On Monday the Government announced its latest initiative to solve the after-hours care crisis — a $204.5 million investment to expand Health Direct, rebranding the 24/7 helpline as 1800Medicare, which will be available in all states and territories.

This is on top of the $644 million it has pledged to add 50 more Medicare Urgent Care Clinics – which the RACGP has sharply criticised, pointing to the hefty $250/head cost and inadequate clinical handovers—as well as unanswered questions about the impact on general practice.

However, the College’s response to the proposed improvements and expansion of the helpline, which uses nurses to triage callers and refer them to relevant services, has been decidedly different.

The RACGP has given the proposal an enthusiastic endorsement, with President Dr Michael Wright saying: “It will help more GPs across Australia provide after-hours care on weekends and during the week.”

Registered nurses staffing the phoneline will provide advice and refer patients to services such as their GP, ED or urgent care clinic – or connect them to a free telehealth appointment.

“If you need urgent GP care that can’t wait for your regular GP to be available, the triage nurses will connect you to a free telehealth session with a 1800MEDICARE GP via phone or video, available all weekend and weeknights between 6pm and 8am,” Labor’s announcement of the expanded service explained.

But that hasn’t assuaged concerns from the AMA – and many GPs – that the service will disrupt continuity of care.

AMA President and GP Dr Danielle McMullen said the service must be “part of an integrated GP-led model of primary care, otherwise it runs the danger of undermining the role of the patient’s usual GP and fragmenting care.”

“1800 Medicare should not be seen as a substitute for care by a patient’s usual GP and wherever possible should link patients back to their usual GP or if that is not possible, other local GPs,” Dr McMullen said, adding that the service also needs to be properly evaluated.

A Healthed survey with more than 1800 respondents so far found a majority of GPs share these concerns. More than 70% said that while they think 1800Medicare could complement their practice, they have concerns about fragmented care.

That said, 64% feel the impact on their practice will be minimal, while one third are significantly concerned about disrupted continuity of care for patients who use the service, and a further 40% are slightly concerned about this.

We also asked GPs what safeguards they would want to see to combat this concern.

An analysis of nearly 800 responses found that timely communication with their GP — for example, via a discharge summary or email — was by far the predominant theme, suggested by 48% of respondents.

Referral back to the usual GP for follow-up was the second most common theme, suggested by 15%.

Some respondents (10%) said strict limits on the scope – such as only urgent cases or straightforward conditions, rather than complex cases – would also minimise the risk.

Other suggestions included integration with My Health Record, ensuring nursing staff are experienced with good references, and making sure any test results get to the regular GP without them having to chase them down.

What your colleagues are saying

“Amazing that I cannot bill Medicare for a patient I have not seen face-to-face within the last 12 months, but this service will be able to!”

“A small fee should be charged to avoid abuse and unnecessary use of the service. Personally, I think it’s a political stunt with no added value to reduce stress on the health system. The service can only advise patients to either: 1) go to A&E or 2) see your GP the next morning, which achieves nothing.”

“Better to also have an option for practices to do their own after-hours phone consult with their regular patients. Only possible if decent fundings are allocated. This is best as we have access to patient records and will be better for continuity of care. Doctors may be happier to be rostered on call if they are adequately reimbursed.”

“A transcript of the consultation should be forwarded to the clinic the patient usually attends. I worry that the service will not have many relevant medical details of the patient which may lead to inappropriate treatment advice.”

“Adequate communication with the patients GP is the cornerstone of success for this service. My main concern is unnecessary costs to treat mainly the worried well who walk away with the same fears that they come with, making this service a futile and costly waste of time.”

“Ensure that all clinicians manning the phones are well trained in appropriate triage and advice provision and this is rigorously and regularly reviewed. Ensure patients regular GPs are always notified about an episode of patient contact with the service & provided with a summary of the presenting issue and what advice was given.”

“All encounters are documented by the provider, and the notes are sent to the patient’s GP within 24 hours. Patients using the service need to have a regular GP (being registered with MyMedicare, which is checked when a patient makes a call to the service, could help ensure this) to enable follow-up if required (and also so their GP is aware of the episode).”

“Healthdirect was meant to reduce the number of people going to ED and failed abysmally. This is a further fragmentation and likely to cost a lot more money to Medicare, which will then be taken out of the GP medical remuneration, making GP an even less attractive area for medical professionals, and extend the time it takes to pay for Hex.”