But it’s mighty hard to establish who commands oversight of this booming industry and what happens on the fringes...
RACGP President Dr Frank Jones says many new providers outside the NAMDS umbrella are “not recognised as general practice in the general practice definition”.
Currently, the college does not have a definition of what a deputising service does or should do, but it is pushing for better governance and more transparency. It wants a requirement that vocationally registered GPs are at the centre of after-hours care, and is seeking consultations with government to work on improved standards and accreditation for primary care in the 24/7 economy...
“Because of patients’ expectations and Gen-Y attitudes, after-hours has become a very difficult area. I think there is unmet need. But can we afford for consumerism to drive this?” he asks. “For example, if you have forgotten your pill script, is it appropriate to call a doctor at 11pm, to get a new prescription, subsidised by Medicare? We can debate that. Patients need to think about that.”..
Canberra GP Dr Thinus van Rensburg says he is more than happy to have his patients seen by an after-hours deputiser. He has heard no complaints about clinical care, and it’s less work for him. But, after reviewing patients’ records, he suspects urgent MBS item numbers are being used for non-urgent conditions.
“Of the 59 cases I looked at, I could confirm the billing of 20% of them, and every one was a 597, the item number for urgent, rather than non-urgent, home-visit calls between 6 and 11pm. Of those, one was for a patient who is known to have epilepsy. Another was a lady who thought she had high blood pressure. All the rest were kids with colds and flu.”..
The same story seems to be playing out at the long-established GP Access After Hours (GPAAH) service that operates a roster of 250 GPs working out of five hospital-located clinics around Newcastle, NSW.
GPAAH has not seen a fall in patients coinciding with direct marketing by a home-visit service, but neither have emergency departments in the Lower Hunter region witnessed a drop in low-acuity patients, GPAAH clinical director Dr Lee Fong says.
“This suggests the additional $3 million in annual urgent after-hours home visit MBS revenue being billed in our region is coming from patients who are being diverted from daytime general practice,” Dr Fong says.
If so, he says, rather than saving the taxpayer money by converting an ED visit into an after-hours MBS item, a $37.05 day-time GP MBS item is being converted to an urgent after-hours $129.80 MBS item...
The Department of Health, which runs the Approved Medical Deputising Service program, says all deputisers must abide by the NAMDS definition of a deputising service whether they are members of that organisation or not.
The definition is: “An AMDS is an organisation which directly arranges for medical practitioners to provide after-hours medical services to patients of Practice Principals during the absence of, and at the request of, the Practice Principals.”
You and I might struggle to reconcile these words with the glaring fact that marketing campaigns are underway, in letterboxes, on TV, pitched directly at consumers with no recourse to practice principals whatsoever..."