Clara Tuck Meng Soo | ACT government GP payroll tax making general practice unviable

I also saw an elderly Thai couple earlier in the afternoon; I have an arrangement with them where I charge one of them a concession rate and then bulk-bill the other when they see me together. They are amongst the last few of the patients who have followed me to my new practice whom I still bulk-bill.

I then went to a doctors' meeting where we all talked angrily and fearfully about the payroll tax that will be applied to general practices in the ACT.

I don't have a philosophical problem with bulk-billing. My old practice for a long time bulk-billed everyone with a concession card. I loved the feeling of seeing a well-off senior public servant followed by someone who had slept rough on the streets; those were the happiest times of my professional life.

But when politicians and public servants excoriate Canberra GPs about the low bulk-billing rate here, they fail to mention that bulk-billing means taking a 2-3 per cent pay cut every year, year after year.

Yes, the heartless thing about bulk-billing is that it is indexed at a lower rate than the consumer price index. So, GPs are forced to choose between their conscience and their income in a way that no high-minded politician or public servant has to do. In my case, economic reality finally ended my dream; after two years of losing $70,000 a year, I had to close my old practice.

So, I don't think that there will be any choice for me but to impose a new payroll tax levy on the patients in my practice. The only question is exactly how large a levy we impose and when we put it in place. The margins in my practice are too small for me to just absorb the tax. And having closed one practice earlier this year, I don't want to have to close another one. Of course, that will have an effect on some patients. And knowing the doctors at my practice, we will make our little concessions for the patients we know.

I dream about what it would have been if the ACT government had actually announced an indefinite suspension of payroll tax for general practice in Canberra. I imagine lots of general practitioners moving to work in a city that had a bold vision of working with general practice.

That would have had a real effect at increasing access to general practice in Canberra.

I saw my pharmacist in the morning to fill a prescription. We started talking about two-monthly prescriptions and the impact this will have on pharmacies. It seems his pharmacy, which is in an inner-city suburb, won't be badly affected but some of the pharmacies in the outer suburbs are already shedding staff. I told him about the impending payroll tax on general practices.

He hadn't heard about it and he was shocked and mentioned that most pharmacists are employed as contractors. So, a payroll tax on general practices will reverberate through the health system.

Pharmacies, physiotherapists, optometrists, psychologists and all the other allied health workers could get caught up in this.

And it may not stop with payroll tax. I also exchanged emails over the weekend with my lawyer.

We've been talking about payroll tax on and off through the year. I asked him if the imposition of payroll tax will affect the position of GPs with regard to other employee entitlements.

Because GPs mostly work as contractors, they don't get superannuation, sick leave or annual leave or workers compensation paid for by the general practices they work in. If state and territory governments are now going to say that all these people working in health industries are not really contractors but employees, what is the ATO going to say about all these other entitlements?

The long-term underinvestment in Medicare by federal governments in Australia over decades has been masked by the use of contracts in general practice. If general practices now have to deduct employees' entitlements from GPs, the pay packet suddenly looks very unattractive.

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I think a lot of younger GPs will start looking at alternatives like the APS where a mid-level salary and entitlements and security of tenure will suddenly look like a very attractive option.

I was on holiday in England recently where I met up with an old friend from university who is now a consultant psychiatrist and we talked about the NHS. Decades of underinvestment in the NHS has created a situation where junior doctors, nurses and allied health workers are leaving the NHS in droves. They have 18,000 unfilled vacancies.

And it becomes a vicious cycle where the workers who are left are so stressed out that they burn out and leave too.

I don't want my Asian man with chronic schizophrenia or my young patient to chronic pain to stop seeing me. And the elderly Thai couple would be completely lost in emergency departments.

So, I will try to shield them from the payroll tax levy that my practice will impose. But eventually, these pressures build up and I have to think about the survival of the practice and all the other patients I see. And the day when economic pressures mean they can't afford to see me anymore will be a sad day for them and for me.

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