Leanne Wells (Facilitator)
We would like to acknowledge Traditional Owners of Country throughout Australia and recognise the continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures, and to Elders past and present.
Welcome to a vodcast series produced to support the implementation of the General Practice in Aged Care Incentive.
The new incentive enables the delivery of high quality, person-centred care, to people living in residential aged care homes by their regular GP and practice.
The incentive is aligned with the introduction of MyMedicare, or rather voluntary patient registration, which facilitates ongoing relationships between individuals, their GP and the general practice, and enables proactive, planned, continuous care.
The incentive commenced on 1 July 2024. It's a major measure under the Strengthening Medicare primary care reforms and part of the Australian government's response to the Royal Commission into Aged Care Quality and Safety.
I'm Leanne Wells. I'll be talking with expert panellists across four sessions about the need for the incentive; what constitutes quality care in the aged care setting; the hallmarks of team-based care; variation in general practice and implementation enablers.
Joining me are:
- Dr Paresh Dawda, an advisor on primary aged care and GP leader with a special interest in aged care;
- Andrew Haywood, Head of Workforce Strategy, at the Aged and Community Care Providers Association;
- Karen Booth, a nurse leader, President of the Australian Primary Care Nurses Association and Clinical Advisor - Nursing to the Australian Digital Health Agency;
- Sophie Piron, a practice manager from Adelaide;
- Dr Anthony Marinucci, a GP leader, with a special interest in aged care also;
- Ann Davies, OAM, a consumer leader;
- Laila Hallam, a consumer leader, and;
- Kate Tye, Executive Manager, Primary Care Development at Nepean Blue Mountains Primary Health Network.
Let's start with our first discussion, which explores the context in which the General Practice in Aged Care Incentive has been introduced, the needs that drove its inception, the kind of care it aims to support, and the benefits of this approach.
To make a start, I'd like to ask our panel about the current context for this incentive. Why is it important and why is it being implemented now?
Paresh Dawda (GP)
Thanks for the question, Leanne.
I think this incentive is important because, ahmm, it's really a response from, ahmm, the, the government to the Aged Care Royal Commission. The Aged Care Royal Commission very specifically heard, whilst there's good aspects of general practice care happening in aged care, many residents who live in residential aged care homes, ahmm, are perhaps not receiving that optimal primary care.
Ahmm, one of the things I think people heard was the need for proactive, comprehensive, continuous primary care. And I think what this incentive is trying to do is help, ahmm, really take a step forward in that direction to encourage and incentivise continuous, ah, proactive comprehensive, primary care.
Leanne Wells (Facilitator)
And Andrew to you for, umm, an industry or provider aged care, residential aged care provider, perspective on the current context and the key drivers for this incentive.
Andrew Hayward (Aged & Community Care Providers)
Yeah thanks for the question Leanne. Ahmm, the drivers for this incentive are the continuity of care, ahmm, just acknowledging the, umm, the number of, umm, residents in residential aged care that are looking for critical care, umm, from their GPs. Umm, just acknowledging also that the, umm, the demographic ah trends. So, we've got an ageing population with complex health needs, umm, and they require, sort of, person-centred care. Umm, and emphasising that equity and diversity, ahh, in service delivery, and I think, umm, the GP incentive, umm, goes some way to actually addressing that.
Leanne Wells (Facilitator)
Laila to you for a, for a consumer and a, a family carer perspective on, on the incentive.
Laila Hallam (Consumer)
Well, of course, continuity of care and proactive services, but I'd even go as far as to say it's an opportunity for, umm, relationship building. I mean it's actually building in an opportunity to resource GPs so that they can build relationships with the patients that they're serving in particular, or the residents that they're serving, particularly in aged care, where trust and relationship building is really important to older people who will do, you know, who need that, umm, relationship in order to, to, umm, follow, follow the services that they need.
Leanne Wells (Facilitator)
On the health side of things, the incentive is a critical part of the Strengthening Medicare agenda. Karen you, you were on the Strengthening Medicare Taskforce. What's your take on the incentive?
Karen Booth (Nurse)
So, I think every visit is gold and what we need to do is look at how we can encourage GPs and support them to be able to actually go to aged care, to have that continuity of care.
And for me, part of these incentives, and some of the other big picture things that are happening with the health reform, is better connection for care. I think better opportunities for teamwork and teams to, ah, support better access to care and, umm, better, umm, input from other team members. But also that opportunity to support the GP with supporting the patients. And also the poor old aged care staff who really have to battle sometimes to try and get access to care for their patients. So making sure the patient and the care facilities are supported, along with the GP, for a much, much better sort of bigger picture, umm, patient care for the, for people.
