How much financial support your local doctor and local GP clinic gets from the government directly affect how much you pay for your visit to the doctor, and whether doctors are able to bulk bill pensioners etc.
In 2019, under the coalition government, Murwillumbah was reclassified (under the Modified Monash Model (MMM) classification) from a regional to a metropolitan categorisation (MMM1) which directly impacted the ability of local GPs to provide affordable health care and subsequently had a direct impact on the emergency department of the Murwillumbah Hospital.
At the time of the reclassification local Labor Tweed Shire Councillor and Reece Byrnes and Labor Federal MP Justine Elliot highlighted the ‘detrimental’ health consequences for the town and surrounding region of this decision.
Dr Tony Camilleri at Main Street Medical has been a local GP in Murwillumbah for 30 years and has campaigned tirelessly to have the reclassification reversed.
Dr Camilleri told The Echo that the reclassification led to his practice having to remove bulk billing for pensioners, and saw the practice running at significant losses of hundreds of thousands of dollars a year.
‘It also saw the closure of the University of Rural Health established by the Wollongong University and a significant increase in presentations to the Murwillumbah Hospital Emergency Department,’ he explained.
‘The metropolitan classification meant that we lost access to pay rates, Medicare rebates, and teaching rebates etc. The regional classification started 300m down the road from Main Street Medical. Our patients don’t just come from Murwillumbah, they come from the surrounding rural regional areas. Looking at the breakdown for Main Street Medical’s 15,000 patients, 33 per cent have an address in Murwillumbah, seven per cent in the more affluent area east of Murwillumbah, however, that leaves 60 per cent of our patients located in rural and regional areas; yet we were no longer able to get appropriate funding to service them.
‘Murwillumbah is surrounded by and services some of the most disadvantaged and socio-disadvantaged populations in the region.’
The impact of the metropolitan classification also impacted the operation of the Murwillumbah Hospital emergency department (MDH ED) which saw a significant increase in patients presenting at the ED.
Addressing this issue Dr Robert Davies, Director of Emergency Medicine for Northern NSW Local Health District told the Special Commission of Inquiry into Healthcare Funding that the reclassification had directly impacted hospital’s ED.
‘MDH ED has had a more dramatic increase from 17,000 presentations in FY2022 to over 20,000 presentations in FY2024. MDH now frequently receives over 70 presentations per day as opposed to 50 presentations per day last year. This is a result of the loss of rural status when its Modified Monash Model (MMM) classification changed to MM1 under MMM 2019, and subsequent reduction in local General Practitioners as rural loading and incentives were no longer available, and also due to the population increase post-Covid.’, he said.
Following the election of a Labor government Dr Camilleri has spent years actively pursuing the reclassification of the town, repeatedly contacting Councillor Reece Byrnes, Mrs Elliot, and Health Minister Mark Butler and providing evidence over 15 months ago of the ongoing negative consequences of the metropolitan classification.
Classification reversed
On Thursday, February 13 Labor’s Mrs Elliot made the announcement of the reversal back to a regional classification, six years after it took place.
‘GPs will soon get more support from Medicare, with larger bulk billing incentives, thanks to the Albanese Labor government,’ announced Mrs Elliot.
‘Under the Liberals and Nationals, Murwillumbah was stripped of our classification as a “regional” location and instead given a “metropolitan” classification, putting us in the same category as Sydney, Brisbane and Melbourne.
‘This hurt our community, it meant our Medicare payments were lower and it stripped our GPs of the support they needed to bulk bill more patients, more often. In November 2023, the Albanese Labor Government tripled the bulk billing incentive for those who need to see their GP most often: pensioners, concession cardholders, and families with kids and young teenagers,’ she said.
‘Since we increased investment in bulk billing, there have been 45,000 additional bulk billed GP visits on the North Coast. This change to Murwillumbah’s classification means that the Medicare payments our GPs receive to bulk bill a standard consultation with an eligible patient will increase by almost 20 per cent, with the Medicare payments increasing by $11.15, from $64.20 to $75.35 per consult.’
Aged care to lose out?
While Mrs Elliot has focussed on bulk billing Dr Camilleri has said they are still considering if they can bring bulk billing back into their practice. He further emphasised that the reclassification has seen the traditional regional GP clinic approach of Murwillumbah that saw you work in the practice, the hospital, emergency, home visits, and aged care move towards a more profit driven model.
‘What we are seeing is a change in the types practices that are opening that are more corporate and profit based than traditional rural GP owned practices,’ he said.
The result is that there are now some GP services that are declining to do aged care and home visits as these are less profitable areas in which to practice.
‘This reclassification is very good news for Murwillumbah,’ says Mandy Nolan, the Greens candidate for Richmond, ‘but people want answers about why this took so long. The major parties have taken six years to fix this mistake. Richmond has had the same MP for 20 years. Labor has had almost a whole term of government, and we are only now getting a brief announcement via press release on the eve of an election campaign.’
However, Mrs Elliot has highlighted that ‘this is a huge win for our community, and I want to thank all the locals who made their voices heard.’
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