Introduction to General Practice in Aged Care Incentive webinar

General Practice in Aged Care Incentive

August 2024

 

Presented by:

Chair:

Mark Roddam – First Assistant Secretary, Primary Care Division 

Presenters:

• Clare Sullivan – Acting Assistant Secretary, Primary Care Quality and Design Branch
• Craig Gear – Chief Executive Officer, Older Persons Advocacy Network (OPAN)
• Dr Paresh Dawda – Director and Principal, Prestantia Health

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘General Practice in Aged Care Incentive’, ‘What the incentive means for residential aged care providers and staff, as well as for residents, families and carers’, ‘Chair’, ‘Mark Roddam, First Assistant Secretary, Primary Care Division’, ‘Presenters’, ‘Clare Sullivan, Acting Assistant Secretary, Primary Care Quality and Design Branch’, ‘Craig Gear, Chief Executive Officer, Older Persons Advocacy Network (OPAN)’, ‘Dr Paresh Dawda, Director and Principal, Prestantia Health’, ‘August 2024’]

[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]

Mark Roddam:

Thank you all for joining us for today’s webinar. I’m Mark Roddam and I head up the Primary Care Division here at the Department of Health and Aged Care.

I’d like to begin today by acknowledging wherever we are across the country we’re on the lands of Aboriginal and Torres Strait Islander people, for me the Ngunnawal people here in Canberra. And I’d like to pay my respects to Elders past, present and emerging and to any Aboriginal or Torres Strait Islander people with us today. I’d also like to acknowledge those families and other groups with a connection to this region here in Canberra.

We’re really glad you could join us today for the webinar on the GP Aged Care Incentive. We really hope you find it useful and informative and it’s really a great privilege to bring this to you and to be able to discuss and give you more information on the incentive.

There will be a Q&A session at the end of this webinar. You can submit questions in the Q&A function on the right hand side of your screen and we’ll attempt to respond to as many questions as possible. All questions and answers including the ones we may not get to today will be published in a frequently asked questions document on our website. You may need to click on the Q&A icon at the top of your screen to activate the function before submitting any questions. Questions submitted during the registration process have also been considered for today’s presentation and the Q&A session.

There’s no option for you to turn on your video or microphone but webinar slides are now available on our website and this session is being recorded and will be published on our website in the coming days.

Firstly to take us through and outline the incentive I’d like to introduce Clare Sullivan. Clare’s the Acting Assistant Secretary for Primary Care Quality and Design Branch in my division and she’s responsible for the practice support functions including the administration of the Practice Incentive Program and various associated incentives, accreditation policy, the MyMedicare rollout and the design of incentives including the General Practice Aged Care Incentive. So I’ll hand over to you Clare to take us through your slides. Thank you.

Clare Sullivan: 

[Visual of slide with text saying ‘Clare Sullivan’, ‘Acting Assistant Secretary’, ‘Primary Care Quality and Design Branch’]

Thanks so much Mark. Good afternoon everyone. It’s as pleasure to be here and we’re really glad everyone could join our webinar today. So today’s session will focus on the General Practice in Aged Care Incentive with an overview of MyMedicare. So as you may know practices and providers are now able to register, encourage patients to register and begin delivering eligible services as part of the General Practice in Aged Care Incentive.

So my presentation will cover the policy intent of the incentive, an overview of the incentive focusing on residential aged care providers and their staff as well as residents and their families and carers, the benefits of the incentive, how you can participate, and the resources available to support the incentive.

So to get us started the General Practice in Aged Care Incentive has been developed in response to the findings of the Royal Commission into Aged Care Quality and Safety and the Strengthening Medicare Taskforce. So the Royal Commission into Aged Care Quality and Safety found that aged care residents face barriers in accessing timely and high quality care from GPs and that access to GPs is limited for many aged care residents and those who do have access are often provided with substandard care. 

So in light of those findings the Royal Commission recommended that a new model of primary care be developed to encourage holistic, coordinated and proactive primary healthcare for older Australians including those in residential aged care. In addition to the Royal Commission the Strengthening Medicare Taskforce recommended that new funding approaches be developed to provide flexibility and that that support the delivery of multidisciplinary teambased care.

So with those findings in mind and those reports the General Practice in Aged Care Incentive aims to address those calls to action by improving access to quality general practice care for residents of aged care homes. And it does this by incentivising proactive, face to face visits, regular planned reviews and coordinated care planning. And it does this because the evidence suggests that the current delivery of primary care in aged care is typically episodic and reactive, it's predominantly made up of time-based visits to meet acute needs, it’s often delivered by a GP or practice who may not be the resident’s regular GP, and it’s often focused on a high volume of services. What we’d like to see is patients having a regular GP that’s continuing to deliver services once those patients enter aged care and for that care to be high quality and proactive.

