Workforce Incentive Program – Rural Advanced Skills

Presented by:

• Tessa Pascoe – Director, Incentives and Innovation Branch, Department of Health and Aged Care

Speakers:

• Dr Karin Jodlowski-Tan – National Clinical Head of Rural Pathways, RACGP
• Associate Professor Michael Clements – Chair of the RACGP Rural Council, RACGP
• Dr David Campbell – Censor in Chief, ACRRM
• Dr Sarah Chalmers – Past President of the College, ACRRM
• Lauren Cordwell – CEO, RWAV
• Peta Rutherford – CEO, RDAA

[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]

Tessa Pascoe:

Okay. Welcome everyone to the Commonwealth Department of Health and Aged Care’s webinar on the WIP Incentive Program Rural Advanced Skills.

My name is Tessa Pascoe. I am the Director of the Incentives section in Health Workforce Division in the Department and I will today facilitate this webinar alongside my colleague Paul Halloran. And we also have representation from a number of our peak organisations. I’ll introduce those shortly.

I would like to first start off by acknowledging the traditional custodians on the lands of which we are all on and pay my respects to Elders past, present and emerging, and to also acknowledge all the Aboriginal and Torres Strait Islander staff or doctors who are joining us today on this webinar.

I will be providing an overview of the Workforce Incentive Program, the Rural Advanced Skills Program payment.

We are fortunate to have a number of representatives from our general practice and rural generalist colleges and I would just like to introduce some so you know they are on the line. We have from RACGP Associate Professor Michael Clements who is Vice President and Chair of the RACGP Rural Council. We also have Dr Karin Jodlowski-Tan who is a National Clinical Lead Rural. And from the Australian College of Rural and Remote Medicine we do have the immediate past President of the College Dr Sarah Chalmers.

And also the Censor in Chief Dr David Campbell. From the Rural Doctors Association we have our Chief Executive Officer Peta Rutherford. And also from Rural Workforce Agency Victoria we are joined by the CEO Lauren Cordwell. So thank you to everyone for your attendance and taking the time this evening.

Before I get started into the presentation I would like to invite Associate Professor Michael Clements to maybe say a few words about this incentive and then I will sort of move to Peta Rutherford as well. So Michael I’ll hand over to you for a moment.

Associate Professor Michael Clements:

Yeah. Thank you very much. Very pleased to be having this kind of conversation where we’re outlining and talking about how people can access this really important incentive. It had its derivation back in the first Rural Health Commissioner Paul Worley’s workforce meetings where we recognised that if we want to encourage our rural GPs and rural generalists to do work across both the general practice and the hospital space then we needed to incentivise them. So a very simple concept. Took us a while to get here but we’ve worked very closely with the Department and with ACRRM, and we had input from AMA as well and RDAA to design these packages to incentivise doctors such as you working across both of those spaces. 

Going to have an opportunity a little bit later on to talk about how we as a College for our RACGP members can support you in either getting your existing skill recognised. So if you’re already doing the work of an RG but perhaps don’t have that recognition then we’ll be talking about how we can achieve that for you through our recognised prior learning process, but we’d also encourage doctors that perhaps aren’t doing the work yet or perhaps won’t be recognised just yet, we’d like to encourage you to think about attaining those additional skills, perhaps doing extra time in an advanced skills post or working in a rural hospital environment or emergency care environment or an Aboriginal Community Controlled service to actually benefit from these packages.

So the Department’s had a very interactive, very positive working relationship with the Colleges in designing this and I’ve been looking forward to this talk so that we can hopefully help some of you get a better understanding and better access. Thank you.

Tessa Pascoe:

Thank you Michael. All right. We’ll start the slideshow.

Peta Rutherford:

Sorry. I am here.

Tessa Pascoe:

Great. Go for it Peta.

Peta Rutherford:

Thank you for the invitation. And Rural Doctors Association of Australia is really pleased to be part of this webinar and highlight the excellent I guess opportunity that this incentive provides. It’s certainly been a long time coming and we’re really pleased to see it now become reality. And as Michael mentioned it is very much or has been very much part of the work under the National Rural Generalist Pathway and RDAA has been a big part of that. And certainly through the work that we’ve done it’s been deliberately designed around the Collingrove Agreement and definition of the scope of work that a rural generalist does. But I think importantly it also recognises the GPs who may not do the full scope of rural generalist work but do part of it. So whether that’s an emergency service or whether that’s an advanced skill part. I think that’s a really important element. And also retaining community general practice at the core of the incentive. So I think they’re all really important bits in recognition of a broader rural workforce.

