GPs protest scrapped pregnancy counselling exemption

The RACGP has railed against a Federal Government decision to remove non-directive pregnancy counselling (NDPC) telehealth exemptions, saying it will limit access to safe and affordable reproductive healthcare.
 
As of 1 July, Medicare Benefits Schedule (MBS) items 92136 and 92138 have been subject to standard telehealth rules, including the establishment of clinical relationships, following a recommendation from the MBS Review Advisory Committee (MRAC).
 
These items can still be billed, but the patient will need to have had at least one face-to-face attendance at the practice or with the provider delivering the service in the past 12 months.
 
These two items were billed a combined 6308 times in 2023, and 5558 times the year before.
 
In response, the RACGP has written directly to Federal Health and Aged Care Minister Mark Butler, raising its significant concerns with the change, especially for women living in regional and remote areas.
 
Penned by RACGP President Dr Nicole Higgins and RACGP Specific Interests Antenatal and Postnatal Care Chair Dr Ka-Kiu Cheung, the letter explained that GPs are often the first point of contact for people seeking support for an unplanned pregnancy.
 
‘In Australia, access to sexual and reproductive healthcare is often inhibited by poor funding and a lack of minimum service standards in public hospitals,’ it said.
 
‘GP non-directive pregnancy counselling services offer a safe, confidential process that helps the patient explore concerns they have about a pregnancy, along with the provision of unbiased, evidence-based information about all options and services available to the patient.
 
‘Such discussions often require extended consultation times, with GPs playing a role in the coordination of these services.’
 
Dr Higgins emphasised that the services are particularly important for women living outside Australia’s major cities.
 
‘These are consultations that take time and to be able to counsel women appropriately. Especially with non-directive pregnancy counselling, we need to make sure we provide as many options as we can,’ she told newsGP.
 
‘As a female GP who lives in a regional area that services a large rural population, we know that women in rural and regional Australia have much less access to reproductive healthcare and counselling compared to other populations.
 
‘This letter is about making sure that we enable as many opportunities as we can to support the women who need these services.’
 
A Department of Health and Aged Care (DoHAC) spokesperson told newsGP the NDPC telehealth items, and exemptions, were first introduced to support patient access at a time where Australians were experiencing ‘sporadic public lockdowns’.
 
‘Now that the COVID-19 pandemic is over, temporary measures have been progressively scaled back as the community and health system revert to a post-pandemic business as usual environment,’ they said.
 
‘The MRAC recommended to not extend the exemption for NDPC telehealth items on the basis that many of these services would be superseded by making blood borne virus and sexual or reproductive health items permanent and could be provided as part of other GP telehealth services.
 
‘The MRAC final report is currently with the Government for consideration and any decisions will be made in due course.’
 
Several significant changes to the MBS came into effect on 1 July which will impact GPs, including an indexation factor of 3.5% applied to most general medical services items.
 
On Monday, the RACGP welcomed a decision to make MBS blood borne virus and sexual reproductive health (BBVSRH) items permanent and available outside of the established clinical relationship criteria.
 
However last week, it raised concerns about the removal of Level C phone consultations for COVID-19 antiviral assessments (items 93716 and 93717) which were introduced in 2022.
 
Dr Higgins said any changes must be made with the assurance that patients will not be worse off.
 
She said for pregnant women, the vital services must remain exempt especially given the time-sensitive nature of these appointments, with many women not able to travel to see their GP.
 
‘This removal will disadvantage women at a time-critical point in their pregnancy,’ she said.
 
‘We know we’ve got areas within Australia that are reproductive healthcare deserts where it is often difficult to access medical termination services or be linked in with maternity care.
 
‘This letter is asking for Government to recognise that GPs have an ongoing, continual relationship with our patients, and we need to provide access to women in a highly specific area, so I urge Minister Butler to take the RACGP’s advice.’
 
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MBS Medicare Medicare Benefits Schedule pregnancy telehealth women’s health