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Outcome 5 - Primary Care

Access to comprehensive, community-based health care, including first point of call services for prevention, diagnosis and treatment of ill-health, and for ongoing management of chronic disease.

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Outcome Summary

Outcome 5 aims to provide access to cost-effective community-based primary care, and ensure a stronger primary health care system. The department worked to achieve this outcome by managing initiatives under the programs outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 5 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 5 was managed in 2009-10 by the Primary and Ambulatory Care Division, the Health Workforce Division, the Mental Health and Chronic Disease Division and the Medical Benefits Division. The department’s state and territory offices also contributed to the achievement of the outcome.

Programs Administered under Outcome 5 and 2009-10 Objectives

Program 5.1: Primary Care Education and Training

Support high quality training for GP registrars.
Strengthen general practice education and training.
Provide access to GP registrars.

Program 5.2: Primary Care Financing, Quality and Access

Improve access to primary care.

Program 5.3: Primary Care Policy, Innovation and Research

Improve service delivery.
Help GPs to access best business practices.
Foster a primary care system focusing equally on prevention, diagnosis and treatment.

Program 5.4: Primary Care Practice Incentives

Encourage general practices to improve the quality of care provided to patients, encourage behavioural changes and continue improvements in general practice.

Major Achievements

The National Primary Health Care Strategy was released, which provides a framework through which better frontline care can be delivered to all Australians.
A total of 21 GP Super Clinics were either completed, provided early services or were under construction by 30 June 2010. This included nine GP Super Clinic funding recipients providing early services while the construction of the new clinics is being completed. This included the GP Super Clinics in Ballan, Strathpine and Port Stephens becoming operational.
The number of general practice training places on the Australian General Practice Training program increased to 700 in 2010 and placements on the Prevocational General Practice Placements program increased to 380. This will support the growth of the general practice workforce, particularly in areas experiencing workforce shortage.
Strengthened general practice education and training by improving the regional training provider network and providing better training arrangements for junior doctors and general practice registrars to ensure sustainable growth.
Ninety-five Indigenous Health Project Officer positions and 43 Aboriginal and Torres Strait Islander Outreach Worker positions were funded.
One hundred health service provider grants were offered to improve after-hours primary care services in Australia.
The take up rate of 14.6 per cent of the eligible children for the Medicare Benefits Schedule Healthy Kids Check is well above the 10 per cent target.

Challenges

High level of complexity in implementing Indigenous health programs within mainstream primary health care.

Program 5.1: Primary Care Education and Training

Program 5.1 aims to ensure the community receives high quality general practice services by supporting general practice education and training, and providing access to GP registrars throughout Australia.

Key Strategic Directions for 2009-10

The department’s strategies to achieve this aim were to:

provide high quality training for general practice registrars; and
provide access to general practice registrars in all areas of Australia including rural, remote and outer metropolitan locations.

Major Activities

High Quality Training for GP Registrars

Expanding and Refining General Practice Training

The department funds General Practice Education and Training Ltd to manage general practice training nationally. The delivery of training is subcontracted to a network of regional training providers. The 2009-10 Budget introduced changes to achieve efficiencies in the Australian General Practice Training program and the Prevocational General Practice Placements program. The role of General Practice Education and Training Ltd was expanded to include the management of the Prevocational General Practice Placements program which was transferred from the two general practice colleges commencing on 1 January 2010. This streamlines the administration of the program and better integrates and aligns it with the Australian General Practice Training program, ensuring a more cohesive approach to general practice training.

The regional training provider network was reviewed and restructured with a number of providers merging, reducing the network from 21 to 18 providers. Merger negotiations are continuing with two other providers, with a resolution expected in late 2010. These mergers have resulted in an improved delivery platform that retains a regional focus and continues to deliver quality general practice training.

Strengthened General Practice Platform and More Training Places

The department continues to work with General Practice Education and Training Ltd to increase training places on the Australian General Practice Training program. This resulted in 75 extra places in 2009 and 100 places in 2010 bringing the total intake for each year up to 675 in 2009 and 700 in 2010. All places on the training program were filled and the benchmark of fifty per cent of registrars training in rural and remote locations was met. The department and General Practice Education and Training Ltd are working together to manage the future expansion of general practice training places which will see the number of training places double from 600 in 2008 to 1200 new places each year from 2014. The department is also providing additional funding for remote training to increase the number of training places on the Remote Vocational Training Scheme from 15 to 22 places ongoing from 2011. Communities across Australia will benefit from improved access to general practice services as a result of these increases as registrars deliver services while they train.

During 2009-10, the number of placements on the Prevocational General Practice Placements program was boosted from 280 to 380 placements in 2010. The department will work with General Practice Education and Training Ltd to manage further increases that will see the number of placements more than double from 380 in 2010 to 975 placements in 2012 onwards. These increases will enable more junior doctors to experience general practice and free up capacity within the hospital system to accommodate more interns.

Access to GP Registrars

Supporting the General Practice Workforce

A possible barrier to doctors taking up general practice was removed by simplifying the rules of the Australian General Practice Training program. In 2009-10, the department and General Practice Education and Training Ltd amended the rules of the program to provide doctors with more flexibility in where they complete their training including a range of options to meet program requirements by working in areas of workforce shortage.

The expansion of general practice training is reliant on attracting and retaining more quality supervisors to meet the increased demand for training. To achieve this, in
2009-10, the level of remuneration provided to supervisors was increased. The department implemented this increase through its funding arrangements with General Practice Education and Training Ltd.

