A rural New South Wales town with one GP almost lost its vaccination clinic at the height of the pandemic because of what has been described as a “ridiculous” and “unjustifiable” Medicare billing rule that needlessly limits access to care.
Under the Medicare Benefits Schedule, doctors can’t claim payment from the government for a Covid-19 vaccination provided in their clinic by a nurse, unless a GP is on the premises to supervise. This is despite nurses being trained to administer vaccines and doing so in other settings without doctor supervision.
The rule meant Dr Nicholas O’Ryan, a GP in Canowindra, almost had to cancel a pop-up vaccination clinic he had organised for the town of fewer than 3,000 people, located between Orange and Cowra.
The day before the clinic was set to open, in September last year, O’Ryan was notified he was a close contact of a Covid case. At the time, all close contacts of positive cases had to isolate for two weeks, even if a negative test was returned.
As O’Ryan was the town’s only GP, there was no one else to supervise at the clinic, which was operating for one day only with the goal of administering about 1,000 vaccinations.
“I was so frustrated,” said O’Ryan, who also works at the local hospital’s emergency department. “I had to follow the rules and do the right thing as a doctor setting an example. But we needed to get these vaccines done.”
“My workload, if I couldn’t have done it on the day planned, would have been a nightmare. I don’t get home before 9pm most nights, so I’m working on the edge as it is.”
The clinic was only able to go ahead after O’Ryan was granted special permission to be at the clinic in a separate room in protective gear.
“It could have been a public health disaster,” said Karen Booth, the president of the Australian Primary Health Care Nurses Association.
At the time there was concern about the slow pace of the vaccine rollout, and criticism that vulnerable and high-risk areas were missing out.
O’Ryan’s wife and the manager of the GP practice, Kathryn O’Ryan, called everyone she could for help, which led to Booth learning of the predicament facing Canowindra.
“I had the [then] health minister’s number in my phone,” Booth said.
“I got permission for Nicholas to attend the vaccination clinic in full PPE, but hidden away in a separate room, in order to meet the rule obligations.
“It highlights the ridiculous nature of the rule, and the lack of thought by those responsible for implementing the MBS item number for Covid vaccines.”
O’Ryan said he had made himself useful by entering all of the patient details into the computer to save the nurses time. “I sat there in my little room and I entered the data from the nurses. They would leave notes outside for me to collect,” he said. “The patients didn’t even know I was there.”
The GP said the billing data being tied to his name made it seem he was administering the vaccinations, even though the nurses did all of that work.
Booth said the rule needs to change, given it is about billing and not patient safety.
“Just let nurses do what they are amazingly skilled at, and free the doctors up to go and do house calls to see sicker patients,” she said. “It’s a rule that is certainly affecting patient access.”
She said if vaccine funding for clinics was attached to the patient service rather than the doctor billing the item, nurses would no longer need GP supervision.
Prof Julie Leask, from the University of Sydney’s Susan Wakil school of nursing and midwifery, said a barrier to high Covid vaccination and booster rates was patients being turned away.
“These unjustifiable rules mean patients miss out and contribute to lower vaccination rates in some communities where GP access is limited,” she said. “These rules don’t allow nurses to operate within their scope of practice and unnecessarily limit some people in accessing timely and convenient services.”
