The Hunter's homelessness crisis is made worse when people can't see a GP, leaders in the health and housing sectors say.
They argue that the decline in bulk billing has far-reaching consequences for people falling below the poverty line and towards homelessness.
"The poor are getting poorer and sicker. It's distressing," said Dr Fiona Van Leeuwen, chair of the Hunter General Practitioners Association.
Dr Van Leeuwen said financial pressures were "really pressing people to the wall".
"They're needing to find ways to cobble their income together and prioritise spending, so often healthcare will be seen as a low priority unless people are acutely unwell," she said.
"This leaves them very vulnerable to not getting early intervention, chronic disease management and preventive care."
Lack of access to affordable general practice care means "people will present later and sicker at the emergency department".
Homelessness NSW chief executive Trina Jones said some people can't afford to see a GP "because of the cost of living".
She said when this happens, they miss out on referrals to support services.
The cost for a standard GP consultation is about $70 to $90 in the Hunter, with a Medicare rebate of about $40. So people are faced with an out-of-pocket gap fee of up to $50 to see a doctor.
Some GPs in the region bulk-bill the most disadvantaged patients on compassionate grounds, but it can be difficult to get an appointment due to the GP shortage.
Ms Jones added that working people in difficult financial circumstances were getting sick, but "not getting access to the doctor".
This means they're sometimes "not fit for work because they're not well".
Without a steady and well-paying job, they can lose their rental property or fail to meet mortgage payments.
Dr Van Leeuwen said the matter highlighted that Medicare and "the whole way the health system is run" needs to be reviewed.
The Australian Medical Association [AMA] said last month that the Medicare rebate freeze, which successive governments had maintained, led to "falling bulk-billing rates and patients waiting longer to access a GP".
In this month's federal budget, the Albanese government announced $5.7 billion over five years to "strengthen Medicare and make it cheaper and easier to see a doctor".
This included new incentives for GPs to bulk bill patients aged under 16, pensioners and concession card holders. GPs said this wasn't enough to resolve the difficulty most people have in finding a doctor who bulk-bills.
The budget also included $99 million over four years to "connect frequent hospital users to general practices to receive comprehensive, multidisciplinary care in the community".
A further $79 million was allocated to improve access to care for "people with chronic conditions in under-serviced communities".
The government also said it would "invest in new services to help homeless people and culturally and linguistically diverse communities to access primary care".
Medicare rebates were indexed in the budget [a standard consultation rebate rose from $39.75 to $41.40], but the AMA had called for the rebates to be doubled.
Dr Lee Fong, Hunter General Practitioners Association secretary, said the federal budget was a step forward, but "so much more needs to be done".
"The Medicare bulk-billing rebate system is broken," Dr Fong said.
"That means less and less GPs can provide quality care without charging a gap payment.
"Until that gets sorted out, those who can least afford a gap - and that includes the homeless - are going to suffer the most."
He said federal, state and local governments should collaborate to "come up with regional solutions".
"And for the sake of the vulnerable, the sooner we can do that, the better," he said.
In a submission to last year's NSW Parliamentary inquiry into homelessness among people aged over 55, AMA NSW said "ill health - physical and mental - can increase an individual's risk of homelessness".
"Similarly, homelessness can trigger poor health and/or exacerbate an already existing condition."
The submission added that it was challenging to co-ordinate "social and health services from mainstream general practice".
"Equipping general practitioners with the tools and education to better meet the needs of these complex patients will increase the system's capacity to assist people experiencing homelessness."
Homeless people in Newcastle can access medical treatment through the Soul Cafe.
Soul Cafe chief executive Rick Prosser said the Soul Hub connects people to support networks.
"We're fortunate that our specialised services, whether it be chiropractic or anything health-related, come from specialists in their field who donate their time," Mr Prosser said.
"We have a sphere of volunteering where people bring their specialised services or capacity into the mix. That is offered directly to our guests.
"We're not proactively looking for specialised services in the health area. It emerges and comes to us."
He said the Soul Hub was moving to a new building this year, which would boost capacity for specialists.
"That's how we are designing it and what we are planning towards."
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