So to support improved health outcomes for older people the General Practice in Aged Care Incentive aims to encourage care that is planned and proactive, so it focuses on delivering regular care to individual residents, including care planning services. It’s also delivered to a resident by the same GP and practice the majority of the time. We want the care to support local GPs and practices in providing care to patients even in small numbers, and we want care that encourages GPs and practices to follow patients into the residential aged care home to really embed that continuity of care with their practitioner.

So stepping back for the moment what you’ll see there on screen is a snapshot of how the General Practice in Aged Care Incentive fits within the broader policy environment. So the General Practice in Aged Care Incentive is not a standalone reform. It contributes to a broader policy ecosystem which aims to support the delivery of high quality primary care and to improve the health outcomes of older Australians. So it leverages those well established systems for providing health and care to people in residential aged care, the Medicare system and the aged care system. 

And as I just mentioned it forms part of the Australian Government’s Strengthening Medicare reforms. So it’s delivered through MyMedicare, Australia’s new voluntary patient registration system which is a key reform under Strengthening Medicare. And the incentive will also operate alongside other reforms to the Medicare Benefits Schedule that rollout under MyMedicare such as the Triple Bulk Billing Incentive and changes to chronic condition management plans which commence in November. And as we’ll explain in a moment it leverages a wide range of existing MBS and Department of Veteran Affairs servicing items as an incentive to deliver more proactive care to residents.

In addition the incentive sits within the environment of reforms to aged care and its legislative and regulatory frameworks. And that includes the Aged Care Act which is undergoing important legislative reform to further support the delivery of high quality care.

So against that background I’ll now provide an overview of the incentive and how it can be accessed. So let’s start with who can participate. Residents, general practitioners and primary care providers can participate in the General Practice in Aged Care Incentive with some eligibility requirements. So aged care residents need to be permanent residents of a residential aged care home, and that doesn’t include those in respite care. Residents need to be registered in MyMedicare and connected to a practice and provider who is willing to deliver the General Practice in Aged Care Incentive. And there is no minimum age limit for residents to participate in the incentive. It’s up to the GP and the practice to decide if they are participating in the incentive and to provide care under the servicing requirements of the incentive.

For general practitioners they must be registered in MyMedicare and be an eligible provider type as outlined in the program guidelines. Solo practitioners can also participate if they meet the eligibility criteria.

And primary care practices also need to be registered in MyMedicare and need to be willing to deliver the General Practice in Aged Care Incentive and be connected to an eligible resident.

So they’re the basic eligibility requirements. I’ll now outline some of the key features of the incentive.

So eligible primary care providers and practices registered in MyMedicare will receive incentives for providing their registered patients with care planning and regular visits. That’s the crux of the incentive. So what’s required for the responsible provider and their care team to receive those incentives is that they’ll need to deliver at least ten eligible services over 12 months consisting of two care planning items and eight regular visits delivered two per quarter in separate calendar months. And for those delivering those services, so if they deliver at least ten services in that way, responsible providers or doctors will receive $300 per patient per annum and the practice will receive $130 per patient per annum.

I just wanted to note as well there’s no difference in the incentive amount for First Nations patients and no requirement for the GP to cover after hours services.

So let’s have a look at how this works in practice. So the image on this slide shows an example of how the visits can be structured over the 12 month period. So you’ll see there there would be two regular services in a quarter delivered in separate months. And in addition to those two services per quarter, meaning a total of eight, there are also two care planning services. Based on a doctor’s assessment those could include a medicine review, a comprehensive medical assessment or even care planning. And we have received some detailed questions about the structure of care planning sessions and we’d be happy to address those in the Q&A or even in some targeted webinars for medical professionals if that’s of use.

So so far I’ve said that residents can expect to have eight regular visits and two care planning visits. Additional flexibility has been built into the General Practice in Aged Care Incentive to support that delivery of care. The first is that other professionals who work at the GP’s practice like a nurse practitioner, another GP, a practice nurse, an Aboriginal and Torres Strait Islander health practitioner or worker can also deliver these services. It doesn’t include allied health professionals though the doctor or another medical professional can complete care plans in case conferences to bring together a range of health professionals. And the aim with designing the incentive that way is to really encourage multidisciplinary team-based care to provide the most optimal, proactive, continuous care to the resident.

However having said all of that a patient’s regular GP must see them at least once per quarter. This is about allowing for continuity of care while providing options for the doctor to account for periods of leave and other instances where it’s not possible for the regular GP to attend.

We’ve also built in some additional flexibility around rural and remote locations. So in recognition of the additional challenges of delivering care in rural and remote areas there will be rural loadings on the incentive payments and flexible delivery options like telehealth which will be available to practices in the most rural and regional areas. So while that information that I’ve just mentioned is more for medical practitioners I wanted to share it with you for your awareness and so that you know what to expect when you’re receiving services being delivered under the General Practice in Aged Care Incentive.

