Department of Health eyes vaccine MBS ‘recalibration’

The discussions Canberra-based GP Dr Chris Harrison had with patients last week ahead of receiving their AstraZeneca immunisation would sometimes only last the time it took them to walk down the corridor to the treatment room.
 
But since the Australian Technical Advisory Group on Immunisation (ATAGI) decided to preference the Pfizer vaccine for all recipients under the age of 50 due to the fear of links to blood clots, the process has taken a lot longer.
 
‘This week, we’ve brought everyone into my room and we have a discussion – one patient last night was a 45-minute consultation,’ Dr Harrison said at the most recent Department of Health webinar for GPs involved in the COVID vaccine rollout.
 
‘That was a very complex discussion. My own patients, who I know well, it’s fairly efficient. But we’re [also] seeing a lot of new patients who do often have one or two questions.
 
‘So it is certainly more time consuming this week. Definitely.’
 
The additional time required to discuss consent prior to immunisation has prompted the RACGP to return to the DoH in order to try and revise some of the existing Medicare Benefits Schedule (MBS) item numbers that had been set prior to ATAGI’s announcement.
 
RACGP President Dr Karen Price told newsGP ‘intense’ negotiations are underway between the college and the DoH.
 
‘The point has been successfully made that this is not a mass vaccination program anymore, and that vaccine counselling with a patient’s usual GP is a critical part of the rollout,’ she said.
 
‘We are advocating for a solution where a GP can take the necessary time required to provide this counselling and have a number of options on the table.
 
‘These options could include new vaccine counselling item numbers or co-billing the relevant consultation item depending on the time required.
 
‘However, negotiations are still ongoing so we will provide further updates as soon as we know more.’
 
Dr Lucas de Toca, the DoH’s First Assistant Secretary for the COVID-19 Primary Care Response, said during the webinar that the department is aware of concerns related to the time GPs will now likely spend acquiring consent from patients.
 
‘I hate to say the word “recalibration” so many times, but as part of the discussions that we’re having at the moment we are reviewing [the MBS item numbers],’ he said.
 
‘We’ve had concerns from the colleges and others and GPs about how this is impacting the time with patients.
 
‘We are reviewing whether our current settings [and] our current delivery mechanisms are appropriate for what the program will look like moving forward, and we’re considering what implications that has for their funding.’
 
The potential shift in MBS rebates comes as the number of general practices participating in phase 1b of the rollout nears capacity, with more than 4300 sites reportedly now taking part.
 
An additional 134 GP-led mass vaccination clinics and 130 Aboriginal Community Controlled Health Organisations (ACCHOs) have also been administering vaccines, and the National Cabinet is due to again start meeting twice per week in order to help smooth out logistical issues related to the rollout.
 
Dr de Toca addressed some of those concerns during the webinar, in particular problems general practices have had receiving a consistent supply of vaccines and consumables.
 
‘Broadly, these systems are working much better and the updates are happening much faster and deliveries are happening earlier … but there are still areas that are behind or [have a] backlog on some of these issues, so apologies for those who are experiencing that,’ he said.
 
‘[Regarding] the delivery of consumables, we understand that there are still some issues with those in parts of the eastern seaboard and we’re working with the delivery partners to address [them].
 
‘If you have issues with deliveries of vaccines or consumables, contact the VOC [Vaccine Operations Centre] and they can follow up on that.’
 
Dr de Toca also moved to clarify uncertainty regarding practices’ window for ordering vaccines, after reports shifting deadlines without enough notice had seen some clinics miss out on deliveries.
 
‘We’ve moved now to fix ordering windows, which hopefully will help avoid [practices] missing orders,’ he said.
 
‘We completely acknowledge that there were challenges in those first few weeks when the ordering window was short and changed as practices came on board over the four-week period.
 
‘Now it’s going to be a stable ordering window opening on Saturday and closing on Friday night. Practices [will] receive an email when the window opens and a reminder on Thursdays before it closes.
 
‘In this new system – with a fixed ordering window and the fairly large ordering window two weeks ahead – unfortunately, if you miss out on placing an order, you will skip that week.’
 
And while the teething issues that have occurred so far during the rollout have not been planned or welcome, Dr Toca said it emphasised why the DoH had chosen to work with GPs during the rollout.
 
‘What’s happened over the last week, and the shifting and reconsideration of issues that we are doing at the moment … reinforces the importance of partnering with general practice and primary care through this rollout,’ he said.
 
‘I can’t think of other parts of the [health] system that are better equipped and more able to adapt, change and maintain that competence and trust of their patients in the context of certain uncertainty.
 
‘So thank you so much for continuing to do what you do. We are absolutely committed to your role in this in this rollout.’
 
Dr Harrison had a final message for GPs.
 
‘Be flexible,’ he said. ‘Take a breath. Look at the changes. Adapt. Build on the goodwill.
 
‘This is something that’s got to be … done well, and hopefully, rapidly over the next six months. General practice can do it.’
 
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AstraZeneca ATAGI COVID-19 Pfizer vaccine rollout