More GPs could start charging patients a co-payment following the Turnbull government’s decision to extend its freeze on Medicare rebates, doctors say.

The federal budget revealed on Tuesday that Medicare rebates, which have not risen with inflation for almost two years, would remain static for all GP, medical specialist and allied health services until June 2020, saving about $925.3 million between 2018 and 2020. 

The Royal Australian College of General Practitioners president, Dr Frank Jones, told Fairfax Media the decision “will make running a quality practice extremely difficult with the probability you will have to charge a small fee which may deter certain patients (who) may present later unwell and require hospital services.”

While GPs had so far been able to absorb the costs to maintain high bulk-billing levels, he said the extension increased pressure on practices which were increasingly treating complex chronic conditions of the ageing population.

“If you bulk-bill (patients), you are going to be out of pocket. Are you going to cut your hours? Staff? We have overheads like every other small business,” Dr Jones said.

He would not rule out members targeting their patients to campaign against the move, in a similar way to the pathology sector, which has gained about 500,000 signatures on its petition against planned cuts to bulk-billing incentives.

President of the Australian Medical Association Dr Brian Owler has said that the freeze undermined “the value of Medicare” and could not continue, with the cost of equipment and staff rising each year. He said the freeze would affect the poorest and sickest patients the most.

“The only way that GPs can maintain their services, can maintain the quality of the care that they provide, is to start to charge patients…bulk-billing rates are going to of course fall.”

Health Minister Sussan Ley said: “I appreciate the efforts of many GPs to keep costs down during the indexation pause, which Labor first introduced, and we have in return listened to their requests for government to introduce landmark Health Care Home reforms for chronic patients.”

The government will next year start a three-year trial of Health Care Homes, which will pay about 200 GPs to co-ordinate tailored packages for patients with multiple chronic illnesses, in a move away from Medicare’s current fee-for-service model.

Ms Ley said it was “disappointing” that given the government’s commitment to the trial, which was proposed by doctors, “there’s no reciprocal offer to assist taxpayers with the immediate financial challenges our budget faces while it’s implemented”.