Owner of both the practices Dr Gurdeep Bagari has been considering moving to private billing since COVID increased stress on the health system but has tried to delay the decision. He said it was unavoidable if the practices were to survive.

"I tried to postpone it as much as possible," he said, "but now the water is flowing over my head and I can't breathe."

Earlier this year, Dr Bagari announced plans to open a bulk billing practice in Bega. However that practice will also be mixed billing.

"We are going to suffer the same fate down there," practice manager for the centres Melody Charnock said.

"We don't want to go bulk billing for six months and have everyone transfer their health records and then have to change to mix billing. That would be misleading."

Ms Charnock said transitioning to private billing was inevitable for all bulk billing practices, and it was a matter of choosing the right time to change.

Dr Bagari was passionate about providing affordable health care services to the region.

"He's held on as long as he can," Ms Charnock said, "but business doesn't allow for bulk billing.

"Once the facts and figures are clear, we have to go. Otherwise, we look at removing the service altogether."

She said both the Narooma and Tuross practices would have been forced to close within the next two years if bulk billing continued.

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The decision was made because it was deemed bulk billing was not financially viable for providing the services available at the practices.

Bulk billing is paid in accordance with rebates not updated since 2012, and Dr Bagari said they did not cover the real expenses incurred by the practice for providing care.

For example, Medicare pays $39 for stitching up a wound on a patient's leg. Of that, the practice gets $11.70. This has to pay for the dressing, the stitching, the nurse, the local anaesthetic, the receptionist and the rent. The consumables alone cost the practice $24. Dr Bagari said the practice was out of pocket almost $35 for every such operation.

Where a bulk billing practice charges $39, a private practice could charge as much as $80 for the procedure.

"We don't want to be bulk billing and then not paying our staff," he said.

Ms Charnock said private practices earned almost double what a bulk billing practice could, but the expenses were the same: on nurse wages, consumables and with rent increasing three per cent annually.

"Everything in our expenses rises with natural inflation, but the income does not," she said.

"We're not trying to double or triple our income, we're just trying to give it a boost so we can pay for our consumables, pay our rent, pay our wages."

Dr Bagari said the pressure of bulk billing placed time constraints on doctors to try and see as many patients as possible in a day.

He said being a bulk billing practice had hindered recruitment opportunities at the practice. Doctors earn a percentage of their billables, earning more at a private practice.

"Why would a doctor work for a bulk billing practice when they can earn more at a private practice?" Ms Charnock said.

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Dr Bagari worked as receptionist at the Narooma practice last week in an attempt to make ends meet because no-one else was available.

"My community is my family and I will do anything required," he said.

"But I need to make sure we don't lose it forever."

Narooma will have lost two bulk billing practices in the space of a month, after Blue House Surgery closed on May 25.

Ms Charnock said it was important Narooma and Tuross Head Medical Centres remained open for the benefit of the entire south coast region. Currently the two centres service patients from Batemans Bay to Bega.

''It's not just about us staying open," she said. "It's also about the health of the community as a whole in our region.

"If we were to close down and remove yet another service, that's going to put more pressure on the few services that are around.

"How much more strain is going to be on the wider community, and the emergency departments, when it could have been handled at a local GP?"

The only other general practice in Narooma is the Lighthouse Surgery.

"Lighthouse do a great job," Ms Charnock said, "but it's just not feasible they handle our whole community on their own."

From July 1, Narooma and Tuross will not be bulk billed, although Dr Bagari said they would try as hard as possible to make healthcare affordable to the community.

The practices are still accepting bulk billing for the following:

Ms Charnock estimated 60 to 70 per cent of patients would still be bulk billed.

Those in the community who do not fit into one of these concession groups will have to pay, although Dr Bagari said even this amount would still be reduced.

The recommended fee by the Australian Medical Association is $84. Narooma and Tuross will charge $76.

Dr Bagari said the best solution would be Medicare becoming state-funded.

Currently hospitals are state funded, but GP's are federally funded through Medicare.

A doctor working in a hospital can bulk bill patients and receive the full amount from Medicare without incurring the costs of rent, reception staff and electricity, because these are funded by the state government through the hospital.

Dr Bagari said if the state was funding the overheads of GPs, he would be on par with the hospitals.

"Then bulk billing would be sustainable," he said.