Key Strategic Directions for 2005-06
Access to Quality Medical Care Services
Throughout 2005-06, the Department continued to support access to quality medical services through a number of recently announced initiatives, the most prominent of these being the Round the Clock Medicare: Investing in After Hours GP Services Program. This initiative is increasing the public’s access to after hours general practice through the provision of higher Medicare rebates for after hours GP services, complemented by a significant investment in specific after hours GP services through infrastructure support grants.
To date, 3.5 million patients have benefited from the increased rebates for after hours GP services under Round the Clock Medicare. In consultation with the major GP stakeholder groups including the Australian Medical Association, the Royal Australian College of General Practitioners and the Australian Divisions of General Practice, the Department developed guidelines and program support documentation for the infrastructure grants. The first full round of infrastructure grants was offered by the Department in 2005-06 in line with the identified implementation timetable, and applications significantly exceeded the available number of grants.
During 2005-06, the Department commenced work on the National Health Call Centre Network (NHCCN). The NHCCN, agreed by the Council of Australian Governments on 10 February 2006, will enable anyone, anywhere in Australia, to ring for health triage, information and advice on health matters 24 hours a day, seven days a week. Trained nurses will provide advice, using nationally agreed protocols developed in collaboration with the health professions. If treatment is necessary, they will advise callers on how urgently they need to be seen, and will use an electronic services directory to determine where services are available. The NHCCN will also have the capacity to provide add-on services (including an enhanced mental health capacity) and to assist in health threats and emergency situations. The NHCCN is expected to take the first calls by July 2007, with national coverage achieved within four years.
Top of page
Quality Improvement in Primary Care
During 2005-06, the Department introduced a number of new Medicare items to address lifestyle risk factors and support better management of patients with chronic and complex health conditions. The Department, in conjunction with the major GP organisations, developed the new chronic disease management Medicare items which provide a more streamlined approach to care planning and review of services for patients with chronic conditions and complex care needs. Since their inception on 1 July 2005, the new chronic disease management items have had wide GP acceptance, with almost half of Australia’s GPs using the new chronic disease management care plans. This has greatly enhanced access to appropriate care for patients with chronic and/or complex care needs. These new items replaced the previous Enhanced Primary Care multidisciplinary care planning items.
The increase in services available to patients as a result of the new chronic disease management items has resulted in a substantial increase in the amount of structured care being provided to patients with chronic conditions. These chronic disease management items enable GPs to undertake a comprehensive assessment of a patient’s health care needs: identify the most suitable treatment; collaborate with other providers who may be involved in the patient’s team-based care; and review the patient’s progress against their personal care plan. For patients receiving team-based care, the items also provide access to Medicare rebates for certain allied health and dental care services.
The Australian Primary Care Collaboratives Program (APCCP) was also largely rolled out during 2005-06. This is an evidence-based initiative which aims to promote a culture of ongoing innovation and quality improvement within general practices. Flinders University is funded to manage and implement the APCCP. Under this program, 45 Divisions of General Practice from most states and territories, and with a strong representation from rural Divisions, receive funding. The program consists of three phases in which staff from general practices attend learning workshops, undertake rapid quality improvement activities and collect monthly data to track their progress against agreed indicators.
To date, participating practices have improved their clinical outcomes for patients in the targeted areas of diabetes and coronary heart disease, and have increased patient access to primary care services. The first collaborative phase ran from March to September 2005, with the second wave running from October 2005 to May 2006. Within participating practices there was an average 24 per cent improvement in the number of patients able to be seen by a GP on their day of choice. Significant improvements in practice quality were also achieved in participating Indigenous services. Around 1.4 million patients Australia wide attend practices involved in this program.
The Department implemented another quality of care initiative on 1 May 2006 – the new Medicare health assessment item for refugees and other humanitarian entrants to Australia. This item is enabling GPs to undertake comprehensive health assessments and introduce people to the Australian primary care system as soon as possible after their arrival in Australia.
Strengthened National Infrastructure to Integrate and Support Primary Care
2005-06 was the first full year of implementation of the National Quality and Performance System (NQPS) for Divisions of General Practice through Multi-Program Agreements. Designed to drive continuous quality improvement across the entire Divisions network, the NQPS will strengthen the Divisions as a national infrastructure to integrate and support the delivery of primary health care within the community.
The Department has also commenced work on a number of important components that will underpin the NQPS, including a performance review process for Divisions, quality standards and accreditation and the development of an information management strategy that includes a secure national network to support shared information and knowledge exchange.
Top of page
Improved Access to Mainstream Services for Aboriginal and Torres Strait Islander People
During 2005-06, the Department worked towards the introduction of Medicare rebates designed to improve access to mainstream Medicare services for Aboriginal and Torres Strait Islander people. On 1 May 2006, a new Medicare item was introduced that provides for an annual health check for Aboriginal and Torres Strait Islander children up to the age of 14. This health check will assist GPs to take a more comprehensive and preventative approach to the health care needs of Aboriginal and Torres Strait Islander children. It will also assist in the early detection, diagnosis and treatment of common and treatable conditions. There is scope to increase the uptake of the Aboriginal and Torres Strait Islander adult health check item and the Department will be linking information about this item with awareness, information and education activities aimed at promoting the new health check item for Aboriginal and Torres Strait Islander children.
New Medicare rebates for the provision of immunisation and wound management services provided by registered Aboriginal Health Workers on behalf of GPs were also introduced during 2005-06. These rebates operate in a similar way to already existing items for practice nurse services and will help to expand the delivery of primary health care to Aboriginal and Torres Strait Islander people. The Northern Territory is currently the only jurisdiction which registers Aboriginal Health Workers. In 2006-07, the Department will explore the feasibility of future expansion of these Medicare items to other jurisdictions and services.
Support for the Primary Care Workforce
The Department has implemented a successful program to support nursing in general practice through the Australian Divisions of General Practice Network. This program aims to build both the capacity of the Divisions to recruit and deliver support services for nurses working in general practice, and to also broker and coordinate the delivery of education and professional development for practice nurses. Results of the 2006 National Practice Nurse Workforce Survey Report
, funded under this program and released in April 2006, indicate that the number of practice nurses has increased by 23 per cent since 2003, to almost 5,000.
Growth in the role of practice nurses was also reflected in the continued increase in the claiming of Medicare rebates for practice nurse services provided for and on behalf of GPs. In 2005-06, there were 3.2 million claims for the practice nurse immunisation, wound management and rural Pap smear items. Claims for immunisation services peaked from February to May during the back to school and pre-winter vaccination periods, while claims for practice nurse wound management services and Pap smears in rural areas grew steadily over the year.
Another significant initiative implemented during 2005-06 was the extension of the Training for Rural and Remote Procedural GPs Program to include emergency medicine training. Enrolments for this initiative commenced on 1 January 2006 and have proven popular, with 601 doctors registering by 30 June 2006. Also, approximately 743 GPs took advantage of increased Practice Incentives Program Procedural GP payments for rural and remote GPs during 2005-06. These initiatives provide financial incentives to encourage GPs to continue to provide procedural services to rural and remote communities.
Top of page