So let’s talk a bit about the benefits of the incentive for residents, families and carers. So as residents you and your family and carers will benefit from the General Practice in Aged Care Incentive through a few different ways. The first is that you’ll have a formal relationship with your GP, practice and other healthcare professionals. So by registering with MyMedicare you are formalising your relationship with your regular doctor and their practice. We also expect that you’ll receive improved health and wellbeing outcomes and fewer preventable hospitalisations especially during the afterhours period. We expect that the regular visits from a GP and that formal relationship are aimed at identifying concerns early and proactively. This will give you greater access to primary care services delivered in your aged care home and greater access to planning services including health assessments and development of care plans, all of which will give you better regularity of primary care services and proactive continuous care.

So I’ll now go over the services and care that can be accessed under the incentive. So the first step is to register with MyMedicare and I’ll talk a little bit more about this on the next slide. But once the resident is registered in MyMedicare the practice will then register you for the incentive to access services. And when that’s complete doctors and care teams can begin to deliver the services. So registration in MyMedicare by all parties whether it’s yourself as the resident, a doctor or the practice is completely voluntary. It’s up to each person or party to decide if they wish to register and participate. And on the screen is a simplified overview of the registration process. There are some steps which the doctor and the practice need to do. What you can see are the steps that apply for residents and their families and carers. And over the next few slides where I refer to residents I’m collectively referring to yourselves, your families and carers.

So residents or their families and carers can sign up to or register for MyMedicare. And as mentioned residents, the doctor and the clinic must all agree to participate before the sign up can be completed. And there are a few ways that you can sign up for MyMedicare. You can sign up online via the Services Australia website or via the Express Plus Medicare mobile app. And if you sign up online you’ll need your Medicare card. You can also sign up using the paper form and to do this you can complete the form and hand it back to your GP or to staff at the home who will hand it back to your doctor. And if you are signing up for MyMedicare with a Veteran’s card you’ll have to use that paper form.

And you’ll notice when completing the registration in MyMedicare you’ll see an ‘About you’ section which is where you can give information about yourself. I just wanted to let you know this is completely voluntary and you can still sign up for MyMedicare if you choose not to complete those questions. And if you’ve already signed up for MyMedicare you don’t need to do it again. So if you want to check if you are signed up for MyMedicare we suggest you speak to your regular doctor or practice staff.

So this information on the slide next is just for your awareness. The practice will complete these steps. So just quickly practices are responsible for registering their patients for the incentive. Once registered in MyMedicare a resident does not have to do anything further to participate. Practices will register their patients for the incentive through the HPOS system and guidance for practices is available from Services Australia. And just a reminder it’s completely up to the practice and GPs if they wish to participate in the General Practice in Aged Care Incentive.

So for now I’ll throw back to you Mark. Thanks.

Mark Roddam:

Thank you very much Clare. And I can appreciate for everyone tuning in today that there’s a lot of information that Clare has shared there and we’ll make these slides available and also respond to questions and provide any clarification you need at the end. So please keep those questions coming.

I’d now like to introduce Craig Gear, the Chief Executive Officer of the Older Persons Advocacy Network. Craig was appointed CEO of the Older Persons Advocacy Network in 2018. He has a Master of Nursing and over 20 years of clinical and senior management experience within the health and human services sectors, previously serving as Board Chair at the Seniors Rights Service. Craig’s passionate about connecting and improving the health system for all Australians and he also has an insider’s perspective of the challenges involved and has been using that experience to drive better outcomes for at risk communities for more than 20 years. So it’s a pleasure to hand over to you Craig. Thank you.

Craig Gear:

[Visual of slide with text saying ‘Craig Gear’, ‘Chief Executive Officer’, ‘Older Persons Advocacy Network (OPAN)’]

Great. Thanks Mark. And look thank you for having me along today and really bringing forth the perspective I think of older people that we hear from and their families as well. And it’s actually really exciting having this incentive because we do hear about the importance that older people place on their general practitioner and that importance of continuity of care as well.

For those who don’t know the Older Persons Advocacy Network is a service of nine member organisations that deliver the National Aged Care Advocacy Program right across the country. We provide information, education and individual support to older people when they’re having those little challenges with interacting with the aged care system and also the primary care system as well at some points. And so what we saw last year was around 44,000 cases of information and advocacy support and a lot of it was about communication. And we support people in residential aged care and in home care but particularly in residential care the issues that were coming forward to us were around medication management, communication with the team and also with the GP, but also accessing services as well.

