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Key practice challenges 2020 and beyond

A scoping review of healthcare delivery in 2020

From cancellation of multiple elective surgery services, the rise of virtual care and technology mediated medical education, the COVID-19 pandemic has presented multiple challenges for the healthcare sector1

Telehealth

AHPRA expects you to provide telehealth services as you would in face-to-face consultations. You must practice in accordance with the national boards’ regulatory standards, codes and guidelines and you must ensure you have appropriate professional indemnity insurance.

Healthcare practitioners’ risks

  • Communication difficulties
    • IT illiterate patients
    • Absence of non-verbal cues
    • Technical issues
  • Missed information
  • Dissatisfaction may be due to:
    • Timing
    • Impaired patient rapport
  • Misdiagnosis
    • Greatest potential liability to telehealth
    • Lack of normal communication
    • Lack of visual cues
    • Inability to examine the patient

Summary of key points

  • Only provide telehealth when it is clinically appropriate to do so
    • Ask yourself:
      • Would a face-to-face interaction add anything to the consultation?
      • Is this a consultation which requires a physical examination in order to properly diagnose the presenting complaint?
    • Always ensure you determine clinical suitability of telehealth consultation
    • Video calls are preferable to telephone calls
    • Select a telecommunications service that is secure and complies with privacy laws.
    • Record consent, health information, management plan and follow-up as usual
    • Regulators may scrutinise your telehealth records and billings – appropriate record keeping is your best

Aged care

  • Aged Care Act 1997 should be replaced with a New Act by 01 July
  • The new Aged Care Act will focus on achieving the following new regulatory frameworks which will underpin a new aged care system:
    • Australian Aged Care Commission
      • Independent corporate Commonwealth entity
      • Approve service providers & subsidies, monitor risks, quality & safety
    • Australian Aged Care Pricing Authority
      • Determine prices for aged care services (identify and determine price caps and other economic recommendations)
    • Inspector-General of Aged Care
      • Independent office to monitor on administration and governance
      • Reform implementation, performance & attainment of the the New Act
    • Expansion of Medicare – improvements access to medical and allied health services
      • Access to additional services - to mitigate the negative impacts of COVID-19
      • Creation of Medicare Benefits Schedule item – increased allied health services.
    • Telehealth – by 01 November 2021, increased access to special telehealth services.
      • Expand access – to MBS specialist telehealth to people receiving care at home.
      • Require necessary equipment, clinically & cultural capable staff to support telehealth services at residences and at
    • Personal care workers – by 01 July, the AHPRA may establish a national board and registration scheme for personal care workers, based on five principles:
  1. Mandatory minimum qualification
  2. Ongoing training & professional development
  3. Minimum levels of English proficiency
  4. Criminal history screening
  5. Code of conduct & investigation of complaints
  • Skilled workers – registered nurses, medical doctors, GPs &
    • The three key recommendations that impact the skilled aged care workforce:
      • Workplace planning
        • Establish an Aged Care Workforce Planning Division
        • Strengthen the capacity of the Aged Care Workforce Council
      • Remuneration
        • Improved remuneration for aged care workers
        • Aged Care Pricing Authority to set prices to attract skilled staff
      • Training & review
  • Review of certificated-based courses undergraduate curricula
  • Dementia and palliative care training
  • Minimum staff time standard for residential

Opioids regulatory changes

  • Revised opioid PBS listings for the management of severe pain, effective 01 October 2020
    • PBS listings requiring an annual secondary review will now allow a palliative care nurse practitioner to conduct the
    • The requirements for the annual secondary reviews have been removed for patients whose clinical condition is such that a secondary review is rendered not
    • PBS listings have been restructured to include:
      • Treatment phases
      • Reflect the length of time a patient has been treated
    • Additional PBS restructuring:
      • Removal of requirement to provide the date of the review and the name of the medical practitioner consulted
      • Prescribers need to keep this information for compliance purposes.

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