Support for Rural and Remote Workforce

In 2009-10, the Australian Government provided funding to the CRANAplus Bush Support Services (BSS) (formerly known as the Bush Crisis Line) to assist health practitioners manage the stress associated with rural, remote and very remote practice.
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Performance Information for Outcome 5

Program 5.1: Deliverables

Qualitative Deliverables

High Quality Training for GP Registrars
Qualitative Deliverable:	Timely production of evidence-based research.
Result: Deliverable met.
General Practice Education and Training Ltd provides the department with regular policy and data reports that cover key policy and operational issues impacting on the Australian General Practice Training program and the Prevocational General Practice Placements program, including progress in implementing the business activities and directions outlined in the Minister’s Statement of Expectations. An analysis of the distribution of training places on the Australian General Practice Training program was undertaken following the introduction of the new Australian Standard Geographical Classification - Remoteness Area geographical classification system. The analysis is informing General Practice Education and Training Ltd’s approach to the allocation of training places in 2011.
Qualitative Deliverable:	Regular stakeholder participation in program development, through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
The department liaised regularly with General Practice Education and Training Ltd and other stakeholders including Remote Vocational Training Scheme Ltd and General Practice Registrars Australia to discuss and resolve issues associated with general practice training including the impact of changes to the regional training provider structure and the significant increases in training places.

Quantitative Deliverables

High Quality Training for GP Registrars
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-1.5%
Result: Deliverable not met.
In 2009-10, the HECS Reimbursement Scheme was a demand driven program that underspent its appropriation due to an overestimation of the number of participants eligible for payment. From 1 July 2010, the HECS program was merged with the Scaling Rural Health program and funding has been increased to accommodate the anticipated increase in the number of participants. In 2010-11, the department will conduct a comprehensive dissemination strategy to raise awareness of the new HECS Scheme and to increase participation rates.
Quantitative Deliverable:	Number of general practice training places filled on the Australian General Practice Training program.
2009-10 Target:	675	2009-10 Actual:	675 in 2009 700 in 2010
Result: Deliverable met.
General Practice Education and Training Ltd, which manages the Australian General Practice Training program, filled all 675 training places offered in 2009. The number of training places was increased to 700 for 2010. All 700 places were filled with a record 1010 eligible applications being received for that training year.

Program 5.1: Key Performance Indicators

Quantitative Key Performance Indicators

High Quality Training for GP Registrars
Quantitative Indicator:	Number of new general practice training places filled on the Remote Vocational Training Scheme.
2009-10 Target:	15	2009-10 Actual:	15 in 2009 15 in 2010
Result: Indicator met.
Remote Vocational Training Scheme Ltd filled all 15 places offered on the program for 2009 and 2010.

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Program 5.2: Primary Care Financing, Quality and Access

Program 5.2 aims to improve access to primary care through initiatives to expand the number of health care services, improve patient management of chronic disease, influence the quality and standard of rural health care services, provide after-hours health services, improve access to health services for women and Indigenous people, and by introducing a new funding formula for Divisions of General Practice.

Key Strategic Direction for 2009-10

The department’s strategy to achieve this aim was to:

improve the availability and quality of primary care services for Australians.

Major Activities

Improved Availability and Quality of Primary Care Services

GP Super Clinics

GP Super Clinics bring together general practitioners, nurses, visiting medical specialists, allied health professionals and other health care providers, to deliver primary health care that is tailored to the needs and priorities of local communities. The clinics support primary health care providers to deliver multidisciplinary team-based care, and aim to better integrate Australian, state and territory, and local government funded services. In 2009-10, the department worked to establish GP Super Clinics around the country, collaborating with state, territory and local governments and funding recipients.

A total of 21 GP Super Clinics were either completed, provided early services or were under construction by 30 June 2010. This included nine GP Super Clinic funding recipients providing early services while the construction of the new clinics is being completed. This included the GP Super Clinics in Ballan, Strathpine and Port Stephens becoming operational.

GP Super Clinics in these communities are now providing better access to multidisciplinary, team-based primary health care services tailored to community needs, focused on improving the management of chronic disease and promoting better preventative health care.

In addition to continuing to implement the original 36 Super Clinics outlined above, in 2010-11, the department will also implement the Australian Government’s National Health and Hospitals Network¹ program Improved Primary Care Infrastructure. The program will improve the quality and accessibility of primary health care services by investing in the construction of about 23 additional GP Super Clinics. In 2010-11, the department will commence offering grants for the new GP Super Clinics announced in the 2010-11 Budget. Grants will also be offered under the Primary Care Infrastructure Grants initiative which will assist around 425 existing general practices, primary care and community health services and Aboriginal Medical Services to enhance their existing facilities to improve access to integrated general practice and primary health care and support the development of the future health workforce. The department opened the 2010-11 grant round for the Improved Primary Care Infrastructure grants in June 2010.

After Hours Program and National Health Call Centre

The National Health Call Centre Network operates under a single national name Healthdirect Australia². Healthdirect Australia’s registered nurses are supported by electronic decision making software which assists nurses to provide accurate health triage advice. The registered nurses assess callers’ symptoms and direct patients to the most appropriate level and point of care. This may be to a GP, an emergency department, or self care. People can access information and advice 24 hours a day, seven days a week. In addition, people can contact Healthdirect Australia for comprehensive information on illnesses and health conditions, including advice for the self-management of symptoms and healthy lifestyle. They can also find the details of their local health services.

The National Health Call Centre Network operates in the Australian Capital Territory, New South Wales, the Northern Territory, South Australia, Tasmania and Western Australia. In 2009-10, Healthdirect Australia answered 760,195 telephone calls.

The department in 2009-10 worked closely with the National Health Call Centre Network to establish the new Pregnancy, Birth and Baby Helpline³. The helpline will improve the range and accessibility of objective and dependable pregnancy, birthing and maternity related information and support to assist women, their partners and families in making decisions. The department will continue to work with the network and maternity-related services in 2010-11 to ensure the helpline and related website are successfully implemented and delivered.

In 2010-11, the department will start to implement the Australian Government’s National Health and Hospitals Network program Improving Access to After Hours Primary Care. The department will develop a telephone-based GP medical advice and diagnostic helpline which will be added to the Healthdirect Australia service from 1 July 2011, providing access to GP care outside normal practice hours.

