Last rites for after-hours services

The MBS Review Taskforce's report on after-hours services sounds the death knell for the sector's largest operator

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It’s back to the drawing board for after-hours service providers now that a high-level review has all but torpedoed the main profit driver of the sector’s major player.

The final report of the MBS Review Taskforce on after-hours services recommends limiting the use of urgent MBS item numbers for home visits to fully qualified GPs who normally engage in daytime practice.

In other words, no-one solely working for a medical deputising service (MDS) – including vocationally registered GPs and GP registrars – would be able to claim the lucrative urgent items 597-600.

In sticking by the recommendations, which were outlined in its interim report in July, the MBS review taskforce has been accused of putting doctors’ interests before those of the public.

The AMA supports change in the sector but criticised the way the politically sensitive news was released, via a leak to a mainstream newspaper.

AMA President Dr Michael Gannon said “misinformation” in Sydney’s Daily Telegraph smeared all after-hours services with allegations of poor practices including the use of “unqualified” doctors.

“Access to after-hours GP services is a critical part of our health system,” Dr Gannon said.

“Many families depend on these services, but they should not be seen as a substitute for a visit to a patient’s usual GP.”

Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association, said the report showed little recognition of interests and feedback other than from GPs.

‘The preliminary report was released for public consultation for about six weeks over June and July. We put in a submission, along with many others — submissions were not made public.

“In other words, this taskforce is saying ‘We do not care that many consumers, unable to afford care not subsidised by Medicare, will now go to already-stretched hospital emergency departments to seek the care they need’.

“The taskforce, consisting of 10 GPs and only one consumer representative — nominated by the government — is saying: ‘We only care about ensuring funding is exclusively available to some GPs — although we have demonstrated we are unwilling or unable to provide sufficient services to meet demand’.

“The fact is that medical deputising services emerged because general practitioners and general practices were, and are, not providing those services.”

The proposed changes are widely seen as an attack on the business model of the National Home Doctor Service, the biggest operator in the sector.

The General Practice Deputising Association, a group of deputisers set up in opposition to the NHDS-backed industry organisation, also registered concerns, saying the proposed overhaul should be accompanied by a raft of reforms to ensure after-hours care remained viable.

GPDA president Dr Nathan Pinskier said the report reinforced the association’s concerns about the “inappropriate behaviour” of some after-hours services and the need to take decisive action.

“The data contained within the report clearly indicates the impact that after-hours services more focused on consult volume rather than the delivery of appropriate after-hours care have had in the community and then real need for action that will deliver better outcomes for patients and better utilisation of scarce health resources.”

Dr Pinskier told The Medical Republic  the GPDA was seeking “a “whole package of changes” supported by research to find an effective solution.

“The current after-hours model was introduced to deal with a workforce shortage.  It was a great program, but it has run its race,” he said.

“It produces bad outcomes when you have itinerant doctors seeing patients on a long-term basis.”

The GPDA recommended in its submission that the after-hours work should be provided by fellows of the RACGP and those doctors on a defined pathway to fellowship working in medical deputising.

“While the findings of the MBS Review Taskforce are important, there are other measures that may be implemented to restore confidence in the sector, deliver high quality, effective and safe care, whilst continuing to support genuine and legitimate deputising services,” Dr Pinskier said.

“These measures may be implemented without compromising access for the community to the medical care deputising services provide on behalf of general practice.”

Dr Gannon said the taskforce’s report properly identified a range of concerns about current after-hours services. 

“The AMA wants to see a model of after-hours care that ensures medical deputising services – the companies that provide the after-hours services in many cases – employ doctors with the right skills, training and supervision, and are properly accredited,” Dr Gannon said. 

Dr Gannon said the report should not be used to attack the doctors who work for the MDS, whatever their qualifications. 

“These are hard-working doctors who are delivering care to their communities – care that would otherwise not be available at crucial times of the day, especially for young families. 

“We need to focus on tackling poor models of care, rather than demonising doctors or undermining confidence in the after-hours primary care services that play an important role in the health system and in the community.”