more, saying Australia's Medicare healthcare system - the "best in the world" - is at risk of becoming like America's, where the poor simply can't afford to go to the doctors.
"It's very sad to see our [universal] insurance health scheme [Medicare] going downhill," he said.
"It's a very good system, if it works well for all parties, where our patients have good access to the care they deserve."
Dr Shenouda said while the latest federal funding reforms have helped, they are now not going far enough to address increasing costs pressures as the nation deals with high inflation.
In spite of the declining rate of bulk billing across the Riverina, he said GPs were still prioritising bulk billing for those who need it most, even if it means making a loss.
"We are trying to balance things by patients who can pay and that's why the bulk billing rate is going down," Dr Shenouda said.
He said the average GP consult is $44, and pointed out that it will only cost the government close to 10 times this figure to see each patient who presents in a hospital's emergency department instead.
In light of these pressures, Dr Shenouda has now called on the federal government to step in.
He said if the government really wants to help, they will foot the rebate gap, enabling GPs to see patients without making a loss.
Dr Shenouda also called for more support for longer consults, saying the current subsidies don't have enough incentives for those, yet they are still very important.
"It makes more money for practices if a GP sees five patients an hour instead of two longer consults," he said.
He said this means doctors can spend more quality time with their patients which he believes will improve their standard of care.
Wagga MP Joe McGirr agreed, saying he is "very concerned" by the lack of bulk billing services for local patients.
"Sadly, I'm not surprised, because the shortage of GPs - especially in rural and regional areas - has reached crisis point, with fewer than 15 per cent of graduates now choosing careers in general practice," Dr McGirr said.
He said this shortage has put "serious pressure on emergency departments and small rural health services."
"Hospitals are now relying heavily on locums just to keep services operating," he said.
Dr McGirr stressed that general practice is a federal responsibility.
"The federal government needs to step up more and make sure general practice has a viable future, addressing the shortage of doctors and the problems in primary care, and working to support the state government."
Dr McGirr said he is advocating at a state level with the government to set up the Select Committee into Remote, Rural and Regional Health.
"As chair of that committee, our first task focused on the health workforce as a core component of improving regional health care," he said.
It comes amid plans by the state government to institute a payroll tax on GPs, which has raised concerns among doctors that they will be forced to pay taxes twice - to both state and federal governments.
In August 2023, the state government instituted a 12-month pause on payroll tax audits on GPs, however, a recent statement from the NSW finance minister's office said it is continuing "to engage with GPs and stakeholders as it finds a solution to payroll tax issues."
"I am also pressing the government not to introduce a GP payroll tax, which would push up the price of consultations, and will continue to advocate for appropriately resourced and staffed regional health services," Dr McGirr said.
Federal member for Riverina Michael McCormack also raised serious concerns over the Cleanbill report and took aim at the federal health minister Mark Butler over the issue.
"While the Riverina has been facing a decline in accessibility to affordable health services we have had Health Minister Mark Butler pretend there's no problem, making the absurd suggestion that you should just 'ring around' to find a bulk billing doctor," Mr McCormack said.
"[In doing so he is] totally ignoring the fact many of us in the regions have to travel significant distances to see a doctor and have to wait weeks to get in."