Kerrie Aust | ACT government GP payroll tax a crisis for Canberra doctors

The ACT government's decision to impose additional payroll tax on GPs has left many worrying how they will keep their doors open, and they arrived looking angry and exhausted.

While it's normal for practices to pay payroll tax on the wages of staff such as receptionists and nurses, GPs' earnings have previously been exempt as they work under independent arrangements.

However, Chief Minister Andrew Barr and Health Minister Rachel Stephen-Smith are unapologetic that the Revenue Office now has GPs in its sights.

This is unfathomable to anyone who understands the precarious state of general practice in Canberra - a city with the lowest number of GPs per patient. GP training positions remain vacant here year after year and high-quality practices close their doors.

Good GPs retire and practices struggle to find someone who can take over their patient base. Clinic rooms around Canberra are vacant. Junior doctors tell us they can't afford to choose general practice as a place to train.

In the end, the ACT government's new tax is a tax on patients. GPs will have no choice but to raise their fees, because they cannot absorb any more costs. The Medicare rebate doesn't cover even 50 per cent of the actual cost of seeing a patient, including the GP's administrative work, the costs of reception and nursing staff, insurance, rent and surgical items.

This is why bulk-billing rates are falling around the country - the lowest is the ACT at 57 per cent - and patient fees are rising. While federal government's new bulk-billing incentives may halt the slide, nothing is guaranteed.

GPs are constantly being asked to do more for less. We stay back late to fit in urgent cases and quietly under-charge patients we know are doing it toughest.

Yet we keep showing up, believing our patients deserve our time, and knowing that health outcomes are better for those who get continuity-of-care, seeing the same doctor, who knows their history well.

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All this is clearly invisible to the ACT government. Practice owners have explained to the government their tight financial margins; how they have cut administrative staff to remain viable; how they fear they will have to reduce their hours or services or both. Yet, while the government has listened, they have not truly heard.

Just over a week ago, the ACT government announced it would offer GPs an amnesty on payroll tax as other states have recently done. However, they created an absurd caveat: practices would need to bulk bill 65 per cent of their patients to qualify.

It was a kick in the guts. General practice is desperately sick in this country, and nowhere more so than in Canberra. The ACT government wants to lay the blame on the federal government, saying the chronic underfunding of general practice is a federal issue - which is true. Yet the GPs at Tuesday night's meeting could not have been clearer: if the ACT government doesn't back down on this tax, the death knell for many general practices in this city will sound like the taxman knocking.