‘Professional attendance’ a sticking point in COVID vaccine rollout

Anastasia Tsirtsakis

9/02/2021 4:59:23 PM

More than 5000 general practices have put their hand up to take part in the nationwide vaccination program, but questions over MBS rebate requirements could stall momentum.

Nurse preparing to administer a vaccine.
As it stands, GPs must attend to each patient receiving a COVID vaccine for practices to claim the MBS item number.

Practices that have expressed interest in taking part in the vaccination program will hear from the Department of Health (DoH) within two weeks.
But as the rollout date inches closer, a common concern has emerged among GPs; whether practices will be able to claim the Medicare Benefits Schedule (MBS) item number if the vaccine is administered by a practice nurse without a GP consultation.
During a recent COVID-19 webinar for general practice, Dr Lucas De Toca, Acting First Assistant Secretary for the DoH’s COVID-19 Primary Care Response, said the department is still working to finalise the descriptor in consultation with peak bodies, including the RACGP.
But as it stands, the items are classed as ‘professional attendance’.
‘They do require some degree of interaction of the GP in the conduct of the consultation,’ he said.
‘Of course, primary care functions in a multidisciplinary team and registered nurses, Aboriginal health practitioners or other authorised immunisers, according to the scope of practice and jurisdiction regulations, can provide the immunisation in itself.
‘But again, pending the finalisation of the MBS descriptor, these items are professional attendance items.’
However, RACGP President Dr Karen Price, who has been directly involved in the consultation process with the DoH, told newsGP such a requirement would make the vaccination program ‘very unworkable’ for general practice.
‘I think that would kill it dead in the water,’ she said.
‘The feedback from our members has been very strong on that.’
The rollout is set to be one of the largest mass vaccination programs ever undertaken in Australia, and the Federal Government has set a target of vaccinating all adults in Australia by October, starting with 80,000 doses per week.
However, to meet the target, new preprint modelling from the University of New South Wales suggests up to 200,000 people will need to be vaccinated per day.
That would require participating general practices to administer an average of 50 doses per day, seven days a week, for about six months.
‘Taking into account the necessary screening and record-keeping involved in addition to their usual workload, this may be quite a stretch for all but the largest practices,’ the authors note.
GP and practice owner Dr Mukesh Haikerwal, who is also a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), is likewise concerned about the potential workload for GPs, especially if they are required to consult with every patient who receives a vaccination.
He told newsGP that while GPs should have ‘governance and oversight over everything’, that mandating they be ‘in front of every single patient, every single time, is just not tenable’.
‘We’ve got proper governance, we’ve got proper processes, we’ve got properly trained people that we are happy to have do some of the work whilst working to that governance structure – that is what every organisation does all the time,’ he said.
‘To tie it just to the GP, makes it very hard to make this work.’
Dr Andrew Webster, a Darwin-based GP and Head of Clinical Governance with the Danila Dilba Health Service, previously told newsGP the prospect of professional attendance also poses particular challenges for smaller practices and Aboriginal Community Controlled Health Services (ACCHOs) in remote communities.
He said nurses and Aboriginal health practitioners deliver the bulk of services, and only have a visiting GP fortnightly, or once per week at best.
While the DoH was unable to provide comment prior to publication, it is expected to finalise the language around the item descriptor soon.
Until then, Dr Price said the college will continue to ‘advocate strongly on behalf of our members’.
‘So that we can – as we always have – work in partnership with our fabulous nurses to deliver this,’ she said.
‘We support our nurses in that vaccination role by not necessarily attending every single patient, but certainly by being around and on call for medical issues.’
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A.Prof Christopher David Hogan   10/02/2021 10:10:40 AM

Negotiating with government is a tangled dance. Most negotiation is done face to face with representatives but another important negotiation is done in the public arena . This is when we show government how determined & united we are as a profession to demand reasonable remuneration under reasonable conditions .
At this time we show all concerned that we are united behind our representatives & that they speak for all of us.

Dr Abdul Ahad Khan   10/02/2021 10:56:51 AM

Should not the Pharmacist be also required to have the presence of a GP Face-to-Face with each Recipient of the Vaccine from the Pharmacist ???

Dr Andrew Robert Jackson   13/02/2021 4:04:24 PM

The current offer based in Descriptor A (item 3) is either dumb or cunning.

It woefully insufficient and again relies on GP's
goodwill which I suggest is fast running out, after decades of rebate real value decline and five years of rebate freeze.

Fact is, practices can take it or leave it if the numbers don't add up.

If Medicare rebates are to be used, the minimum must be in my view

- item 23 minimum for EACH completed vaccine injection no scrooge-like discounts for the second injection

- the payment is made howsoever the vaccine is properly given irrespective of the amount of time the GP is in the room
- NO penalty if the second injection is given elsewhere - new legislated AIR upload laws penalty $6k will ensure the Vax penetration can be monitored by government and GP's
- bulk billing incentives fully apply
- PIP payment $10 for each patient vaccinated fully
- all consumables government funded
- after hours is 6pm -9am and all weekend and public holidays.

Dr Albert Liebenberg   14/02/2021 6:02:02 AM

What will probably happen in real life is that our practice will have extended hours , including weekends (Saturday + Sunday) to accommodate immunization , Our regular day to day appointments cannot be suspended in favour of the immunization drive.
What will happen to the "80/20" rule?
Will the vaccination item number be available after hours/weekends?

Dr Abdul Ahad Khan   14/02/2021 10:32:55 AM

The extremely Stringent Requirements for giving the COVID Vaccine for GPs is a masked attempt at discouraging GPs from participating.

Stunning to note that for Pharmacists, there is no need for a GP to see each & every Vaccine Recipient – nor is there any need for a GP to be available in the Pharmacy Premise !!!!!

The Requirements for a GP Surgery, need to be relaxed this way, as the Vaccine Recipients are not acutely Ill Patients & we are not conducting COVID Testing :
*The Practice Nurse should be able to give the Vaccine on her own.
* The GP need not see the Patient Face-to -Face at all, excepting when an Anaphylactic
Reaction has occured.
* There ought to be the Presence of a GP in the Premises at all times that the Practice
Nurse is giving the Vaccine, to deal with any Anaphylaxis.
* Only 15 mts wait Post-Dose should be sufficient.
* Pre-Dose Counselling can be replaced by a Brochure, the Contents of which are
Standardised by the RACGP / FACRRM ( similar to what the College of S