Leanne Wells (Facilitator)
Kate, I might come to you for your thoughts on this too, because, you know, Primary Health Networks, you work in a Primary Health Network, there are, I suppose, multiple purposes and functions they fulfil, but a key one is supporting integration of the system.
Umm, your thoughts on the incentive and why it's important?
Kate Tye (PHN)
We have a growing ageing population and the average age of an older person entering, umm, permanently into a residential aged care home is 86 years of age, and they have a number of comorbidities and therefore, umm, complexity in their needs and the importance of primary healthcare cannot be unvalued at all in any way.
Umm, as a Primary Health Network, one of our key roles, as you said, is to connect across the system. Umm, and the and, building on what Karen said around the importance of, umm, communication and the importance of relationships with residential aged care homes and with general practice, umm, that's critical. So that's a key role that, umm, the PHNs play in that space.
The other thing that PHNs do is work with general practice to assist them to implement and adopt new ways of working and GPACI requires general practices to think a little bit differently about how they would provide care in residential aged care. How they use multidisciplinary teams, how they, umm, can really work together, umm, with the team in their practice, but also those other, umm, care providers that, umm, that work within the residential aged care home.
Leanne Wells (Facilitator)
Anthony to you, umm, you're a GP with an interest in aged care. What are the main needs do you think this is really going to help the system respond to better, this incentive?
Anthony Marinucci (GP)
Umm, so I think, we all understand the theory behind excellent primary care and how important it is and how much of an impact it makes, umm, on, on patient outcomes.
What, umm ah, I think this the incentive aims to address is the, the cost of delivering that care. Ahmm, currently Medicare is a fee for service system, so we're remunerated, umm, every time we touch base with the patient. But as we know good continuous, umm, care requires a lot of work outside of that. Ahmm, and I think this is one of the main issues a lot of, umm, doctors find that, umm, they're requested to do a lot of work outside of those bounds of the, of the basic consultation.
So this incentive tries to aim, to sort of remunerate, umm, for work outside of the, the, the fee for service model. So I think in that context I think it's a very positive thing.
Umm, and ultimately if we can be a little bit more remunerated for all of the work across the board that we do, it might end up being a little bit more attractive for doctors around the country to continue working in aged care.
Leanne Wells (Facilitator)
Ann, I just want to come to you, umm, there's aged care sector drivers for the incentive, there's healthcare sector drivers, there's clearly, consumer need and demand drivers. How do you see this incentive, umm, being a positive thing and, and, playing into, I suppose, the emphasis we hear all the time now about, umm, the need to, ah step up attention to aged care quality standards.
Ann Davies (Consumer)
Look, there's always been a great difficulty in attracting GPs to visit residential aged care facilities. And to give care to older people. And, this really is due to time constraints, remuneration, location, administrative difficulties and also the perception that, umm, about willingness to practice in aged care.
So I'm very excited about this incentive and I think the introduction of, umm, GP, the, ah, GP aged care incentive, absolutely strengths, strengthens the quality of care, ahh, in that consumers own GP reinforces the continuative care, ahh, they have a knowledge of the medical history, ahh, and what primary care services have been required prior to a person's admission to an aged care facility, umm, and, and they are able to give a more personalised, ahh, medical care.
So, I think the GP is best placed to interact with the consumer, family members, umm, and to facilitate, ahh, shared decision making and they're best place to be a consumer advocate.
So, I think this is a most wonderful incentive.
Leanne Wells (Facilitator)
Ah Sophie, just wondering if you've got any perspectives from a practice management point of view on the incentive, and how, how it's a, it's a positive shift.
Sophie Piron (Practice Manager)
From a, from a practice point of view, I think that, umm, there is that aspect of, of consistency and, and continuity of care, but there is a recognition from, umm, this incentive that there's, umm, a contribution from the general practice towards the provision of services into aged care facilities.
Umm, where, you know, the staff may not be visiting the, the aged care facility, the GP is visiting the aged care facility, but there's a lot that goes on behind the scenes from the general practice perspective in relation to the provision of, umm, facilities to, eh, services to aged care facilities. And, umm, I think the way that this incentive is structured is a recognition of that.
Leanne Wells (Facilitator)
We've also touched on, umm, the principle, I suppose, of person-centred care. I'd just like to get, perhaps starting with Laila and then coming to you Ann, on from the person-centred perspective or lens on this, what is high quality primary healthcare for living, ahh, for people living in a residential aged care home?
