Opinion

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Patient end support items: Widening the healthcare gap

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In March 2026, Patient End Support (PES) item numbers were re-introduced across Australia.
 
The problem is one key phrase: ‘MBS PES services can only be claimed if a private specialist or consultant physician referred to the patient has also billed a relevant MBS video consultation’.
 
Specifically, there is one key word, ‘private’. Patients seeing public system specialists, unfortunately, do not qualify.
 
Advocacy for the re-introduction of the PES item numbers from multiple bodies including the RACGP, the Victorian-based Virtual Specialist Consults and the West Australian Virtual Immunology service aimed to support defragmentation of care between GPs and non-GP specialists.
 
According to the Medicare Benefits Schedule (MBS), the PES item numbers are:
 
‘For GPs, prescribed medical practitioners (PMPs) or nurse practitioners (NPs) to provide face-to-face clinical support to a patient during a video consultation with a non-GP specialist or consultant physician. The support provided during these consultations may include physical assessments, helping the patient understand the other specialist, collaborating in care with the other specialist or facilitating clinical handover.’
 
This is a significant step towards supporting collaborative care and patients to continue care in their local community.

In recognition of the importance of this work, the item numbers provide a higher Medicare rebate for the patient than the equivalent time-based number.

Add to this the synchronous sharing of information and decision making, and there is clear benefit for all involved.
 
For the rebate to be available in primary care, the non-GP specialist must claim the equivalent item number first.
 
‘Providers using the PES items are encouraged to confirm the specialist or consultant physician will also be submitting a claim to the MBS prior to claiming the item,’ the MBS states.
 
‘If a video attendance is not being billed to the MBS, the patient-side provider cannot use PES items (though they may consider if a general attendance or another face-to-face item is appropriate to claim).’
 
There is strong support for the PES item numbers. It was a recommendation in the MBS Review Advisory Committee (MRAC) Telehealth post-implementation review report that PES item numbers were re-introduced. However, the report concludes that:
 
‘Previous GP patient-end support items were based on consultations between GPs and private non-GP specialists, and the creation of new patient-end support services represents an opportunity to consider how consultations with non-GP specialists working in public hospital settings may also be included. It was noted by the MRAC that patient-end support for consultations with private practitioners only was a shortcoming, particularly in relation to First Nations health and patients who cannot afford private non-GP specialist care.’
 
Though the complexity of federal versus state funding of healthcare is an ongoing issue, the benefits of a well implemented PES consultation model are significant.

Key steps that would maximise the impact are to:

• remove the requirement for a ‘private specialist or consultant’
• remove the administration burden on GPs to ensure the non-GP specialist has claimed their item number first
• support use of the PES item numbers with public hospital clinics.

Patients, especially those who struggle to access healthcare, are being inadvertently disadvantaged by the current restrictions on the PES item numbers.

This is an opportunity for Australia to defragment care, prioritise community-based continuity and, likely, end up saving healthcare dollars through collaborative and shared decision making.
 
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MBS Medicare item numbers non-GP specialist patient end support

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