4.           Concerns raised by stakeholders about urgent after-hours items

Concerns about the use of these items have been raised with members of the Taskforce by individual GPs and consumers. Concerns have also been raised by the RACGP, AMA, ACRRM, RDAA and Consumers Health Forum and the RACGP and AMA have released public statements on this topic.

The RACGP position statement on after-hours care states:

While the RACGP recognises the need for patients to have access to urgent care when their regular general practice is closed, it has significant concerns about any model of service delivery that fragments care, compromises the quality of healthcare service and fails to use limited healthcare funding efficiently[2].

Urgent after-hours visits attract a premium Medicare rebate. Currently those premium rebates are often being billed by doctors who do not have any postgraduate or specialist qualifications in general practice, at a cost to the taxpayer and Medicare of over $250 million in the last year alone.

The RACGP is supportive of after-hours medical services, however in the interests of patient safety they absolutely must be offered by suitably qualified doctors[3].

The Review of After-Hours Primary Health Care undertaken for the Australian Government in 2014 (Prof Claire Jackson, 2014) noted significant concerns about the use of the urgent after-hours items, including by MDSs.

Areas of concern identified by stakeholders include:

     The routine claiming by some doctors of ‘urgent’ items for services which are not urgent, when there are lower rebated MBS items that support non-urgent after-hours home visits or after-hours attendances at GP clinics. This additional Medicare expenditure could be better utilised for other forms of patient care.

     The relatively high rebates for the urgent after-hours items compared with other GP services.

     The provision of care by doctors who are not linked to a patient’s usual general practice.

     The clustering of services in areas of relatively high population density where short travel times and high numbers of clients maximise efficiencies and throughput.

     Urgent after-hours arrangements are subsidising services to consumers who could have been seen more cost effectively in consulting rooms in a general practice during normal business hours.

     The quality of care that the consumers receive from some doctors providing urgent after-hours services.

     The regular use of MDSs by some patients may compromise the continuity of care they receive from their usual GP.

     Growth in the use of urgent after-hours items is underpinned by new business models that have been able to leverage the opportunity provided by relatively high-priced MBS items, rather than any true increase in the clinical need for these services.

     Direct-to-consumer advertising that emphasises patient convenience over clinical need. The RACGP has also expressed concern over the direct consumer advertising stating: “The RACGP’s view is this type of advertising encourages the excessive and unnecessary use of after-hours health services, which is inappropriate.”

     Appointment services that can be accessed during business hours, allowing a patient to ‘book’ an ostensibly urgent service in advance of the after-hours period and wait for several hours before seeing a doctor.

 

 

 


[2] Royal Australian College of General Practitioners. 2016. After-hours home visiting services in primary healthcare: Position Statement. Available at http://www.racgp.org.au/download/Documents/Policies/Health%20systems/After-hours-position-statement.pdf

[3] RACGP media release. 13 March 2017. RACGP calls for focus on patient safety in after-hours debate. Available at http://www.racgp.org.au/yourracgp/news/media-releases/racgp-calls-for-focus-on-patient-safety-in-after-hours-debate/