September 2001

CONTENTS

Divisions win funding for Nurse
Forum on Quality
GPDV chooses accreditation
Medical Practitioners Act
AGM and board election
Update on Budget initiatives

Diabetes

Asthma

Cervical Screening

Practice Nurses

Mental Health

Implementation

EPC and Residential Care

Divisions win funding for Nurse

Geelong and Central Highlands Divisions have both successfully won through a rigorous selection process to be funded by the Department of Human Services to develop and trial nurse practitioner models of practice. Through projects like these, Victorian divisions are leading the way in developing innovative and collaborative approaches to addressing the health needs of their local communities.

The GP Association of Geelong (Geelong Division) is collaborating with Diabetes Australia to develop a model for a Diabetes Nurse Practitioner which focusses on the provision of diabetes education for people in supported residential accommodation, and helps GPs to manage their patients in these facilities. Geelong has built on its history of strong collaborations with Diabetes Australia, and after the division identified the need, both organisations worked closely together on the submission.

Central Highlands Division is trialling a model of Nurse Practitioner where practice nurses are able to take on an advanced nursing role within a general practice clinic. The model is based on successful trials in the UK, and is being trialled in two large GP-run clinics which were already employing highly skilled practice nurses, and were interested in extending aspects of their role. The Practice Nurse Practitioners will be able to initiate certain defined sorts of patient treatment and management, with supervision and collaboration available from GPs.

Another of the funded demonstration projects has also substantial divisional involvement. The Diabetes Crisis Intervention & Management Nurse Practitioner model is being trialled in Western Melbourne as a collaboration between Diabetes Australia and the Diabetes Alliance Group (which includes five divisions). Many other funded projects also successfully sought stakeholder support from their local Divisions of General Practice. A full list of funded Nurse Practitioner Projects is available from GPDV, or email DHS at Belinda.Gilsenan@dhs.vic.gov.au .

Forum on Quality

The summary of the GPDV Forum on Quality in General Practice, held on 19 August, is now on the GPDV website at www.gpdv.com.au

GPDV chooses accreditation

The board of GPDV, recognising the wide acceptance of accreditation among GPs, has decided that GPDV should undertake a formal process that provides an objective measure of quality management and organisation. GPDV is now negotiating to use the QICSA program.

QICSA, which is based at LaTrobe University, is licensed by the Quality Improvement Council (QIC) to offer the QIC's programs in Victoria. QIC is a company established to promote quality in health and community services throughout Australia, primarily through its accreditation program which is based on the Australian Health & Community Services Standards. The GPDV board believes that the QICSA program is suitable for GPDV – and divisions - as it is based on participation, self-assessment and continuous quality improvement rather than a pass at a single point in time.

Whitehorse Division, which, has been accredited through QICSA and is about to start on re-accreditation, speaks highly of it both as a process for improving management and also for gaining recognition from funders and stakeholders as an effective, well-run organisation.

Medical Practitioners Act

The DHS discussion paper on the need for amendments to the Medical Practice Act 1994 and the Nurses Act 1993 has now been released. Its purpose is to

• canvas issues in regulation of the practice of medicine and nursing and the need, if any, for further reform of relevant legislation
• ensure that any proposals for reform comply with the guiding legislative principles of the National Competition Policy

Although the DHS paper discusses a number of issues relating to both doctors and nurses, the GPDV board has focused on matters relating to corporatisation and interstate registration along state borders. The initial response of the GPDV board is that it is essential to:

1. Regulate non-GP owners of general practices in the same way as owners who are GPs;
2. Maintain clinical autonomy for all GPs working in Victoria;
3. Act preventively, as has been the case in other states, rather than waiting for evidence of harm.

DHS is seeking feedback on the proposed reforms by 5 October 2001. Once the paper has been finalised the necessary amendments to legislation will be put to Parliament in March 2002.

Your division has a copy of the GPDV paper. The DHS paper is on the DHS Web site: www.dhs.vic.gov.au/pdpd/

AGM and board election

The Annual General Meeting of General Practice Divisions – Victoria Ltd will be held at the November Forum on Sunday 18 November. The AGM will incorporate the election of Board members to fill the four positions that will fall vacant this year.

