The ACT Health Minister has called on the federal government to reconsider cutting off Canberra from bulk-billing incentives, as 30,000 members of a key affordable healthcare provider face an uncertain future.
However, Royal Australian College of General Practitioners president Karen Price said bulk billing wasn't the answer and broader reform of the system was needed.
The National Health Co-op has entered voluntary administration saying the end of JobKeeper and "recent staff changes" had left an "insurmountable" forecast deficit.
Health Minister Rachel Stephen-Smith said it highlighted the difficulty to make a bulk-billing general practice "add up" in the ACT.
Dr Price said "Band-Aid" solutions for parts of the system wouldn't help.
"You've got to see the system as a whole. To have one part of it working and not the whole [system] working is problematic."
Dr Price said Medicare hadn't adapted to modern medicine practices and changing health needs.
The Co-op's eight clinics across Canberra, servicing 30,000 members, will operate "business as usual" for the coming months, including scheduled COVID-19 vaccinations.
"Members can make their appointments in the usual way ... it's operating while we assess options for the future," administrator Michael Slaven said.
He said the organisation was solvent and could stay operational for at least three months.
One option under consideration is whether some or all of the clinics could be operated by existing medical practices.
While the Co-op remains operational for the coming months, Australian Medical Association ACT president Walter Abhayaratna feared there could be a detrimental effect on the broader health system should its 30,000 members have to be managed elsewhere.
He said it may push the most vulnerable to the emergency department rather than fronting the cost of an appointment, or risk them not presenting at all.
He said the ACT now had an opportunity to pause, and understand the cause of a "vicious cycle" plaguing the health system.
Dr Abhayaratna said GP non-referral bulk billing rates in the ACT were up to 15 per cent lower than the national rate, making it less sustainable for Canberra practices.
"Here is this moment in time where we've got something that is going to change the system, potentially for the worse," he said.
"We can stop and start understanding why it's so difficult in Canberra for primary care and get some awareness and understanding."
"We have the lowest rate of bulk billing of any capital city in the country, of any jurisdiction in the country," she said.
"We have the lowest number of GPs as a proportion per population anywhere in the country.
"It is very, very difficult to make a bulk-billing practice add up in the ACT. We do recognise that and so this is going to be very, very disappointing news for [The Co-op's] 30,000 members."
From January 2020, Canberra and Queanbeyan doctors were made no longer eligible for federal government rural incentives to bulk bill.
Ms Stephen-Smith said she would write to her federal counterpart, Greg Hunt, calling on him to reconsider the decision to cut off the ACT from those incentives.
Former AMA ACT president and Canberra GP Antonio Di Dio said returning the federal government's rural bulk-billing incentive could "make a real difference".
While GP rebates are the jurisdiction of the Commonwealth, Dr Di Dio said steps could be taken on a local level.
He said the ACT government could introduce a subsidy scheme to help bridge the gap for "middle ground" Canberrans to incentivise GPs to bulk bill.
The Co-op's Coombs clinic was planned to be home to the ACT government's new walk-in health centre, due to open in July.
That project has now been delayed.
"We're not wanting to put a timeframe on it at this point in time," Ms Stephen-Smith said.
"It really does depend on some of the decisions that are made by the administrators in terms of whether we can get into the site we had already identified."
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