So I suppose off the back of that story older people have said to us they really love that connection with their general practitioner and having to see them regularly to make sure that their care is being monitored. And so this incentive does help with that. And Clare’s sort of talked you through about how as an older person or a family member you could assist someone with registering through the online program, the app or through the paper-based forms. And we do know that older people may want some assistance in that. They might also be able to register themselves and do it themselves as well. And it’s important that people realise this is voluntary and this is consent based. So that’s why we want people to do the registration.

Now we do know also that sometimes people have other people that act as their supported decision maker or as a substitute decision maker. So in those situations those people can actually still assist if this is the wishes and preferences they think of the older person, from wanting to connect with their regular GP, and that might be a pattern that people have demonstrated. Then someone else can assist with that and that might be the enduring guardian, someone that’s been appointed under the guardianship process or the next of kin who might have that authority. So that responsible person can do that on behalf of that person. Now if there’s no power of attorney or guardianship appointed then residential aged care homes will have processes in place for that next person down the list as well.

Older people have also asked us can they change their doctor in this registration. We know there might be reasons to change their doctor, personal choice, and people have absolutely that right to do that. It also might be about that a GP may decide to no longer provide services or be changing their service model. So that can happen but again it’s a voluntary system for someone else to come on but those changes are possible.

It's really important to remember for those rural and remote areas that there are incentives and that telehealth is possible for that as well which is complementary to that face to face work. So we see that regular contact with the GP is so important and this is going to assist in some of that as well. So if anyone’s got any questions, if you’re an older person or a family member, please call us on 1800 700 600 and we can assist you with that.

Mark Roddam:

I really want to thank you Craig for the way you’ve worked with the team here on the rollout of this incentive and your ongoing relationship with the Department. So thank you very much.

I would now like to introduce Dr Paresh Dawda from Prestantia Health. Paresh is a practicing GP and business owner with a breadth and depth of experience across clinical service delivery systems in Australia and the UK and extensive knowledge of systems in the US and New Zealand. So Paresh is Director and Principal of Prestantia Health and he offers healthcare and consultancy services and his passion lies in human centred healthcare. And again Paresh has done an enormous amount of work to support the rollout of the GP in Aged Care Incentive. So over to you Paresh.

Dr Paresh Dawda:

[Visual of slide with text saying ‘Dr Paresh Dawda’, ‘Director and Principal’, ‘Prestantia Health’]

Great. Thank you Mark so much. Good afternoon everyone. I’ll really speak to the benefits for residential aged care providers and how they support residents with accessing the incentive. When we’re thinking about this incentive in aged care it will really benefit providers in a number of ways I think. Firstly knowing that residents are going to get that regular, coordinated primary healthcare I think is really important. And based on what you already heard and what’s been described a doctor and the care team participating in this initiative will visit the resident at least ten times a year in different formats.

By including care planning items, two of the care planning items as necessary, it gives a degree of assurance that care plans will be reviewed as the care needs change for that resident. The opportunity for more residents to have a regular GP as the incentive really supports doctors and their team where possible to visit the residents at home in their own homes within the residential aged care home.

Staff also within the homes will feel supported as part of the extended healthcare team really. And finally I think there’s something about support to meet the Aged Care Quality Standards by ensuring residents can have access to that safe and effective clinical care.

So if we move on and think about how providers support residents to access these regular services. Within residential aged care homes the support can really support the implementation of the General Practice in Aged Care Incentive in a number of ways. Understanding the incentive, its benefits and role will help. Supporting the residents to be registered in MyMedicare, supporting practices and general practitioners to deliver services to residents in aged care homes. The Department’s actually going to hold a webinar for doctors to provide more details on the incentive to them as well. One of the things we really wish to clarify is it is not the responsibility of residential aged care providers and their staff to register the residents with MyMedicare or obtain that informed consent, search for practices registered with MyMedicare and the incentive and recommend or promote one practice or GP more than another.

I think the emphasis on registration for MyMedicare being voluntary is important. The decision to register with MyMedicare and the choice of GP of course rests with that aged care resident in collaboration with their family or carers. It’s the responsibility of the practice to link the resident to the GP in MyMedicare and then select the indicator on the patient’s MyMedicare profile to participate in the incentive.

However providers do have an important role in supporting the residents, their families and carers to understand and participate if they choose in MyMedicare and the incentive.

Often when we’re looking at this it’s helpful to think about a patient’s story. And so what we’re going to do is consider the General Practice in Aged Care Incentive really from that real world perspective. A case study’s been developed to provide an example of how the incentive could work in practice and how a resident will benefit. So if we think about Bernie, Bernie is an 86 year old man. He’s a retired civil engineer. Since retiring he’s lived in the same house for 25 years with his wife Mabel. Bernie and Mabel have been married for over 60 years. They have little family support with two children living overseas and only one, their son Paul, living closer to them. Paul has enduring power of attorney.