And again I guess just thank you to the Department in the development and the design of this, in listening to feedback and responding to that. And Tessa you’ve been a big part of that. But certainly in recognition of rural generalists or rural GPs who work on a part time basis. And I think again that was a really important addition in the design of this initiative. So I’ll hand back to you but we do see it as a really good opportunity as Michael said for people to think about their service provision, the scope of that and possibly obtaining additional skills. And it’s an incentive in recognition of the work that a lot of rural GPs and rural generalists do. So thank you.

Tessa Pascoe:

[Visual of slide with text saying ‘Workforce Incentive Program – Rural Advanced Skills webinar’, ‘3 April 2024’, ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’]

Thanks Peta. Thank you for those lovely words. Okay. So as part of this webinar we have linked in with Slido so that if there are questions from you doctors and rural generalists we are happy to hear of those questions. Hopefully we’ll address most of those during this process. So we might just go to the Slido. There we are. So if you scan that QR code and enter that passcode of 1krq1f. You will be able to write down your questions. If they’re not answered as part of this process today we are happy to take those questions on board. You are free to also send any questions through to our mailbox in the Department which is WIP@health.gov.au and we will look to addressing those questions as well. Part of that will assist us also to refine our guidelines and also our frequently asked questions that we have on the website.

I just see it’s popping up there now.

This webinar will cover the WIP Rural Advanced Skills as an overview. It will also address the eligibility criteria, the payment values, application process and provide some support and resources for applicants. We will try to get into some detail on these topics based on the questions and issues that doctors have raised either with us in the Department directly or through the Rural Workforce Agencies.

Okay. So this WIP Rural Advanced Skills payment, it is a new payment. It was funded in the Australian Government’s October 2022 Budget with a commitment of $74.1 million over three years. The Government recognises the challenges delivering primary care in rural and remote communities. GPs are often the main health providers in their communities and are regularly called upon to deliver a vast array of services beyond the traditional remit of general practice.

This payment provides additional funding and support for GPs and rural generalists that develop and employ advanced skills and specialist training in a range of disciplines. It aims to recognise and reward what many GPs and rural generalists have been doing for some time. The payments opened in January this year and doctors can apply for services delivered between January 2023 and December 2025. So these payments are focused on general practitioners and rural generalists and we will go through the eligibility criteria.

There are two payment streams for this WIP Rural Advanced Skills. Both streams provide the same value of incentives from $4,000 to $10,500 per year per stream. And they depend on the number of services provided and rurality.

Stream 1 is for emergency medicine and relates to emergency and/or emergency after hours services. Stream 2 is for advanced skills. Under this stream doctors holding additional skills including but not limited to anaesthetics, First Nations health, mental health, obstetrics and surgery are able to apply. Doctors can claim either or both payment streams where they are eligible and meet all the program requirements.

Doctors need to submit an online application form through the Rural Workforce Agency and I’ll explain this further in the webinar.

One of the great things about the other incentive, the WIP Doctor Stream, is that for most doctors the payments are automated. This is because for most doctors payments are based on the value of the MBS items that they claim and Services Australia can determine from their provider numbers where those services are delivered. For the WIP Rural Advanced Skills payment this automated approach was not possible. The aim of this program is to recognise the broad scope of work required of rural generalists and rural GPs not only providing primary care to their communities but also emergency and procedural and non-procedural services in hospital and other community settings. As this work is often undertaken outside of the MBS we could not capture it using an automated system therefore we needed to develop a process for doctors to provide information to us to allow us to determine what services were being delivered and where.

We have worked with stakeholders, and many of them are online today, to develop an application process that is as simple as possible for doctors to complete. In saying this I recognise that there is some work required by doctors and that completing the form may be particularly complex for some doctors working across multiple locations or applying several different advanced skills.

We might move onto eligibility.

