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Incentives hold out promise of better after hours care

The Federal Government has promised patients will find it simpler and easier to see a GP at night or on weekends following the reinstatement of incentives for medical practices to provide after hours services.

In a move strongly supported by the AMA, Health Minister Sussan Ley has announced that almost $99 million will be provided next financial year to pay practices that operate extended hours or make arrangements for their patients to receive after hours care.

Ms Ley said access to after hours GP care was an issue that was raised consistently during her consultations with the medical profession and the community since becoming Minister, and the incentive would give “positive support” to practices that ensured their patients had access to after hours care.

The reinstatement of the incentive was a key recommendation of the review of after hours primary health services led by Professor Claire Jackson, and followed widespread dissatisfaction with the arrangement under the previous Labor Government to give Medicare Locals responsibility for co-ordinating and funding after hours services.

AMA President Associate Professor Brian Owler applauded the Minister for moving so swiftly to reinstate the Practice Incentives Program After Hours Incentive.

A/Professor Owler said the AMA had been calling for the return of the PIP funding “for some time” because of the benefit it would provide to both patients and practices.

“The new PIP payment structure will encourage and support general practices to provide after hours coverage for their patients, which will in turn ensure continuity of care,” the AMA President said. “Individual practices will now have greater control over after hours services for their patients, [and] patients will benefit.”

To pay for the reinstatement of the PIP incentive, the Government has scrapped the After Hours GP Helpline and redirected funds freed up by the abandonment of the Medicare Locals network.

Though some complained that the Helpline has provided a vital service, the Jackson review found there was little evidence it had reduced the pressure on rural doctors to attend after hours call-outs or improved continuity of care. It recommended that the service be scrapped and the funds instead directed into GP incentives.

While details of eligibility requirements for the incentives are yet to be released, the scheme –which commences on 1 July – will offer five payment levels depending on the degree of service provided.

They range from the very basic, level 1 service involving “formal” arrangements for patients to seek after hours care at another provider, through to a full service model where a practice has staff rostered on around the clock, seven days a week.

The incentive would rise from $1 for each Standardised Whole Patient Equivalent (an age-weighted measure based on GP and other non-referred consultation items in the MBS) at a level 1 practice, rising to $11 per SWPE at the top end.

The Minister said all practices would be required to inform patients of their after hours arrangements, and to ensure that correct details were provided in the National Health Service Directory.

“Under these new arrangements, patients will be able to easily find out what after-hours services are available, including services provided by arrangement outside of the patient’s usual general practice,” Ms Ley said.

The reintroduction of the after hours PIP has coincided with the Federal Government’s move to scrap Medicare Locals and replace them with larger Primary Health Networks.

Importantly, the Government has specified a different role for PHNs regarding the provision of after hours services than that fulfilled by the Medicare Locals.

Under the new arrangement, PHNs will be required to work with “key local stakeholders” to plan, co-ordinate and support after hours health services, with a particular focus on “addressing gaps in after hours service provision, ‘at risk’ populations and improved service integration”.

A/Professor Owler said the change in focus and function was welcome.

“The Government has listened and responded to AMA concerns about giving responsibility for after hours funding to Medicare Locals, which has proven to largely be a failure and simply increased red tape for practices,” the AMA President said. “While the new Primary Health Networks will still have a role to play in ensuring community access to after hours health services, their focus will be on gaps in service delivery.”

Adrian Rollins