RACGP view on telehealth is self-serving at best

Telehealth and its various policy and political ramifications was back in the news this week, with the Royal Australian College of General Practitioners (RACGP) again changing its policy position on MBS funding of primary care telehealth, despite previous lobbying efforts to the contrary.

We’ve been critical of the changing position of the college on Medicare-funded telehealth and its fellow travellers at the AMA in the past, but this week we saw a triple backflip with pike as Omicron swept through the land. We have witnessed the medical fraternity going from dead set against telehealth in primary care to agreeing it is essential in a pandemic, but all of this is conditional it seems on doctors’ income not being affected.

Three years ago, it was “telehealth will never replace face-to-face consults”, despite no one ever arguing it would. Then the pandemic struck and telehealth was seen as the saviour, with the GP lobby sensing an opportunity for the many phone calls GPs do every day to finally be paid for properly through Medicare. Good on them – it succeeded. But then private “pop-up” services came around and began to threaten the bottom line, allegedly threatening continuity of care and undermining general practice, and more furious lobbying began. The government caved in, restrictions were introduced, and then Omicron happened.

With general practices now swamped, common sense would say the restrictions on MBS-funded telehealth should be eased to relieve the burden on primary care and allow it to continue its essential day to day work in order to avoid the collapse of the health system. And yet the college still continues to reject the help of telehealth providers, who could take a big load off the back of the profession.

The RACGP’s latest lobbying campaign is to let immunocompromised or isolating GPs to be able to continue working from home and claim consultations on the MBS. Fantastic. Go for it. But the lobbying effort does not apply to patients. As is usual with the RACGP, the policy change smacks more of concerns over GP remuneration than patient access to affordable healthcare. The AMA’s position is no better.

“Telehealth is now a permanent fixture of Australia’s healthcare system, and the 12-month rule is not pragmatic for immunocompromised GPs or GPs in isolation,” RACGP president Karen Price is quoted as saying. “So, if I’m an immunocompromised GP doing my best to help patients with tens of thousands of new COVID-19 cases emerging every day in communities across Australia, I may not be able to use telehealth if the patient has not sat opposite me for a physical consultation within 12 months, even if they did 13 months ago.”

Yes, Dr Price. This is a situation that the pop-up clinics you so vehemently oppose could have helped solve.

“We should be doing all we can to maximise our capacity to see patients via telehealth,” she said, while lobbying against it. “If the individual seeking a telehealth consult is an existing patient of the practice, either via face-to-face or telehealth, let’s provide an exemption from the 12-month rule and let common sense prevail.”

Whether or not the individual seeking a telehealth consult is an existing patient or not, in the middle of a global pandemic, common sense says they should be able to access healthcare easily despite their ability to pay or having a regular GP, which many don’t.

The idea of “permanent” telehealth as a policy success story has taken hold in digital health circles in Australia, despite it being nothing of the sort. Telehealth has been pioneered in the secondary health sector, not in primary care, and has been overwhelmingly successful for outpatients, rehabilitation and in particular for allied and mental health over the past decade or so.

Examples include the various stroke telehealth networks, rehab networks and even things like remote interrogation of cardiac devices. Health services around the country and around the world are looking at how to embed remote monitoring and telehealth in day-to-day health provision. This will have a real impact on patients. Paid phone calls for GPs during a pandemic are more than welcome and should remain permanent, but they are not the revolution in telehealth that the RACGP thinks they are.

That brings us to our poll question for the week:

Have doctors’ lobby groups undermined the roll-out of telehealth in Australia?

Vote here or leave your comments below.

Last week, we asked: Will GPs embrace eReferral technology? The vast majority said yes – 90 per cent to 10 per cent. We also asked why you thought GPs wouldn’t embrace the technology. This is what you had to say.