RACGP unveils new telehealth-only guidance

Amid escalating concerns about telehealth-only services and their rapid growth, a new RACGP position statement warns they must not become a substitute for comprehensive general practice care.
 
Released on Thursday, it follows sustained RACGP warnings that the model could undermine the relationship between a patient and their usual GP, fragment care, and put patient safety at risk.
 
It says telehealth is not a substitute for routine in-person care, and that consultations between patients and providers unknown to each other should be limited to specific, clinically justified circumstances.
 
The college also says telehealth should complement comprehensive GP‑led care, that clinicians providing telehealth‑only services must hold appropriate qualifications, and that relevant regulations should be strengthened.
 
The new position statement states that prescribing must be based on a real‑time consultation, and that asynchronous, questionnaire‑only models are unsafe and not supported.
 
However, the RACGP also recognises that more patients are turning to telehealth-only services not offered by their usual GP or practice.
 
Its recommendations are intended to be adopted by telehealth-only providers and medical professionals working in these services.
 
Dr Steven Kaye is a member of the RACGP Expert Committee – Practice Technology and Management which led the position statement. He told newsGP the statement was developed to ensure long-term quality care and patient safety.
 
‘Telehealth providers need to understand the role they are doing as an interim part of the care needs of the patient, that then need to be available in a transparent form for the patient’s ongoing care,’ he said.
 
‘They also need to understand they are not providing comprehensive care, they are not able to examine the patient, they don’t have the ability to coordinate care with allied health practitioners or other specialists, and they are obliged to perform to the same level as all the other practitioners.
 
‘It’s not just isolated care about an individual issue – it’s much more than that – and they need to be able to provide that sort of care too.’
 
General practice manages ‘the full spectrum of a patient’s physical, mental and social health needs’, the position statement says, and the GP–patient relationship built over time allows for more ‘personalised and effective’ care.
 
Dr Kaye reiterates that while the use of telehealth services may be efficient, it does not replace long-term general practice care.
 
‘It is a shortcut but does not provide effective and comprehensive care to the individual ... hence the value in using a GP,’ he said.
 
‘There’s no doubt that long-term “cradle to grave” general practice care is advantageous for people’s health and having those long-term relationships with a GP along the health journey is valuable.’
 
The college identifies telehealth-only services as generally offering ‘episodic services’ typically focused on a product or specific service, often without coordinating with other members of the patient’s healthcare team.
 
Such services, including online weight-management services, instant medical certificates for a small fee, and increasing requests for medicinal cannabis, have raised controversy and prompted safety warnings.
 
Acknowledging the GPs who work in telehealth-only services, the RACGP recommends they ensure the care they provide is not compromised by commercial gain or convenience, particularly services focused on single treatments or medicines.
 
Dr Kaye warns of telehealth services that are biased towards particular products.
 
‘Using these is very dangerous, and a concern to the college,’ he said.
 
‘As far as selling individual products that are then provided without independence, there’s a bias incorporated with that to use those products because of financial or other gains.
 
‘There’s lots, but medicinal cannabis is certainly one of the high-profile ones where the doctor is prescribing a substance for the corporate gain rather than solely for the patient’s gain.’
 
The college’s new position statement comes amid questions raised around the rigour and consistency of recently released telehealth standards from Patients Australia and online provider Eucalyptus.
 
In addition, landmark reforms announced earlier this year and backed by the RACGP stipulate that prescribers record all medicines-related information to My Health Record, including drugs dispensed via telehealth.
 
Even if telehealth is used, Dr Kaye says the patient’s GP should be informed either directly or through an event summary in their My Health Record to continue their care long term.
 
‘The telehealth provider needs to interrogate the real-time prescription monitoring as well as the patient’s My Health Record, to look at the information available, to be more aware of past history and other issues the patient may not volunteer independently,’ he said.
 
The college also says these services must have ‘strong clinical governance, risk management, audit and quality improvement systems’, with their technology meeting Australian privacy law requirements and supporting secure, interoperable information exchange.
 
The RACGP also calls for regulation to be strengthened to protect patient safety and prevent ‘excessive and inappropriate’ prescribing, ‘predatory’ marketing practices that target at-risk populations, and fragmentation of care.
 
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continuity of care GP–patient relationship My Health Record patient safety telehealth telehealth standards telehealth-only services