They have had domestic and gardening assistance through a Commonwealth home care package. Carers assist Bernie with washing and dressing and they also help with medication. They’re a social couple and they have a wide network of friends. Despite being speech impaired Bernie is social and enjoys company, good food and wine. Bernie experienced a major stroke some years ago. In the intervening time Bernie has become less mobile, increasingly frail and at risk of a fall. He is speech impaired and lives with diabetes, chronic heart failure and prostate cancer. He is under the care of a GP that has seen him for over 15 years and an oncologist, and he was recently also seen by a geriatrician or referred to a geriatrician.

Bernie’s health and speech have rapidly declined. His capacity to live independently and Mabel’s incapacity to confidently and safely care for him has led to the decision for Bernie to transition to an aged care home following an aged care team assessment. The aged care home is some distance from his local practice. His GP which has been the longstanding GP unfortunately has indicated that they will not be able to visit him in this new home because of the distance and he’ll need to find a new GP. Mabel will continue to live independently in the family home.

The aged care home that Bernie will be moving to provided Bernie with a list of GPs that attended the facility and information on MyMedicare and explained that there is an incentive to support GPs to visit people in residential aged care. Mabel and Bernie looked through this list and they spoke to one of the GPs on that list, Dr Singh’s clinic. They arranged an extended initial appointment at the aged care home to meet with Dr Singh. At that appointment Dr Singh went through Bernie’s medical history and medications, a shared health summary on My Health Record. Dr Singh explained to them how primary care services within aged care operate.

Together they discussed the importance of a comprehensive medical assessment, one of those care planning services, and agreed to proceed with this. Dr Singh advised that the practice nurse would assist with this and organise an appointment the following week for the practice nurse to come and visit Bernie. The practice nurse attended and assisted with gathering information including the most recent reports from the oncologist and the geriatrician. Following this information a care plan was constructed. 

On the slide here what you see are the visual timelines for Bernie’s care outlined over the course of the slide and hopefully I hope this example provides an idea of how residents can access and benefit from the incentive whilst in an aged care home with a sort of more proactive and more planned approach to their care.

I want to throw the ball back to you Mark. Thank you.

Mark Roddam:

Thank you very much Paresh. That’s really informative. And thanks again for all the work that you’ve done with us on the incentive. I’ll now pass back to Clare Sullivan to talk about the support available to aged care providers and residents and how to access it. Back to you Clare. 

Clare Sullivan:

Thanks very much Mark. So while providers are supporting residents, their families and carers those providers are in turn being supported by primary health networks. So as part of the General Practice in Aged Care Incentive primary health networks are being funded to do a range of things to support the implementation of the incentive. So firstly they’re being funded to collaborate and engage with a range of partners involved in delivering the incentive including aged care home providers, GPs, general practices and Aboriginal Community Controlled Health Services in their regions. And that kind of support involves establishing arrangements between stakeholders where appropriate.

They’re also being funded to develop processes and strategies to connect and establish relationships between older people living in aged care homes and aged care homes with primary care especially in cases where no relationship currently exists. This might include providing support to facilitate visits to older people living in aged care homes to encourage that continuity of care that we’ve been speaking about which is at the heart of the incentive.

They’re also being funded to develop or use existing tools to support stakeholders to sign up and appropriately use the MyMedicare platform and to identify and share examples of best practice arrangements between aged care home providers, GPs and general practices and Aboriginal Community Controlled Health Services in your region. So again this could include establishing relationships and networks to improve capacity.

If you have any queries about any of that providers can speak to their relevant primary health network or contact the Department.

So there are a number of resources and tools available to support the implementation of the General Practice in Aged Care Incentive. So the Department is publishing resources to support all groups involved in the incentive including GPs to understand the incentive, to support older people and to promote the delivery of high quality care. As Paresh mentioned we also had some upcoming webinars for GPs to talk through the incentive and how it works in detail specific to them and the resources that are available. And as part of these resources an information booklet has been developed for residents, their families and carers to understand the incentive and how it will impact them. A range of information kits have been developed for residential aged care providers and aged care experts and peak body organisations to help them understand, communicate and support the General Practice in Aged Care Incentive with residents, members and the community. And those information kits include resources such as template presentations that support people to effectively communicate about the incentive to residents or staff or other members. All of these resources are really trying to encourage a partnership approach so that every person and organisation involved in delivering the General Practice in Aged Care Incentive has support and resources to enable that continuity of care that we’re aiming to deliver through the incentive to residents.

So Mark back to you. Thank you.

