RACGP calls for urgent overhaul of telehealth

Anastasia Tsirtsakis

30/06/2020 3:58:37 PM

A surge in ‘pop-up’ services raises concerns for outcomes and practice viability, according to RACGP President Dr Harry Nespolon.

Dr Harry Nespolon
RACGP President Dr Harry Nespolon wants telehealth to continue beyond September and the COVID-19 pandemic ‘to ensure GPs can continue to offer flexible, patient-centered care’.

It has been four months since the Federal Government introduced unrestricted Medicare rebates for telehealth, a healthcare reform that saw the general practice profession fundamentally change almost overnight.
In addition to supporting GPs to continue delivering important primary care services to their patients while ensuring health and safety during the COVID-19 pandemic, the fast-tracked use of technology has presented practices with the opportunity to improve patient access and increase flexibility in service delivery.
The program is due to expire on 30 September, but the RACGP sees value in its continuation – for GPs and patients. In its continued advocacy for members, the college has been meeting with the Government and key general practice peak bodies to discuss the future of telehealth.
‘To ensure GPs can continue to offer flexible, patient-centered care, the RACGP is strongly in favour of retaining telehealth beyond September and the COVID-19 emergency,’ RACGP President Dr Harry Nespolon told newsGP.
‘We have long held the stance that expanded access to appropriate telehealth services will improve outcomes for patients, providers and funders.’

However, the college is first calling for reform by restricting access to telehealth items through a patient’s regular practice and non-GP specialists.
Dr Nespolon said that while telehealth has largely been a success story, he is concerned over the surge in entrepreneurial, profit-driven models.
‘The RACGP has strongly advocated for subsidised telehealth consultations because we recognise the leading role GPs have on the frontline of COVID-19 and, as a result, it has played a crucial role in decreasing the risks for patients, general practices and their staff,’ he said.
‘However, we are concerned about these “pop-up” telehealth services. That was not the intentioned use of telehealth.
‘To ensure it is not exploited and that the community receives the highest quality care, the RACGP has been calling on the Federal Government from the start to limit patient eligibility for telehealth.’
Among the pop-up telehealth services raising concern is ‘Instant Consult’. Marketed by Chemist Warehouse, consumers of the retail pharmacy chain are reportedly encouraged to download an app; they are then able to connect with a doctor within 15 minutes for a bulk-billed telehealth consultation and obtain a script.
Similarly, Priceline has set up ‘Scripts Now’, an instant script service.
‘These on-demand telehealth services are not linked to a patient’s regular GP or practice,’ Dr Nespolon said.
‘They do not have an existing relationship with the patient, understanding of their life situation or prior knowledge of a patient’s medical history – all of which is critical to delivering patient-centred, comprehensive and coordinated care.’
Beyond fears about continuity of care, there is additional concern regarding what this structure means for a patient’s privacy and the unapproved use of data during and after a consultation.

The RACGP is calling for telehealth reform by restricting access to items through a patient’s regular practice.

The aim of telehealth has been to ensure GPs are supported to continue looking after the healthcare needs of their patients, and the RACGP’s position on the matter is clear, arguing that the effectiveness of the model is improved where the GP has an existing rapport with the patient, and knows their past history. 
A patient’s regular GP or practice is often local, and therefore best placed to direct the patient to a range of local health and social services – knowledge that Dr Nespolon says should not be underestimated.
‘The reality is that the care being delivered through these services will be fragmented, less than ideal, and as has been shown, downright inappropriate,’ he said. ‘This lends itself to duplication of services and can compromise patient safety if medications are prescribed without the patient’s GP knowing that this has happened.
‘The evidence is clear on this: patients who have an ongoing relationship with their GP report higher levels of satisfaction and better health outcomes, helping to take the burden off hospitals.’
The business model itself, Dr Nespolon says, undermines the viability of brick-and-mortar practices by redirecting funding into services set up with the intention of ‘only dealing with the easy or administrative problems’.
‘We have particular concern for small, rural practices whose role within their communities cannot be underestimated,’ he said.
‘We need to take measures to ensure health and safety during the pandemic, but also beyond that by helping to secure the future of our general practices, especially those in rural and remote areas.
‘Telehealth services should only be accessible to patients through their regular GP, a GP who can offer face-to-face consultations when needed by the clinical presentation.’
There have been 14 million telehealth consultations billed to Medicare since March.
Dr Krystyna de Lange, Chair of the RACGP’s National Faculty for GPs in Training, told ABC News that telehealth has revolutionised the way she and other GPs deliver medical care.
‘Not everyone has access to the internet, not everyone has access to video platforms, so being able to utilise the telephone has actually been a really important factor in this being successful in our community,’ she said.
Dr Nespolon says GPs have demonstrated the benefits of telehealth when offered in the format intended, and that has an important role to play in the current and future delivery of primary care.
‘General practice has seen rapid reform in a short period of time, and we are proud of our GPs and how they have adapted and integrated the necessary changes,’ he said.  
The RACGP assures its members it is doing everything in its power to put an end to pop-up telehealth services.
The college has also noted a rise in grassroots activities and petitions, and encourages all members to get involved to ensure both the public and decision-makers are aware of the concerning trend, and that appropriate action is taken.
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Dr Virginia Baird   1/07/2020 8:37:11 AM

Thanks RACGP. I have this week had first hand experience of a patient contacting Chemist Warehouse to get a repeat script for mirtazapine, to then be directed to a telehealth appointment with the linked GP service. She was then issued a new script by the "telehealth doctor". And yet within the week I was still counselling the patient and issued a script for another medication. We are a large family practice in a rural area and are bulk billing telehealth appointments, at a loss, so to have a doctor who doesn't know the patient dipping into Medicare funding, instead of directing the patient to their usual GP practice is in my opinion unethical.

Dr Duncan MacWalter   1/07/2020 3:13:42 PM

Let's make sure we don't throw the baby out with the bathwater though.
We are not post-Covid. We still need telehealth and the nuances of how that's done to protect patient autonomy without being a barrier to access is important.
I wouldn't want to see a reactionary removal of these numbers.
And whilst a number of opportunistic providers have arrived, do we have evidence it's having a significant impact?