Attachment F – Summary for consumers

 

Attendance

Type of Attendance

Applicable time

Monday to Friday*

Saturday*

Sunday/and or public holiday

Standard attendance items

Standard attendance in consulting rooms

Between 8am and 8pm

Between 8am and 12 noon

N/A

Urgent after-hours items

Urgent attendance – after-hours

Between 7am – 8am and 6pm – 11pm

Between 7am – 8am and 12 noon – 11pm

Between 7am – 11pm

Urgent attendance – unsociable hours

Between 11pm – 7am

Between 11pm – 7am

Between 11pm – 7am

Non-urgent after-hours items

Non-urgent after hours at consulting rooms

Before 8am or after 8pm

Before 8am or after 1pm

All day

Non-urgent after hours at a place other than consulting rooms

Before 8am or after 6pm

Before 8am or after 12 noon

All day

 

The tables below describe the medical service, the recommendation(s) of the Taskforce, what the recommendation does, what would be different and why the recommendation(s) has been made.

 

Recommendation: no changes to standard after-hours items

Taskforce recommendation

Item

What it does

What would be different

Why

No changes to non-urgent after-hours items.

5000-5067, 5200-5267.

These items cover a non-urgent attendance by a doctor in the afterhours period.

No change.

The Taskforce recognises that after-hours GP services are essential services and highly valued by consumers.

The Taskforce’s view is that MBS funding should continue to be available for home visits, including in the after-hours period.

Funding should continue to be available for after-hours services provided by a patient’s GP, as well as by a medical deputising service (MDS).

 


Recommendation: changes to the item descriptor and explanatory notes for all urgent after-hours items

Taskforce recommendation

Item

What it does

What would be different

Why

Revise item descriptor for the urgent after-hours items. Restrict the use of these items to GPs and other medical practitioners working within a general practice setting.

597, 598, 599, 600

These items cover an urgent attendance by a doctor in the afterhours period.

Consumers will continue to have access to urgent after-hours services that are provided by GPs who provide after-hours care in addition to their in-hours practice.

Any organisation that primarily provides care in the after-hours period will no longer be able to claim these items and will instead claim the non-urgent after-hours items.

The growth in claiming of urgent after-hours GP attendances by MDSs which operate only in the after-hours period is supporting low-value care.

These services are provided at a high cost to the MBS relative to other GP services and many urgent after-hour services are not urgent but are being claimed at this higher cost.

In support of high-value care, GPs who provide after-hours care to their patients, their practice's patients or patients that attend another general practice that shares an after-hours roster will not be impacted by this proposal.

In this setting it is more likely that there will be better assessment of patients, better access to patient records and better follow-up to ensure continuity of care.

The higher rebate available to these GPs recognises the complexity of the service being delivered and the impact on GPs who work normal business hours and are then called out at night.

 

Recommendation: changes to the item descriptor and explanatory notes for all urgent after-hours items

Taskforce recommendation

Item

What it does

What would be different

Why

Revise item descriptor for the urgent after-hours items, replacing the current wording of “the patient’s condition requires urgent medical treatment” with “the patient’s condition requires urgent medical assessment”.

597, 598, 599, 600

These items cover an urgent attendance by a doctor in the afterhours period.

An assessment of a consumert will be the actual trigger for a service, recognising that treatment may not be necessary on the basis of that assessment.

This change better reflects the service that is being delivered.

If an assessment is not deemed to be urgent, then a rebate should be paid for a non-urgent after-hours item.

 


Recommendation: changes to the item descriptor and explanatory notes for all urgent after-hours items

Taskforce recommendation

Item

What it does

What would be different

Why

Revise item descriptor to require that urgent after-hour services must be requested in the same unbroken after-hours period during which the attendance occurs.

597, 598, 599, 600

These items cover an urgent attendance by a doctor in the afterhours period.

In recognition of the time-sensitivity for urgent care, the option of booking the urgent attendance up to two hours prior to the commencement of the after-hours period in which the attendance occurs will be removed.

Urgent after-hours GP services should only be provided in genuinely urgent situations.

Sometimes it is clinically urgent for consumers to see a GP in the after-hours period. Sometimes it is convenient but not urgent for consumers to see a GP after working hours.

If a service is not deemed to be urgent then a rebate should be paid for a non-urgent after-hours item instead.

 

Recommendation: changes to the item descriptor and explanatory notes for all urgent after-hours items

Taskforce recommendation

Item

What it does

What would be different

Why

Revise item descriptor to add requirement that the attending practitioner determines that the urgent assessment of the patient’s condition is required.

 

597, 598, 599, 600

These items cover an urgent attendance by a doctor in the afterhours period.

This requires the attending practitioner to themselves determine that a patient needs urgent assessment, based on the information they have available to them.

Many urgent after-hours services claimed as urgent are not truly urgent, and the distinction between ‘urgent’ and ‘non-urgent’ appears to be not well understood by many medical practitioners.

This change recognises that the attending practitioner is the best placed to determine if a patient requires urgent assessment.

 

Recommendation: changes to the item descriptor and explanatory notes for all urgent after-hours items

Taskforce recommendation

Item

What it does

What would be different

Why

Revise the item descriptor to provide a fuller definition of ‘urgent’.

 

597, 598, 599, 600

These items cover an urgent attendance by a doctor in the afterhours period.

The definition of ‘urgent’ in the urgent after-hours items will be expanded to ensure that it reflects that a patient’s assessment cannot be delayed until the next in-hours period; and requires the attending practitioner to attend the patient at the patient’s location or to reopen their practice rooms.

Urgent after-hours GP services should only be provided in genuinely urgent situations.

Sometimes it is clinically urgent for consumers to see a GP after working hours. Sometimes it is convenient but not urgent for consumers to see a GP after working hours.

If a service is not deemed to be urgent than a rebate should be paid for a non-urgent after-hours item instead.