While defending the Medicare GP co-payment, PM Tony Abbott calls Labor the 'most irresponsible opposition in Australia'.

EXCLUSIVE: Patients will face a $45 gap fee to see a doctor within three years and there is nothing the Senate can do to stop it.

Health Minister Peter Dutton has found a way of bypassing the parliament to implement one of the biggest of his planned cuts to Medicare.

The freeze on the indexation of the Medicare rebate is estimated to save the government $1 billion of the $3.5 billion it wants to save from Medicare by 2017-18.

Unlike the other measures the government has outlined — the $5 cut to the Medicare rebate and the requirement of a doctor see the patient for at least 10 minutes — indexation needs no regulation or legislation.

REVAMPED GP POLICY: AMA predicts a $10 co-payment, not $5

MEDICARE CO-PAYMENT: The Prime Minister’s changes to $7 plan

This means there is no way the Senate can block the move and the savings are locked in for the government.

The government was last week forced to ditch its unpopular $7 GP fee because it could not get it through the Senate where Labor, the Greens and the Palmer United Party opposed it.

Mr Dutton outlined the indexation freeze, the $5 cut to the Medicare rebate (estimated $1 billion saving) and the 10 minute minimum time limit (estimated $1 billion saving) on a GP visit last week to make up the lost savings when the fee was killed.

These measures are all being opposed by the Senate but Mr Dutton has found a way around it.

“If you are pausing indexation then no change is made to the existing schedule. So no action is taken or required. No amendment is made to the existing schedule,” a spokesman for Health Minister Peter Dutton told News Corp Australia.

COMMENT BELOW: Do you back freezing the Medicare rebate to save money?

Australian Medical Association president Dr Brian Owler whose organisation is also opposing the cuts to Medicare stressed his discontent in an email to doctors on Wednesday.

“The AMA is strongly opposed to all three measures in the Government’s package that attack general practice”.

“This is a triple blow that will hit general practice like a wrecking ball. The AMA will do all it can to stop these destructive changes,” he said.

He earlier issued this warning: “What we do know is that the Senate is unable to block one of the key parts of the new policy — that being the freeze on all Medicare rebates,” he said.

The consequence for patients is that while their Medicare rebate is frozen for three years their doctor’s fee will continue to rise by an average 2.5 per cent a year to cover rising wages and rents.

The AMA’s recommended fee for doctors now worth $75 will rise to around $82 by 2018.

The Medicare rebate will, however, remain static at $37 leaving patients with a gap fee of around $45.

If the government is successful in getting its $5 rebate cut through the Senate the hip pocket hit will be even larger for patients.

Then the Medicare rebate will cut from $37 to $32 and frozen at that level leaving patients with a $50 gap.

If the indexation had not been cut or frozen the Medicare rebate would have been worth $40 in 2018 (rising from $37 because of inflation).

Pensioners and children aged under 16 are quarantined from the $5 cut to the Medicare rebate but the indexation freeze still applies to their Medicare rebate.

Professor Owler says the four year freeze on indexation follows a previous freeze imposed by Labor and means the Medicare rebate is “becoming meaningless in terms of the value of providing a service”.

“The only way GPs can cope is to pass the gap on to patients in the way of private billing and people need to be prepared for that,” he said.

Pensioners and children would not be immune from a copayment in time either because the freeze on the Medicare payments would eventually “put pressure on doctors to charge the patient something,” Professor Owler said.

Professor Owler has also taken a swipe at the government for its plans to slash the amount Medicare pays for shorter doctors consultations from January 19 when many doctors will still be on holidays.

“For a government that says is about small business this is a strange way to support small business,’ he said.

“The Minister who stood up at the George Institute two weeks before the federal budget and said he wanted to build up general practice is now tearing it down,” he said.

Opposition health spokeswoman Catherine King said the imposition of the Medicare rebate freeze without parliamentary approval was “mean and tricky”.

“Tony Abbott doesn’t have the courage to take his GP Tax to the voters or the parliament, so he is sneaking it through the back door,” she said.

Consumer’s Health Forum chief Adam Stankevicius said with its freeze on rebate rates for Medicare services the government was “slowly twisting the knife that it plunged into the back of universal health care via its $5 GP rebate cut”.

“The rebate freeze extends beyond GPs, to specialists, allied health professionals, midwives and dental surgeons, which will result in compounding hip pocket pain for many consumers with a chronic illness.,” he said.