HUNTER GPs say they may be forced to stop bulk billing vulnerable patients, pensioners, and children if "significant" changes to the Medicare rebate come into effect in 2020.
The Hunter General Practice Association has warned about $7.5 million dollars used to bulk bill patients in the region each year will be denied to the community's most vulnerable when policy changes to the Medicare rebate take effect in January.
Dr Lee Fong, the association secretary, said under a new government policy, Newcastle, Maitland, Kurri Kurri and Raymond Terrace would be reclassified as "MM 1" - the same as the centre of Sydney - despite the region having higher unemployment rates and higher levels of disadvantage.
The reclassification would see bulk billing incentives for GPs decrease from $9.50 to $6.30 per patient - an estimated loss of $7.5 million.
"By and large, what GPs in the Hunter have been doing is using that additional incentive payment to bulk bill vulnerable people - the pensioners, the health care card holders and children, in particular," Dr Fong said.
"By having this taken away, it makes practices that have already become really vulnerable to a whole bunch of other funding cuts over a couple of years, including - for example - the Medicare funding freeze, and it just takes them that much closer to the edge. At the end of the day, practices will need to react to this change in order to maintain viability - either by charging the people they were bulk billing, increasing the charges for those they weren't bulk billing, or decreasing the quality of the medicine in order to push more people through faster. And none of those things sound like good options."
Dr Fong said the policy changes had happened so quietly they had "slipped under the radar".
"But among GPs, there has been an awakening to what is about to hit the region."
The Hunter General Practice Association said the reclassification assumed the region had access to the same benefits of a major city, yet the area's public hospital system was under "extreme pressure", and the disadvantaged population was "grossly over-represented" within the region's footprint.
Dr Fong said in the past, the government had wanted to increase bulk billing rates, particularly in regional areas where the practice was more "scarce".
But to address the medical workforce problems in rural and regional communities, the government had since decided to "re-organise the whole system" of encouraging doctors to bulk bill.
Using the "Modified Monash Model" for classification, only doctors in areas classified as "very remote and rural" would be able to access the higher bulk billing incentive payment.
"It means that for GPs in the Hunter, for every patient that they bulk bill, they are going to be getting $3.30 less per patient - which may not sound like a lot, but by the time you add it up - say for the practice I work at, it means a reduction in the practice income of about $85,000 per year.
"If you also look at collaborative practice like GP Access After Hours, which sees about 50,000 patients a year, that's more than $150,000 a year.
"Then, when you look at the bigger picture - that is happening all across the region."
Dr Fong said the principle of taking money and putting it into the rural workforce was "a good thing".
"The problem is how the government is going about it," he said. "They are robbing Peter to pay Paul, and in particular, they are taking money away from regional areas like us.
"I wouldn't have as much of a problem if they took money away in the metropolitan areas like Mosman - where the Medicare spend per head is already twice that of the Hunter region.
"But they lump us into the same classification as the centre of Sydney, or the centre of Melbourne - which isn't appropriate.
"Because in the Hunter, we do have greater levels of disadvantage and unemployment, we have a higher proportion of vulnerable people. We should be exempt from this change."
Dr Fong said there was a focus on quality of care in the Hunter.
"The way medicare works, the longer the doctor sees you for, the less they are charging you for that time," he said.
"So the other alternative is they get to five minutes and say, 'time's up', and that's the model you see more in Sydney and Melbourne in the bulk billing clinics.
"The final option is for a GP to say, 'I've had enough of this', and just shut up shop.
"A lot of our older GPs are saying that."
The association has begun a campaign and created a petition to raise awareness of the issue to try to stop the changes.
"Hopefully we can get the community behind this as well," Dr Fong said.
"People can also write to their local member."
A spokesperson for the Minister for Health, Greg Hunt, said the changes were necessary so that geographical eligibility was updated from 1991 population statistics to contemporary data to ensure incentives were correctly targeted to rural and remote areas, and not to metropolitan areas.
"The changes are designed to support regional areas and reflect movements in population," he said.
"The vast majority of the Hunter Region is classified as MM 2-5 and is still eligible for rural bulk billing incentives, as well as other incentives as part of the government's Stronger Rural Health Strategy.
"Doctors in areas, including Gosford/Wyong and Newcastle (which are classified as MM 1) can still access bulk billing incentives at a lower fee through MBS items 10990, 64990 and 74990."