A significant alteration in the Medicare rules comes into effect on 1 November 2025 that will dramatically change general practice in Australia. What might superficially seem to be a small alteration needs to be understood by Australian medical practitioners and their patients. A lot is at stake.

A Lesson from 1948
In 1948, the creator of the British National Health Service (NHS), UK Health Minister Aneurin Bevan, boasted that he achieved his goal “by stuffing the doctors’ mouths with gold.” Now, Australia seems intent on following the same failing UK model.
Today, the “stuffing” is done with a once-gold plastic card and high-pressure tactics — wrestling GPs into submission and control through red tape and false promises. The new Bulk Billing Incentive Program (BBPIP) will be used as a lever to control general practice — another step towards the voluntary nationalisation of Australian primary care.

From Independence to Control
From 1 November, practices that bulk bill 100% will be financially favoured by government policy.
Patients who attend practices that do not bulk bill 100% will be discriminated against. These patients will receive less back from their Medicare levy when they attend the GP.
For government, there will be no incentive to increase rebates for patients who attend practices that resist pressure to universally bulk bill. The temptation will be to turn the screws on practices that don’t toe the government bulk billing line.

The result will be a two-tier system:

  • Government Doctors — compliant, centrally funded, and beholden to bureaucracy.
  • Private Family Doctors — independent practitioners maintaining traditional patient
    relationships.

This dynamic is now being reversed in the United Kingdom, where dissatisfaction with the public system has led to a surge in private health insurance.
According to The Guardian, “Almost one in eight Britons now has private medical insurance — the highest proportion since 2008.” While most independent practices in Australia will remain mixed billing, the principle at stake is autonomy. Family medicine depends on long-term trust — and that trust is undermined when financial decisions are dictated by Canberra rather than by the doctor-patient relationship.

Every practice is different. A bureaucrat cannot possibly understand the local conditions, demographics, or dynamics that shape the sustainability of each general practice. The thirst for compliance and submission is simply a tool to exert control.

Accreditation, Data, and Control: The Machinery of Nationalisation
When combined with other developments — virtually mandatory accreditation, cloud-based data storage, patient registration through MyMedicare, and blended payments processed via Services Australia — the picture is unmistakable: nationalisation by stealth.
Each of these mechanisms ties practices closer to central oversight, gradually eroding the independence that once defined Australian general practice.

The Consequences
General practice is sliding rapidly toward a system of dwindling patient rebates, government-dependent funding, and state-subsidised clinics — already visible in Canberra and soon in Tasmania. Many practices cannot survive without government support.
Recent news from Victoria demonstrates that even an efficient, well-governed entity cannot provide GP services sustainably under the new model — even with additional government funding.
As reported by The Guardian (16 October 2025): “Closure of GP clinics will leave thousands of vulnerable Victorians without lifesaving healthcare.”
This is nationalisation, not reform — and it will deliver the worst possible outcome for both doctors and patients.

Why Private General Practice Matters
Competition produces better outcomes for patients. The same logic that applies to hospitals applies to general practice: without a private system, the public one collapses under its own weight.
Private medicine and public medicine work together. Otherwise, waiting lists blow out and diversity of care is not maintained.

Conclusion
The 1st of November 2025 may appear administrative. In truth, it represents a profound ideological shift — from a profession of independent clinicians to a bureaucratically managed workforce.
Australia’s health outcomes have long been among the best in the world because general practitioners were trusted to act independently in the best interests of their patients. That independence is now under direct threat.

This is nationalisation by stealth. And unless doctors and patients recognise it for what it is, by the time they do, it will be too late.