GP practice revenue models and growth strategies: frequently asked questions

Question 1

Should I enrol in BBPIP or keep mixed billing?

Accepted Answer

BBPIP pays a 12.5% revenue uplift but requires full bulk billing for all patients. Any departure from full bulk billing forfeits the incentive entirely. The decision depends on your current gap fee revenue versus the projected BBPIP payment, your patient demographic, and whether your workforce will accept the switch. For most practices billing modest gap fees to a mixed demographic, modelling both scenarios against actual patient volume is the only reliable way to decide.

Question 2

What does BBPIP actually pay and how is it calculated?

Accepted Answer

BBPIP pays a practice incentive equal to 12.5% of total MBS billings for fully bulk-billing practices. The November 2025 expansion extended eligibility to all Australians, not just concessional patients, and 3,412 practices enrolled within weeks. Payments are calculated quarterly against your PIP registration. The incentive applies to the practice, not to individual GPs, and is not distributed through GP service agreements unless your agreements specifically provide for it.

Question 3

What subspecialty revenue streams are viable for a GP practice in Australia?

Accepted Answer

Viable subspecialty streams include skin cancer medicine, women's health, aesthetic medicine, GLP-1 and weight management, sports and musculoskeletal medicine, travel medicine, occupational medicine and mental health. Each requires different levels of credentialing investment, capital and demand conditions. Skin cancer and aesthetic medicine have higher setup costs. Weight management and mental health have the lowest barriers to entry. Geography and patient demographics determine which streams are sustainable in your location.

Question 4

How does MyMedicare registration affect my practice revenue?

Accepted Answer

MyMedicare registration unlocks access to longer chronic disease management MBS items including the GPCCMP (item 102) and associated care plan items. It also enables blended payment arrangements for registered patients in future. Practices with low MyMedicare enrolment are not accessing the full value of their chronic disease patient cohort. The GPACI aged care incentive also requires registered patient relationships with residential aged care facilities.

Question 5

What is a direct primary care or subscription model and is it legal in Australia?

Accepted Answer

Direct primary care (DPC) involves patients paying a monthly fee for unlimited or priority access to GP services. In Australia, only one operator has been confirmed as compliant. The Health Insurance Act 1973 prohibits charging patients for Medicare-covered services, which creates a legal constraint that DPC models must navigate carefully. A compliant model must restrict the monthly fee to services not covered by Medicare and must not charge a fee as a condition of accessing bulk-billed services.

Question 6

What is the General Practice in Aged Care Incentive (GPACI) and how do I access it?

Accepted Answer

GPACI replaced the Aged Care Access Incentive in 2024 and pays GPs for providing regular structured care to residents of eligible residential aged care facilities. Payments are made per registered patient at each RACF and are tied to delivery of annual health assessments and regular GP visits. Practices near a residential aged care facility that have not formally enrolled are leaving material revenue on the table. Registration is through MyMedicare and requires a formal relationship with the facility.

Question 7

How does locum dependency affect my practice revenue and value?

Accepted Answer

Locum dependency reduces both revenue and practice value. Locum costs are typically 40-70% higher than equivalent employed or contracted GP costs and are classified as an operating expense that reduces EBITDA. Locum revenue is also less predictable and harder to grow through quality improvement programs. Buyers treat high locum dependency as a risk indicator because the revenue is contingent on continued locum availability, which is not guaranteed in a constrained GP workforce.

Question 8

Can a GP practice offer employer or corporate health contracts?

Accepted Answer

Yes. Employer and corporate wellness contracts involve a business paying for priority access or onsite GP services for their workforce. These are typically structured as fee-for-service arrangements outside the MBS. Viability depends on proximity to a significant employer, workforce size, and whether the employer values reduced worker absenteeism or injury management enough to pay a retainer. These contracts require a separate engagement and billing structure from standard patient services.

Question 9

What is the difference between a practice manager and a business manager in a GP practice?

Accepted Answer

A practice manager typically handles day-to-day clinical operations: rostering, compliance, accreditation, patient flow and staff management. A business manager operates at a higher level, overseeing financial performance, revenue model decisions, commercial contracts, growth strategy and reporting to ownership. Most GP practices conflate the two roles. As practices grow beyond one site or $3-5 million in revenue, the distinction matters. Expecting a practice manager to perform business management functions without the title, authority or remuneration is a common source of under-performance.

Question 10

How does a GP practice owner manage clinical workload alongside ownership responsibilities?

Accepted Answer

Owner-GPs who attempt to maintain a full clinical load while managing a growing practice typically under-perform in both roles. The operational and strategic demands of ownership are not compatible with full-time clinical work once a practice exceeds a single-site operation or faces active growth challenges. Effective owner-GPs ring-fence protected time for management and decision-making, delegate operational functions to a capable practice or business manager, and make a conscious decision about their clinical contribution relative to their ownership role.

Question 11

What payroll tax obligations apply to GP contractor payments?

Accepted Answer

Payroll tax applies to contractor payments in most states where the contractor is engaged under a relevant contract as defined in state revenue legislation. Following the Thomas and Naaz decision in NSW, the ATO and state revenue offices have increased scrutiny of GP contractor arrangements. Queensland enacted a blanket payroll tax exemption for GP wages in 2024. In other states, practices must assess each contractor arrangement against the relevant state's contractor provisions. Undisclosed payroll tax exposure is a significant due diligence issue in practice sales.

Question 12

Are GP registrars employees or contractors, and what does it mean for my payroll tax liability?

Accepted Answer

Under the Single Employer Model introduced in 2023, GP registrars are employed by their training organisation, not by the practice. The practice pays a hosting fee to the training organisation rather than directly employing or contracting the registrar. This removes the payroll tax risk that previously attached to registrar payments in some states. However, practices that have previously treated registrars as direct contractors may have historic payroll tax exposure that needs assessment before a sale.