The department will also continue to work with states and territories, and the National Health Call Centre Network to explore new initiatives that can be delivered through the network’s infrastructure platform. The platform has the capacity to support additional services and assist in emerging health surveillance threats and emergency situations.

The General Practice After Hours Program improves access to doctors outside normal business hours by providing grants to support the viability of after hours general practice services. The grants assist people across Australia to see a doctor for urgent care after hours, without having to visit a hospital emergency department.

The department through this program awards about 100 grants annually to assist new and existing after hours general practice services to meet their operating costs. In 2009-10, 100 new grants were awarded. Grants are offered to a maximum of $100,000 (GST exclusive) over two years. Services funded under the program included general practices and medical deputising services.

In addition, the department continued to administer funding arrangements with 204 after hours services that were awarded grants in previous years to support community access to primary health care services.

New funding arrangements from 1 July 2013 will be introduced through the newly established Medicare Locals, to support the provision of face-to-face after hours primary care services at the local level. Once implemented, this measure means that together with the telephone-based GP medical advice and diagnostic helpline, anyone, anywhere in Australia will be able to access after hours primary care services via telephone and if needed, be directed to a local after hours primary care provider.

New Funding Formula for the Divisions of General Practice Program

A new funding formula for the Divisions of General Practice Program, introduced in January 2010, will benefit patients, GPs, primary health care professionals and local communities by introducing updated demographic data to provide a stronger basis for determining core funding allocations for Divisions of General Practice. In 2010-11, the funding allocations based on the new formula will enable all divisions to continue to provide services to local communities and to support general practitioners.

Engaging Divisions of General Practice to Improve Indigenous Access to Mainstream Primary Care

The department continued its commitment to improve health outcomes for Aboriginal and Torres Strait Islander people and commenced delivery of the Council of Australian Governments’ National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. Through the Divisions of General Practice Network, funding was provided to assist mainstream primary care services to provide culturally-sensitive care for Indigenous Australians.

Under the Engaging Divisions of General Practice to Improve Indigenous Access to Mainstream Primary Care Program, the department is providing funding over three years, for 80 full time equivalent Indigenous Health Project Officer positions, in 90 Divisions of General Practice. In 2009-10, the department funded 80 full time equivalent new positions. Positions are also being funded in the Australian General Practice Network, state-based organisations, the National Aboriginal and Community Controlled Health Organisation and its state and territory affiliates. In 2009-10, the department funded 15 full time equivalent new positions in these organisations. Project officers are providing a focus on Indigenous health issues at the local level and helping the community, mainstream primary care providers and Indigenous health services work together to improve health outcomes for Aboriginal and Torres Strait Islander people.

The department also funded 43 Aboriginal and Torres Strait Islander Outreach Worker positions in 2009-10. Local Aboriginal and Torres Strait Islander people are working to identify individuals who would benefit from improved access to health services. Outreach workers are undertaking non-clinical tasks such as assisting Aboriginal and Torres Strait Islander people to visit a GP, attend follow-up care and fill prescriptions. This is helping to increase community engagement with health services, including the uptake of Indigenous health checks. In 2010-11, the department will provide funding for an additional 40 outreach worker positions.

In May 2010, the department engaged the state-based organisations of the Divisions of General Practice Network as fund-holders for delivery of the Council of Australian Governments’ Care Coordination and Supplementary Services Program in all jurisdictions. The program provides better coordinated care and improved access to specialist, allied health and local transport services for Indigenous patients enrolled in general practices participating in the Practice Incentives Program Indigenous Health Incentive. The fund-holders are developing state and territory level implementation plans and the delivery of the Care Coordination and Supplementary Services Program which will commence in late 2010.

During the year, the department faced the challenge of implementing Indigenous health programs within mainstream primary care. To respond to this, the department consulted closely with key medical professional organisations and Indigenous health bodies on implementation arrangements. In 2010-11, the department will manage contractual arrangements for fund-holders that require consultation between mainstream primary care and Indigenous health organisations in program delivery and closely monitor program uptake.

Healthy Kids Check

The Medicare Healthy Kids Check aims to improve health and well-being outcomes for Australian children by encouraging early detection of lifestyle risk factors and physical health issues, and facilitating early intervention strategies. From 1 July 2008 to 30 June 2010, 81,078 Healthy Kids Checks were provided to eligible children.⁴

The department negotiated the second year of funding with all states and territories to promote integration of the Healthy Kids Check with their own services. All funding agreements are in place.

The department during 2009-10 also revised promotional resources for GPs and practice nurses about the Healthy Kids Check item, following the changes to the structure of health assessments as a result of the Medicare Benefits Schedule Review. The promotional resources include a fact sheet, proforma guide to assist medical practitioners and practice nurses in undertaking the Healthy Kids Check, and the Get Set 4 Life Guide for parents of four year old children. These resources are useful tools for GPs and practice nurses when conducting a Healthy Kids Check.

Table 5.2.1: Proportion of Healthy Kids Checks for eligible population

1 Accessible at www.yourhealth.gov.au.

2 Telephone: 1800 022 222.

3 Telephone: 1800 88 24 36.

4 Data from May 2010 onwards consists of services to children in eligible age groups who have received a health assessment under Medicare Benefi ts Schedule items 701 to 707.

