2.           Overview for consumers

This overview for consumers offers a brief outline of the report’s findings and recommendations in the context of consumers. Specific consumer impacts for each of the recommendations are provided in Attachment F – Summary for consumers.

2.1         Scope of the review and impact of recommendations

There are 28 after-hours MBS items. The current review of after-hours MBS items is considering four of these— items 597, 598, 599 and 600 which are for ‘urgent’ after-hours attendances in clinics, residential aged care facilities (RACFs) or the consumer’s home.

The draft recommendations in this report propose to change the urgent after-hours items so that only doctors who work mainly in normal business hours and provide after-hours care in addition to this workload are able to claim these items. The relatively high fees for the urgent after-hours items are intended to compensate these doctors for the additional expense and lifestyle disruption they experience when they provide after-hours care.

For doctors who work predominantly in the after-hours period, such as those employed by medical deputising services, the after-hours period is in effect their normal business hours—they don’t provide after-hours services in addition to other work and don’t have the same lifestyle and expense imposts that ‘in-hours’ doctors experience when they provide after-hours care.

No changes are being proposed to the remaining ‘non-urgent’ or ‘standard’ items, some of which are also available for home or RACF visits, and there is no proposal to remove the urgent after-hours items from the MBS.

2.2         Key principles and facts

  1. Consumers need and want access to after-hours health care.
  2. Consumers get a payment from Medicare for after-hours GP care when they:
  • visit an after-hours clinic/service; or
  • ask a GP to see them at home.
  1. Sometimes it is clinically urgent for consumers to see a GP after working hours. Sometimes it is convenient but not genuinely urgent for consumers to see a GP after working hours.
  2. Medicare pays for two kinds of after-hours care:
  • standard care; and
  • clinically urgent care, which is a higher payment.
  1. Doctors and consumers have reported that some companies providing after-hours services:
  • charge consumers (and therefore Medicare) the higher ‘urgent’ fee when the matter is not clinically urgent, and the lower ‘non-urgent’ fee should be charged;
  • do not check with/report back to the consumer’s usual GP (where they have one), as medical deputising services are supposed to do; and/or
  • encourage people to use their after-hours service for convenience, and then charge the higher ‘clinically urgent’ fee.
  1. The reports of Medicare payments for after-hours GP visits show that:
  • The number of urgent after-hours services has more than doubled in five years, from around 730,000 in 2010–11 to 1. 87 million in 2015–16.
  • The cost of after-hours services is similarly increasing, from $90.8m in 2010–11 to $245.9m in 2015–16. At the same time there has been no significant impact on the use of hospital emergency department services.
  1. Reports from the medical profession indicate that many urgent after-hours services are not urgent and should not be claimed at the higher rate.
  2. The growth in use of urgent after-hours services does not seem to reflect consumers’ clinical needs, but has coincided with the entry of new businesses into the market with models which promote these services to consumers, emphasising convenience and no out-of-pocket costs.

2.3         Taskforce findings

The Taskforce is of the view that:

  • After-hours GP services are essential services, highly valued by consumers.
  • Nothing should be done that prevents consumers from accessing after-hours GP services delivered by appropriately qualified clinicians.
  • GPs who provide after-hours care should have a relationship with the consumer’s usual general practice so information is shared and quality, safe care is maintained.
  • Companies which just provide after-hours GP services provide an important service when local GPs cannot visit patients in the after-hours period.
  • Urgent after-hours GP services should only be provided in genuinely clinically urgent situations.
  • The MBS fees for urgent after-hours services should reflect the complexity of the service and the impact on GPs who work in-hours and then are called out in the after-hours period.
  • Consumers and Medicare should pay the standard fee—not the higher ‘urgent’ fee—when the care provided is not urgent.

2.4         Recommendations

  1. MBS funding should continue to be available for home visits, including in the after-hours period, for services provided by:
    1. a consumer’s GP
    2. a medical deputising service i.e. a service that works closely with local GPs to provide services when the practice is not open.
  1. MBS funding for urgent after-hours services should only be payable if a GP who normally works during the in-hours period is recalled to work for management of a patient who needs, in the opinion of the GP, urgent assessment.
    1. The higher rebate recognises the additional clinical value provided by, and impost on, GPs who deliver these services to their own patients, the practice’s patients or patients of other local practices where on-call work is shared.
    2. In this setting it is more likely that there will be better patient triage, based on knowledge of the patient’s circumstances by the GP (or a closely supervised GP trainee), better access to patient records facilitating management, and better follow-up to ensure continuity of care.
  1. Where a business has been established specifically to routinely provide care in the after-hours period (including a medical deputising service) then all of the other items for after-hour services should remain available. 
  2. The MBS items for urgent after-hours attendances should not be available where the consumer has made an appointment prior to the commencement of the after-hours period (that is, 6pm on weeknights).