Advocating for general practice during a pandemic

Michael Wright

6/10/2020 4:19:43 PM

Dr Michael Wright writes about the latest RACGP efforts in a time of major change for Australian healthcare.

Desk with stethescope
Change is coming to general practice.

This has certainly been a year like no other.
The COVID-19 pandemic has affected all of our lives, and we in general practice have been at the forefront. Practices have rapidly adopted COVID-safe practices, embraced telehealth and continued to provide patients with access to safe, quality care.
But amid the uncertainty and stresses, the RACGP has been working across a number of fronts to ensure changes that support high-quality care and general practice viability. We have been advocating on behalf of Australia’s GPs to help shape the future for primary care.
This is the first in a series of monthly columns to keep you updated about the work the RACGP has been doing, as well as emerging Government initiatives, which I am writing in my capacity as Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR).
September saw some substantial announcements.
Extension of telehealth items
On 18 September, Federal Health Minister Greg Hunt announced that Medicare Benefits Schedule (MBS) items for telehealth (video and telephone consultations) would be extended for six months, until 31 March 2021. Announced at the onset of the pandemic, these items were originally due to expire on 30 September this year.
Telehealth has become a standard part of patient care in majority of practices in a remarkably short period of time, so the extension has been welcomed by both patients and practices.
The RACGP and other general practice groups also successfully argued for removal of the GP-only restriction requiring telehealth consultations to be bulk-billed for some patient cohorts. This allows all practices flexibility to either bulk bill or to incorporate telehealth into their usual billing policies and practices.
One negative change has been that the temporary doubling of the bulk-billing incentive and the bulk billing item number for ‘vulnerable’ patients finished on September 30.
We believe telehealth has proven its worth during the pandemic, and continue to call for permanent access for our patients beyond the current temporary item numbers. We want to ensure telehealth will play an essential role in general practice well into the future.
While there is broad agreement that telehealth needs to continue, finding a way to make it sustainable remains to be resolved.
We have been actively involved in discussions with the Federal Government regarding how to embed telehealth in 10-Year Primary Health Care Plan. We are working directly with Minister Hunt, the Department of Health (DoH) and other key stakeholders to create the best possible model for telehealth.
If you have thoughts and views on your experience with telehealth and what its future should look like, please get in touch.
More detail is available on these changes at this newsGP story, as well as the updated RACGP fact sheet and college website.
Telehealth in residential aged care facilities
The DoH COVID-19 Telehealth Items Guide currently states that people in residential aged care facilities (RACFs) must be present when receiving an MBS service by video or telephone.
That means nurses or other health practitioners cannot represent a patient in a consultation with a doctor without that patient being present.
We believe this needs to change.
We have written to Aged Care Minister Richard Colbeck and Minister Hunt stating our feeling that this requirement acts as a barrier to patients accessing telehealth care from their GP.
We have asked both ministers to consider strategies to address this issue, such as:

  • introducing separate MBS items for GP telehealth services for RACF residents that could be used without patients being present, which could help if a patient was not able to communicate
  • consulting key stakeholders regarding the development of a voluntary patient enrolment model for aged care, where GPs and practices would be funded through a fixed payment to support the delivery of additional and more comprehensive care.
We made it clear that our intention is not to disempower aged care residents, but to enable residents to receive the right care when they need it and prevent health conditions from deteriorating.

Electrocardiogram MBS item changes
As of 1 August this year, patient rebates for GP-performed electrocardiograms (ECGs) were restricted to the new MBS item number 11707, which covers tracing only. These changes flowed from the ongoing MBS Review.
We have gone on record with our strong opposition to these changes, as we consider the reduction of support for access to community-based, GP-led ECG services to be poorly timed and unjustified.
In response to our calls, the Secretary of the DoH Professor Brendan Murphy wrote to tell us that a review of the changes would be conducted six months from the date of implementation.
After this correspondence, we joined forces with many other prominent health advocacy organisations to write to Minister Hunt to express our concern that our advice on this matter had been dismissed. In our joint letter, we called for an immediate review of the changes and meaningful consultation with the sector.
The letter was co-signed by the RACGP, the Australian Medical Association, the Australian College of Rural and Remote Medicine, Australian Pathology, the Australasian Association of Nuclear Medicine Specialists, the Australian and New Zealand Society of Nuclear Medicine, the Australian Diagnostic Imaging Association, and the Royal Australian and New Zealand College of Radiologists.
We believe the strength of the opposition to these changes has conveyed our dismay. Watch this space for further updates.
Detailed feedback from RACGP members is vital to inform our understanding of how these ECG changes are rippling through your practice and how it affects your patients. Please let us know your thoughts.
Aged care royal commission draft propositions
In August, the Royal Commission into Aged Care Quality and Safety put out draft propositions on mental, allied and oral health services.
These draft propositions unfortunately effectively overlooked the crucial role GPs play as the main providers of medical care to RACF residents.
And worse, the propositions suggested significant changes that would affect general practice service delivery – and many propositions were underpinned by flawed logic failing to recognise the issues and challenges the sector faces.
The RACGP’s single biggest concern was a proposed new primary care model for people receiving aged care services.
In our submission responding to the propositions, we have asked the royal commission to directly engage with GPs to co-design any future propositions which may affect general practice. These propositions have emerged seemingly without consultation with GPs
While we support some of the underlying principles of the model, we cannot support the proposed separation of aged care from routine general practice care, or a model that does not address the chronic underfunding of aged care general practice services.
We also wrote directly to the commissioners to state our concerns about the lack of engagement with the general practice community throughout the Royal Commission into Aged Care Quality and Safety.
It is frustrating that GPs have not been extensively consulted, given our central role in patient care in RACFs. We will push for a stronger GP involvement in the process, as well as greater recognition of the role we play keeping many of our older Australians healthy.
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