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Performance Information for Outcome 5

Program 5.2: Deliverables

Qualitative Deliverables

Improved Availability and Quality of Primary Care Services
Qualitative Deliverable:	Regular stakeholder participation in program development through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
The department conducted regular meetings with key stakeholders throughout the year, including the Australian Medical Association, the Australian General Practice Network, Division of General Practice, the Rural Doctors Association of Australia, and the Royal Australian College of General Practitioners. These meetings provided the department with an opportunity to identify and respond to stakeholders’ concerns and to help shape program and policy development.
Qualitative Deliverable:	The department administers the General Practice After Hours program through annual funding rounds. Successful applicants are offered a Government funding agreement to support the provision of after hours services to their communities. A competitive-based funding process will be administered during 2009-10 and the successful applicants are offered a funding agreement.
Result: Deliverable met.
In 2009-10, the department administered a competitive-based funding round and offered 100 participants a grant to support the provision of after hours services to their communities.
Qualitative Deliverable:	Delivery of a registered nurse-based telephone health triage service in participating jurisdictions. The registered nurse-based telephone triage service is delivered to participating jurisdictions in 2009-10.
Result: Deliverable met.
The department worked with the National Health Call Centre Network to deliver a registered nurse-based telephone triage service to all participating jurisdictions in 2009-10. The service was available to people in New South Wales, the Australian Capital Territory, the Northern Territory, South Australia, Western Australia and Tasmania.

Quantitative Deliverables

Improved Availability and Quality of Primary Care Services
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-3.3%
Result: Deliverable not met.
The administered expenses for Program 5.2 underspent by 3.3 per cent. In 2009-10, the following programs contributed to this underspend: GP Super Clinic expenditure was less than the projected 2009-10 Budget due to delays in meeting construction milestones. External factors (such as local council building planning and approval processes, availability of construction workforce, materials and weather conditions) impacted on funding recipients’ abilities to meet milestones. The department will continue to monitor sites closely in 2010-11 to address potential future milestone slippages and minimise potential future program underspends; the National Health Call Centre Network program underspend was due to planned consultancy work not being conducted and the reduced need for legal services; the Bushfire Relief program had a significant underspend. Funding was originally provided for two mobile GP clinics. The mobile clinics were not needed due to the efforts of the Victorian State and Australian Governments during the initial emergency response; the Women’s Safety Agenda had a significant underspend. In 2009-10, program uptake of domestic violence awareness training by eligible practice nurses and Aboriginal Health Workers was lower than expected. Only small numbers of practice nurses and Aboriginal Health Workers sought financial support to attend training; and Aged Care Access Initiative 2009-10 target of less than 0.5 per cent variance between the actual and budgeted expenses was due to a lower than expected uptake in the GP Aged Care Incentive component of the Aged Care Access Initiative.
Quantitative Deliverable:	Number of grants awarded to establish GP Super Clinics (two grants were awarded in 2007-08 and all grants will be awarded by June 2010).
2009-10 Target:	11	2009-10 Actual:	15
Result: Deliverable met.
During 2009-10, 15 grants were awarded, resulting in a total of 36 grants awarded by June 2010. In 2009-10, the Australian Government announced an additional five GP Super Clinic locations, resulting in a total of 36 GP Super Clinics, across 37 sites, to be established around the country.
Quantitative Deliverable:	Additional workforce for the prevention and management of chronic disease (funding commences 1 July 2009).
2009-10 Target:	71	2009-10 Actual:	117
Result: Deliverable met.
In 2009-10, the department exceeded the target and funded 83 new Aboriginal and Torres Strait Islander Outreach Workers, 20 practice managers and 14 additional health professionals under the Indigenous Chronic Disease Package. Achieving this result in 2010-11 will be a challenge for the department, as workforce shortages across the sector may impede recruitment of additional staff. For more information on this activity, please refer to the Outcome 8 chapter in this annual report.

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Program 5.2: Key Performance Indicators

Qualitative Key Performance Indicator

Improved Availability and Quality of Primary Care Services
Qualitative Indicator:	Increased safety through the dissemination of health information. The National Health Call Centre Network provides a high quality health call centre service in line with COAG expectations. Measured against a number of key indicators including the proportion of calls answered in a specified timeframe and user satisfaction with the service.
Result: Indicator met.
The National Health Call Centre Network (Healthdirect Australia)⁵ assists consumers by providing health information, assessing callers’ symptoms and offering advice on what to do and where to find local health services if further assistance is required to meet their health needs. In 2009-10, the registered nurses working for Healthdirect Australia commonly recommended and advised callers to provide self-care. Healthdirect Australia provided callers with high quality health information, with the five most popular caller requests for information being pandemic (H1N1) influenza, fever, medications, chicken pox and pertussis. Healthdirect Australia also provided callers with contact details and information on locally based services including medical centres, pharmacies, dental services, emergency departments, hospitals, mental health services and community health services, among others. In 2009-10, Healthdirect Australia played an important role during the pandemic (H1N1) influenza 2009 outbreak in Australia, responding to a significant increase in calls to assist callers with their queries and concerns in relation to the disease. Between July 2009 and June 2010, Healthdirect Australia answered 760,195 phone calls, with 87 per cent of calls answered within twenty seconds. Customer satisfaction was high with 99 per cent of users citing they were satisfied or highly satisfied with Healthdirect Australia’s service.

