New telehealth rules will stop Australians getting healthcare, nurses say

From November 1, patients of nurse practitioners - nurses with advanced training - will have to see them in person once a year to get Medicare rebates for virtual appointments.

These rules, set by the federal government, already apply to general practitioners.

Canberra-based Isabel Reeves runs a business helping people manage their Type 1 diabetes.

She has 580 patients from every state and territory of Australia, including some living very remotely, such as on stations in Western Australia and the Hayman Islands in Queensland.

Simon Rattenbury, 55, is one of these patients. Originally from Yass, he spent two years travelling around Australia and now lives in Darwin.

He said his GP does not know much about type 1 diabetes, which impacts about one in 200 Australians.

"Over the phone, I can still ask exactly the same questions as what I can ask face to face," Mr Rattenbury said.

"[The changes are] making people use practitioners or doctors or educators that they're not real comfortable with."

Mr Rattenbury said he would fly from Darwin to Canberra once a year to make sure he can continue seeing Ms Reeves with a Medicare rebate.

Charles Darwin University adjunct associate professor Chris Helms, based in Canberra, said that as a primary healthcare nurse practitioner, he "can diagnose and treat just about everything you might see in a typical general practice".

He specialises in gender-affirming healthcare and sexual health and can prescribe medication to people with conditions like HIV, hepatitis B and C.

Many of his patients live regionally and sought him out because they could not get care in their local area or felt unsafe doing so.

"This is a cost-shifting measure by the government, which further marginalises my patients by hitting their pocketbooks during a cost-of-living crisis," he said.

Chief executive of the Australian College of Nurse Practitioners, Leanne Boast, said nurse practitioners were filling gaps created by GPs leaving remote areas.

"A lot of nurse practitioners ... reach out into rural and remote communities more. We're also more likely to provide mobile services at times, home visiting, and things like that," Ms Boast said.

"This rule means that a nurse practitioner or a group of nurse practitioners couldn't take over that practice and set up and provide services to the local community and outreach via telehealth to a region around them."

She said nurse practitioners were being singled out, as the rules would not apply to allied health practitioners.

A federal health spokesperson said the government wants to discourage online-only health businesses.

"Higher quality care is achieved through telehealth [when a] patient has an ongoing relationship with their provider," they said.

"There are risks of lower quality and lower value care when telehealth is not used optimally. This can include missed opportunities for early diagnosis and intervention."

Telehealth services exempt from this new requirement include care for children under the age of 12 months, homeless people, patients of Aboriginal medical services, people isolating with COVID, impacted by a natural disaster or being treated for blood-borne viruses, sexual or reproductive health issues.

The Royal College of General Practitioners president Michael Wright said bringing nurse practitioner rules in line with GPs shows respect for the profession.

"Except in some extenuating circumstances, telehealth services should only be provided to patients where there is an existing clinical relationship. That is the kind of care that keeps people healthy and out of hospital," he said.

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"There are good reasons this rule applies to GPs, and it's appropriate for nurse practitioners to also provide their telehealth patients with continuity of care in a consistent system.

"Where care is fragmented between health services that don't communicate and patients see different providers each time, that continuity of care is lost."

But Ms Boast said nurse practitioners were disadvantaged compared to GPs.

"There's no bulk-billing incentives, there's much lower rebates, there's no practice incentives to support nurse practitioners setting up and operating practices," she said.

Nurse practitioners cannot enrol in MyMedicare, a new federal government initiative that allows patients to use telehealth for two years, unless they are connected to a GP.