‘Bulk billing is almost non-existent’: Tasmanian councils turning to ratepayers to prop up flailing GP clinics

People in one of the lowest income areas of Tasmania are paying extra in their council rates to prop up health services and subsidise local GP bulk-billing clinics.

Dr John Saul, the president of the AMA in Tasmania, says Glamorgan-Spring Bay council on the state's east coast is one of several rural areas charging ratepayers for GP services so the most vulnerable patients can receive healthcare.

"Bulk-billing is becoming almost non-existent," said Saul, a rural GP.

"Funding for Medicare is seen as a federal responsibility but we are seeing desperate councils stepping in with funding, and in some council areas the state government is providing funding as well."

The Glamorgan-Spring Bay council mayor, Robert Young, said it was impossible to get bulk-billing doctors and even doctors who charge private fees to work in the region without heavily subsidising them.

"With no help from the state or federal government it costs us $550,000 a year which goes towards GPs, primarily those that bulk bill but also some goes towards private GPs as well," he said.

The east coast is an ageing community, with a median age of 56 "and getting older", Young said.

"We have a high proportion of retirees and people on government benefits," he said. "They can't just find money for a doctor - a retiree can't ask their boss for a pay rise or more hours."

The region's 5,000 ratepayers pay a $90 medical levy as part of their rates to subsidise council-operated GP clinics.

"As a council we have had to cut funding from everywhere else to pay GPs from our ordinary revenue as well, there is nothing left for us to cut," Young said.

"If a doctor leaves or goes on holiday we have to get a locum in, and they cost almost $2,000 a day here."

He said his council does not receive federal or state government assistance.

The Huon Valley council has also stepped in to run the Dover and Geeveston medical centres. Acting mayor Sally Doyle said that while "owning and operating medical centres is not council core business", if council did not fund the clinics they would have closed.

Ratepayers will pay $433,000 toward the running of the centres this financial year, she said.

A spokeswoman for premier Jeremy Rockliff said the Tasmanian government provides support to several general practices across the state.

"Primary health is the responsibility of the federal government, however the state is continuing to step into this space to fill service need with innovative solutions," she said.

Guardian Australia has contacted the federal minister, Mark Butler, for comment.

Meanwhile Saul, who has been a GP for 40 years, said the health care situation across the state is so dire that he came out of retirement to help manage a clinic at Nubeena on the Tasman peninsula. The clinic was on the brink of closing because it is primarily a bulk-billing practice.

For most of his career, Saul and two of his colleagues operated private-billing clinics, charging AMA recommended rates. Saul said these clinics, and GPs who largely charge private fees, generally "do very well". It is unsustainable for most clinics to rely entirely on bulk billing, he said.

Medicare rebates for bulk-billed GP consultations haven't kept pace with the cost of inflation. These costs are now being passed on to patients, with clinics increasingly scrapping bulk billing altogether and introducing private fees to meet the costs of running a practice. But patients in Nubeena and surrounding areas cannot afford private fees.

"It is a highly underprivileged area," Saul said. "There is a high level of bulk-billing in our clinic, but we would not be able to survive or offer bulk-billing without the financial support of the state government, and support from the Tasman council."

Tasman council provides a council-owned house for doctors to live in rent free when they work at the clinic, and a heavily subsidised building for medical students to use. The mayor, Kelly Spaulding, said it means council has to rent a separate house for its general manager.

"We don't offer as much support as some councils do," Spaulding said. "Some councils also put an amount in their rates to go back into the medical services, but we don't think we should have to do that, and we have pulled back the amount of support we offer for that reason. It should be the federal government and state governments funding health services - that's why we pay taxes."

President of the Royal Australian College of General Practitioners, Adj Prof Karen Price, said she was not surprised that councils were stepping in.

The College is calling for a 10% increase to Medicare rebates for consultations that are longer than 20 minutes, and a new Medicare item for consults lasting more than hour.

"To make up for funding shortfalls affecting many practices the college cautiously backs councils and state governments supporting bulk-billing practices, particularly those in rural and remote areas where health services can be few and far between," Price said.

"This is a national problem that affects many communities across Australia."

Price said funding from state and local governments "isn't a silver bullet capable of making up for a lack of sustainable, long-term funding for general practice care".

"But in the meantime, we will take what we can get," she said.

President of the Australian Medical Association, Prof Steve Robson, said it was not unusual for state and territory governments or local government to provide financial support for general practice, particularly in rural areas.

"However, this is not an excuse for the commonwealth to avoid its funding responsibilities," he said.

"The AMA would like to see a national conversation about how the states/territories can do more to support general practice but, at the end of the day, the commonwealth needs to significantly lift its own game."