Voluntary patient enrolment - the facts

We have heard your feedback and, like you, we recognise the critical need for Medicare rebate reform to ensure longer, more complex consultations attract rebates that reflect the extra resourcing involved. AMA believes this should always be delivered through a fee-for-service Medicare model. 

Whole-of-healthcare reform is critical
General practice is the bedrock of healthcare in Australia. It’s also under enormous strain and many practices are struggling to deliver quality healthcare and remain financially sustainable under the current Medicare system. Practices have closed down and continue to close down due to financial and workforce pressures. 

Quality general practice is being compromised by decades of funding neglect by the Australian Government, the establishment of pop-up telehealth services, high-throughput clinics that restrict patients to one health problem at a time, and government initiatives to extend the scope of practice for other professions to autonomously diagnose and prescribe.  The relentless fragmentation of care from all quarters is rapidly eroding the continuity of care that underlies the benefits of primary care delivered by GPs.

The current Medicare funding model is not fit for purpose. Appropriately indexing the rebates is absolutely essential for general practice. GPs deliver 180 million services each year. Increasing each of those by $10 will cost $1.8 billion. 

However, indexing rebates alone does nothing to protect the essential GP-patient relationship. 

Funding reform is critical and requires a framework on which to build that reform.  The AMA, along with the RACGP, supports the Australian Government’s Primary Health Care 10 Year Plan 2022-2032.

Implementing voluntary patient enrolment (VPE) is one of many pillars of reform that have been recommended in the plan. And they are all still recommendations. 

VPE is not capitation
Capitation refers to a payment arrangement for healthcare service providers in which the provider (eg a doctor or group of doctors) receives a set payment for every patient attributed to them, regardless of the number of times the patient seeks care. 

VPE is not capitation, and the AMA does not and will not support a move to capitation. Fee for service must remain the bedrock of GP funding, supplemented by other funding streams. We continue to advocate for improved funding for FFS MBS items.

Why VPE?
Voluntary patient enrolment with a GP or a practice establishes a formal relationship with the patient, providing a basis for shared goals and outcomes.  This in turn provides a framework for funding reform that rewards continuity of care.  For example, chronic disease management plans and health assessments would be linked to these relationships. 

This funding is in addition to – not instead of – Medicare fee for service.  The move to blended payments is well established with Practice Incentive Payments.

While it’s well known in our profession that many patients are loyal to their GP, VPE gives the government a means, for the first time, to formally recognise that relationship. The data generated and provided to government brings to light the critical work of GPs that until now has been invisible to government. 
 
VPE is only part of the solution
The AMA supports VPE, provided it is designed appropriately, strengthens the position of general practice in our health system, and provides a basis for government to deliver extra investment into general practice.  AMA Queensland will oppose any initiatives that do not increase funding into general practice.  No funding, no reform.

VPE aims to build upon the position general practitioners hold as the experts in primary healthcare, by supporting better team-based preventative care and chronic disease management. 

It will help to protect the GP-patient relationship from fragmentation.

We know VPE is only one part of the solution. That’s why we’re calling for other reforms to support a thriving and viable general practice sector, including:

• a review of MBS indexation to ensure it reflects the rising costs of providing high-quality medical care and running a medical practice:
• funding to enable general practitioners to provide team-based care
• funding to support GPs to:
  • provide after-hours care
  • provide chronic wound care
  • provide complex care and mental health care
  • spend longer with patients 
  • work in rural and remote regions
  • train the future generation of GPs
  • attract and retain nursing and administration staff.     

These policy asks are the core of the AMA’s advocacy for GPs in addition to, and separate from, VPE. 

Safeguarding support for GPs
We believe that, if implemented properly, VPE should improve the support available to GPs to improve patient quality of care and outcomes, improve access, decrease duplication of services and reward GPs for providing continuing, comprehensive care.

The AMA and RACGP have agreed on a set of key principles that must underpin any VPE model to ensure any reform delivers value to the community, to general practitioners, and to the health system and we have provided this to Health Minister Mark Butler to inform the Strengthening Medicare Taskforce, of which the AMA is a member.  

Over the next few months, we will continue to engage with you, our members, through a variety of forums and channels on how we can achieve reform in this space together.

Read more about our 7-point plan to Modernise Medicare.