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09 Sep 2019

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

General practice as a career can offer great diversity. As GPs, we deal with patients across all walks and stages of life. We deal with all manner of issues across the spectrums of physical and mental health. There is also great diversity in how we work. Some of us own the practice we work in, either solely or in partnership, some of us are independent contractors, others are employees. While the diversity our career provides is a strength, it can also serve to fragment us on occasion. Recent calls to delay the introduction of the Practice Incentive Program (PIP) Quality Improvement Incentive (QII) a recent example.

As a long-time member of the AMA and as Chair of the Council of General Practice, balancing the diverse views of the profession is often a challenge. The AMA nevertheless endeavours to consider the great breadth of perspectives and embark on a course of action that will best serve the general practice profession and our patients.

For the better part of the last decade the AMA has been working towards seeing GPs better supported and rewarded for providing quality care in a rapidly changing environment. Furthermore, the AMA wants to see the central role of general practice in the provision of cost-effective, holistic and comprehensive care for its patients recognised and appropriately funded.

For most of that time the AMA has been working with other key organisations and the Department of Health through the PIP Advisory Group (PIPAG) to bring the QII to fruition. This work focussed on developing and implementing an incentive that would better support more general practices and equip them with information to direct and drive their quality improvement activities; an incentive that would support continuous quality improvement in both the delivery of best practice care and patient outcomes.

Central to any quality improvement activity is the collection of data. Data that provides information about where things are at, and how they are improving. In developing the QII, it was important for the AMA that all PIP eligible practices could undertake their own quality improvement journey, while demonstrating collectively the value of general practice within the health system. Regardless of where practices sat on the quality improvement continuum, the AMA wanted all PIP eligible practices to be supported in establishing their own base line data against which they would assess their progress.

Also important was ensuring the privacy of patient, practitioner and practice, and minimising any unintended consequences, particularly those that work against the quality of patient care. Such as those seen with the introduction of the Quality Outcomes Framework in the UK, where the focus is more about the measure than the patient. Due consideration was given to the appropriateness of measures, what data would inform those measures and the framework that would govern the collection and use of the data.

Ensuring this new incentive was appropriately funded and did not replace other valuable incentives such as the GP Aged Care Access Initiative, the Procedural GP payment and the Indigenous Health Incentive was a high priority for the AMA. For the AMA, it was important the incentive supported general practices rather than the commercial interests of some third party.

For those who think a quality improvement incentive has been a long time coming, you are correct, it has. A lot of discussion, concern raising and addressing, and work has gone on to get the incentive to the starting blocks. While some transitional issues are still being worked through, the overall response of general practice to the incentive is reassuring and it is time to move forward with no more delays. At last advice, more than 4,000 general practices, that is two-thirds of PIP eligible practices, are now registered for the QI Incentive.


Published: 09 Sep 2019