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Chapter 2: General practice access

2.3 Telehealth

The pandemic has seen rapid change to the use of technology in the general practice sector. The RACGP has long advocated for the introduction of telehealth (phone and video) consultation items to complement face-to-face care in general practice.

From 13 March 2020, Medicare Benefits Schedule (MBS) telehealth items were made available to support GPs and other doctors, nurses, midwives and allied health professionals to provide services by phone or video to all Australians. On average, more than 1.1 million GP telehealth services were provided each week in April 2020, declining to one million per week the following month, and fewer than one million per week in June.41

From 20 April to 30 September 2020, non‑GP specialists and allied health professionals were permitted to privately bill all COVID-19 telehealth consultations, however bulk-billing requirements remained in place for GPs seeing vulnerable patients.

By allowing communication and collaboration remotely and at a distance, telehealth was key to the prompt adoption of COVID-19 suppression strategies. In addition to allowing business to be conducted as usual, telehealth ensures people can access care in a way that reduces their potential exposure to infection, while maintaining continuity of care. It also mitigates the infection risk for key healthcare workers who are at the frontline of the pandemic.

2.3.1 Technology use in general practice

GPs have embraced change and rapidly adapted their models of care to ensure the safety of patients, ongoing accessibility of quality general practice care, and safety of practice staff.

Overall use of telehealth has increased significantly as a result of the pandemic, with 97% of respondents providing care via either phone (96%) or video (30%), compared to just 15% prior to the pandemic (Figure 28).5 

While 97% of GPs report they are using telehealth,5 about 65% of GP consults in April and May 2020 were provided face to face.41 Telehealth is complementing face-to-face care, with GPs deciding how best to meet their patients’ needs.

Prior to the pandemic, more GPs aged ≥45 years were using telehealth (17%) than those aged <45 years (11%).5 Ease of adopting telehealth was mixed. Of those GPs using telehealth for the first time, four in ten (40%) found it ‘easy’ or ‘very easy’, but three in ten (30%) found adapting to telehealth ‘difficult’ or ‘very difficult’.5

Figure 28. Use of telehealth has increased significantly since the start of the pandemic

Use of telehealth has increased significantly since the start of the pandemic

Measure: GP responses to the question ‘Did / do you provide care using telehealth prior to and during the pandemic?’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

Figure 29. Two-thirds of GP consultations between April and June 2020 were face to face

Two-thirds of GP consultations between April and June 2020 were face to face

Measure: Telehealth (phone) MBS items: 91795, 91809, 91810, 91811 ,92016, 92068, 92069, 92070, 92071, 92072, 92145, 92138, 92154, 92155, 92156, 92157, 92176, 92194, 92196, 92124, 92125, 92126, 92127, 92128, 92129, 91842, 91843, 92216

Telehealth (video) MBS items: 91790, 91800, 91801, 91802, 92004, 92024, 92025, 92026, 92027, 92028, 92142, 92136, 92146, 92147, 92148, 92149, 92170, 92182, 92184, 92112, 92113, 92114, 92115, 92116, 92117, 91818, 91819, 92210

Face-to-face MBS items: 3, 23, 36, 44, 715, 721, 723, 729, 731, 732, 139, 4001, 90250, 90251, 90252, 90253, 90264, 90271, 90273, 2700, 2701, 2712, 2713, 2715, 2717, 2721, 2729, 2725, 2731, 599

Billings in February, March, April, May and June 2020

Data source: Services Australia. MBS item statistics reports [Accessed 15 August 2020].

2.3.2 GP and patient attitudes toward telehealth

More than two in three (67%) GPs report a positive change in attitude toward using telehealth as the result of the pandemic – only 10% felt more negative (Figure 30). GPs practising in a group practice are more positive toward using telehealth than GPs practising in a solo practice (69% versus 52%).5

GPs cite many reasons for feeling more positive towards using telehealth. The most common reason is that MBS items now support use of telehealth. GPs also report that their patients like the convenience of telehealth, telehealth supports GP safety in the workplace, and patient access to care has been improved (Figure 31).

Free text responses from GPs highlight some other benefits of telehealth, including:

  • the ability to see their patients more regularly, or in a more timely manner, rather than patients saving up all their concerns over a period of time, to discuss in one longer consult
  • an increased feeling of safety, security and familiarity for patients, and building a closer relationship with them, by consulting with them in their own home – this was particularly raised as a benefit for mental health consultations and counselling.24

Patients, too, report positive experiences of telehealth, with two in three of those surveyed reporting that they would be open to continuing to use telehealth after the pandemic.42 Patients report multiple reasons in favour of using telehealth, including:

  • convenience, eg easier appointment times and no travel
  • improved accessibility
  • personal safety by avoiding time in the waiting room with other sick people.43

Of those few GPs who feel more negative towards telehealth, the majority (95%) indicate that the reason they feel this way is that telehealth has limitations to care provision.5 This supports the RACGP’s position that telehealth should always complement, rather than replace, face-to-face consultations. This is reflected in Figure 32.

One in five of those who felt more negative toward telehealth cited technical limitations as a reason.5

Figure 30. Most GPs feel more positive about using telehealth than they did before the pandemic

Most GPs feel more positive about using telehealth than they did before the pandemic

Measure: GP responses to the question ‘Has your attitude toward telehealth changed as a result of the pandemic?’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

Figure 31. MBS support to provide telehealth is the main contributing factor to GPs’ positive attitude toward telehealth

MBS support to provide telehealth is the main contributing factor to GPs’ positive attitude toward telehealth

Measure: GP responses to the question ‘You selected that you are more positive towards using telehealth in your practice as the result of the pandemic. What are the main reason/s for this change?’
Base: Responses to survey question, n = 1200
Source: EY Sweeney, RACGP GP Survey, May 2020.

2.3.3 The future of telehealth in general practice

Seven in ten GPs think that continuing telehealth after the pandemic would support patient access to high-quality care in general practice.24 Free text responses highlight that telehealth should only be available for patients already known to the practice, and for specific types of consults such as routine repeat scripts, discussing uncomplicated test results, some counselling, or doing referrals after recently seeing the patient.24 However, a strong theme emerged that it is essential to see patients face to face to provide high-quality care, conduct examinations and provide ad hoc preventive interventions.24 

When asked how much of routine care could be provided by telehealth in non‑pandemic circumstances, most GPs (55%) suggested it would be appropriate for up to 25% of their consultations. A further 35% of respondents thought between 26% and 50% of consultations could be managed by telehealth in non-pandemic circumstances (Figure 32). This may reflect estimates that approximately 25% of the work GPs do is for care coordination and administration, which has historically not attracted remuneration through a patient rebate (Figure 44). Telehealth rebates can support many of these care coordination activities.

Figure 32. Most GPs think up to 25% of their patient consultations can be via telehealth post-pandemic*

Most GPs think up to 25% of their patient consultations can be via telehealth post-pandemic

*Data less than 5% is not labelled.
Measure: GP responses to the question ‘Looking forward, post-pandemic, what proportion of consultations do you think could be handled via telehealth?’
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

© 2021 The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807