‘We need resources’: RACGP on the front foot as COVID community care looms

Anastasia Tsirtsakis

16/11/2021 5:06:16 PM

To ensure the sustainability of general practice and that COVID-safe infection controls can be observed, the college is seeking further funding to cover costs, including for PPE.

Person in PPE cleaning consulting room.
To ensure the safety of GPs and practice staff, the college is seeking additional funding for PPE.

As Australia switches strategies to ‘living with COVID-19’, it has been confirmed that primary care – and GPs specifically – will have a key role to play in caring for patients who test positive in the community.
A suite of new measures were announced by Federal Health Minister Greg Hunt last month as part of a $180 million package to support primary care, including a new Medicare Benefits Schedule (MBS) item number.
For practices who choose to see patients face to face, the additional $25 bonus to the patient’s usual baseline Medicare rebate, is intended to contribute to the extra costs of treating infectious patients. 
But RACGP President Dr Karen Price says the item is only a small piece of the puzzle and that more funding and support for general practice is needed.
Speaking to newsGP, she said the college recognises that practices have faced the additional costs of keeping their patients safe for the past 18 months and that once COVID is widespread there will be even higher costs to keep staff and patients safe, from equipment to cleaning supplies and PPE.
‘We are providing an enormous saving to the overall health sector, without a doubt,’ Dr Price said.
‘But the costs of providing that service in an international pandemic cannot be borne by the sector who have really saved the nation with vaccination. We need to be recognised as part of the whole health system.
‘We can do this – this is well within our training – but we need resources to do so, like every other sector of the health system.’
Meanwhile, as national vaccination rates surpass the 80% target and restrictions continue to ease, an increasing number of COVID-positive patients will likely have their care managed in the community. Such an approach will ease the burden on hospitals, but it could also make it more difficult to ensure the safety of GPs and other practice staff.
Throughout the pandemic practices have had to source the majority of their personal protective equipment (PPE) independently, and the costs of being able to implement COVID-safe protocols, even with the new item number, could be a barrier to delivering care.
Dr Price said the college recognises this and is working hard to secure additional grants and funding to support practices, including access to PPE through the Primary Health Networks (PHNs), so that practices and GPs are not left out-of-pocket.
‘A comment was made that PPE would be provided from the PHNs,’ she said. ‘We are yet to see exactly what that means.
‘Of course, we would require … as everybody in the hospital sector does, full PPE with fit-testing and with the ability for someone to be a spotter, which means a staff member needs to spot you donning and doffing.
‘So I expect there will be more to come, and I am awaiting those details.’
The new MBS item 93715, introduced on 8 November and available until 30 June 2022, can only be accessed by GPs and other medical practitioners when providing a clinically relevant in-person service to a patient who has recently been diagnosed with COVID-19, following positive laboratory PCR testing.
While not restricted to services provided in the consulting room, it cannot be provided in conjunction with telehealth services.
The item can be co-claimed, but only in conjunction with another eligible MBS item, including:

  • standard in-person business
  • after-hours general attendance items
  • urgent after-hours items
  • residential aged care facility attendance items.
Practices are also not required to bulk bill consultations with COVID-positive patients, and are free to charge whatever fee they deem appropriate, which Dr Price says is a significant advocacy win for the sustainability of general practice.

KP-hero.jpgRACGP President Dr Karen Price says the college is listening to member concerns to help ensure GPs are prepared for treating COVID patients in the community.
‘We understand the GP respiratory clinic benchmark price set by the Commonwealth is $120 per encounter,’ she said. ‘We know that the Commonwealth has suggested that’s a price point for seeing a patient in the community.
‘So I’d encourage GPs to have a look at that and make sure they’re not running at a loss. The removal of the mandatory bulk billing allows doctors to do that.’
Dr Price also stressed that GPs are not obliged to offer the service, and that it is suggested, as per the guidelines, that practitioners who are immunocompromised do not see infectious patients face-to-face.
‘This is not something that GPs must or have to do,’ she said.
As part of the measures announced last month, GPs who are supervising COVID-positive patients will also be supplied with pulse oximeters from the national medical stockpile for remote monitoring of patients at home.
At present, the college is developing COVID pathways, including guidance on how to monitor patients at home depending on the practice structure, as well as points on how to escalate a case if need be. There will also be handouts to assist patients with directions on how to monitor their own health.
Dr Price emphasises that the college is listening to members’ concerns and advocating ‘very strongly’ to ensure practices, as part of the broader health system, are prepared for what’s to come.
‘What I see coming is winter 2022 and beyond,’ she said.
We’ve seen what happens in Europe; we’ve seen how this virus can bounce back, even in the vaccinated. And the fact that people have been isolating for nearly two years, there is some concern about the burden of other respiratory illness and gastrointestinal illness. How will the health system adapt?
‘This is a question that hasn’t been answered fully yet and I am continuing to ask it because it’s important that general practice and GPs, who are highly trained specialist medical experts who have always seen infectious disease in the community, are resourced to manage this.
‘Without utilising the general practice capacity, the health system will be overwhelmed, and we need to address that; we need to address it with resources, with funding, with pathways and with integration.’
So when can practices expect to know more?
‘We are asking for the further resourcing and the further integration to be delivered to general practice and to the colleges in as timely a way as possible because we know that small business needs time to adapt its systems,’ Dr Price said.
‘It needs time to think it through, even while they’re doing their business as usual.
‘We recognise that this is imperative.’
For assistance around managing billing and on how to communicate with patients about the cost of their care, the RACGP has a suite of resources available.
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Dr James Courts   17/11/2021 6:59:14 AM

So why agree that $25 ($8.25 in your pocket after practice costs and tax deducted, never mind additional PPE costs) per COVID positive patient seen, was anything but a stupid idea?

Dr Dhara Prathmesh Contractor   17/11/2021 7:42:45 AM

Practices cannot sustain with $25 consultation.
Why such a big discrepancy?
They Have been paying $120 to respiratory clinics to see just URTI patient.
And now asking GP to see COVID19 positive patients at $25?
Who thinks it is sustainable?
Even one reception staff hourly rate is much higher than that.
Small GP practices will get swallowed away by this discrepancy. Cannot sustain the cost of seeing bulk billed patients vs staff payrolls
and now COVID19 patients at $25.
We love our patients and our community.
But unfortunately with these discrepancies, getting hard to explain patients of why we are moving to private billings. And want to keep our doors open. And getting difficult situations at front desk daily.

Will be difficult to put strategies out safely.
To maintain staff and doctors safety and monetary viability. At $25!

DB   17/11/2021 2:12:11 PM

Pitiful. I can't believe being celebrated as a win.
$120 for an urti quick flick.
$25 for a covid positive patient.
Not by me.