Mark Roddam:

Thank you very much again Clare. And just a reminder all these tools and resources will be published in the coming weeks. We’ll provide attendees at the webinar today with links to all of the materials once published. In addition to that we’ve got a few other options available for assistance and support. For support with signing up for MyMedicare you can call Services Australia or the Department of Veterans Affairs if it’s related to Veterans. Or for other enquiries not related to registration you can send us an email at mymedicare@health.gov.au. And further information is also available online at Services Australia and the Department of Health and Aged Care website.

We’ll now move onto the Q&A segment of our webinar. So thank you all for submitting your questions to use either when registering or during the webinar today. So I’ll now go to those questions.

First question is:

Q:        Would the Commonwealth be open to trialling some innovative, virtual and across boundary GP into aged care models for regional locations?

Now Clare I might give that one to you but I know we do have the loadings and extra support for those in rural and regional locations. But I’ll hand over to you for that.

Clare Sullivan:

Thanks so much Mark. No. You’re absolutely right. In addition to that flexibility that we built into the General Practice in Aged Care Incentive we’ve also funded primary health networks to support the implementation of the incentive in a range of areas where market failure or GP shortages might be an impediment to the incentive. So one of those activities is we funded a selection of PHNs with a grant to develop innovative solutions to areas of GP shortage or thin markets in their regions to help connect and provide solutions to a lack of primary care services in those areas. So along with the additional flexibility and regional loadings we’re doing everything we can to support the implementation of the General Practice in Aged Care Incentive in those areas.

Mark Roddam:

Thank you very much Clare. Next question I’ve got is:

Q:        There is significantly increased complexity and yet no commensurate increased funding for GPs. How will this attract GPs into aged care work?

Now Clare I know the Department has done some modelling around this and particularly when you bring the triple bulk billing incentive into consideration here it becomes significantly more attractive for GPs and primary care practices to get involved in this work. But did you want to talk a little bit more about that?

Clare Sullivan:

Absolutely. That’s absolutely right. So the servicing requirements of the incentive are really about promoting flexibility through enabling the delivery of team based care. So while one of those regular visits that I mentioned before can be delivered by a member of the care team, so one visit per quarter, and that’s really about freeing up the time of the GP if they’re not able to attend but making sure that there is continuity of care for the resident. So the responsible provider does not need to be present if an alternative provider is delivering an eligible service in line with the servicing requirements under the incentive. 

But in addition as you say Mark this incentive forms part of the Government’s Strengthening Medicare reform agenda and that reform agenda provides a range of considerable benefits that GPs and practices operating under the General Practice in Aged Care Incentive can take the benefit of. So as I mentioned rural loadings. There’s also the triple bulk billing incentives and in November the chronic condition management items. All of these we think will make most GPs as good or better off under the General Practice in Aged Care Incentive. 

So we consider at the moment that there is a lot that’s been built into the incentive to make it attractive to GPs and to incentivise them to leave their clinic room and go to the residential aged care home and deliver that regular care over the 12 month period. Thanks Mark. 

Mark Roddam:

Good questions here so thank you to everyone for sending them in.

Q:        How will the Department measure value for money from these incentives? Will it measure the length of the consult some doctors provide when they see patients in aged care, and will it specify this and if so how it will be measured? Some doctors spend very few minutes with their residential aged care facility resident or patient. 

Now I know as with measures like this we have an evaluation plan and it would seem to me that that would be exactly what we want the evaluation to measure. But I’ll start with you Clare. I don’t know if Paresh you have anything to add here but start with you Clare and then see if Paresh has anything to add.

Clare Sullivan:

Yeah. Sure. That’s right Mark. As a new incentive we have a monitoring and evaluation framework. We’ll be monitoring over the next three years. And that framework will be looking at the entire incentive, so all aspects of the model including how the model encourages continuity of care and encourages a diversity of practice types. It will have an economic evaluation component to be looking at value for money. And it will have a range of quantitative and qualitative aspects to it. So we’ll be hearing from everyone involved in the incentive including residents about how it’s working on the ground and that relationship between the GP and the resident, how’s that going. So it’s pretty comprehensive and we expect that we’ll have a pretty good picture as the incentive rolls out over the next few years as we go – not just at the end – as we go along and we can make continuous improvement if needed.

We’ve structured the incentive at the moment so that we are trying to encourage that continuity of care, so those longer items are being rewarded in the bundle of care, those shorter items not so much. So I might pass over to Paresh. If you wanted to add anything on to that. 

Dr Paresh Dawda:

Great. Thanks Clare. And really important question. I think I’d probably add two or three comments to that. So firstly I think the Department has commissioned an evaluator and for example we’re going to be talking to those evaluators in the next week or so around some of the concepts that Clare and Mark, you’ve identified to ensure that that evaluation is really holistic and comprehensive. So I think it’s important the evaluation plan kind of captures the holistic nature of it. So I think that would be kind of my first point.