I would now like to focus on this eligibility for the incentive, for the payment. To be eligible for the program doctors must be vocationally recognised. They must practice in an MM3 to 7 location. However they don’t need to work in an eligible area throughout the entire assessment period. You can count the services you deliver in the MM3 to 7 locations towards your payment calculation. You do need to provide a minimum level of primary care services during the assessment period and you’ll need to provide evidence of these service levels, and you’ll also need to provide evidence that you have completed the necessary advanced skills training or have sufficient prior experience in order to claim a Stream 2 payment.

There is some nuance to understanding some of these requirements and so I’m now going to go through some of the common eligibility questions we have received within the Department.

One of the questions we often receive is about the primary care requirements for doctors working full time or part time. In developing this payment one of the issues we heard from stakeholders is the need for flexibility in the payment to recognise doctors who work part time and may also deliver emergency and advanced skill services to their communities. This had to be balanced with the need for the program to not only recognise doctors for their emergency and advanced skills but not at the expense of the delivery of primary care.

With this in mind different primary care thresholds for full time and part time doctors were established in order to claim the payment. For the purposes of this program a doctor is considered full time when working 0.6 FTE and above, so about three days a week on average over a year. A part time doctor is any doctor working less than that 0.6 FTE. Doctors working full time need to provide 96 primary care rosters in an MM3 to 7 location over the course of a 12 month assessment period in order to claim a payment. This equates to two rosters per week over 48 weeks. Doctors working part time need to provide 48 primary care rosters in MM3 to 7.

I would note that these primary care rosters and all emergency and advanced skills rosters do not need to be spread across the entire 12 month assessment period in order for you to be eligible. If you work five days per week you could reach your primary care requirements before you’re halfway through the year.

The threshold has been deliberately set low because we need to reflect on the many diverse working arrangements of rural doctors. A doctor may be working full time but working two days per week in general practice and three days per week in a hospital or they may be working a few days but these are long days and intense trips out to isolated remote communities. Different rural communities will have different arrangements. We have tried to build in as much flexibility as we can to recognise as many different arrangements as possible. The data we collect from doctors through this program, where they work and how they deliver advanced skill services will help us better understand these arrangements and will be used to help evaluate the program and potentially refine it in the future.

As noted previously the WIP Rural Advanced Skills payment was developed to support the rural generalist pathway. As a result the list of advanced skills eligible for support through this incentive aligns with the additional rural skills training offered by RACGP or the advanced specialist training offered by the Australian College of Rural and Remote Medicine as part of their rural generalist training pathways. There is no capacity at this time within the Department to add further advanced skills or to assess those so we do refer to the College’s assessment of those skills and we’ll talk to that in a moment.

Currently under this program there are no training eligibility requirements for emergency medicine. The Department assumes that if you are a doctor delivering emergency services in a hospital then you are qualified or experienced to do so. When a hospital verifies that your service level in providing these additional skills – sorry. When a hospital verifies that you’re delivering these skills we accept those as verification of your qualification or your credentials. Unfortunately a similar approach was not possible for applications for Stream 2 and that’s the Advanced Skills stream. To claim a Stream 2 payment doctors do need to provide evidence that they have completed the Advanced Skills training. In many instances doctors may have advanced skills in an eligible discipline but may not have completed the specific course within those Colleges. This is particular true of doctors delivering procedural services in hospitals. Many doctors who are delivering the procedural services like anaesthetics or obstetrics in hospitals may have developed their skills through a relevant specialist College. As with emergency medicine applicants the Department assumes that if you’re delivering those procedural services in a hospital and the hospital is willing to verify that service delivery then we accept that as sufficient evidence that you have the necessary advanced skills.

For the non-procedural advanced skills it’s a bit trickier to assess. And these ones I’m referring to the First Nations health. So we have extended access to the incentive to doctors who have completed 12 months or more prior experience working in an Aboriginal Community Controlled health service or an Aboriginal medical service, and recognising these as additional skills and experience developed working directly with the First Nations patients and communities. And there’s more about this within the guidelines. We’ve made similar allowances for mental health where we recognise doctors with 12 months or more experience working in a mental health specific setting such as Headspace clinics. 

