Telehealth changes must be reconsidered

Transcript: AMA Queensland President, Dr Maria Boulton, ABC Gold Coast, Mornings with Alex Easton, Thursday 7 July 2022

Subjects:   Telehealth cuts, COVID and influenza, booster shots

ALEX EASTON:   Have you used a phone appointment to access a GP over the past couple of years? The ability to check in with your GP over the phone for some of us has been a small blessing from the COVID pandemic. It's made it slightly easier to access pretty scarce medical services, particularly if you're outside the capital cities, which obviously we all are, but there's been a new change to the Medicare rebate that could make that a bit harder. This change, which kicked in from July 1, means Medicare is no longer providing a rebate for any phone appointment with the GP that lasts longer than 20 minutes. It still provides them for shorter phone appointments, and it still provides the rebate for video calls.

Maria Boulton is the President of the Australian Medical Association in Queensland. Good morning, Maria and thank you for joining us. How big a difference have phone appointments like this made in the ability of people to access GP services and for the very busy GP clinics of places like the Sunshine Coast and Gold Coast to actually provide those services in the first place?

DR MARIA BOULTON:   Good morning, Alex. Telehealth rebates have been amazing and we really needed them through the pandemic, because not only do we have people who perhaps are anxious to go out, to sit in a GP waiting room, but we also have people who have respiratory symptoms who can access their GP via phone. It is a busy time for us, especially now that it's winter and we're seeing a lot of respiratory illness, but I think above all, patients just appreciate having that convenience, but they also appreciate having the ability to just phone the GP. We see a lot of patients who have mental illness, who don't feel up for having a shower, getting dressed, etc, but they can easily access their GP through the phone.

ALEX EASTON:    The change they're talking about, I guess the idea, the ability to do video appointments has been there already, but a lot of people have been opting for the phone ones instead because technically it's a lot simpler to just ring someone than to go through the whole video chat process. It's been getting criticism because people, particularly in remote areas, don't often have the same level of internet access they do in more built-up areas. How big a difference do you think that would make to people being able to access telehealth?

DR MARIA BOULTON:   Yeah, more than 90 per cent of people access telehealth services through the phone, not video, and there's many issues for that. Sometimes people just don't want to be on video. Sometimes people don't have fast NBN or they don't have a smart phone. My clinic is in metro Brisbane and we didn't get onto the NBN until late 2020. No video software would work on the slow internet that we used to have, and that is in metro Brisbane, so let alone rural remote regional areas. It's nonsensical why the government has removed that rebate at this time. We're in the middle of a wave of COVID. We know that telehealth has improved the way that people can access medical services. It makes no sense to me. It really doesn't.

ALEX EASTON:   Yeah. As you said, we are in the middle of the wave, the Chief Health Officer, John Gerrard, was just saying yesterday that the combination of the current wave, plus the flu, has put really unprecedented pressure on hospital beds. Here's a little bit of him.

We have never experienced anything like this, to have such a large number of beds occupied in a pandemic, on top of influenza. This has not happened in my lifetime.

He's saying that this looks like it will continue for years as COVID continues to evolve and this issue just continues. The Commonwealth has provided extra funding to the states to compensate for COVID, but is that anywhere near enough?

DR MARIA BOULTON:   No, it isn't. It isn't. I'm a GP and GPs are always forgotten, yet we are the ones that do the bulk of the work all the time and we're the ones that keep people healthy and out of hospital. I mean, this removal of this rebate is an example of the government just making a terrible decision. They haven't considered the patient's needs. We know that patients need to access us on the phone. We know that when you have someone with COVID - and I was speaking to Queensland Health yesterday, and I've also spoken federally about this - if you have a patient who has COVID and you're considering them for an antiviral medication, by the time you run through how they're doing, all the screening questions, all their symptoms, and then go on to check the interactions for the medications, that's at least 25 minutes on the phone, at least 25 minutes on the phone.

ALEX EASTON:   Presumably this is all about saving money off the budget, but the other thing I suppose is we've got a new government who has rules that are coming in that were set in place by the old government. I don't know, is the Labor government, would they have been able to reverse that in time for the July 1 change?

DR MARIA BOULTON:   I think they can. I think when people need to do something, you're able to do it. Certainly we are still pushing for them to reverse that and hope that they will. I think that it's nonsensical to think as a government, that by reducing people's access to their GP that you will save money, because what'll happen is that say somebody becomes worse or say someone ends up in hospital, it costs much more. A GP phone appointment is much cheaper than somebody visiting emergency department.

ALEX EASTON:   Definitely. The AMA, before the last federal election, sent a list of requests or suggestions on the sorts of things that were needed basically, just to get the health system functioning again, to get hospitals working, to get primary care services working, that kind of thing. A lot of that was, pretty much all of that, was just ignored in the budget itself. We're still waiting for the new government's first budget, but the rhetoric we are hearing is all about just how badly indebted we are and how bad the finances are. Do you see any prospect of things improving?

DR MARIA BOULTON:   Yeah, so I think I remember speaking to you about this. Federally, I know that our current prime minister did promise some money to primary care, and he did promise that we could get involved in that process so that we make sure that money goes to where it's actually needed. State-wise too, we've had our recent state budget and AMA has been pushing for extra beds, which we did get. We're getting 2,500 extra beds, but some of them won't come online until 2028.

In the meantime, what we have is in the next 12 months in the state budget, we've had an increase of 5.6 per cent in spending, but that's only just above inflation, and with the state that our hospitals are in at the moment - I was in a Metro South hospital the other day, and the ambulance ramping and the people waiting on stretchers and the people waiting in emergency beds to get a hospital bed, it's a real crisis. We would've liked to have seen more in the current budget to alleviate those problems now, because I don't see a way out of this unless we have real reform, real funding, but also look at efficiencies, also look at other things like making sure that hospitals work seven days a week so that patients can go home on a Saturday and a Sunday, so that on Monday, which is traditionally a very busy day in emergency, there's enough beds for people to go into.

ALEX EASTON:   You're hearing from Australian Medical Association Queensland President Dr Maria Boulton. Maria, ATAGI met yesterday to discuss, amongst other things, whether or not a fourth dose of the COVID vaccine should be approved. The AMA has been pushing that for health professionals in particular. Have you seen any indication yet of which way ATAGI's gone on it?

DR MARIA BOULTON:   Yeah, we're hearing whispers that ATAGI will bring down the age of eligibility, which we would fully support. We're also asking for ATAGI to consider healthcare workers. They are at the front line. There were 2,000 furloughed healthcare workers in Queensland hospitals yesterday. We need to keep those healthcare workers at work. We need to protect them with everything we have. That's why we're advocating for them to be considered as well, but yeah, like you, I'm waiting to see what they announce today, but we are expecting that they will announce a drop in the eligibility in ages for the fourth dose.

ALEX EASTON:   All right. Maria Boulton, thank you so much for your time this morning.