Telehealth in Australian general practice: medico-legal essentials for GPs

Telehealth — real-time GP consultations delivered by video or telephone — became a permanent fixture of Australian healthcare after the COVID-19 pandemic transformed temporary emergency MBS items into an enduring, structured service. As of 2022, permanent telehealth items replaced the emergency framework, with clearer rules around patient eligibility, modality tiers, and clinical accountability (MBS Online). The launch of MyMedicare in October 2023 further strengthened telehealth by anchoring continuity-of-care payments and relationship eligibility at the practice level.

Telehealth offers genuine benefits: it removes travel barriers, reduces waiting times for stable chronic-disease reviews, and expands access — particularly for patients in rural and remote areas. For patients managing well-established conditions, telehealth consultations carry equivalent clinical outcomes to face-to-face for many tasks (Smith Lancet Psychiatry 2020).

The medico-legal framework governing telehealth is more detailed than many GPs and patients realise. The AHPRA Telehealth Guidelines 2024 and Medical Board Technology-based Consultation Guidelines 2024 place explicit duties on practitioners: documented clinical reasoning for why telehealth is appropriate, identity verification, informed consent, explicit acknowledgement of examination limitations, a written emergency response plan, and thorough safety-netting. These are not optional — they are as legally binding as the standard of care in any face-to-face setting.

A. Core clinical — the AU general-practice framework

The 12-month relationship rule

For most GP telehealth attendance MBS items, Medicare funding requires that the GP or their practice has seen the patient at least once — face-to-face or by telehealth — within the preceding 12 months. This is the existing-relationship requirement (MBS Online).

Without this relationship, the encounter cannot be billed under the standard telehealth items. Specifically defined exceptions where a prior relationship is not required include:

• Pregnancy ≤12 weeks gestation — antenatal initial review item 16590
• Blood-borne virus (BBV) management — HIV, hepatitis B, hepatitis C
• Child protection (urgent)
• Urgent rural or remote access — Modified Monash Model (MMM) exemption categories
• Residential aged-care facility (RACF) residents
• Declared exemption areas — bushfire, flood, declared disaster
• Palliative urgent care — end-of-life

MyMedicare registration changes the relationship requirement from the individual GP to the practice as a whole. Once a patient is registered with a practice, any GP at that practice may deliver telehealth — the relationship is held at the practice level. This has practical benefits for practices with multiple doctors and for after-hours or locum cover.

Video vs phone — why the tier matters

The RACGP Telehealth Standards 2024 and AHPRA both designate video as the preferred modality. Video consultations allow visual assessment of appearance, skin, respiratory effort, and the patient’s environment. Phone consultations carry a reduced MBS rebate and are appropriate when the patient lacks equipment or internet connectivity, when a brief follow-up does not require visual assessment, or when video technology has failed.

Modality	Level A	Level B	Level C	Level D
Face-to-face	3	23	36	44
Video telehealth	91790	91791	91792	91793
Phone telehealth	91890	91891	91892	91893

MHCP via telehealth: video 91842 / phone 91843. The GP Chronic Condition Management Plan (GPCCMP) items 965/967 — preparation and review — are permissible via telehealth.

Examination limitations — what telehealth cannot do

Physical examination is limited or impossible via telehealth. Every telehealth consultation carries the potential for diagnostic underdetermination compared to face-to-face, and the AHPRA Guidelines 2024 require this to be explicit in documentation and in the patient consultation itself.

Practical workarounds for some examination components:

• Blood pressure — patient uses home BP cuff (validated device; technique checked by GP)
• Heart rate — wrist pulse or pulse oximeter
• Oxygen saturation — home pulse oximeter
• Blood glucose — home meter or continuous glucose monitor reading shared
• Spirometry — home spirometry device with app for established asthma/COPD monitoring
• Dermatology photos — well-lit, clearly focused, multiple angles; appropriate adjunct but not substitute for dermoscopy for suspicious lesions
• Active range of motion — patient demonstrates movement on camera

Document explicitly which examination components were performed and which were not possible: “Cardiovascular examination not performed — auditory auscultation not possible via video.”

B. Prescribing via telehealth

Routine prescriptions

Standard PBS prescriptions for established medications can be issued via telehealth within an existing relationship. Chronic disease medications, contraception, antihypertensives, antidepressants, thyroid replacement — all are routinely managed via telehealth in stable patients with documented clinical reasoning.

Drugs of dependence and controlled substances

The regulatory requirements for prescribing monitored and controlled substances via telehealth are stricter than for standard PBS medications, and vary by state.