5 Telephone: 1800 022 222.

Quantitative Key Performance Indicators

Improved Availability and Quality of Primary Care Services
Quantitative Indicator:	Number of GP Super Clinics that commence delivery of services, including interim services (it is anticipated that all GP Super Clinics will be operational by end 2011-12).
2009-10 Target:	13	2009-10 Actual:	12⁶
Result: Indicator met.
During 2009-10, three GP Super Clinics became operational and nine GP Super Clinic funding recipients commenced the provision of early services, while construction of the new clinics is being completed. An additional site which had been expected to open by 30 June 2010 commenced operations in July 2010. In 2008-09, two GP Super Clinics commenced early services. The GP Super Clinics program is a construction program. The completion and opening of a GP Super Clinic is dependent on a number of external factors, including whether the clinic will be a refurbishment of existing premises or a newly constructed facility and the availability of suitable land/buildings to acquire. The timeframe is also dependent upon local planning and development approvals, tender process for construction, availability of construction workforce and materials and weather conditions which may impact on construction. In 2010-11, the department will continue to work closely with funding recipients to ensure timelines are met.
Quantitative Indicator:	Number of GPs supported to maintain procedural skills under the Training for Rural and Remote Procedural GPs program (Medicare Australia data).
2009-10 Target:	1,695	2009-10 Actual:	1,552
Result: Indicator not met.
In 2009-10, participation in the program achieved 91.6 per cent of expectation. This result was a decrease of 6.4 per cent in the number of doctors receiving payments under the Rural Procedural Grants Program in 2008-09 (1,658). In 2007-08, 1,537 doctors were supported under the program. This is a demand-driven program and the 2009-10 take-up was lower than expected. A new IT system will allow more effective monitoring of the grants program from 1 July 2010. During 2009-10, the program was renamed the Rural Procedural Grants Program and moved to Outcome 12.
Quantitative Indicator:	Estimated number of patients seen.
2009-10 Target:	17,500	2009-10 Actual:	This measure was moved to Outcome 6 in the 2009-10 Budget and is now reported under Outcome 6.
Result: Refer to Outcome 6.
The department’s 2009-10 Portfolio Budget Statements published this Quantitative Key Performance Indicator in error. For details on this Key Performance Indicator please refer to Outcome 6.

6 An additional GP Super Clinic site which had been expected to open by 30 June 2010 commenced early services in July 2010. This brings the actual total to 13, consistent with the 2009-10 target.

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Program 5.3: Primary Care Policy, Innovation and Research

Program 5.3 aims to improve service delivery, help GPs to access best business practices and foster a primary care system focusing equally on prevention, diagnosis and treatment.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

promote innovation and research in primary care.

Major Activities

Primary Care Innovation and Research

National Primary Health Care Strategy

The National Primary Health Care Strategy is the first comprehensive national policy statement for primary health care in Australia, and provides the platform to build a strong and efficient primary health care system into the future. The strategy provides a roadmap to guide current and future policy, planning and practice in the Australian primary health care sector.

A major achievement for the department in 2009-10 was the release of the strategy by the Minister for Health and Ageing on 11 May 2010. Extensive direction for the strategy came from the health reform consultations undertaken by the Australian Government in 2009-10. The department also received advice from the External Reference Group and from the 265 written submissions that were received in response to the discussion paper: Towards a National Primary Health Care Strategy.⁷ The recommendations of the strategy and the National Health and Hospitals Reform Commission informed the development of the Government’s 2010-11 primary health care reforms, underpinning the National Health and Hospitals Network.

In 2010-11, the department will continue to work with central agencies⁸ and state and territory health departments to address the challenges facing the primary health care sector, by implementing the National Health and Hospitals Network Agreement and the National Primary Health Care Strategy.

Maternity Reform

The department commenced implementation of the Maternity Reform package in 2009-10 by establishing the Maternity Services Advisory Group.

In March 2010, legislation was passed to provide new arrangements for patients of appropriately qualified and experienced nurse practitioners and midwives working collaboratively with medical practitioners. These new arrangements will allow midwives to have access to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from 1 November 2010.

The department also supported the new National Nursing and Midwifery Board to develop appropriate eligible midwife registration standards. These standards were approved by the Australian Health Ministers’ Advisory Council on 17 June 2010.

The department has introduced the Professional Indemnity Insurance product available through the Medical Insurance Group Australia for eligible midwives from 1 July 2010. In 2009-10, the department carried out extensive negotiations with stakeholders to discuss the new collaboration arrangements between midwives and medical practitioners. From 1 July 2010, the department commenced a new 24 hour a day, seven days a week pregnancy helpline.

The department engaged the National Health and Medical Research Council to develop a National Guidance for Collaborative Maternity Care, due to be delivered to the department on 1 September 2010. The department also developed an evaluation framework to assess the appropriateness, effectiveness and efficiency of the Maternity Reform package and has undertaken a review of maternal and perinatal mortality and morbidity data collections in Australia, with the report provided to the department in July 2010.

Primary Health Care Research

The department is committed to providing a high quality primary health care system for all Australians and recognises that research is critical for continuous improvement. The department’s Primary Health Care Research, Evaluation and Development Strategy has continued to build a strong research capacity to support evidence-based health reform in the primary health care sector.

During the year, the department provided opportunities through the strategy for research, education, training and support to improve the quality and innovative approaches to primary health care services delivery to the Australian community.

In 2009-10, the department also improved the transfer of knowledge between researchers and policy makers through collaborative projects with the Australian Primary Health Care Research Institute and the Primary Health Care Research and Information Service. This increase in collaboration improved policy decision-making and service delivery.

The department also undertook extensive consultations with researchers regarding alignment of the research activities funded through the strategy with the key priority areas of the National Primary Health Care Strategy. In 2010-11, the strategy will offer new research program arrangements to continue the support for primary health care reform.

Building the primary health care evidence-base on best practice will help inform policy development and clinical experience supporting general practice and other health professionals to deliver better patient care and health outcomes. In 2009-10, through the National Integrated Diabetes Program, the department funded the development and review of clinical guidelines, in areas such as type 1 and type 2 diabetes, stroke, and cardiovascular absolute risk management. To achieve this, the department worked with the Australian Diabetes Society, the Australasian Paediatric Endocrine Group, the Baker Heart and International Diabetes Institute, the National Stroke Foundation, and the National Vascular Disease Prevention Alliance through the National Stroke Foundation.

In 2009-10, the department also worked with the Royal Australian College of General Practitioners and the Rural Health Education Foundation to implement and distribute evidence-based clinical guidelines on type 2 diabetes.

Through the Sharing Health Care Initiative, the department supported universities and other organisations to undertake research focusing on chronic disease self-management. Such research is increasing the information flow between different health sectors, which allows for better chronic disease management of the population. Findings from this research will strengthen the evidence-base on the efficacy of chronic disease self-management and lead to reliable, well-considered policy development.

