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Consider incentives for four-year-old health checks: RACGP


Jolyon Attwooll


23/01/2024 3:30:00 AM

The college has outlined how potential improvements to the practice incentives program could boost patient outcomes.

GP providing four-year-old with a health check
Incentivising four-year-old health checks are among the RACGP proposals in a recent submission.

Offering incentives for four-year-old health-checks and longer consultations are among a suite of suggestions put forward by the RACGP to improve the impact of general practice incentives.
 
In a submission to the ‘Effectiveness Review of General Practice Incentives’ run by the Department of Health and Aged (DoHAC), the RACGP set out its backing for the program – and outlined how more targeted measures could boost preventive care and help keep patients out of hospital.
 
‘Throughout this consultation, many GPs have emphasised that the practice incentive programs are critical to the viability of their practice and continuing to provide patient care,’ the submission states.
 
As well as noting the current impact, the RACGP submission called the review ‘a significant opportunity to enhance the effectiveness of the current general practice incentives as a funding model into the future and to shape the primary healthcare system’.
 
Included among the RACGP’s proposals are the suggestion to look into incentives for four-year-old health checks, and to consider socio-economic factors when calculating practice payments.
 
‘Prevention and health promotion in the early years, from conception to five years of age, is critical for an individual’s lifelong health and wellbeing,’ the RACGP states.
 
‘It may also be an opportunity to redress health inequalities.
 
‘Reinstating the four-year-old health checks could incentivise GPs to screen the child’s functional development, capacity, independence, and participation in daily activities, along with developing early intervention goals, if needed, in collaboration with the child’s family.’
 
Other opportunities to support children’s development in their first 2000 days should also be investigated, the RACGP suggests.
 
The college also indicates that incentives for longer consultations, with a payment to support GPs who reach a certain threshold using fee-for-service, could have the dual impact of boosting more complex care and helping redress a general practice pay gap.
 
‘Female GPs spend 19 minutes on average with patients compared to 16 minutes for their male counterparts,’ the RACGP submission states.
 
‘However, Medicare pays less per minute for longer consultations, meaning women GPs and their patients are being unfairly penalised.’
 
These measures and a broader, sustained increase in investment would help improve ‘preventive, coordinated and proactive primary care’, according to the college – and the stance is strongly endorsed by RACGP President Dr Nicole Higgins.
 
‘We need to refocus our health system to prioritise keeping people healthy and out of hospital, as well as better supporting the growing number of older Australians and people with chronic, complex diseases,’ she said.
 
‘This is a significant opportunity to improve preventive care, right from the start of life, and onwards.’
 
The RACGP President believes other measures such as social prescribing could be worked in to the incentive scheme, citing research suggesting that Australia spends less per capita on preventive health compared to the OECD average.
 
‘There are many more opportunities to improve preventive care and health equity in our country, and better support our growing population of older people and those with chronic disease, by reforming our health funding and incentives,’ Dr Higgins said.
 
‘Every community in Australia is unique, and we need to ensure they can access the care they need, and that its affordable.’
 
Other suggestions set out by the RACGP include increasing the Indigenous Health Incentive to reflect the complexity of care.
 
The submission also notes the potential challenges of introducing and targeting changes to the incentive program fairly – and the added complexity that could be caused by payroll tax.
 
‘We note many GPs are not practice owners,’ its authors write.
 
‘For some, the income is not shared effectively with GPs therefore incentives cannot incentivise the behaviour changes they are intended for.
 
‘We note that general practice incentives may positively influence the infrastructure of practice if this is appropriately administered, thus influencing behaviour of GPs.
 
‘The DoHAC must closely consider the split between funding to individual GPs and other providers and to the practice, cognisant of the payroll tax issue as some incentive payment flows are a potential concern for payroll tax.’
 
They also highlighted the impact of red tape, a view reinforced by a newsGP poll last year in which 87% of respondents reported finding the practice incentive programs to be an administrative burden.
 
‘Historically, incentives have been rigid and have not provided appropriate flexibility to enable practices to respond to evolving circumstances,’ the submission notes.
 
‘While maximising the practice and workforce incentive programs can otherwise improve financial sustainability for general practices, continued support to navigate the complex requirements of these programs, and adequate flexibility in the future is essential.’
 
Dr Higgins believes that the changes outlined in the submission could make a fundamental difference to patient care.
 
‘While [the practice incentive programs] need to be redesigned, they are key to ensuring disadvantaged patients, including in rural areas, can get the care they need, and the practices serving them stay viable,’ she said.
 
‘However, they come with significant administrative burden, and there is a lot of room for improvement and simplification, so GPs have more time to spend with their patients.’
 
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Dr Helen Louise Schinckel   23/01/2024 12:35:20 PM

Stop siphoning money off to random item numbers- the answer is simple- pay for the work done to the doctors who do it - double the rebate for level b and level c consults so doctors actually get a pay rise not cut when they start general practice. Otherwise general practice will continue to die


Dr Michael Lucas Bailey   23/01/2024 1:39:55 PM

It was called the “4 Year Old Health Assessment” and was billed as a health assessment. It was removed from the MBS because it was claimed there was no evidence for it, if I recall correctly. Is the indication now that it is needed as a PIP to support practice owners and corporates? Clinically I found it well structured and useful at the time.


Rural GP   23/01/2024 2:22:55 PM

The yield for this type of screening has to be pretty low. Most parents have alreaDY raised their concerns, they dont need a new item number and a RN tick box . Cant think of any new diagnosis arisen because of a 4 year old health check, over my career.
What would make a difference? Where is the best bang for the buck?
A: Give us 55-60 health check item ( like the 45-50) and just get out of the way. This where CVS health checks and cancer screening get real.