In these circumstances you will need to provide some written evidence from your employer verifying the prior experience you have attained. It does not need to be elaborate. Just a letter stating the time period in which you were employed, the type of services you delivered when employed at that location and a signature from a third party such as your employer. This can be attached to your application either at the time you are filling it in or emailed to your rural workforce agency afterwards.

We have had many requests from doctors asking if their prior learning in an eligible discipline is sufficient to meet the eligibility requirements. The Department is not equipped to judge those specific training courses to see that they align with the advanced rural skills training or the advanced specialist training offered by RACGP or ACRRM. If you have completed training in an eligible discipline outside the list of eligible training or qualifications outlined in the program guidelines I urge you to get in contact with ACRRM or RACGP to determine your eligibility. The Colleges will be able to assess your prior learning and education to determine its alignment with its own advanced skills training qualifications. If either of the Colleges determine that you have the necessary training to claim an advanced skill payment then you can provide a copy of that determination as an attachment to your application form.

I might just go to RACGP, so Associate Professor Michael Clements. Is there anything you’d like to add in that space? 

Associate Professor Michael Clements:

Yeah. Thank you. I think one of the most common queries we are getting is people that are doing the work, already working in emergency departments for example or already providing services, but haven’t yet had us the College recognise them as an RG. So for those people I absolutely encourage you to look at our website for how to get RG recognition under RPL. It’s free at the moment for any GPs that are seeking to get recognition. So that’s one of the easiest and most streamlined ways of getting recognised for the work that you’re already doing.

It's also common for people to approach us saying ‘Well I do advanced skin cancer surgery in my practice. I do advanced women’s health. I do advanced XYZ’. And they may very well be doing that but it’s not under an approved framework where we’ve got an advanced skill and can actually approve that for you. So many of you that are listening will already be meeting the criteria and just need our help in getting recognised. But some of you may not be meeting these criteria because it’s not a formally recognised advanced skill.

I would add that after working with the Department, our small town rural general practice advanced skill which was recently endorsed and approved and rolled out by us has actually been supported by the Department as well. So the Department has said that they’re happy to support one of our RGs that has used the small town rural general practice program as their advanced skill to attain these advanced skills. And Karin will be hopping on a little bit later to talk specifically about how to get recognised if you’ve got any questions about that. So thank you Tess.

Tessa Pascoe:

Thank you Michael. I’m just wondering if Dr David Campbell – did you want to add anything from ACRRM’s perspective?

Dr David Campbell:

Yeah. Thanks very much Tessa. And I think the first point to make is that the skills outlined for this program are very closely aligned to the ACRRM advanced specialised training group of skills that we’ve got so it’s going to be quite straightforward for ACRRM fellows to access these payments. And for those that haven’t been awarded an advanced specialist training qualification through ACRRM training – and we have many members who fit into that category – we’re able to issue them with a certificate of equivalence which we are putting together now. And as Censor I’ve already started to provide some of our members with those certificates to enable them to access this program. So it’s a very straightforward process of applying to the College for recognition of their existing skills, whatever prior training they’ve done outside our fellowship training, and particularly for procedural skills or hospital-based skills, current evidence of credentialling etcetera which will then enable us to provide that certificate of equivalence which we are putting together now. Thanks Tess.

Tessa Pascoe:

Thank you.

Okay. So eligibility, classifying rosters.

One of the major challenges for the Department found in designing and administering payments was in delineating between what is primary care and what are advanced skills. So essentially a roster can only be claimed for one discipline at a time and the doctors can claim either an emergency or an advanced skill for that time period. For example if you are working in general practice you cannot claim that mental health roster as part of your routine general practice consultations. You can count the roster that is being delivered in a separate specified roster to address that. So during the day you may have a session that is focused on primary care in the morning and then you may run a mental health service in the afternoon. That could claim as the two separate rosters, one for primary care and one for advanced skill.

When we say you can only claim one roster in a 24 hour period that is referring to the 24 hour period is you can only claim one roster per stream. But you could potentially claim the two streams in the one day if you’re doing four hours in each of those. 

And for doctors in the MM6 to 7 location you can definitely count those rosters in the hospital setting towards primary care when it is supported by the employer. The guidelines and the FAQs will talk more to that and particularly go to those First Nations and mental health and small town rural general practice requirements.

