Workforce Incentive Payments should be maintained “in the short term”, says “softened” general practice incentives review report.
Workforce Incentive Payments should stick around for at least the next few years, recommends general practice incentive review report.
Today, the Department of Health and Aged Care released the expert advisory panel report on the review of general practice incentive payment – namely the Practice Incentives Program and the Workforce Incentive Program.
The report’s recommendations largely aligned with the consultation briefing paper released by DoHAC last month, which the RACGP labelled as “a pathway towards … capitation” .
While 90% of Commonwealth funding is paid to general practice through the MBS, the remaining 10% of government funding for GPs comes from a combination of the PIP, WIP and other grants.
The report recommended that “Australia should increase blended payments in general practice”, by increasing the non-fee-paying component of general practice income from 10% to 40%.
The Baseline Practice Payment would be “opt-in” and require the practice to be accredited – or exempt – and signed up for MyMedicare, “so that all patients, whether registered in MyMedicare or not, will benefit from the MyMedicare system”.
It would be provided quarterly to eligible practices.
“The Baseline Practice Payment will provide predictable funding, in addition to the MBS, that practices can use as they wish to support and build multidisciplinary teams, both in house and through collaboration with partners,” reads the report.
“The objective is to give general practices flexibility to create care teams for their patients.
Practices would also be required to provide comprehensive data on service delivery to their PHN.
While the consultation paper recommended that current PIP and WIP payments should be wholly replaced by new blended incentive payments – much to the ire of ACRRM – the final report took a “softened” and “delayed” approach, RACGP president Nicole Higgins told The Medical Republic.
“In the short term, the Australian Government should retain the WIP-Doctor Stream and WIP-Rural Advanced Skills Stream as an incentive to doctors working in rural and remote areas and refine these to increase their effectiveness in promoting continuity of care,” reads the report.
The report suggested the government look more deeply into the impacts of redirecting WIP payments from practitioners to practice over the next three years.
“Over time, existing PIP and WIP practice payments – and other relevant programs and payments – should be rolled into the Baseline Practice Payment to ensure general practices remain viable, meeting patient needs and supporting continuity of care,” it reads.
Speaking to TMR, ACRRM president Dr Dan Haliday said the college was pleased that the voices of rural doctors had been heard.
Dr Halliday said that while the college supported the principle of a flexible payment framework, it would be concerned if payments like the WIP, which had been quite successful in rural areas, were scrapped without consideration of the sector.
The report did not attach any monetary figures to the initiatives – as “the level of funding for general practice and primary care are also outside the scope of this review”.
However, it said the transition and longer-term viability of general practice would depend on increased commonwealth funding.
The report called for a 10-year funding commitment including bolstered funding payments and payments to help with the transition.
“The Australian Government should invest in enabling reforms such as accreditation and a performance framework to support the new general practice blended payments architecture within the context of a cohesive vision for primary care by 2032,” it reads.
Dr Halliday said the report demonstrated a “realisation that underfunding has been chronic”.
“ACRRM welcomes the recognition that general practice has been underfunded for many years and that there will be changes needed to provide certainty of funding if any proposals which come out of the review are to be successfully implemented,” he said.
“The concern we have had as a college is that despite the review being primarily about a transition to multidisciplinary care, the role of rural generalists seems to receive very little attention in the report.
“The report’s description of multidisciplinary-based primary care practices appears to largely omit rural generalists among the contributing roles.
“This is an interesting development, particularly given the fact that rural generalist medicine has been recognised as the highest growth medical specialty amongst the Medical Deans’ Association medical student survey reports.
“To not take advantage of the growing interest in this specialty, would seem to be a somewhat flawed approach in terms of the outcome of the report.”
While the report focused on ensuring continuity of generalised care, it did acknowledge the value of sub-speciality care – like women’s health and LQBTQIA+ clinics.
“The government should further consider how sub-speciality primary care providers can be funded to work with general practices as part of a multidisciplinary team that delivers comprehensive primary care for specific populations,” it said.
“The lesson that must be reinforced for all elements of the primary care system is that mono-provider models of care are becoming outdated, can be more expensive, and will not scale up in an era of increasing workforce shortages and rapidly rising demand.”
Related
The report also maintained the recommendation for independent pricing authority to advise Commonwealth payments to general practice.
Dr Halliday said the “devil [would] be in the detail”.
“If done well, it has the opportunity to address significant disparities in health funding.”
Dr Higgins said the RACGP took issue with the conflation between primary care and general practice funding in the report.
“[The incentives should] enable general practice to employ other primary care providers versus sharing general practice funding with other providers, because that then dilutes [general practice] funding and contributes to fragmentation duplication of services.”
Dr Higgins said the peak bodies were not part of the original process to develop the recommendations but would work to co-design implementation of the new architecture.
