Australians with urgent but non-life-threatening medical conditions have been prevented from accessing bulk-billed telehealth consults during the pandemic because they do not have a regular GP.
Anna Blair* suffers from chronic health conditions including regular, painful urinary tract infections that require urgent treatment. But she has found the rules around telehealth appointments to be more “frustrating” and “annoying” than helpful.
To help prevent the spread of Covid the government made changes to allow telehealth appointments to be bulk-billed, encouraging patients to avoid physically attending a GP practice. But patients can only be bulk-billed for telehealth if they have seen their regular GP or another health professional at the same practice, face-to-face in the 12 months prior.
Blair could not see her regular Sydney GP when she began experiencing symptoms, including urinating blood and a burning sensation, because the doctor was on medical leave. No appointments with other practitioners at the clinic were available. The condition commonly requires a script for antibiotics, and delaying this treatment can lead to the infection spreading to the bladder or kidneys.
Blair found a different clinic with appointments available, but was told that because she had not attended the clinic before, she could not access bulk-billed telehealth.
“The telehealth rules have the biggest impact when you need same-day care and can’t get into your regular practice,” Blair said.
“It prompts you to either delay seeking care, which can have major consequences when it’s infection-related, or pay big gap fees elsewhere for simple appointments.”
The president of the Royal Australian College of General Practitioners, Dr Karen Price, said the 12-month rule was in place to help established, accredited GP practices provide better care and to stop opportunistic, digital-only “dial-a-doc” practices emerging just to “click over a high volume of appointments as fast as possible”.
But she said “we do need some more commonsense flexibility” in the telehealth rules.
Price has written to the department of health saying that the 12-month rule is affecting immunocompromised GPs and patients in particular. The letter said that immunocompromised GPs, and GPs caring for immunocompromised family members, should not be forced to see patients face-to-face even after 12 months due to the increased risk Covid presents to them.
“While the number of immunocompromised GPs or those caring for immunocompromised family is low, the current demand for general practice care is unprecedented – requiring flexibility of rules that were established at a time when the impact of the Covid-19 pandemic was unknown,” the letter said.
“While GPs furloughing can see patients via telehealth, the strict application of the 12-month rule means that they are often precluded from seeing some patients via telehealth, despite the fact the patient is known to the GP and the practice.”
However, a spokeswoman for the Department of Health said access to telehealth is strong. So far this year, telehealth represents approximately 30% of GP services compared with 23% of services throughout 2021.
The government is also providing personal protective equipment to clinics to help GPs provide safe face to face treatment to people with respiratory symptoms, the spokesperson said.
She added that access to bulk-billed services, whether by telehealth or face to face is ultimately a decision of the practitioner and their practice.
“The government encourages practitioners to bulk-bill with incentive payments for bulk-billed services to eligible patients, and practitioners take their patients’ circumstances into account when setting their private fees. While the government sets the value of the MBS rebates, practitioners are free to determine their fees for their services, and whether all, some or none of their patients are bulk-billed.”
Price said access to care was the “hallmark” of a good health system.
“Doctors should be able to practise in a way that is the intent of Medicare, which is to provide access to healthcare as part of a social contract of the government to the electorate,” she said.
“Nobody wants to waste taxpayers dollars on any kind of ill-conceived business model, but we just want to have some common sense applied.”
*Name changed for medical privacy
