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Concern after panel declares PIP and WIP ‘not actually essential’


Michelle Wisbey


30/08/2024 4:15:02 PM

That is according to the latest consultation from a panel tasked with assessing the future of GP incentives, and it is ringing alarm bells for the RACGP.

GP taking a man's blood pressure.
Around 270 people attended the Department of Health and Aged Care’s Review of General Practice Incentives Consultation webinar.

The RACGP has raised significant concerns about the future of general practice incentives, after an expert panel tasked with assessing their efficacy said the PIP and WIP are ‘not actually essential for the survival of private practices’.
 
More than 270 people attended a Review of General Practice Incentives Consultation webinar on Thursday, hosted by the Department of Health and Aged Care, after its latest review recommended the current incentives undergo a major overhaul.
 
The review’s assessment includes the Practice Incentives Program (PIP) and Workforce Incentives Program (WIP) as part of its plans to redesign the current incentive programs by 2032.
 
The RACGP has raised fresh concerns after the panel appeared to be heading in a direction opposite to what the college, and many of its members, called for in relation to the PIP and WIP.
 
In response, RACGP President Dr Nicole Higgins told newsGP what general practice needs is an increase of funding money into the specialty, especially as demand for services is predicted to skyrocket.
 
She said the flagged changes to the PIP and WIP will most impact Australia’s rural workforce, and have the potential to push GPs out of the regions.
 
‘I urge GPs to remember that this panel is only able to make recommendations, and the Federal Government must review these before they are officially accepted or rejected, so we still have time to act,’ Dr Higgins said.
 
‘We know that enhancing general practice with greater financial incentives and reducing their complexity is essential for their success and for improving our patient outcomes, and the practice incentive programs are critical to the viability of practices and continuous patient care.
 
‘We need general practice incentives to be better targeted to high quality general practice, and if we do that, patient outcomes will improve.’
 
The panel’s latest comments come after its initial report recommended eligibility for accreditation expand to include non-traditional general practice models.
 
On Thursday, it said these changes ‘would not happen overnight’, flagging an eight-year timeframe.
 
‘It’s not as if all practices are going to be expected to actually fulfill all these criteria overnight in order to get any payments,’ it said.
 
‘We’re very, very aware of the fact that these kinds of things need to be introduced gradually, they need to be supported, and we’ve had lots of discussions about what the support would actually look like.’
 
That plan comes as the panel’s key recommendation, revealed earlier this month, is to replace existing PIP and WIP payments ‘while ensuring viability of general practices to meet patient needs’.
 
The panel also said changes to accreditation could be on the way to consider multidisciplinary care teams, leading to further scope of practice concerns from the RACGP.
 
It said GPs can be able to coordinate multidisciplinary care teams through increasing the scope of practice for other healthcare professionals, such as allowing patients to receive repeat scripts without seeing a GP.
 
‘We probably want members of those multidisciplinary teams to actually have training in general practice so they can work in general practice,’ the panel said.
 
‘We’ve actually considered the training of nurses and nurse practitioners in general practice itself, and potentially maybe even pharmacists and other people who could actually benefit general practice.’
 
The RACGP has previously raised concerns about controversial scope of practice changes, such as pharmacy prescribing, citing the increase risk to patient safety and care fragmentation.
 
Panel member, practice manager and Inala Primary Care Chief Executive Officer, Tracey Johnson, added that changes must reflect the ‘new style of practice that we’re imagining’.
 
‘Decades ago, a general practice used to be a place that GPs worked. It will continue to be a place that GPs can and do work, but there are also other people who are now part of the team,’ she said.
 
‘If we have direct bundled payments to practices that are not comfortably fitting into a doctor only kind of circumstance, we need to change the accreditation framework and make payments available to a broader group of practices who are still providing cradle to grave care.’
 
However, that ‘new style’ comes following little input from peak bodies, including the RACGP, with Dr Higgins saying previously that this failure to co-design was ‘nothing but disrespectful’.
 
The RACGP supports multidisciplinary care teams within general practice, saying they can benefit patients, but Dr Higgins said the role GPs play in primary healthcare must not be diminished.

‘GPs cannot stand by and watch our health system be reduced, we need to stand up and ensure we don’t trade off quality and safety for convenience,’ she said.
 
‘We cannot have a healthcare system that is reduced to tasks and activities, one that is fractured and broken and where our patients are not getting the high-quality care they need and deserve.’
 
Ms Johnson also provided assurances around persistent capitation concerns, saying ‘the new money that we’re proposing to have invested in primary care does not equate to capitation’.
 
‘This report, in no way, shape or form, says that all of a sudden, the way you will get your payment is by a payment outcomes model,’ Ms Johnson said.
 
‘There will be more data sharing, because that’s how you get needs-based funding, but in terms of a capitation model, that was never part of our plan or is not part of our recommendations.’
 
The panel was then questioned about whether it has considered the effect of payroll tax and take-home pay for practitioners.
 
‘You don’t start designing a healthcare system based on a taxation system because both the needs of patients become more present and ever dangerous to us in primary care,’ Ms Johnson said.
 
‘Simply because payments go to the practice does not mean that, in turn, the practice could not have a way of directing elements of those payments to practitioners.’
 
However, questions remain about just now this will be regulated in the future.
 
Dr Jason Agostino, a GP and senior medical advisor at the National Aboriginal Community Controlled Health Organisation, confirmed there is a separate process underway for the Indigenous Incentives Payment.
 
‘The Indigenous Health Incentive for the purpose of this review is considered out of scope,’ he said.
 
‘We’ve already started a reform process around that where it’s moving away from sign-on payments to be more focused on outcome payments.’
 
