Another GP policy fail as PIP revamp is shelved

The overhaul will be put on ice for at least a year

The biggest ever revamp of the $300 million Practice Incentives Program will be shelved for at least a year amid fears it would have triggered mass closures of GP practices.

The reforms, designed to set the foundations for pay-for-performance in general practice (see box), have instead become the latest GP policy flop for the Federal Government, coming in the wake of the delayed Health Care Homes trial and the botched roll-out of the cervical screening register.

From May, a number of the current PIP incentives — covering asthma, quality prescribing, diabetes and aged care — were to have been scrapped and replaced by a new quality improvement incentive.

The new incentive would have demanded practices to collect de-identified data from practice software, covering things like GP prescribing and patient conditions, and to send it to Primary Health Care Networks.

But there remain issues around the security of the information the department wanted, and the IT logistics facing practices collecting and send it.

As a result, the health department has written to practices telling them that incentive overhaul will be delayed until May 2019. Meanwhile, the incentives destined for the dustbin will remain.

The AMA has long warned the government the policy was being rushed. And despite a government pledge that no practice would be left worse off, the AMA has argued that some could go under.

“There are a lot of practices out there whose viability depends on the PIP,” AMA Vice-President Dr Tony Bartone told Australian Doctor.

“Take away their PIP and their profitability or their viability shrinks to zero.

"Especially in rural and regional areas, it is the difference between viability and closing up shop."

He said the funding formula the government had been using for the PIP revamp was “ludicrous”.

“There was a strong case for additional funding for PIP but did that has not happened [with this reform].

"The government really needs to start putting some meat on the bone of all their rhetoric about the importance of general practice.”

The health department has written to around 5,500 practices telling them of the delays.

“[It] it is important that we get this right,” the letter states.

“The additional 12 months will enable the department … to ensure that any implementation issues are identified and addressed and that general practices have adequate opportunity to prepare.”

Explainer: What is the Quality Improvement PIP?

The government wants practices to collect data on everything they do and chase individualised targets for improvement, either self-selected or chosen by the government. It’s meant to be like a professional development plan.

The department will pay practices to upload electronic data from their IT systems to a third-party QI provider at least four times a year.

It is not clear what organisations might provide QI, but it is likely to be a similar list to those that provide clinical audits, such as NPS MedicineWise, the RACGP or organisations like the one behind the collaboratives movement called the Improvement Foundation.

Practices will be paid more when they use this data and feedback from the QI provider to show they are improving on their measures. This may well include measures based on the PIPs that did not survive, such as providing more care plan reviews for patients with diabetes.

The department attempts to point out that its version of QI is about relative improvement rather than absolute outcomes and “is therefore NOT a pay for performance scheme” (emphasis in original). The capital letters are meant to be reassuring, but clearly these reforms would lay the architecture for a pay-for-performance scheme should someone somewhere in government change their mind.

At the moment, the proposals are being given the soft sell — improvement will be measured against a practice’s previous results, in the context of similar practices across the country.

The AMA, RACGP and RDAA are supporting this model of quality improvement in principle.

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