7 Accessible at www.health.gov.au/internet/main/publishing.nsf/Content/PHS-DiscussionPaper.

8 Department of the Prime Minister and Cabinet; The Treasury and Department of Finance and Deregulation. For further information go to www.apsc.gov.au/faq/whatisaps.htm.

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Performance Information for Outcome 5

Program 5.3: Deliverables

Qualitative Deliverables

Primary Care Innovation and Research
Qualitative Deliverable:	Regular stakeholder participation in program development through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers.
Result: Deliverable met.
The department encouraged stakeholders to participate in the development of the National Primary Health Care Strategy, and the development of the health reform measures delivered under the National Health and Hospitals Network agreement.
Qualitative Deliverable:	Establishment of a stakeholder advisory group for the Maternity Reform package.
Result: Deliverable met.
In 2009-10, the department established the Maternity Services Advisory Group, comprising key stakeholders including consumers, clinicians (both medical and midwifery), professional organisations and industry representatives. The department held three Maternity Services Advisory Group meetings during 2009-10.
Qualitative Deliverable:	In 2009-10, the department will provide funding to 26 university departments to support training activities, including support for early-mid career researchers through the Researcher Development Program. Performance will be measured based on the proportion of funded university departments conducting training activities and the number of individuals completing Researcher Development Program placements.
Result: Deliverable met.
The department funded 26 university departments of rural health and general practice through the Research Capacity Building initiative and Researcher Development Program. All funded university departments conducted training activities and in excess of 70 individuals completed placements through the Researcher Development Program.
Qualitative Deliverable:	In order to build the evidence-base for primary health care, the department will provide funding for priority-driven research projects through the Australian Primary Health Care Research Institute and investigator driven projects through National Health and Medical Research Centre administered initiatives. Performance will be measured based on the proportion of projects which are completed on time and report on findings.
Result: Deliverable met.
Researches undertaken through these projects were completed within agreed timeframes. The findings have been disseminated and reported locally. A proportion of these projects have also been reported nationally through the Primary Health Care Research and Information Service website.⁹ Some of the research findings were incorporated into policy development to help inform the 2010-11 primary health reforms.
Qualitative Deliverable:	Access to research will be supported by providing funding to the Primary Health Care Research and Information Service, including funding to conduct the 2009 General Practice and Primary Health Care Research Conference. Performance will be measured based on the successful convening of the 2009 General Practice and Primary Health Care Research Conference; and the number of Primary Health Care Research and Information Service information resources developed and disseminated.
Result: Deliverable met.
In 2009-10, the department continued to fund the Primary Health Care Research and Information Service. The Primary Health Care Research and Information Service successfully convened the 2009 General Practice and Primary Health Care Research Conference, which was attended by 460 delegates from the primary health care research, policy and service delivery sectors. In 2009-10, the Primary Health Care Research and Information Service continued to contribute to knowledge transfer with the development and dissemination of 91 detailed information sources.

⁹ Accessible at www.phcris.org.au.

Quantitative Deliverables

Primary Care Innovation and Research
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-3.5%
Result: Deliverable not met.
The administered expenses for Program 5.3 underspent by 3.5 per cent. The Maternity Services Communications and Data program underspend was a result of unanticipated complexity around the meaning for ‘eligible midwife.’ In particular the registration standard and the interaction with the scheduled medicines standard requiring state and territories governments involvement.
Quantitative Deliverable:	Number of knowledge exchange opportunities organised between researchers and the department. (Includes seminars, presentations, round table discussions and more focussed consultations including rapid response reports).
2009-10 Target:	10	2009-10 Actual:	20
Result: Deliverable met.
In 2009-10, the department, the Australian Primary Health Care Research Institute and the Primary Health Care Research and Information Service organised 20 knowledge exchange opportunities between researchers and the department on policy relevant topics. The 20 policy relevant opportunities provided broader exposure of research and enhanced the understanding of both the specific areas of research and potential applicability to policy makers. The number of events was much higher than planned due to researchers’ availability and the timing of completing research projects.

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Program 5.3: Key Performance Indicators

Qualitative Key Performance Indicator

Qualitative Indicator:	Passage of the Maternity Reform legislation and establishment of a maternity stakeholder advisory group.
Result: Indicator met.
In March 2010, legislation was passed for the: Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010; Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010; and Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2010. In 2009-10, the department established the Maternity Services Advisory Group, with representatives from consumer groups, clinicians (both medical and midwifery), professional organisations and industry representatives. The group provided advice on a range of key implementation questions which has informed decisions around Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access, midwife eligibility and collaborative arrangements between midwives and medical practitioners.

Quantitative Key Performance Indicator

Primary Care Innovation and Research
Quantitative Indicator:	Number of primary health care research projects completed.
2009-10 Target:	12	2009-10 Actual:	32
Result: Indicator met.
In 2009-10, the department funded 32 research projects, which were completed by the Australian Primary Health Care Research Institute, and the Primary Health Care Research and Information Service. The number of completed projects was significantly higher than the 2009-10 target, due to the research cycle ending in that year. Trend data is not available for this indicator as it was new in 2009-10.

Program 5.4: Primary Care Practice Incentives

Program 5.4 aims to encourage general practices to improve the quality of care to patients, encourage behavioural changes and continue improvements in general practice. Incentives are intended to provide support to teach medical students, ensure patients have access to after hours care, employ practice nurses, encourage continued availability of procedural services in rural and remote areas and improve cervical screening rates.

Key Strategic Direction for 2009-10

The department’s strategy to achieve these aims was to:

improve the health outcomes for Australians by supporting general practices to deliver high quality care.

