GPs are warning they may have to increase fees to keep practices viable without a boost to Medicare, demanding higher rebates for longer consultations to treat chronically ill patients as part of a list of pre-election demands.

Royal Australian College of General Practitioners President Karen Price said many GPs who charged private fees opted to bulk-bill vulnerable patients, but practices had to pass on rising costs to those who could afford to pay.

RACGP President Dr Karen Price.Credit:Alex Ellinghausen

“It’s called cross subsidisation,” Dr Price said. “Often the patients who need the most complex care, and particularly the longer care are those who are the least able to afford it.”

In a pre-election statement to be published on Tuesday, the RACGP will demand a 10 per cent increase to the Medicare rebate for consultations longer than 20 minutes, as well as a new $200 rebate for consultations of one hour or more.

The patient’s Medicare rebate for Level C consultations (20 to 40 minutes) would increase from $75.75 to about $83.30 and Level D consultations (40 minutes plus) from $111.50 to $122.65.

“The current Medicare rebate structure devalues longer consultations, with patient rebates decreasing significantly as a person spends more time with their GP,” the statement said.

Dr Price said the current Medicare benefits schedule “rewards high volume, high throughput, medicine, and that’s not what we’ve got today. It was designed a long time ago.”

Health Minister Greg Hunt announced on Sunday that telehealth Medicare rebates for 20 to 40 minutes GP phone consultations will be extended by another six months and 20 million pieces of personal protective equipment will be provided to GPs, as part of a $24 million investment that also includes specialist telehealth.

The RACGP is also calling for GP telehealth phone consultations to be made permanent and be extended to longer phone consultations, GP mental health and management plan consultations.

Therese Sampson, 51, from the Central Coast of NSW has rheumatoid arthritis, fibromyalgia, a liver condition caused by medication and diverticulosis, a painful bowel condition.

She relies on bulk billed, monthly long appointments with her GP to manage her complex health needs and said she supported raising the Medicare rebate to ensure patients could access the level of care they needed.

“I’ve been at my doctor’s at seven o’clock at night. I’m sure they’d close at 5.30[pm],” Ms Sampson said.

Dr Price said GPs were trained to deliver “comprehensive, thorough, whole person care” but found “the system doesn’t fit that model of care.”

She said Australia’s ageing population and the added demands of the pandemic were placing a greater time burden on GPs, who had to juggle their duty to patients with complex health issues with the economic reality.

“You suddenly realise, if you are going to see this patient and add another 20 minutes on to your consultation, you’re not going to earn as much as if you kick them out the door and see another patient,” she said.

“The amount of time required [to treat chronically ill patients] is significant.”

GPs are paid $6.52 per minute if a short consultation lasts only six minutes, but when patients require longer consultations this can drop below $2 per minute, an RACGP analysis of the Medicare benefits schedule shows. The rebate for a consultation of less than 20 minutes is $39.10.

The proposed Medicare rebate increases, if implemented by whoever forms government after this year’s federal election, would cost the budget almost $130 million in the first year.

But the RACGP argues it will save money by helping GPs to treat patients who would otherwise clog emergency rooms, while reducing preventable hospitalisations by treating ailments early.

A PriceWaterhouseCoopers analysis the college commissioned in 2020 found the reforms it advocated could save $5.6 billion over five years.

“One hospital admission could pay for a patient to visit their GP twice a week for a year,” Dr Price said.

She said there had been an increase in vulnerable patients presenting to emergency departments and being admitted to hospital with acute health problems that could have been prevented through investment in GP care.

The RACGP election statement also called for funding for preventive care for vulnerable Australians, including aged care, mental health, and disability care, incentives for rural GPs and funding for post-discharge consultations to reduce hospital readmissions.

Mr Hunt’s office was contacted for comment.

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