I think the second thing I’d add is when we think about the envelope within which this incentive sits, Strengthening Medicare, it’s part of a big reform and it’s actually a different way, it’s a fundamentally different way of looking at incentives compared to what’s gone before. And so the importance of evaluation and monitoring and being adaptive, that continuous quality improvement Clare you spoke to, it’s almost fundamental. And this is really the first of the incentives under the Strengthening Medicare that’s kind of taken this approach and I think it’s going to be a really important learning point.

My kind of sense of knowing and working the different systems and having a lot of knowledge about different systems is it’s a nudge in a direction which heads towards that proactive planned care compared to what we’ve had in the past. It’s not necessarily a silver bullet solution but that’s okay. It’s a step in the right direction.

Mark Roddam:

Thanks Paresh. An important question here.

Q:        Is the incentive available for non-accredited clinics?

And I know we do have a period whereby sole practitioners can register to deliver the incentive. Did you just want to explain that for us Clare? Thank you. 

Clare Sullivan:

That’s absolutely right. So there is a period up until the 30th of June 2025 where practices who are not accredited can still register for MyMedicare and deliver services under the General Practice in Aged Care Incentive. So if you are not accredited you can still register. And that includes solo providers, so solo practitioners who generally deliver services through mobile or outreach models. Sorry. Mobile practitioners can register and the exemption applies to general practices who generally deliver services through mobile outreach models.

Anything else that you wanted to add there Paresh?

Dr Paresh Dawda:

No. Look I think that’s absolutely right. And I think again having an accreditation gives a degree of quality assurance in the long run. So it’s great that I think this incentive is giving people space and time to work towards an accreditation where it doesn’t exist at the moment.

Mark Roddam:

Thank you both again. I will come to you on this one Craig. So it’s a pat on the back.

Q:        Well done Department of Health and OPAN. Really glad to see the incentives for GPs in nursing homes. We need them back. But many GPs don’t have the incentive to engage in allied health in the practice incentive scheme as already claimed for registered nurses. How can the Government support more incentives for GPs to engage and work with allied health in multidisciplinary teams?

So I’ll probably come more to you on that last part Craig from an advocacy perspective and what you see happening in the residential aged care sector, how we can get that allied health work happening in aged care as we are trying to encourage through this incentive.

Craig Gear:

Absolutely. And firstly a callout to all the aged care workers out there. Tomorrow is Aged Care Worker Day. So thank you for all the work that you all do out there but also thank you to the really amazing allied health practitioners out there. We know that what makes a difference as well as the GP is access to allied health and that that’s part of people maintaining their function or that rehabilitation. And it’s absolutely needed. My understanding is that some of the chronic management planned incentives and [0:44:45]. So I think facilities do need to be thinking about is there in-house allied health and making sure that those allied health minutes are there and are facilitated but also where someone is wanting to access people from outside as well. But older people are telling us it’s a really important part of care in their home but also care in residential aged care as well.

Clare any thoughts on the allied health?

Clare Sullivan:

I might throw to Paresh and only because I actually did technically cut out exactly when you said my name so I didn’t hear that bit. But Paresh did you have any comments?

Dr Paresh Dawda:

I was just going to add a couple of comments really. Whilst the incentive doesn’t directly incentivise general practices to employ allied health personnel etcetera the idea of having the care planning services, two of those full care planning services is that actually becomes a facilitated enabler to engage with allied health. So for example as I do a care plan or a contribution to the care plan for a resident in aged care I might identify an allied healthcare need, suggest physiotherapy, podiatry, dietician, whatever it may be. And within that care planning service is the potential for that resident to then get a rebate for some of those allied health services with some maybe provided by the residential aged care home as well under their sort of funding arrangements. So I think that’s number one.

Number two, one of those care planning services is case conferencing and case conferencing is a really powerful way of getting the whole care team including allied health on the same page around the care and the goals of that patient and working together. And so I think that’s another enabler. That’s another facilitator to support multidisciplinary team based care including allied health.

Mark Roddam:

Thank you. Thank you both on that. I’m pretty sure the answer to this is no.

Q:        Do patients need two face to face visits before being able to be registered with a practice and MyMedicare?

Clare?

Clare Sullivan:

That’s correct. The answer is no. There’s an exemption that applies for residents to register for MyMedicare. You don’t need to comply with that two visits within the last 12 months. So that’s correct. There’s an exemption.

Mark Roddam:

Thank you Clare. There’s a comment in the chat there. I just want to make sure everyone is aware. So just from the team here at the Department of Health.

Q:        We’re aware of some technical difficulties with the Q&A function. If your question is not already captured please email us at mymedicare@health.gov.au with your question and we will follow up from there.

