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Final Review of General Practice Incentives report revealed
It recommends a suite of changes which, if accepted, would see GPs’ incentives undergo a major shakeup, including a new payment architecture and a shift in the foundation of general practice.
The Federal Government will now take time to consider the review’s four key recommendations.
A new funding architecture for general practices could be on the way, after an Expert Advisory Panel handed down its highly anticipated Review of General Practice Incentives.
Released on Tuesday, the report made four recommendations to the Federal Government, focusing on current and future payments to general practice, as well as laying bare the current issues facing Australian patients.
Through these recommendations, the panel called for:
- a simplified general practice payment architecture
- support for quality care
- independent pricing of general practice and primary care payments
- effective transition to the new payment model.
The panel was tasked with assessing the efficiency of existing incentives, including the Practice Incentives Program, (PIP) and Workforce Incentives Program (WIP), and to redesign the current incentive programs through a ‘shared vision for the future of general practice’ by 2032.
‘The panel envisages a primary care system that is funded using a blend of fee-for-service and other payments made directly to practices,’ its final report concluded.
This would see an average of 60% of a practice’s income coming from fee-for-service payments, down from 90% now, and the extra 40% to allow for other health professionals to join primary care teams.
The panel is also calling for the ratio of GPs to other health professionals to shift in the future to about one to one.
The RACGP has backed some items within the report, including appropriately funding change management activities, commissioning an independent primary care pricing authority, and adopting a phased approach to implementing the reforms.
However, it says more work is needed to ensure these significant changes are fit-for-purpose and will improve patient outcomes.
Importantly, coordinated and continuous care delivered by a patient’s GP and the general practice teams they lead is essential. GPs must be at the centre of healthcare for improved patient outcomes.
The college also raised concerns about the report’s continuous conflation of general practice with primary care, saying that funding for general practice cannot be effectively split over many providers and could lead to care fragmentation and a two-tier system.
The panel’s first recommendation is for a new opt-in, simplified general practice payment architecture that ‘better supports community and patient needs and encourages high-quality, accessible and multidisciplinary care’.
It says this should include a new Baseline Practice Payment which gives practices flexibility to use the funds to provide multidisciplinary care to their populations, and includes funding for coordinating the primary care team, and is calculated based on patient needs, socio-economic status and location.
It also wants funding to promote quality and innovation, teaching, after-hours care and targeted initiatives, to require general practices to participate in MyMedicare to access these payments, and for practices to provide comprehensive service delivery information and data.
‘The panel believes the new payment architecture will require increased Australian Government investment to ensure its effectiveness, fund the necessary change supports, and ensure practice viability during and after the transition,’ it said.
It wants the Commonwealth to keep the WIP–Doctor Stream and the WIP–Rural Advanced Skills Stream in the short term as an incentive to doctors working in rural and remote areas.
‘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 said.
‘In doing so, the new Baseline Practice Payment should continue to support rural and remote workforce objectives, such as maintaining services and increasing comprehensive primary care in underserved communities.’
It says that within three years, the Government should consider the evidence and impact of redirecting WIP funding from providers to practices.
The RACGP welcome this change in the final report following its strong advocacy and member feedback, after previous reports recommended that WIP funding be redirected.
It also urged the Federal Government not to rush into any reforms without considering any unintended consequences, and that it should commit to increased funding for patients, specifically through general practice.
The report makes a clear recommendation on deep partnership and engagement with the primary care sector during the design and implementation of these reforms, including investment in education and training as the sector transitions to the new payment model’.
However, the RACGP said more needs to be done to ensure effective consultation and partnership with GPs across Australia.
The panel’s second recommendation is for the Federal Government to invest in enabling reforms such as accreditation and a performance framework, and that this should support the new payment architecture.
Thirdly, it recommended independent pricing of general practice and primary care payments.
The panel said an independent primary care pricing authority should be established to provide advice on the design and pricing of Commonwealth payments to general practices and primary care providers.
This authority would provide advice to the Health Minister on the payment design and level of MBS rebates and other Commonwealth payments.
According to the panel, it will also make evidence-based recommendations on the costs of providing team-based primary care services ‘that will underpin pricing recommendations to the Minister’, add to publicly available data on the primary care sector, and support its ongoing design.
Finally, the panel has recommended the Federal Government facilitate an ‘effective transition to the new payment model’.
It said this transition must include a phased approach to implementing the reforms, extra funding for new general practice payments under the new payment architecture, and funding and support for change management activities to enable general practices to transition to new arrangements.
The review clarified that payments and funding to other types of primary care organisations was not in its scope and not considered and is also calling on the Federal Government to separately consider how it can ensure the ongoing sustainability, expansion and integration of these services.
It also stated that the PIP Indigenous Health Incentive is outside of its scope but urged that the current three-year transition to new arrangements be implemented and evaluated before considering further redesign.
The Federal Government will now consider the recommendations.
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