WIP Rural Advanced Skill payments cover as I mentioned earlier the period between January ’23 and December ’25 and these payments are made annually. So the assessment period can commence at any time. And the Department’s stakeholders supported us with the design of this, that we noted that for many doctors they do not align with the January to December timeframe. Ideally if you could get three 12 month periods from that January to December by each of the three years you would maximise your claim. But for some doctors that may not be the case and they may only be able to claim two 12 month periods during that timeframe.

The service levels for the WIP Rural Advanced Skills incentive are calculated based on the number of rosters delivered as I mentioned for four hours or more, and you can only claim the one roster for each type each day per stream. So a doctor working eight hours in primary care can claim one roster but a doctor providing primary care service in the morning and on-call emergency services throughout the evening can claim one primary care and one emergency roster for that 24 hour period.

While doctors are required to provide a minimum number of primary care rosters to be eligible for payment the value of payments is based on the number of emergency and/or advanced skill rosters delivered and the location in which they are delivered.

While we have a minimum number of primary care rosters as an eligibility requirement they do not count towards a payment calculation. They do count however towards your WIP doctor stream payment calculation. So this WIP Rural Advanced Skills payment is a different payment and can be in addition to the WIP doctor stream payment.

The table that is on the screen now outlines the payment levels by service level.

For MM3 there is one payment amount for all payment levels A, B and C. You’ll see that is the same. That’s $4,000 across all. $4,000 per year across each of those payment levels for MM3. For MM4 to 5 and MM6 to 7 the payment amount increases over three levels as the number of rosters increase. These rosters and these levels are based on 11 rosters a year or 22 rosters a year or 48 rosters a year in those rosters for either emergency medicine or those advanced skills. And these are based on an averaging of one roster a month or a fortnight or a week. And this allows for the four weeks annual leave.

I acknowledge that there is some work required for doctors to submit an application for WIP Rural Advanced Skills payment. Ideally we would like to be able to replicate the automated payment calculation system that’s used by the WIP doctor stream however as I mentioned before it was not possible. The purpose of this incentive is to recognise the additional emergency and advanced skills work that these rural doctors are delivering often outside of general practice or the MBS. Doctors therefore need to provide a manual account of their service delivery in order to receive a payment. We have worked closely with the Rural Workforce Agencies and stakeholders to design an application process that is as easy as possible for doctors to complete. We have developed an online application process, the form that hopefully makes it easier for you to understand what information is required and the supporting evidence that is needed to be provided.

So basically you would need to provide evidence of the necessary qualifications or credentials, the number of primary care services that you deliver and where, and the number of advanced skill services or emergency services that you deliver and where. Most of the complexity in the form relates to doctors working across multiple locations or delivering multiple advanced skills over the course of the assessment period.

For most doctors so far we understand they’ve been able to navigate and complete the form with little or no assistance. One issue we have heard from doctors has been about collecting the signatures from the employers to verify their activity.

Doctors have two ways to do this. The employer can sign the application electronically before the doctor submits the form to the Rural Workforce Agency, or the doctor can submit the application to the Rural Workforce Agency and then ask their employer to verify post submission. How this is done is when you do submit the application form to the Rural Workforce Agency as part of that process you’ll get a copy or a PDF of the completed form sent to your email address. The doctor can then print out the application form and ask their employer to sign it and then you can scan it and send it to the Rural Workforce Agency. Details on how to do this are included in the application form that is sent to you on the email.

Similarly you can actually submit additional evidence of service levels or advanced skills by email to the Rural Workforce Agency post submission. If you have missed any of the evidence needed in your application the Rural Workforce Agency who is undertaking your assessment will actually contact you and support you through that process. You can contact your Rural Workforce Agency or us in the Department as I said through that WIP mailbox at any time during the process if you need assistance to understand eligibility or the evidence required. Details are available on our Department’s website.

So the key resources that we have are the WIP Rural Advanced Skills Guidelines. We also have a frequently asked questions document, fact sheet and an application form. The Rural Workforce Agencies are a key resource to assist you with understanding eligibility requirements and are responsible for that assessment process of your application. And as I mentioned before we have the WIP mailbox.

Those addresses are there. 

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