Members retiring by rotation, and eligible for re-election, are:

Metropolitan

John McEncroe IE Melb
Harry Hemley Melbourne

Rural & Regional

Nola Maxfield S Gippsland
Rob Grenfell West Vic

Update on Budget initiatives

Programs for diabetes, asthma, cervical screening, practice nurses and mental health announced in the 2001-2002 Federal Budget will be progressively introduced from November 2001.

All the Practice Incentive Program (PIP) initiatives are being developed by DH&AC in consultation with the GP MoU Group and stakeholders. ADGP is negotiating on behalf of divisions.

GPDV is seeking early information about details of the incentive payments so that divisions will be able to advise their members before the payments are introduced, which is expected to start from November.

Diabetes

The initiative will provide incentives to GPs to improve prevention, provide earlier diagnosis and improve management of diabetes. Incentive payments will be available to:

• practices that use a register and recall/reminder system;
• practices that reach a target level of care for their patients with diabetes (similar to the GP Immunisation Outcomes Payment); and
• GPs for each patient for whom they complete an annual program of care (similar to the GP Immunisation Service Incentive Payment).

Asthma

The GP Asthma Initiative will help GPs further improve the clinical care they provide to patients with moderate to severe asthma by supporting the evidence-based 3+ Visit Plan developed and evaluated by the National Asthma Council.

Asthma incentive payments will be available to:

• practices that that sign-up to the program to implement the Asthma "3+ Visit Plan";
• GPs for each patient for whom they complete an Asthma "3+ Visit Plan" (similar to the GP Immunisation Service Incentive Payment).

Cervical Screening

This initiative will support GPs in encouraging women to undergo cervical screening. Incentive payments will be available to:

• practices that sign-up to the program to improve their cervical screening rates; especially screening of women who have not been screened for over four years;
• practices that reach a target cervical screening coverage (similar to the GP Immunisation Outcomes Payment);
• GPs for each patient 20-69 they screen who has not had a Pap smear in the past four years (similar to the GP Immunisation Service Incentive Payment).

Practice Nurses

The Practice Nursing PIP Incentive of an average of $8,000 per EFT GP will be available to general practices in rural, remote and other areas of high workforce need if an enrolled nurse is employed for the equivalent of two sessions per week per full time GP.

Mental Health

Incentives will be made available for PIP type programs for mental health treatment and care in general practice. Funding is also to be made available for new MBS items for mental health care. The first payment for the mental health initiative is not expected until November next year. Education and training will be provided before then to provide GPs with the necessary training to access the incentives.

Implementation

Payments for diabetes registers, and the asthma and cervical screening programs are expected to start in the November 2001 PIP payment run.

Service Incentive Payments for diabetes, asthma and cervical screening will start in December 2001.

The MBS book in November will include new items, which will be used to signal completion of necessary activities to be eligible for diabetes, asthma or cervical screening incentive payments. More detail of these items will be included in the HIC material to be provided shortly.

Practices wishing to apply for the practice nurse incentive will receive an application form in November 2001. The first payment for the practice nurse incentive will be made in February 2002.

Contact your division for the most up-to-date information from ADGP and DH&AC on the implementation of these new initiatives.

EPC and Residential Care

GPDV is to examine ways to promote the use of the seven new Residential Aged Care MBS Items and to overcome barriers to their use.

The seven new item numbers were released in the November 2000 Medicare Benefits Schedule to enable GPs to contribute to Care Planning and to organise or participate in Case Conferencing in Residential Aged Care Facilities. They were not part of the original package of items nor of the training provided to GPs through divisions. Although these Resi Care MBS items provide an opportunity for GPs and divisions to work more closely with the aged care sector, they have received very little attention to date and have been used very little by GPs in Victoria.

The key outcome that is expected from this project is to achieve optimum use of EPC residential care items by GPs in Victoria.

GPDV will employ a consultant

• to determine the needs and issues for the residential care sector and GPs in taking up these EPC items,
• to advise on the strategies needed to address the issues.

The project will be supported by the advice and expertise of a reference group comprising

• Victorian Association of Health & Extended Care (VAHEC)
• Australian Nursing Homes & Extended Care Association (ANHECA)
• National Ageing Research Institute (NARI)
• Residential Care Rights (consumers)
• DHS Aged Care
• DH&AC Aged Care
• DH&AC Primary Care

The Reference Group met for the first time on 11 September and helped draft a brief for tender by consultants.