‘Clear and consistent’ telehealth rules to start in September

New telehealth guidelines that clamp down on asynchronous prescribing services have been released by the Medical Board of Australia (MBA).
 
The Guidelines: Telehealth consultations with patients will take effect from September this year, with one of the key changes relating to the way prescriptions can be carried out.
 
‘Prescribing or providing healthcare for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board,’ the updated guidelines now state.
 
‘This includes asynchronous requests for medication communicated by text, email, live-chat or online that do not take place in the context of a real-time continuous consultation and are based on the patient completing a health questionnaire, when the practitioner has never spoken with the patient.
 
‘Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and the management of the patient was appropriate and necessary in the circumstances.’
 
The measure is aimed at clamping down the actions of multiple start-up companies that currently offer prescriptions without a real-time consultation with a doctor.
 
Dr Anne Tonkin, the Chair of the MBA, said that a doctor who has not consulted directly with a patient and does not have access to medical records ‘is unable to exercise good, safe clinical judgement’.
 
‘Prescribing medication is not a tick and flick exercise,’ she said.
 
‘It relies on a doctor’s skill and judgement, having consulted a patient, and recognises that prescription medication can cause harm when not used properly.’
 
RACGP President Dr Nicole Higgins welcomed the revised guidelines, describing them as ‘very clear and consistent’ on ABC Radio National.
 
‘This now brings back prescribing and management back to where it should be,’ she said. ‘This is a healthcare decision, it’s not a business solution.’
 
According to the guidelines, GPs will still be permitted to see new patients for the first time using telehealth, as well as issue new and repeat scripts; however, in most instances, patients will only be able to access MBS rebates for these consultations if they have consulted with a separate GP at the same practice in the previous 12 months.
 
The MBA also suggests that video consultations are preferable to phone consultations ‘when practical’, and states that telehealth is ‘most appropriate in the context of a continuing clinical relationship with a patient that also involves in-person consultations’.
 
‘A mix of in-person and telehealth consultations can provide high quality, accessible, ongoing medical care,’ the guidelines say.  
 
‘The Board recognises the important role that telehealth can play in accessing episodic and emergency care, particularly in rural and remote settings, for patients who are unable to travel for an in-person consultation, to support inclusive care, and when patients may not be able to consult with their usual doctor.
 
‘These guidelines do not prevent or discourage one-off telehealth consultations.’
 
Dr Higgins discussed a similar theme on the ABC.
 
‘We know that best practice is about having continuity of care,’ the RACGP President said. ‘Ideally, it’s best done with your regular GP but … this also recognises that sometimes that isn’t the case, we need to make sure that we have a consultation in real time.’
 
Draft revised guidelines went out for consultation at the end of last year.
 
In its announcement this week, the MBA said that around 770 submissions had been received in response to the draft version.
 
Of those more than 650 – almost 85% of the total – had been submitted by customers of two asynchronous prescribing companies – with the MBA noting ‘at least one of which offered consumers the chance of a $500 prize for completing a survey about their service’.
 
In the submissions, which remain on the MBA website, combined contributions relating to InstantScripts and Medmate customers are listed.
 
In its own submission in response to the draft changes, the RACGP described the guidelines as ‘helpful, clear, relevant and workable’, with a few suggested amendments.
 
The current guidelines date back to 2012, well before a huge expansion in telehealth took place in 2020 in response to lockdown measures brought in due to the COVID-19 pandemic.
 
‘Telehealth is here to stay,’ Dr Tonkin said.
 
‘It plays an important role in healthcare in Australia and has opened great opportunities to improve access to and delivery of care.’
 
The MBA says it expects all medical practitioners to follow the good medical practice code of conduct, regardless of the format of the consultations.
 
The new guidelines are due to be reviewed at least every five years.
 
The RACGP’s guide to providing telephone and video consultations in general practice is available on the college’s website.
 
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Medical Board of Australia prescribing telehealth