Laila Hallam (Consumer)
I think from a patient perspective, I think we can't underestimate the value a GP actually brings by knowing who the person is, not over medicalising the issues that they face because, generally speaking, they have a lot of stuff going on. But even so, what we want them to do is live their best life, even within a […], and particularly within a residential aged care facility. So, it actually wraps up a whole lot of things. It, it's, it's visitation, it's relationship building and it's making sure that they are living as good a life as they can and not focused on the medicalisation or the deterioration points. So, I think that there's a lot, a lot of benefits from a, from a patient’s perspective to have that kind of oversight by people who know them.
Ann Davies (Consumer)
And I think, umm, this means putting people and families at the centre of decision making. And, ah, working alongside staff to get the best outcomes.
And, ah, and in this regard, with the, ah, ah, incentive, ah, step, I think person-centred care will be strengthened, ahh, and certainly it will be under the new standards.
Leanne Wells (Facilitator)
From your perspective, Anthony, umm, what is, how would you describe, umm, good, quality, primary care for people living in residential aged care?
Anthony Marinucci (GP)
So, for me, I'd like to define rather than saying ‘patient-centred care’, I like to say ‘patient-driven care’. So, I think the most important thing to recognise is that we all as we, as we age, umm, our focus of care, or our care plans and our lives change. Umm, and often when people are admitted into a residential aged care facility, they tend to be towards the latter stages of their life. Umm, so often there is a very, very different focus, ahh, on what we're, what we're trying to treat, umm, or what we're trying to do with their care.
So, in that context, one of the most important things that, umm, is required is communication. Umm, so, and communication between doctor, between patient, between family, between facility. Umm, it's a very, very complex area aged care. There's a lot of stakeholders, umm, and often messages can get confused. I think, umm, mirroring the, the thoughts of what Sophie said before, having the practice involved there is often a lot of scheduling required to, umm, make sure that effective communication is in place.
And then by doing that, where we can set a really appropriate care plan in place, umm, which is the really the foundation of any, umm, sort of care model. If we, if we don't get the sort of foundations right, then we can't really hope to deliver really good outcomes.
So for me, I would say the absolute bedrock is effective, excellent communication and education to patients and families. And anything from there, I think you'll be winning.
Karen Booth (Nurse)
Look, I think the, the aged care incentive, umm, payment is part of the big picture and I think we have, ahh, MyMedicare where patients who are enrolled will be able to have longer consultation as well, and, umm, and more in depth consultations for some issues.
I think the GP incentive, the aged care incentive, will actually help focus on things that Laila said earlier about early intervention and prevention. And I know in my role as a nurse in general practice, I loved doing aged health assessments. We do them in the practice or go to someone's home and see them at home or go to the aged care facility.
Leanne Wells (Facilitator)
How does the incentive differ from, ahh, the current way general practice and, and other members of the care team are remunerated to work in aged care facilities? How does, how does it better enable the high quality primary care you've all just described?
Sophie Piron (Practice Manager)
From a practice perspective, umm, dealing with previous incentives has always been a little bit tricky about how do you allocate, you know, some aspect of it to the practice, how do you allocate some of it to the general practitioner? Umm, I think this incentive, umm, for me, makes things, umm, a lot clearer. One aspect of it is very clearly directed towards the general practitioner and the other general, very clearly, directed to the practice. But it also, umm, from a practice point of view, umm, really does speak to that continuity of care. That as a practice, you really have to have a commitment to having a primary practitioner, umm, for that, that patient. And so it really enables us in terms of, I guess, quality control and quality improvement. It enables us to look at, umm, what's happening with that particular resident and, umm, how that service is being delivered and ensuring that it's being delivered in the way that provides consistency, umm, and continuity of care for that resident.
Andrew Hayward (Aged & Community Care Providers)
So, I think that’s threefold. Ah I think, umm, what this incentive does is actually encourages GP engagement, umm, with the residential aged care. Umm, I think it provides financial support, ahmm, which, umm, obviously motivates the GP, umm, to dedicate their time to residential aged care. Ahmm, and that in itself then ensures continuity of care.
Ahmm, I think, secondly, it improves integration, ahmm, so it facilitates communication, ah, and collaboration between the GP, the aged care facility, the staff, ah, the residents, the families, ahmm, and provides that timely and, umm, and consistent care to the ah, the, the older Australians.
Ahmm, and then thirdly, it strengthens resources, so this can help implement systems ahmm, and support timely assessments.
Paresh Dawda (GP)
I think what the incentive does is to, ahmm, really get us to think in terms of practice based population health. So, we're now looking after a population of people who live in residential aged care home. Umm, so that's kind of the paradigm it's set. Within that the, ahh, registration system and linking it to MyMedicare and voluntary registration, umm, you know, act, actually, ah, sends a very subtle message that once that resident is registered with us, we're accountable for their care. The formalisation of that relationship, I think with it, ahh, bring, brings, ahh, is clarity of role, responsibility and accountability.