Feedback from the consultation process will be collated for the Expert Advisory Panel’s consideration as it finalises its report.
 
The RACGP will publish further submissions into the consultation shortly and has already provided input to the National Rural Generalist Pathway’s Strategic Council.
 
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Dr Brendan Sean Chaston   31/08/2024 11:30:12 AM

Obviously big changes to primary care are coming over the next decade. Change is not the issue - it’s the uncertainty. It’s unlikely to affect me as I’ve only got a decade left. My problem is I supervise registrars who still have an opportunity to pursue other medical disciplines. Am I doing them a disservice? All current indicators suggest the future looks quite bleak. Hopefully I’m wrong. The college morally needs to be very upfront about this potential and ensure all registrars enter the program with full knowledge of this uncertainty. Let’s try not to emulate the behaviour of a dodgy used car salesman and deliberately not declare/conceal potential costly problems.


Dr Lisa Melanie O'Rourke   31/08/2024 11:47:19 AM

All of this means that there will become a two tiered system of medicine -A private system where GPs provide high quality healthcare to those that can afford it with little medicare rebate from government and a second cheaper system for the low income patients or for those who dont value their health enough to pay for it. In the second system Doctors who remain oblivious to where this is going will remain tethered to government getting a relative annual pay cut to supervise nurse led care with little autonomy. All government changes are based on the presumption that a nurse or pharmacist could be trained to do what GPs do in a short course and their wages will remain below what is expected for GPs but above that expected by nurses or pharmacists. The assumption is theat GPs are a lower quality of Dr than specialists and are more like Physician Assistants and it is that basic error that is not being addressed .


Dr Bradley Arthur Olsen   31/08/2024 12:15:11 PM

Yes, you guessed what's next- panel declares GPs "not actually essential"


Dr Gerard Phillip Connors   31/08/2024 1:13:35 PM

I’ve been a GP in both a community health centre and a large mixed ( more private than bulk billing) practice. I note Ms Johnson’s comments and agree that ideally practices should be multi- disciplinary
As we know this may not always be possible due to lack of access to GP’s and other health workers in rural and regional areas.
I also note from Inala’s website that they are a mixed billing practice ( like many practices today), but that they are a not for profit ( unlike almost all other GP practices) and that only 80% of their income comes from billing’s.
If the panel and then the Government can take those sort of actors into consideration , given how much work and risk their is for GP owners it would be much appreciated
I’m suggesting that rather than cutting funding , as the RACGP has said funding needs to be increased
Using Inala as an example it needs to be somewhere up to a 20% increase , plus a reasonable profit margin to make it worthwhile to run a practice.


Dr John Brett Deery   31/08/2024 1:15:06 PM

WIP/PIP "Not essential" - removing PIP/WIP would lead to far more pain than payroll tax!


Dr Serafim Dafillis   31/08/2024 1:49:03 PM

Yes stopping PIPS and WIPS will impact general practices as they are budgeted in every practices running costs... access any cuts will just be added to the patient.

As for incentives, GPs are not in need of incentives, we did or job just fine. The same inventive amount should be added to the patients Medicare rebate- question is, why is this not happening??


Dr Peter James Strickland   31/08/2024 5:03:14 PM

Having PIP only allows the govt. to keep control over private GPs. The best incentives for general practice are paying the patients a decent rebate for consultations and procedures. For example, removing a suspicious skin lesion should have the same rebate for a competent experienced GP as for a specialist surgeon, OR experienced GPs are better at assessing PTSD in their own patients than many psychiatrists. I can easily assess autism in any child with a parent, and an inexperienced paediatrician's opinion is not required, as they are more likely to place an unnecessary diagnosis of being on the 'created' autism spectrum disorder. --and when the child is quite normal, may be bored, highly intelligent etc, and not truly autistic at all. Simply have govt. paying proper GP fees, and that will relieve all these specialist 'hold-ups', and use the GP medical workforce, and save the NDIS a fortune. Forget about PIPs ---they are only dollars, and not a measure of competence.


Dr James Donald McKenzie   31/08/2024 6:30:54 PM

I am not privy to who these people are on this committee or how they are even on there. Unfortunately our profession has been taken over by bureaucracy who really have no idea about looking after people. Apart from providing the worst care for the lowest price. Lip service health care that is essentially providing care with the philosophy that anything is better than nothing. Rather than excellence.

When did practice management dictate health care? Seriously what has happened to our profession? Pathetic!


Dr Anna Kelly   1/09/2024 1:28:08 PM

I'm sorry for the state of our medical system, but I will not take a pay cut. With a multitude of Government funding changes potentially reducing GP take home pay, it is important that we act to maintain our income. This is in an environment when others are asking for and receiving pay increases. Either cop a drop in pay or pass costs on to patients. Yes, they will end up in ED, but remember, it's the squeaky wheel that gets oiled. The State and Federal Governments are very practiced at ignoring our pleas. It's interesting to note the lack of bulk billing practiced by our primary care allied health colleagues. Why do we not hear about their "bulk billing rates" or rates for specialists? We need to be firm with our boundaries and communicate clearly to our patients that our take home pay is unchanged, the government is collecting money by stealth through us. When Emergency Departments are overwhelmed, there may be more incentive to make General Practice more appealing.


Dr Barrington   2/09/2024 3:36:02 PM

OK then. What would all these govt boffins do if we just stopped administering Medicare for them, engaging with PIPs and WIPs (and whatever their next silly time-wasting-mind-control, data-collection-by-stealth, loyalty program will be), playing with MyMedicare, MHR etc etc. Bcs, I know I would still make a living, but they'd have no control over me, I'd have less red-tape to deal with and they'd lose their precious supply of data...
#datastrike