Real-time prescription monitoring (RTPM) is mandatory before issuing any Schedule 8 (S8) controlled substance or Schedule 4D (S4D) drug of dependence in all states and territories. RTPM platforms by state:

• VIC: SafeScript
• NSW: SafeScript NSW
• QLD: QScript
• SA: ScriptCheck SA
• WA: Monitored Medicines
• TAS: DORA (Drug and Poisons Information System of Tasmania)
• ACT: MMS (Medicines Management System)
• NT: implementation in progress

Per the RACGP Telehealth Standards 2024 and Faculty of Pain Medicine ANZCA position statement 2024, face-to-face is recommended for:

• New opioid initiation in chronic pain
• Opioid dose escalation
• Chronic high-dose opioids (>50–100 oral morphine equivalents/day)
• New benzodiazepine or Z-drug prescription
• New ADHD stimulant initiation — Authority-required prescribing and state-specific regulations apply
• Suspected diversion or aberrant use

Continuation of established stable prescriptions at the same dose, with documented clinical review and RTPM compliance, is permissible via telehealth per Davy MJA 2022.

Pregabalin was rescheduled to Schedule 4 monitored in 2024 — check RTPM before prescribing in any state where it is monitored.

Medical cannabis

TGA Special Access Scheme B (SAS-B) or Authorised Prescriber pathway is required. Telehealth is permitted for ongoing monitoring within an established care relationship.

C. Medico-legal duties in telehealth

AHPRA and Medical Board framework

The AHPRA Telehealth Guidelines 2024 and Medical Board Guidelines 2024 establish that the standard of care via telehealth is the same as face-to-face care. The practitioner’s duty of care does not diminish because the medium has changed.

Required documentation at every telehealth encounter:

1. Modality — video or phone; reason for choice of modality
2. Clinical reasoning — why telehealth is appropriate for this presentation
3. Identity verification — method used (Medicare card, known clinical details, voice recognition in established relationship)
4. Consent process — patient advised of modality, limitations, and privacy arrangements; consent documented
5. Examination component — what was examined and what could not be assessed remotely
6. Assessment and management plan
7. Safety-net advice — when to call 000, go to ED, or attend clinic; documented in the record
8. Emergency response plan — if relevant to the presentation

Informed consent

At the start of the first telehealth consultation (and when the mode changes from video to phone), confirm:

• The modality and any privacy or recording implications
• That examination is limited — specific to the presentation (“I won’t be able to listen to your chest today”)
• The emergency procedure: the patient’s current address, what to do if the call is disconnected
• The identity of any third party present on either end (interpreter, chaperone, family member)

Document this consent verbally and in the clinical record.

Privacy and platform security

The Privacy Act 1988 (Cth) and the Australian Privacy Principles (APPs) apply fully to telehealth consultations. State health records legislation (Victorian HRA 2001, NSW HRIP 2002, etc.) applies concurrently. Use a secure, encrypted platform configured for Australian healthcare use — platforms such as HotDoc, HealthEngine, and Coviu are designed for this purpose. Do not use generic consumer video tools without confirming they meet Australian healthcare-tier security requirements. No recording without explicit patient consent.

Emergency response during telehealth

Suicide risk or psychiatric crisis:

• Do not disconnect.
• Call 000 to the patient’s stated location.
• Remain on the call until emergency services arrive.
• Document the incident, the intervention, and the handover.
• Arrange face-to-face follow-up as soon as practicable.

Acute medical emergency (chest pain, anaphylaxis, severe asthma, stroke):

• Call 000 to the patient’s location while remaining on the call.
• Give basic first-aid instructions if the patient or a bystander can act on them.
• Stay connected until emergency services confirm attendance.

Family violence active risk:

• If it is safe to ask, use safe-question framing; if coercion is evident and it is unsafe to continue, end the call on a safe pretext.
• Mandatory reporting obligations apply by state where relevant.

D. Australian operations

MyMedicare

MyMedicare launched 1 October 2023 as voluntary patient registration with a specific GP practice. Benefits include:

• A quarterly continuity-of-care payment to the practice
• Practice-wide relationship for telehealth eligibility — any GP at the registered practice can deliver telehealth
• Access to additional services (Chronic Wound Consumables Scheme, enhanced after-hours access)
• Alignment with Practice Incentive Programme (PIP) digital health and quality-improvement activities

MyMedicare registration does not cost patients anything and can be done through the Medicare app or myGov.

Chronic disease management via telehealth

The GPCCMP (items 965/967 from 1 July 2025) and allied health CDM items (including speech pathology, dietetics, and other disciplines) are permissible via telehealth. Document examination limitations explicitly when physical review was not possible. Allied health services funded under CDM are claimed under the relevant allied health item (e.g., speech pathology 10970) when delivered via telehealth, under the same eligibility rules.