Major Activities

Support for General Practices in Delivering Care

eHealth

Supporting general practices to adopt new technologies will contribute to improved health outcomes for patients by facilitating the reliable and secure exchange of health information to inform clinical decision making, and ensure a comprehensive and effective continuum of care for communities across Australia.

The department introduced the Practice Incentives Program eHealth Incentive in August 2009, which replaced the Information Management/Information Technology Incentive. The new incentive encourages the adoption of new eHealth technology, as it becomes available, to assist practices to improve their administration processes and the quality of care provided to patients. The department worked in close consultation with the medical profession, and the National E-Health Transition Authority¹⁰, to develop the incentive requirements and align with the directions set out in the Australian Government’s National eHealth Strategy.

By June 2010, the department provided incentive payments to about 78 per cent (3,871 practices) of eligible practices participating in the Practice Incentives Program compared with about 69 per cent (3,300 practices) in August 2009. The average payment to practices through the eHealth Incentive is about $20,000 a year.

In 2010-11, the department will continue to monitor participation in this incentive and consult with the medical profession and the National E-Health Transition Authority, regarding future requirements of the eHealth Incentive to encourage continuing improvements in the use of eHealth technologies in general practice.

Practice Incentives – Indigenous Health

The Practice Incentives Program Indigenous Health Incentive forms part of the Council of Australian Governments’ National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. In May 2010, the department commenced the Indigenous Health Incentive to support general practices and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease.

The department worked with Medicare Australia in 2009-10, to develop a chronic disease registration system and the incentive payment scheme. In December 2009, and again in May 2010, Medicare Australia wrote to all eligible practices and Indigenous Health Services to promote the Indigenous Health Incentive and invite participation. In May 2010 the first incentive payments were made to eligible practices. About 850 practices and Indigenous health services have joined the Indigenous Health Incentive and about 2,900 eligible patients have been registered.

In 2010-11, the department will continue to monitor participation in this incentive and undertake additional promotional activities to increase participation if required.

Practice Nurses

The Practice Incentives Program Practice Nurse Incentive supports general practices to employ practice nurses. The incentives are available to eligible practices in rural and remote areas, and urban areas of workforce shortage. Practice nurses are a key member of the primary health care team and provide clinical and administrative support, freeing up doctors to provide more consultations. In 2009-10, 74 per cent of eligible practices were participating in the incentive compared with 72 per cent in 2008-09.

In 2009-10, the department identified a range of administrative changes to the Practice Incentives Program to reduce ‘red tape’ for practices. The department worked closely with Medicare Australia to advise practices and implement the move from prospective to retrospective payments for the incentive.

In 2010-11, the department will commence work on the new funding arrangements for practice nurses. A new simplified, single funding stream, commencing on 1 January 2012, will replace the current funding provided through the Practice Incentives Program Practice Nurse Incentive and the Medicare Benefits Schedule.

General Practice Immunisation Incentives

The General Practice Immunisation Incentive Scheme aims to encourage at least 90 per cent of practices to fully immunise 90 per cent of children under seven years of age who attend their practices. The incentive provides payments to practices meeting the immunisation target and funding to the Divisions of General Practice, state-based organisations and the Australian General Practice Network to improve the proportion of children who are immunised at local, state and territory and national levels. Immunisation is the safest and most effective way of giving protection against a disease.

In 2009-10, more than 80 per cent of practices achieved the target of 90 per cent or greater immunisation coverage of children in their practice. The department is working to increase the percentage of practices achieving the target immunisation rate. This will be achieved by continuing to fund the Australian General Practice Network, Divisions of General Practice, and state-based organisations to promote best practice, ensure data quality, and support general practice to improve immunisation coverage including by targeting hard to reach children, such as those from refugee and migrant groups.

The department developed new entry requirements in 2009-10, relating to vaccine management for non-accredited practices participating in the General Practice Immunisation Incentive Scheme in close consultation with the medical profession, to improve the quality and safety of immunisation activities. The new entry requirements will apply from August 2010.

In 2010-11, the department will continue to monitor participation in the General Practice Immunisation Incentive Scheme and compliance with the new entry requirements.

image of doctor examining older man

¹⁰ Accessible at www.nehta.gov.au.

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Performance Information for Outcome 5

Program 5.4: Deliverables

Qualitative Deliverables

Support for General Practices in Delivering Care
Qualitative Deliverable:	Regular stakeholder participation in program development through such avenues as surveys, conferences, meetings, and submissions on departmental discussion papers. The department will consult with medical and Indigenous stakeholders in 2009-10 to develop the requirements for the new Indigenous Health Incentive. The number of stakeholder opportunities to participate in program development including through surveys and regular meetings will be used to measure the level of stakeholder participation.
Result: Deliverable met.
In 2009-10, the Practice Incentives Program advisory group met formally twice, in addition to progressing work out of session. The advisory group was the primary vehicle for consultation with the medical profession on the development of the new Indigenous Health Incentive. Permanent members of the advisory group are the Australian College of Rural and Remote Medicine, the Australian General Practice Network, the Australian Medical Association, the Royal Australian College of General Practitioners and the Rural Doctors Association of Australia. The Australian Indigenous Doctors’ Association and the National Aboriginal Community Controlled Health Organisation also participated in advisory group consultations on the development of the Indigenous Health Incentive.

Quantitative Deliverables

Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-7.4%
Result: Deliverable not met.
The administered expenses for Program 5.4 underspent by 7.4 per cent. In 2009-10, the department implemented four administrative changes to the Practice Incentives Program, these included: the introduction of retrospective rather than prospective payments; annual process to confirm practice details to ensure the accuracy of Practice Incentives Program payments; cessation of recalculation payments; and the development of an online administration system. The Practice Incentives Program is a demand driven program, with expenditure determined by the uptake of individual incentives by general practices. The transition period for the administrative changes also impacted expenditure, for example through the shift from prospective to retrospective payments.
Quantitative Deliverable:	Percentage of GP patient care provided by practices participating in the Practice Incentive program.
2009-10 Target:	81.8%	2009-10 Actual:	82.5%
Result: Deliverable met.
In 2009-10, the percentage of GP patient care provided by practices participating in the Practice Incentives Program increased from 81.8 per cent in 2008-09 to 82.5 per cent in 2009-10. The percentage of GP patient care provided by practices participating in the Practice Incentives Program has increased over the past three years from 81.4 per cent in 2007-08 and 81.9 per cent in 2008-09.

