RACGP calls for flexibility around vaccine counselling rebate

Anastasia Tsirtsakis

26/07/2021 4:05:36 PM

As it stands, the counselling MBS item number is linked to a vaccine suitability assessment, which GPs say is impractical.

A GP consulting with a patient.
Tasmania-based GP Dr Emil Djakic says in the five weeks since the counselling item number was introduced, he has yet to use it even once.

It was following numerous changes to the vaccine rollout, and amid mounting confusion in the community, that the Federal Government, on 18 June, announced the introduction of an MBS vaccine counselling item number.
Initially applicable to patients aged 50 and over, eligibility was later expanded to all patient cohorts, irrespective of age.
But while the announcement was hailed as a step in the right direction to help address vaccine hesitancy, the item number’s strict criteria has left many GPs unable to utilise it in practice.
According to the MBS descriptor, item number 10660, which is equivalent to a Level B consultation at $39.10, can only be billed ‘in conjunction with an appropriate MBS COVID-19 vaccine suitability assessment item’.
That is to say, that if a patient is assessed as being a suitable candidate for vaccination and gives their consent, billing the item number then requires a GP to have a vaccine available and ready to go immediately.
But with many practices booking their vaccine clinics weeks in advance, GP and practice owner Dr Emil Djakic says the item number is not fit for operational use.
He told newsGP that in the five weeks since the item was introduced, he has yet to find an opportunity to bill it even once.
‘This item number … is a little bit of an anachronism,’ Dr Djakic said.
‘In order to run a vaccine clinic at the practice in any way that’s efficient and sustainable from a business point of view, you really need these clinics to be running at the right rate.
‘These can become long and protracted and difficult conversations, and they’re really not fit for purpose in the stream and flow of what an effective clinic is. I don’t think that is well understood by the [Department of Health].
‘A functioning vaccine clinic in general practice runs on what I would describe as “a lean methodology” – and that is, your patient has to arrive, understand why they’ve arrived, register, move through the system to have a vaccine, wait 10–15 minutes and then move on. And that machine has to move because I’ve got 150 people lined up at this clinic.’
Dr Sean Stevens, who is a member of the RACGP’s COVID Working Group, told newsGP the college has been strongly advocating for greater flexibility around the item number to allow GPs to conduct a counselling consult and administer the vaccine on a separate date.
‘If the Government wishes to encourage GPs to discuss this very complex and important issue, then it needs to be properly funded,’ he said.
‘And making it essential that it is tied to the ability to give a vaccine the same day makes it very unwieldy and largely unusable. So, as a college, we’ve been working hard to advocate for the item number to become much more practical for GPs.’
As it stands, GPs unable to offer a vaccine directly after the counselling consultation, have been left with no other option but to bill a time-based consultation, which Dr Stevens says is not reflective of the true complexity of the discussion being had.
‘If the patient comes in for other issues and then you end up having a 10-minute discussion around the complexities of the vaccination, then that’s not reflected in the MBS rebate,’ he said.
Meanwhile, the current criteria also rule out the counselling service being offered via telehealth. However, the RACGP is advocating that by giving GPs greater flexibility, it would allow patients the chance to have the conversation, be informed, and receive the vaccine at a later date.
‘I think this is just another example of the Government falling for a compartmentalisation of what is general practice,’ Dr Djakic said.
‘And that is trying to find ways to attach money to the doing of specific things – and I stand philosophically completely opposed.’
As concerns grow around vaccine hesitancy in light of anti-lockdown protests over the weekend, Dr Stevens says the need for greater flexibility for GPs to undergo vaccine counselling with their patients is both necessary and critical to the success of the rollout.
‘This sort of discussion is occurring in many, if not most, consultations of those patients who are in the eligible age groups, and we’re seeing some misinformation,’ he said.
‘We’re [also] seeing some very complex messaging coming out of the Government and ATAGI, which the general public struggle a lot of the time to make sense of. And so they really need somebody who they trust, who has that health literacy that GPs have, and can translate those complex messages to an individual perspective.’
To date, 11.2 million COVID vaccine doses have been administered in Australia, more than 5.8 million of which have been delivered by primary care, with Federal Health Minister describing GPs as ‘the backbone’ of the rollout.
Dr Stevens says it has been clear from the moment general practice joined the rollout, that they have been ‘shouldering the lion’s share of the burden’.
‘The Government wants us to do that, the Prime Minister is encouraging people to talk with their GP,’ he said. ‘So they need to resource GPs to have that consultation and discussion.’
Dr Stevens also acknowledged the challenges and concerns expressed by GPs involved in the rollout, and assured RACGP members that the college is ‘working day and night on this’.
‘We’re meeting regularly [and] we’re engaging with Government regularly,’ he said.
‘We’ve got a good working relationship with the Federal Minister and the Federal Department of Health, and they are working tirelessly behind the scenes to make sure that these sorts of wins occur.
‘It’s not seen by members a lot of the time, but I liken it to a duck on a still pond beavering furiously under the water, and looking very still and calm on the surface.
‘It’s supporting our members to be able to support their patients.’
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Dr William Trevor Hurlow   27/07/2021 10:34:01 PM

I fully agree with the total uselessness of the rules around this so - called "vaccine counselling rebate". Another example of an absolutely useless and impractical MBS concession. Heralded by the government as a generous addition to the vaccine rollout arsenal - but totally impractical and in my opinion and of no value in promoting the vaccine rollout. Too often vaccine counselling occurs separately from the jabs. RACGP please show us what you can do in correcting this