1 March 2021

GP accreditation, capitation to help fix aged care

Aged Care Clinical General Practice

Practices could be incentivised to enrol senior patients, among proposed reforms from the Royal Commission into Aged Care Quality and Safety.


The final report from the Royal Commission into Aged Care Quality and Safety, made public today, lays out a plan to overhaul primary care delivery in the aged care sector.

By 2058, the proportion of Australia’s population aged 85 and above will almost double, and there will be just three working age people for every Australian aged 65 and over.

Royal Commissioners Tony Pagone QC and Lynelle Briggs AO wrote in their interim report that the current aged care system, which encompasses home, community and residential care, is “fragmented, unsupported and underfunded”.

The final report itself, titled Care, Dignity and Respect, includes almost 150 recommendations addressing a wide range of issues such as Indigenous-specific aged care pathways, staff training requirements and access to care.

In relation to access to care, the commissioners found improved knowledge is needed to ensure older Australians can find and use the supports they are entitled to, and a specific focus should be placed on improving GP knowledge of the sector given their frequent contact with older patients.

The major recommendation relevant to GPs, however, is a proposed new model of patient care which would see practices enrol to become aged care accredited and deliver more holistic, co-ordinated care to aged care patients.

The reasoning behind this recommendation, according to the commissioners, is to create a higher financial incentive for GPs to take on aged care patients.

“General practitioners are primarily funded by fee-for-service,” the commissioners wrote.  

“We heard evidence about the problems with the fee-for-service funding model, particularly that it creates an incentive for care that responds to an episode of ill health, rather than encouraging care that proactively attempts to reduce the risk of ill health.

“The fee-for-service model is considered by some to be ‘in conflict with the proactive, coordinated and ongoing team based approaches that are needed to support the prevention and optimal management of chronic and complex conditions’”.

Under the proposed new primary care model, in the commissioners’ words:

  • General practices could apply to the Australian Government to become accredited aged care general practices
  • Each accredited practice would enrol people receiving residential care or personal care at home who choose to be enrolled with that practice
  • Each accredited practice would receive an annual capitation payment for every enrolled person, based on the person’s level of assessed need
  • The accredited practice would be required to meet the primary health care needs of each enrolled older person, including through cooperative arrangements with other general practices to provide after-hours care
  • Participation would be voluntary for general practices and patients.

Commissioner Pagone specifies in the report that such a model would need to be trialled for up to ten years in order to prove viability.

Commissioner Briggs, however, recommends this model be implemented immediately, considering it the “only viable option” to address health access issues in older Australians.

The Government is expected to respond to the proposed recommendations in Parliament by 31 May 2021.

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5 Comments on "GP accreditation, capitation to help fix aged care"

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Iliya Englin
Member
Iliya Englin
1 year 2 months ago
The commission definitely hit “full retard”, especially with the comments about fee-for-service. It is the capped fee that discourages doctors from attending to patients. If you want neglect, give someone a token fee and make them perform an unlimited number of services for it – see what happens next year. This is a recipe for people walking out. Taking an average suburban doc: it takes an hour door-to-door for a visit to a nursing home for up to 3 patients (similar time, as travel is the most significant component). 4 standard consultations are lost in the rooms – that could… Read more »
Ima Nonymous
Guest
Ima Nonymous
1 year 2 months ago
I agree that the general level of fees for the time spent is woeful. The whole fee for service issue is eroding what is left of dedication and commitment in the general practice community in my opinion. A compounding problem is that Medicare has vague rules in the MBS as to what has to be done to be entitled to a set fee. Time spent is no longer enough – it is now time spent and notes recorded – effectively adding at least ten minutes to the time spent unless you spend the entire appointment typing. On top of this,… Read more »
Stephen Scholem
Guest
Stephen Scholem
1 year 2 months ago
If I had a dollar for every time health bureaucrats who have never treated a patient in their lives came up with yet another way to reinvent the wheel I’d be a rich man. Health assessments and care plans are already a form of capitation, linked to formal holistic assessment and care of older patients. Residential aged care capitation payments have been around for years. The problem has not been in the systems, it’s in the measly amounts allocated to these payments. Triple the payments and you’d get a bit of incentive. Also there is a fundamental structural drift from… Read more »
Primo Bentivegna
Member
Primo Bentivegna
1 year 2 months ago

Good luck finding GPs willing to preform aged care in the future!

Peter Bradley
Member
Peter Bradley
1 year 2 months ago

Yeah, well good luck with all the above. I tell you what. The way things are going, my long held view that GPs would be better off being paid a properly structured public service type salary is beginning to sound better by the day.

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