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Canberra is spoilt for services – right? Well, no, not so much when it comes to finding a bulk-billing general practitioner. This low rate in the national capital has been an irritant for years, especially for low-income households – and there are plenty of those in Canberra although they often go unheard and unseen, obscured in the homogeneity of our tree-lined suburbs. If your neighbourhood has a problem, such as lack of GPs, you can choose to ride with reality or make waves. In Canberra's north, the frustrated citizens are choosing action over inertia and, in doing so, are finding a solution in one of our oldest institutions – the co-operative. Several years ago the West Belconnen Health Co-op was born from a need – and the solution has thrived ever since. It has changed its name to the National Health Co-op, now has medical clinics on the south side as well as the north, and is expanding across the nation. This Canberra product has found a national opening and is rapidly becoming a success story. The co-op is owned by its patients – 33,028 people – who pay a joining fee of $30 and an annual fee of $100 – or $10 a month – to see a doctor. Are they better off, rather than seeing a private GP, paying around $70 and receiving about half back through Medicare? That depends on your individual circumstances but the scheme is proving popular – it has signed up the equivalent of 10 per cent of Canberra's population. In 2003 the ACT had the lowest bulk-billing rates in the country, around 37 per cent compared to about 87 per cent across the country. By 2014-15, Canberra's bulk-billing rate was 57 per cent, compared with a national rate of 83 per cent. At that time south Canberra had the lowest level of bulk-billing in Australia, at 45.1 per cent, while Belconnen had the highest level of bulk-billing in the ACT at 65.6 per cent. About a decade ago, some large medical centres attracted GPs from surrounding suburbs to give up their individual practices. Some centres bulk-billed for only the first year. Subsequently, residents in west Belconnen became concerned at the lack of local GPs. At Charnwood, pharmacist Brian Frith and his staff knew the shortage of doctors in the area was critical because of the amount of triage work they were doing. Complaints were also being made to the Neighbourhood Watch group and a primary school P & C. A community meeting was convened, and those who attended heard about a health co-operative that had been operating in Melbourne for 30 years. The decision was made to give that model a go in west Belconnen. Pro-bono consultant David Bailey became a critical link. He went to Britain to recruit the newly formed co-op's first doctor. With two $200,000 grants, from the ACT and federal governments, the co-op opened its doors in 2010, with 100 members on its books. Now the National Health Co-op is the largest bulk-billing provider in the ACT and therefore has influenced the overall rate. CEO Adrian Watts is a big fan of the co-operative model. "If we look back at our roots as a country, we've had co-operatives operating here since the very early days and some of them are still existing – our farming and grain-growing communities would not have survived without co-operatives," he says. "For me it's about demonstrating what the community can do together, not just looking to government to solve things, or business to solve things." In a co-operative, no dividends can be paid back to members. For the health co-op, that means the money earned goes to health services. "Co-operatives are really going to be the way of the future over the next couple of decades in Australia – it's that gap between what governments can't solve and what business chooses not to," Watts says. "There's a big niche market left in a lot of industries where this is value just being taken out of the system. "We've proved in the healthcare system that you can keep the value back in the healthcare system by keeping it owned by the consumer. "A private business might have to return 30 per cent to its shareholders every year. "They would look at this part of the market and say, we're not really interested in that, we're not really interested in operating a four-GP practice because we'd rather run 20 and then we can make a lot of money. "I understand that and I think that's fair for them to do that but it leaves open a whole lot of the market where the community can take the value." Watts was asked to join the co-op's board in 2010, to share his financial experience as an accountant. "We'd proved you could employ a GP, you could actually own a practice as a community – to me, that was a terrific example of how the community can get together," he says. "For me it was really my passion for community development and the belief that we can do a whole lot more together as a community. "I had firsthand experience of waiting in a line for three or four hours trying to see a GP myself." When Watts became CEO, he took the co-op off the general public's radar. "I said, right, we're going to put the brakes on this for a couple of years, we're going to lay low for a while, we're not going to be putting out press releases, you won't find us in the newspapers much," he says. This period of consolidation was to "prove what we did was best practice in medicine, prove to our members that we were delivering best-quality health care". The expansion continued, with two more clinics opened in the last 12 months and the Higgins practice will open within four weeks. "It will only be a kilometre away from our clinic in Holt but there's a great demand in west Belconnen for health services." What's next for this group? Well, the rest of the nation. The co-op is expanding across the ACT's northern border shortly – to Yass. The NSW town already has 450 members in the co-op and soon they have their own clinic. That's not the whole story. "We realised we couldn't just keep this model here in the ACT, it's too big a prospect – from my side, I couldn't ethically just keep this here and not give this to the rest of Australia," Watts says. Around the world, 81 million people get their health services from a health co-operative, he says. But expansion poses questions. "Do you serve your current members or do you serve your future members?" he asks. "That's a difficult question for a membership-based organisation because technically you've got to provide the services to the members – it's a bit of a chicken and egg scenario. "What we've proved over the last six years is we've got a really solid business, it works well, we've got a really strong team of professionals. "We've built ourselves up to a very solid entity that can take this across the country now." Andrew Leigh, member for Fenner, the federal electorate covering the north of Canberra, is impressed by the work of the co-op. "With the lowest bulk-billing rates in the nation, the ACT has long needed a service like the National Health Co-op," he says. "Since it first opened in Charnwood in 2010, the National Health Co-op has shown that it is possible to provide good quality health care with bulk-billing and a small annual membership fee. "By providing allied health services on site, the Co-op makes it easier for patients to see the specialists they need to stay healthy. "I recall my predecessor Bob McMullan telling me that getting a small federal grant to help kickstart the Co-op in 2010 was one of his proudest achievements in politics. I continue to be impressed by what the Co-op has achieved in the past six years." Twitter: @rosspeakeCT

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