Oliver Frank *
Practices participating in the QI PIP will receive 70 cents or less per consultation, if one divides the $5.00 per patient per year offered by the scheme by the average of seven visits per year that Australians make to general practice. For practices with more than 10,000 SWPEs (standardised whole patient equivalent), the payment per consultation is likely to be less than 70 cents, because the QI PIP payment is capped at $50,000 per practice per year. Apart from being able to receive this relatively small amount of money, are there any other reasons why GPs should or would see this new scheme as important?
The Fact Sheet from the Department of Health scheme states that the Scheme:
“(…) aims to recognise and support those practices that commit to improving the care they provide to their patients. Participating practices will be supported to utilise the clinical information they have about their own communities and their knowledge of the particular needs of their own patients to develop innovative strategies to drive improvement. (…) This information will be collated at the local level by the Primary Health Networks to assist in supporting improvement.”
However, there is NO explanation of what PHNs will be doing with their local practices towards this, how they will do it, what will be expected of practices or how much time will be required from GPs, practice nurses and other staff. That time needs to be costed by practices and deducted from the potential QI PIP payments received, to work out the net value to the practice of participating.
Many general practices already work to improve the quality of the care that they provide. In some cases, this is through individual GPs reflecting on and sometimes auditing their care of their patients. Some practices review and discuss at practice meetings the performance of the whole practice or even of individual GPs, and they are sometimes able to compare this with the performance of other practices locally, regionally or nationally. Some practices participate in programs such as NPS MedicineInsight or those run by the Improvement Foundation. NPS sends statistics to GPs comparing their prescribing with that of other GPs.
Some practices might never have actively participated in any quality improvement activities in which they monitor their own performance or in which their performance is compared with that of other practices. The GPs in such practices can mistakenly assume or believe that their and their practice’s performance is at least average or better. This is known as the Dunning-Kruger effect. For such GPs and practices, participating in the QI PIP scheme might be their first experience, apart from the prescribing feedback from NPS, of peer comparison or benchmarking. Finding that their or their practice’s performance is below the median, or in the bottom quartile of performance, can surprise and even shock GPs. Such discoveries can have a strong motivating effect.
Are general practices purely independent private practices providing care for individual patients, or are they an essential part of the public health system caring for populations? They are probably both, although their public health role is not formally acknowledged or paid. Acceptance of the possible public health role of Australian general practices is made more difficult by the fact that because Australians are not required to be enrolled in only one practice at a time, no general practice knows for whose care it should hold itself or be held responsible.
Like the other programs and schemes that use data from general practice, the QI PIP has a potential to help to demonstrate the value for money that general practice provides, and that general practice is the most cost-effective part of the health system. How much and in what ways it adds to the evidence generated by those other programs and schemes, and by the various academic research projects conducted in and about general practice, remains to be seen.
* Oliver Frank is a GP at Hillcrest in the inner north east of Adelaide