Program 5.4: Key Performance Indicators

Quantitative Key Performance Indicators

Support for General Practices in Delivering Care

Quantitative Indicator:

Number of Practice Incentives Program practices participating in the eHealth incentive.

2009-10 Target:

4,200

2009-10 Actual:

3,871

Result: Indicator substantially met.

The Practice Incentives Program is a demand driven program, and is entirely voluntary. During 2009-10, the uptake of the eHealth Incentive payment continued to increase since the first payments were made in August 2009. It is expected that participation in the eHealth Incentive will continue to increase over time.

The incentive was introduced in August 2009 so there is no historical data to report.

Quantitative Indicator:

Number of Practice Incentives Program practices signed onto the Indigenous Health Incentive (commences May 2010).

2009-10 Target:

3,700

2009-10 Actual:

853

Result: Indicator not met.

The Practice Incentives Program Indigenous Health Incentive was introduced in May 2010 and resulted in lower than expected take-up for the financial year. The program is a demand driven program. It is expected that participation in the Indigenous Health Incentive will continue to increase over time.

Quantitative Indicator:

Number of Practice Incentives Program practices providing teaching sessions to medical students.

2009-10 Target:

1,680

2009-10 Actual:

1,783

Result: Indicator met.

In 2009-10, the number of Practice Incentives Program practices providing teaching sessions increased from 1,593 in 2008-09 to 1,783. The number of teaching sessions provided also increased by 30 per cent, allowing more undergraduate medical students access to training in general practice.

The table below shows the number of Practice Incentives Program practices providing teaching sessions and the number of teaching sessions provided has increased over time.

	2007-08	2008-09	2009-10
Number of Practice Incentives Program practices providing teaching sessions	1,571	1,593	1,783
Number of teaching sessions provided	92,346	101,255	130,124

Quantitative Indicator:

Number of Practice Incentives Program practices supported to employ a practice nurse.

2009-10 Target:

2,520

2009-10 Actual:

2,504

Result: Indicator substantially met.

The Practice Incentives Program is a demand driven program, and the estimated increase in participation in this incentive is dependent on the dynamics of the general practice sector and the availability of practice nurses. The actual result for 2009-10 is within 0.6 per cent of the target.

The number of Practice Incentives Program practices supported to employ a practice nurse has increased over time from 2,334 in 2007-08 and 2,405 in 2008-09.

Quantitative Indicator:

Increase or maintain the number of Practice Incentives Program practices in rural and remote areas supported to maintain local access to procedural services.

2009-10 Target:

360

2009-10 Actual:

334

Result: Indicator substantially met.

In 2009-10, the department introduced a range of administrative changes to the Practice Incentives Program to reduce ‘red tape’ for practices. These changes included a move from quarterly prospective payments to six-monthly retrospective payments for the Practice Incentives Program procedural GP payments, which affected reporting requirements against the key performance indicator.

The department will continue to monitor procedural GP payments to determine if the gradual decrease in uptake, as outlined in the table below, is due to administrative changes or other factors.

The table below shows the number and percentage of eligible Practice Incentives Program practices in rural and remote areas supported to maintain local access to procedural services.

	2007-08	2008-09	2009-10
Number of Practice Incentives Program practices in rural and remote areas supported to maintain local access to procedural services	366	354	334
Percentage of eligible practices supported to maintain local access to procedural services	24	23	22

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Outcome 5 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 5.1: Primary Care Education and Training
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	158,182	155,754	( 2,428)	153,853
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,928	5,132	204	5,009
Revenues from other sources	197	136	( 61)	201
Unfunded depreciation expense¹	-	-	-	104
Operating loss / (surplus)	-	3	3	-
Total for Program 5.1	163,307	161,025	( 2,282)	159,167
Program 5.2: Primary Care Financing, Quality and Access
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	361,042	349,117	( 11,925)	358,084
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	25,368	25,124	( 244)	25,790
Revenues from other sources	1,013	664	( 349)	1,034
Unfunded depreciation expense¹	-	-	-	537
Operating loss / (surplus)	-	14	14	-
Total for Program 5.2	387,423	374,919	( 12,504)	385,445
Program 5.3: Primary Care Policy, Innovation and Research
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	31,175	30,085	( 1,090)	26,588
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	4,469	4,453	( 16)	4,543
Revenues from other sources	178	118	( 60)	182
Unfunded depreciation expense¹	-	-	-	95
Operating loss / (surplus)	-	2	2	-
Total for Program 5.3	35,822	34,658	( 1,164)	31,408
Program 5.4: Primary Care Practices Incentives
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	289,893	268,303	( 21,590)	297,990
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	2,082	2,150	68	2,116
Revenues from other sources	83	57	( 26)	85
Unfunded depreciation expense¹	-	-	-	44
Operating loss / (surplus)	-	1	1	-
Total for Program 5.4	292,058	270,511	( 21,547)	300,235
Outcome 5 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	840,292	803,259	( 37,033)	836,515
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	36,847	36,859	12	37,458
Revenues from other sources	1,471	975	( 496)	1,502
Unfunded depreciation expense¹	-	-	-	780
Operating loss / (surplus)	-	20	20	-
Total Expenses for Outcome 5	878,610	841,113	( 37,497)	876,255
Average Staffing Level (Number)	278	271	( 7)	266

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

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