Red tape fix needed to improve aged care incentive

Insufficient financial incentives, administrative complexity, onerous clinical service requirements and disrupted continuity of care are plaguing the General Practice in Aged Care Incentive (GPACI).
 
That is according to an early insights report examining the first six months of uptake, effectiveness and sustainability of the program and whether it is fit for purpose.
 
The report reveals key challenges GPs are facing, reiterating initial sentiments aired before the program was launched a year ago.
 
The RACGP provided feedback about the size of the incentive and administrative requirements in a letter to Federal Health and Ageing Minister Mark Butler when the GPACI was implemented and wrote to him again more recently with feedback received from members, suggesting ways the incentive could be reformed to work better for patients and GPs.
 
Based on survey data of GPs and practices, Primary Health Networks (PHNs), aged care facilities, residents and their families, the insights report tracks feedback from the GPACI rollout, stakeholder experiences, and identifies ‘emerging challenges’.
 
Since the lead up to its launch on 1 August 2024 as the first incentive delivered through MyMedicare to ‘improve access to proactive, continuous, and coordinated primary care for aged care residents’, GPs and practices have expressed dissatisfaction with the GPACI and say there is room for improvements.
 
Initial uptake of the program has been strong with, as of November 2024, more than 82,000 aged care residents registered under MyMedicare and the GPACI, and more than $14.3 million paid to general practices and providers.
 
Eligible care planning services have also risen, indicating ‘early signs of improved proactive care to be explored in later years’.
 
However, Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, told newsGP while the incentive is an important reform in the delivery of aged care, work is still needed to boost uptake and efficiency.
 
‘The overall sentiment after one year of the GPACI’s launch can be characterised as “cautious optimism overshadowed by frustration”,’ he said.
 
‘I applaud the intent – there is strong agreement that recognising and funding GPs’ work in aged care is overdue and is essential – but in relation to execution, sentiment is negative.
 
‘Many feel let down that a program meant to help has instead added to their workload in unproductive ways.’
 
Insights from the report, commissioned by the Department of Health, Disability and Ageing (DoHDA), reveal that excessive administrative complexity remains the main barrier, with the double registration process required for both MyMedicare and the GPACI, and tracking of service delivery per patient described by GPs as ‘overly burdensome’.
 
‘By far the most common complaint is that the GPACI introduced too much bureaucracy into what is already a logistically difficult service area, furthermore compounded by challenges in registering patients in aged care to MyMedicare,’ Dr Marinucci said.
 
‘The strict requirements of eight monthly visits plus two care plans per year for each patient are also seen as onerous and inflexible by many practitioners.’
 
Backed by multiple surveys, including a newsGP poll conducted ahead of the GPACI’s launch, GPs are still saying there is insufficient financial incentive to take part.
 
Dr Marinucci said the payment amount of $300 per year per patient for the GP and $130 for the practice is ‘widely viewed’ as too low to compensate for the time and complexity of providing high-quality care in aged care facilities.
 
The incentive’s design also lends more benefits for larger practices, with survey responses indicating smaller practices and GPs with fewer aged care patients are finding the model less viable.
 
‘The GPACI’s structure seems to favour high-volume providers, which inadvertently penalises small general practices or solo GPs,’ Dr Marinucci said.
 
Continuity of care also remains a challenge, as most residents change GPs when entering aged care, and only 20% of residents retained their previous GP, according to the report, but at the same time reported moderate satisfaction with GP care.
 
Dr Marinucci says this can lead to uncertainty around patient outcomes.
 
‘Is the GPACI improving care for residents in tangible ways? There are a few encouraging signs,’ he said.
 
‘Medicare data showed a 25% rise in comprehensive care planning services.’
 
The 25% increase of total eligible care planning services in the first six months after the incentive launch is compared to the same period in previous years (2021–24), which the report states is indicative of the need to explore improved proactive care.
 
Also noted in the report, is the need for PHN roles to be strengthened. Delays in funding and ‘unclear expectations regarding their role’ impacted PHNs’ effectiveness in supporting implementation and timely support to general practices during the GPACI’s early rollout phase.
 
The DoHDA states that comprehensive monitoring and evaluation of the GPACI is in place from 2024 to 2027, with the early insights report a ‘baseline of initial monitoring and evaluation data’, to be used for future assessment and policy decisions.
 
The Federal Government will continue to work closely with stakeholders to address findings from the monitoring and evaluation.
 
Dr Marinucci warns the ongoing challenges need to be addressed using the feedback from GPs and other stakeholders.
 
‘Unless we fix the red tape, uptake will wane, and potentially even worse – the added burden on GPs may be causing some to reduce aged care visits or quit altogether,’ he said.
 
‘This is counter-productive to the original intent of the program.’
 
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