Critical doctor shortages are prompting practitioners to ask patients to pay $140 to obtain appointments ahead of other patients who have not agreed to become a ''regular patient''.

They say the money will cover costs associated with setting up individual preventive healthcare plans but the queue jumping is part of the attraction

Doctors from the newly opened GP super clinic in Gunnedah, which is part of a federal government program, are leading the push.

The Australian Medical Association said it expected giving appointments preference to people who had paid an upfront fee would become more widespread as doctors devised ways to maintain incomes in the face of the government's refusal to raise the schedule fee payment.

However Health Consumers NSW believes the doctors are putting their own interests ahead of the patients'.

Dr Chris Gittoes, one of five doctors at the Gunnedah Rural Health Centre, has written to patients thanking them ''for the opportunity to offer to become your regular doctor''.

In his letter, a copy of which the Herald has, Dr Gittoes explained there was a critical shortage of doctors in Gunnedah and patients often found it difficult to see a regular doctor.

''I intend to book up to two weeks in advance. I am happy to see any patient, however, while I cannot guarantee you will get a timely appointment every time … I will endeavour to give priority appointments to my regular patients,'' he wrote. ''I intend to limit my books to patients who are interested in having me as their regular doctor.''

He proposed patients should have a preventive healthcare plan. ''This is similar to when you board an aeroplane and the pilot has a checksheet to prevent the plane from crashing. Car companies have preventive maintenance schedules for your car to ensure safe and reliable motoring. Your healthcare is no different.

''The fee for your investment in your health will be $140.''

The chairman of the AMA Council of General Practice, Dr Brian Morton, disagreed that the payment amounted to a doctors' form of private insurance.

He said others were likely to consider imposing similar fees for a preventive care approach.

''The problem is that the government has not made any changes to the schedule fee and there has been no attempt to keep pace with inflation for many years,'' he said.

The objectives of the GP super clinic program state that although health professionals would retain autonomy over fees, clinics would be strongly encouraged to bulk-bill.

The executive director of Health Consumers NSW, Morag Morrison, said many already found it difficult to meet medical costs without doctors imposing their own additional charges.

''This has come out of left field. Obviously the doctors have decided to go into marketing but I'm unsure about the morality of dangling a carrot like healthcare, and then charging patients more,'' she said.

Some Gunnedah doctors resisted joining the new health centre and Dr Gittoes's letter has set the cat among the pigeons.

Dr Gittoes said doctors were entitled to some incentives to live in communities without the services and comforts offered by larger towns.

He said he could not make a living from bulk-billing patients. ''If I bulk-billed, I'd be earning less than a 24-year-old driving a truck at one of the local mines.''