industry & reform compelled people to act in a certain way and was really mandatory , you would have the ACCC on your case very quickly .
So , there ’ s some really important legal issues here that are very concerning because there ’ s really nothing voluntary about being forced into having a potentially expensive telehealth consultation with your usual registered GP for a short consultation .
Whichever way you spin it , the loser is the consumer because they ’ re paying outof-pocket costs and being denied access to Medicare entitlements that they pay for through their taxes . It ’ s very , very complex .
Do you think there will be specific cohorts of patients who will be most affected by this ? The people I think will be the worst affected will be those in regional , remote and rural areas . I ’ m very concerned about the potential impact on them because firstly , some of them don ’ t have a GP practice nearby .
It ’ s not that they wouldn ’ t like to register for a GP practice , there just isn ’ t one . The practices that are there can be booked up months in advance . You can ’ t just jump online and get a quick script on the weekend because you can ’ t get in for three weeks .
I think it is a real area of concern that , perhaps , is not being properly thought out .
How about doctors and primary care practitioners ? How does this plan affect them ? In my view it ’ s a really old-fashioned way of structuring primary healthcare , because it ’ s locking them into bricks and mortar practices on the street corner . That isn ’ t where the future of health service delivery and medicine is going .
The conversations I ’ m having with GPs suggest they don ’ t want that anymore : they want to be more mobile and digitallyenabled , and they don ’ t necessarily want to be tied to a practice .
They ’ d like to be able to deliver really good health services from home via telehealth , and see patients face to face when they need to . It feels quite , paternally speaking , like a very retrograde , backward step , tying not just patients but also a modern , new , digitally-savvy cohort of doctors and GPs into this old-fashioned world that they are not that interested in .
What might happen also is that some patients who can will probably go to the nearest public hospital emergency department instead of the GP . That might actually move patients away from GP practices , which will make their situation worse , not better .
Then , of course hospitals are under great pressure because of the pandemic and so many other problems , so that would put further pressure on the public hospital system as well . There ’ s all these downstream effects that will happen .
Do you think this plan will improve patient outcomes , or do you think that there ’ s a better way ? I don ’ t know that the evidence is strong that it ’ s going to deliver what it promises . One of the arguments I ’ ve heard is , based on the NHS in the UK , where you do have to register with your GP .
The difference in why you can ’ t really run that argument here is that when you go to your GP in the UK you will not ever be charged any money whereas here in Australia , it ’ s the opposite . GPs can charge whatever they want , so you are not comparing apples with apples .
The other argument I see in support of VPR is continuity of care . Continuity of care is very important . The question is , how do you deliver continuity of care in a modern , digitised health system ? To my mind , the way we do that here is My Health Record . It is not by locking patients ’ records into a desktop computer sitting in a bricks and mortar practice .
Continuity of care should be all practitioners engaging with My Health Record . It ’ s incumbent upon all practitioners to put all the records there so that anyone who sees the patient can jump on there and see everything that has happened . Where the patient ’ s been , when they ’ ve been to an emergency department , or filled a script , or all the things that have happened to them , and ensure that they continue that care . I just don ’ t know that it ’ s going to achieve the desired outcome .
In 2018 a study reported that 80 per cent of Australian patients report having a usual GP , and 90 per cent report having a usual GP practice . If 80 per cent of patients are already doing what GPs argue is best for them , and 90 per cent are happy to see another GP in the same practice if theirs isn ’ t available , why are we forcing them to do something that they ’ re already doing ? I find that perplexing .
That same study reported that 25 per cent of people seek care from multiple practices each year ; one of the reasons is to avoid out-of-pocket costs . Why would
“ Does this arrangement intrude into that private contract between a doctor and a patient ?
you deny them that ? Consumers are struggling to meet out-of-pockets costs . Why would you take that away from them ? They need to be able to manage the cost of their healthcare , and it seems that we ’ re hell bent on not allowing them to do that .
These VPR changes are expected to come into effect in July , yet we haven ’ t seen anything beyond a draft plan . How can practitioners keep up to date and best navigate it ? It ’ s really difficult , and that ’ s a very , very good point . In fact , it ’ s probably a starting point , in that we need to stop making changes to Medicare and allow everyone to catch up .
I really feel for doctors out there in grassroots practice . They haven ’ t got a clue when a rule changes because they ’ re too busy seeing patients . There ’ s really nowhere they can go that is reliable because Medicare is a legal system .
There has to be a process where those changes that are on the Federal Register of Legislation are translated and transferred on to the MBS Online website , which is where some doctors go , though my research found , most of them don ’ t bother going there anymore because they can ’ t navigate it .
Often the law and what is on that website are out of step with each other . What you might find on the MBS Online website may be incorrect because it hasn ’ t kept pace with changes in the law .
My research found that there is literally nowhere for doctors to go for reliable advice and support on Medicare , and that is a very big problem .
I offer online , free information for doctors , but it ’ s not enough . We need a national curriculum , but we also need to slow down changes .
In the US system , when they do an update it ’ s done in a way that enables everyone to be prepared . Here , we will change MBS items and rules , literally twice in a day , very often once a week . When changes are made over there , it ’ s usually done about once every two years . Everybody gets a six-month warning period . ■ nursingreview . com . au | 9