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10 Oct 2017

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

Since the introduction of the Practice Incentive Program (PIP) the nature and number of incentives have been regularly reviewed and modified. The AMA has generally supported this so that the PIP remains fit for purpose as general practice and health care delivery evolves. However, in recent years, the PIP has been conveniently targeted by Government in the quest for budget savings or to fund other programs.

With over 5,400 practices participating in the program[1] and around 83 per cent of general practice care in Australia provided by PIP practices[2], the reach of PIP is extensive. PIP payments are a critical component of practice funding and when that funding is cut – it hurts.

In a sector that is already underfunded, changes to the PIP can mean the difference between a profit and loss. It can make it even harder to deliver quality care and it undermines within the profession the value of accreditation and the benefits of professional standards of practice.

The PIP over the last two decades has helped to drive initiatives such as:

  • the computerisation of practices and active use of practice data and systems to improve the quality of patient care;
  • improved vaccination and cervical screening rates;
  • ensuring access to after hours services and attendances at aged care facilities;
  • encouraging rural proceduralists to maintain their skills;
  • ensuring medical student exposure to general practice;
  • encouraging practices to employ and utilise the skills of practice nurses; and
  • enhanced care for those with specified chronic conditions.

In March 2018, if all goes to plan, five PIP incentives will be replaced with a Quality Improvement Incentive. The new incentive aims to support continuous quality improvement. The incentives that will be replaced are the Quality Prescribing, Cervical Screening, Asthma, Diabetes, and the Aged Care Access.

While this new incentive has the potential in time to see general practices better rewarded for quality improvement, the penny pinching approach by Government threatens its success. Instead of investing new money in the new incentive, the Government has chosen to rob Peter to pay Paul.

Indeed, if the funding pool from ceasing incentives is anything to go by, we estimate many practices will be worse off under the Government’s planned reforms, a scenario the AMA has consistently warned of.

The AMA has taken this issue up with the Minister for Health. An outcome where practices are effectively penalised for taking steps to improve quality in their practices is health policy gone mad. Practices will desert the PIP and, what started out as a good idea, will be completely undermined by the insistence on a cost neutral approach to reforms. It’s a false economy that fails to recognise the benefits of further investing in quality general practice.

The introduction of changes to the PIP e-health incentive should have been an important lesson in how not to implement changes to the PIP. In the absence of new money, the Government simply tried to tack on a new requirement to upload shared health summaries to the MyHealth record. Predictably, many practices pulled out or failed to meet new targets.

Confidence in the PIP is now at an all-time low. Unless the Government rethinks its approach to the QI incentive, it risks further undermining the PIP and adding more financial pressure to an already stressed sector that is the backbone of our health system.

 


 

Published: 10 Oct 2017