Mental health via telehealth

The Smith Lancet Psychiatry 2020 meta-analysis demonstrated clinical equivalence between telehealth-delivered and face-to-face psychological treatments for depression, anxiety, PTSD, and OCD. Mental Health Treatment Plans (MHCP: items 91842 video / 91843 phone) and psychology Better Access sessions are permissible via telehealth.

Face-to-face is recommended by RANZCP and RACGP for: first encounter with severe psychiatric illness; active suicidal ideation or recent attempt; psychosis; clozapine monitoring; first-time antidepressant initiation in adolescents (for early suicide-risk monitoring).

E. Special populations

Rural and remote patients

Telehealth removes the most significant barrier for patients in MMM 5–7 areas — travel to specialist and subspecialist services. Modified Monash Model categories allow exceptions to the 12-month relationship rule for many urgent scenarios. Rural patients accessing specialist opinion via telehealth should be connected through their GP wherever possible, to maintain care coordination. The RACGP maintains updated guidance on MMM eligibility categories.

Aboriginal and Torres Strait Islander patients

An Aboriginal Health Worker or Aboriginal Liaison can co-attend a telehealth consultation, which is both culturally appropriate and clinically effective. ATSI 715 Health Assessments are permissible via telehealth; the first comprehensive assessment is ideally face-to-face to establish rapport and complete full physical assessment. Engage Aboriginal Medical Services (AMS) and NACCHO-affiliated ACCHS pathways for warm handover and follow-up coordination.

Culturally and linguistically diverse (CALD) patients

Use the TIS National Translating and Interpreting Service (131 450) — free for healthcare practitioners and patients. TIS National provides phone and video interpreter services; the Doctors Priority Line offers faster access. Book interpreters at the same time as the telehealth appointment. Telehealth with an interpreter requires explicit consent from the patient about the interpreter’s presence and their role.

Older adults

Many older patients prefer phone to video for familiarity or may lack suitable devices. Phone consultations are clinically appropriate for follow-up appointments, medication reviews, and chronic disease monitoring. For older adults in RACFs, specific telehealth items apply; the relationship rule is waived for RACF residents.

When face-to-face is essential

Telehealth is not appropriate as the primary modality when:

• Acute undifferentiated illness requiring physical examination — fever with meningism, acute abdominal pain, suspected acute coronary syndrome, stroke symptoms → direct to ED or face-to-face
• New suspicious skin lesions — dermoscopy required; photo review alone is not adequate for high-risk lesions
• First encounter for complex presentations — comprehensive baseline history and physical examination
• Mental state assessment for suspected new psychosis or severe mental illness
• Paediatric undifferentiated febrile illness — hydration, meningism, respiratory assessment
• Genital, rectal, or breast examination
• Pre-operative or pre-procedural assessment
• Active suicidal crisis at first presentation — urgent in-person or emergency assessment
• Domestic and family violence when there is concern about coercion or active danger

Always document why face-to-face was recommended when it is — this protects both the patient and the practitioner.

What this article is and is not

This is general health information and systems guidance drawn from current Australian frameworks — AHPRA Telehealth Guidelines 2024, Medical Board Technology-based Consultation Guidelines 2024, RACGP Telehealth Standards 2024, and MBS Online. MBS item numbers and eligibility rules are subject to change — verify current items at mbsonline.gov.au before billing. This is not personal medical advice and does not create a doctor–patient relationship.

For consumer information: HealthDirect 1800 022 222, Better Health Channel, Department of Health — MyMedicare.

For mental health crisis: Lifeline 13 11 14, Beyond Blue 1300 22 4636, 000 if immediate danger.

---

Sources cited

1. AHPRA and National Boards — Telehealth Guidelines 2024
2. Medical Board of Australia — Technology-based consultation guidelines 2024
3. RACGP — Telehealth in general practice (Standards 2024)
4. MBS Online — Telehealth items
5. Department of Health and Aged Care — MyMedicare 2023
6. Faculty of Pain Medicine ANZCA — Opioid prescribing position statement 2024
7. Smith AC et al. — Telehealth for mental health equivalence (Lancet Psychiatry 2020)
8. Davy C et al. — Real-time prescription monitoring in Australia (MJA 2022)
9. Snoswell CL et al. — AU general practice telehealth (BMJ Open 2024)
10. SafeScript Victoria — Real-Time Prescription Monitoring
11. TIS National — Translating and Interpreting Service (131 450)
12. Privacy Act 1988 (Cth)
13. HealthDirect Australia — 1800 022 222
14. Better Health Channel