So apologies from us all for those technical difficulties. Another question on the webinar for GPs. Can we get that emailed out? I assume we can send the – it’s I assume referring to a separate webinar we’ve done just for GPs Clare. We’ll be able to get that to them.

Clare Sullivan:

That’s right. We have one next week which we can have the team circulate the link for.

Mark Roddam:

Here’s a question we haven’t got to.

Q:        In the webinar on the 4th of July this year, so about a month ago, apparently you said patients registering for GP Aged Care Incentive are not required to have two visits in the previous 12 months with a nominated responsible provider. They are exempt.

It sort of crosses over with the previous question. 

Q:        But I assume this is because new residential aged care facility patients do not usually have the option to continue with their current GP. This exemption was not documented in the operational guidelines. If a patient is new to a GP and they’ve just moved into the facility are they exempt from the two visits in the 24 month MyMedicare eligibility criteria?

And I think you’ve cleared that up that the answer is yes.

Clare Sullivan:

Yeah that’s exactly right. And the operational guidelines for the General Practice in Aged Care Incentive also refer back to the MyMedicare operational guidelines. So since that’s a MyMedicare exemption the two guidelines will speak to each other that way. But we’ll clarify if anything’s missing. So thanks for raising that.

Mark Roddam:

A question for you Craig and a thank you for the great info you’ve provided on OPAN and the work that your organisation does.

Q:        You mentioned that 44,000 contacts from consumers were about access to services. Were there many on a lack of access to allied health in residential aged care facilities and would it help to have GPs more able to work with allied health to improve health outcomes for older people?

Craig Gear:

Yeah. So we haven’t specifically delved into that data as yet into looking at whether the access issues were allied health related. It was under care, access to care in general. So it’s something that I’m happy to take away and have a look at. But I know from speaking to members of OPAN’s Older Person’s Reference Group how important they’ve said to us that having that regular access to allied health is, whether that’s physiotherapy, an OT or speech pathologist or other allied health supports. Because it’s what keeps them functioning well and gets them also access to the goods and equipment and support that they need as well. So anything we can do to help inform that sort of need of allied health we’ll bring that forward to the Department as well after this webinar.

Mark Roddam:

Thanks very much Craig. A question for you Paresh.

Q:        Do you think it’s helpful for GPs and clinical outcomes for aged care residents to have greater access to allied health?

Similar question for Craig. So throw that to you.

Dr Paresh Dawda:

Yeah. Look I think residents in the aged care facilities have complex care needs. Often when we look at what matters to them, what’s important to them, it’s often things like pain management, mobility and nutrition. Some of the hard medicine bits are perhaps less important but they’re part of the equation. Which is why I think that multidisciplinary team based care is so, so critical and important. And as I said earlier I think the great thing about this incentive, it’s a step in that direction to help facilitate that and enable that. So absolutely I think it leads to better outcomes.

Mark Roddam:

Thank you very much Paresh. We’ve got time for one final question before we wrap up and I think this might need to go to you Clare.

Q:        In rural areas where half the GP visits can be done remotely and half by a member of the care team is it possible that the registered GP only attends for care planning?

Clare Sullivan:

Thanks for that question. So the responsible GP will do the care planning but they must also do at least one every quarter of the regular visits. So in effect the responsible provider needs to provide at least six of the ten services. But an alternative GP or another member of the care team can deliver the other one service regular visit per quarter. The other thing I would say is in a rural area we do have the flexible option, the flexible delivery option. So in MMM regions 4 to 7 all the visits can be done by telehealth. So there’s that option as well if the GP can’t come out or is finding it difficult to come out. And of course we have the rural loadings for all the incentive payments in those areas. So we do have that requirement that the GP attends four of the eight regular visits but we have built in that flexibility to make that more easy.

Mark Roddam:

Great. Thank you Clare. And thanks again everyone for those questions. We’ve now unfortunately come to the end of our time for Q&A but I really appreciate those questions and we’ll have answers to those questions and more on our website. And we will compile a document with the answers to the more common questions and we’ll send that to everyone who’s registered for the webinar today.

Before we end our webinar we’d really like to get your feedback. We’ve included a QR code in the slides which you can see which will take you to a short webinar survey. And there’s a link I saw in the Q&A as well if you want to click on that and complete that short survey. It really does help us to target and improve our webinars. It only takes about one minute to answer three short questions.

So thank you all for taking the time to join us today and also thanks to Clare, to Craig and Paresh for covering some of the key aspects of the General Practice in Aged Care Incentive and what it means for residential aged care providers and workers, and also importantly residents, their families and carers. So thank you again for joining us today.

[Closing visual of slide with text saying ‘Webinar survey’, image of QR code, ‘Please scan the QR code with your phone to respond to a short webinar survey’, ‘August 2024’]

[End of Transcript]