Leanne Wells (Facilitator)
I've got a final question to ask. Thinking about the beneficiaries in terms of the people, thinking about the beneficiaries in terms of general practices and the general practice setting, but also thinking about the benefits to, umm, residential aged care homes and their capacity to, umm, respond and deliver, ahh, in collaboration with the primary care sector to the needs of their residents. I'd like to ask, umm, I'll start with Andrew, umm, your, your thoughts on, ahh, you know, in, in a nutshell, in an elevator pitch the, the benefits of the incentive.
Andrew Hayward (Aged & Community Care Providers)
My elevator pitch would be, umm, the, ahh, the, the greatest benefit of the, umm, incentive that I see and that the, ah, our members are reporting is that the, the potential for enhanced, umm, health outcomes. So improved, umm, management of chronic conditions, potential reduce, umm, of hospitalisations and better overall quality of life for residents.
Umm, again, you know, we've mentioned relationship building and team, multidisciplined teams, umm, all working in unison, umm, so that sector stability is really, umm ah, important and, umm, it's strengthening those relationships between care providers, GPs and, umm, that consistent delivery which is, umm, really beneficial and imperative.
Ah, and then that in turn increases the, umm, resident and family’s confidence, ah, in the quality of care that they're providing or being provided. Ah, so that builds trust in aged care, ah, in the systems and then, ah, ensures, umm, the comprehensive accessibility, ahh, and again what we already mentioned, the person-centred or person-driven care, umm, is really then enhanced by, ah, their relationship and, ah, their confidence that grows in the, ah, the level of service and care they’re being provided.
Laila Hallam (Consumer)
One day, umm, we're all going to, we are all growing older, and the population is ageing. So, at some point, there's a few of us around this table who will be in an aged care facility at some point.
And I think what we want is to reiterate what Andrew just said with regards to relationships. I think relationships is really important. So, moving out of a transactional medical relationship into a more relational relationship. I think will make a world of difference to the patient with regards to, ahh, their willingness to, umm, share information about what's going on for them so that we get better diagnosis, we get better day-to-day management, we get better adherence to what is suggested that they do.
It also means that, umm, our residents are having a better time of it. You know, they're, they're not having to sit waiting, knowing that there's something that's just not right, but actually not actually having access to the general practice, umm, to be able to come and talk to them. And I think from the perspective of it being a general practice thing, I think that whole team approach is beautiful. So, this whole multidisciplinary approach right through to palliative care is a really lovely way, and a gentle way, for our residents to enjoy what time is left, to be cherished and to, umm, come out with a better quality of life, with medicine not necessarily dominating their lives, but they're living with it, to the end. So, I think it's all about quality of life and better outcomes for them.
Kate Tye (PHN)
I think one of the, umm, important benefits is the opportunity for patients, ah sorry, practitioner experience. Umm, and having, umm, an improved practitioner experience because as been, as has been discussed, umm, it has been quite transactional in the past and this really does drive working in partnership with each other, and GPs and general practices working in partnership with residential aged care homes to deliver the best quality care. And I know that, umm, care managers of residential aged care homes really value the support of GPs, and the support of their teams, umm, in the work that they're actually doing with that individual resident. And I think what we will see, is improved prac, umm, practitioner experience.
The other thing is that it also assists teams to be able to, general practice teams, to be able to look at their patient cohort, understand who those residents are and which homes they're in. Umm, making sure that there are, umm, there are scheduled planned visits for those residents and that they are actually proactively managing their care and doing that because they understand what that patient cohort looks like, what their needs are, and, umm, and that frequency of visit as well. But also who are the care teams that sit within each of those residential care homes as well and what that looks like. Because it looks different in every home and that can be quite challenging for GPs and as a PHN, that's certainly something that we can assist the general practice and also the residential aged care home on as well.
Leanne Wells (Facilitator)
Thank you to our panellists for offering perspectives and insights on high quality primary care and the General Practice in Aged Care Incentive.
This brings us to the end of our first session. During the conversation, our panellists have -
- Acknowledged that access to quality primary care has traditionally been out of reach for many people who live in residential aged care homes.
- Reinforced that the incentive is structured to make a difference by renumerating more person-centred or patient-driven care.
- And have agreed that residents will ultimately have better health outcomes and quality of life because of a more planned, team-based approach to the management of what are typically a very complex set of physical and mental health issues.
Join us for our second session in the General Practice in Aged Care Incentive series on how the incentive can better enable joint working and team-based care for the benefit of people living in residential aged care homes.