Clara Tuck Meng Soo | Sixty-five per cent bulk-billing rates not realistic for Canberra

So, if I saw Mr Wing for his cold and his wife wanted me to check her blood pressure and give her a repeat prescription for her diabetes medications, it was easy to fit her in and bulk-bill her and make up the lost income from private billing. And of course, bulk-billing lowered barriers for both patients and doctors.

So, for a while, it was win-win for patient and doctor.

But over the years, as indexation of the Medicare rebate didn't keep pace with the real cost of things, the gap between the Medicare rebate and the private fee charged for a consultation became larger and larger.

Right now, the Medicare rebate for a standard consultation is $41.20 with another $6.85 as a bulk-billing incentive if the person had a concession card or is under 16 (this bulk-billing incentive will triple to $20.55 on November 1, 2023) whereas the private billing fee for a standard consultation in Canberra is about $100. So, a GP will really have to see six to seven patients per hour if the GP bulk-billed them all to earn roughly the same amount as a GP who saw three patients per hour and privately billed them all.

And that's the rub. Fitting in an extra patient per hour is easy. There's always some non-consultation work GPs have to do they can postpone until later - the results we have to look at, that phone call we have to make or the letter we have to write.

But doubling the number of patients we see an hour needs a wholesale change in the way we have been trained to work.

GP registrars are taught to spend time learning to listen to their patients and learning to communicate with them, to be thorough in their history-taking and examinations and to not miss the opportunity to practice preventative medicine and examined on these same qualities during their Fellowship examinations.

Practising in this way takes time and means even efficient GPs can only see two to four patients per hour. Changing the way we work to see six to seven patients means changing all those habits we have been trained to develop and, to most of us, feels like we are cutting corners and offering substandard care.

And patients in Australia have also been trained to expect this kind of medicine from a good GP.

I received a bunch of flowers today at the end of my day. And with this bunch of flowers came this lovely card of appreciation from a woman and her family to thank me for the care I have given her daughter.

It's moments like this that makes GPs feel like the work they've been doing is worthwhile. And we get cards like this because we have spent time with the person and their family going on their medical and emotional journey with them.

Mr Hashim, who is a taxi driver and his wife, Samara, who is a cleaner (not their real names), will see bulk-billing doctors for their coughs and colds and medical certificates but still see me as their regular GP and come to me for all the major issues in their health. So, patients also like the kind of person-centred medicine that takes time to give.

And in Canberra, a large proportion of the population can afford that care.

We have the population with the highest GDP per head in Australia and that wealth is also fairly well-spread out in a relatively egalitarian city like Canberra. And when you couple that with the fact Canberra has the lowest number of GPs per head of population in Australia, there are obviously major reasons on both the demand and supply side that lead to the low bulk-billing rates in Canberra.

Having more GPs in Canberra would certainly improve access and may result in lower private billing fees but unless there was an enormous expansion in the number of GPs, unlikely I think, to lead to significantly higher bulk-billing rates.

I'm not saying there aren't disadvantaged communities in Canberra. Back in 2019, my practice, the Interchange General Practice saw more than 300 of the people on opiate treatment programs (methadone and buprenorphine) in Canberra at a time when the Alcohol and Drug Clinic saw more than 500 of these same patients.

Our numbers were going up and up because other general practices were not taking them on and everyone was referring new patients to us. I was losing $70,000 per year and I could see this situation was not sustainable.

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I approached our Minister for Health to suggest a plan to subsidise the provision of opiate treatment programs in general practice. I thought this would help the viability of my practice but also encourage other general practices to take on some more of this care.

If successful, such a program could be a model for the ACT government to work with general practice on the care of other disadvantaged groups in Canberra.

The minister listened but didn't promise anything and a week after our last meeting, she announced in the media some money that had been set aside for general practice had been allocated to three community organisations - all worthy ones - but not a cent to general practice.

So, who's lacking in ambition?