‘A critical enabler’: Telehealth successes and failings in focus

A college submission to an official review of the recent expansion of telehealth has explored in detail the benefits to general practice and the significant issues it also created for GPs.
 
The Australian National Audit Office (ANAO) is carrying out a comprehensive review of how the Department of Health (DoH) managed the huge growth in telehealth services prompted by the pandemic.
 
The 27-page RACGP submission for the review was lodged with the ANAO this week.

‘The [Medicare telehealth] items continue to be a critical enabler for patients accessing high-quality and timely general practice services,’ the RACGP document states.
 
The college also describes face-to-face consultations as ‘the gold standard’ but welcomes the permanent installation of telehealth as ‘an invaluable tool’ for both patients and GPs.
 
It notes the widespread take-up of telehealth, which is now offered by 99% of general practices and accounts for more than a fifth of MBS services each year.
 
However, the many obstacles encountered by GPs with the adoption of widespread telehealth are also explored in detail.
 
Among the criticisms levelled at the DoH is the ‘unnecessary’ staged rollout of MBS numbers, as well as constant rule changes which ‘created confusion and resulted in a significant amount of additional administrative work for GPs and practice teams’.  
 
A decision to oblige general practices to bulk bill, which was later relaxed, is also put under the microscope, with the college describing the decision as a threat ‘to the financial viability of practices’.
 
One of the strongest criticisms is reserved for the timing and approach of a DoH telehealth compliance campaign, which initially appeared to target almost 30,000 GPs. It is strongly condemned as ‘very disruptive’ and as having caused ‘significant distress’ when general practice was at the heart of the pandemic response.
 
While the college acknowledges the willingness of the DoH to engage with the RACGP, it states that the telehealth expansion ‘has been defined by an inability to implement key learnings as the COVID-19 situation has evolved’.
 
‘This is particularly evident in the case of major policy decisions such as mandatory bulk billing of telehealth items, the removal of MBS phone items and the existing relationship requirement for telehealth,’ the submission states.
 
‘These decisions have had a profound impact on our members. Despite this, change has been slow or in some cases, not forthcoming at all.’
 
Dr Emil Djakic, who sits on the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR) and is Chair of the RACGP’s Business Sustainability Working Group, says telehealth expansion was overdue even before the pandemic hit.
 
‘We clearly recognise that COVID was the catalyst for progressing this technology, this communication … that we can use in the delivery of healthcare,’ he told newsGP.
 
‘I would happily say “not before time”.
 
‘We are just playing catch up to other industries, who had already moved to recognising that technology has changed.’
 
However, he said the Government is to be congratulated for moving quickly in early 2020.
 
‘I’m sure there’ll be a number of PhDs on this that will conclude that perhaps it wasn’t done as ideally as it could have been,’ he said. ‘But … this was a pandemic event and nobody on the planet in living memory could describe something similar.’
 
Recommendations
Dr Djakic also referred to the extent of the RACGP submission to the ANAO, saying the college took the opportunity to outline the issues and potential improvements ‘very seriously’.
 
The document identifies several potential refinements to telehealth in the future, with the college’s ‘foremost priority’ identified as the reinstatement of MBS phone consultation items for longer GP attendances, chronic disease management and mental health care.
 
Level C phone consultations, extended as a result of the surge in COVID-19 cases at the beginning of the year, are due to end on 30 June. 
 
‘Patients with complex care needs need and deserve flexible and affordable access to healthcare,’ the submission states.
 
It also highlights an absence of research surrounding the relative efficacy of phone and video consultations, an area where it notes a contrast between the direction being pushed by the former government and the wishes of patients.
 
‘Providers were advised they could deliver audio-only services via phone if video is not available, which fails to consider patients’ overwhelming preference for phone services,’ it reads.
 
A huge majority of telehealth consultations remain phone consultations, although video consults have increased to 6% (from 2% in 2020–21) of the total for the financial year to date.
 
While most patients welcomed telehealth – over half the respondents to the 2021 Australian Health Consumer Sentiment Survey rated the quality of their most recent appointment as about the same as in-person – almost 30% felt that the appointment was not as good.
 
Echoing the college’s submission, which describes telehealth as complementing existing face-to-face care, Dr Djakic says it has broadened the choice for both healthcare professionals and patients.
 
‘It has freed us up to do a lot of things that are very much patient centred, particularly if we talk about less mobile, older or frailer people … but also we can talk to those people working who have busy working lives,’ he said.
 
‘There’s productivity stuff to measure in this.’
 
The college, in the meantime, acknowledges that telehealth has moved beyond the initial implementation stage, and expresses the hope that future developments will not have the same impact on general practices.
 
‘Having now entered a new phase of the COVID-19 pandemic where lockdowns are a last resort, we hope that any future changes to MBS telehealth items will be easier for GPs to understand and implement,’ the submission states.
 
According to its website, the ANAO is due to table a report on telehealth in December this year.
 
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