GP North

Related Link: Outreach Worker

Introduction

Mainstream primary care generally provides the first point of contact for health services in Australia, and acts as an important gateway to the health system. However, multiple barriers (including culture) can limit the usage of these services by Aboriginal and Torres Strait Islander peoples. Primary care therefore is seen as a crucial point at which inroads can be made into improving health outcomes for Aboriginal Australians.

Background Information

In December 2007 the Council of Australian Governments (COAG) agreed to a partnership between all levels of government to work with Aboriginal and Torres Strait Islander to close the gap on Indigenous disadvantage. This resulted in the National Indigenous Reform Agreement (Closing the Gap) being established to provide a framework for this task.

In November 2008, COAG agreed to a $1.6 billion Indigenous Health National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes to address the target of closing the gap in life expectancy between Indigenous and non-Indigenous Australians within a generation.

The Indigenous Chronic Disease Package (which funds the CTG program at the divisional level) is the Australian Government’s contribution to the Indigenous Health National Partnership Agreement. This package provides $805.5 million over four years for preventative health, more co-ordinated and patient-focused primary health care and an expanded Indigenous Health Workforce. It also recognises that chronic diseases and associated risk factors are responsible for about two-thirds of the life expectancy gap between Indigenous and non-Indigenous Australians.

Aims and Objectives

Broadly, the CTG Improving Aboriginal Access to Mainstream Primary Care program intends to:

• Increase the overall health of the Aboriginal population
• Improve management of chronic conditions experienced by Aboriginal Australians, and
• Improve access to culturally appropriate primary care services for Aboriginal Australians

Specific objectives of the program are to:

• Support mainstream primary care services to encourage Indigenous Australians to self-identify
• Increase the uptake of Indigenous specific Medicare Benefits Schedule (MBS) items including Indigenous health assessments and follow up items
• Increase access to mainstream primary care services by Aboriginal and Torres Strait Islander peoples
• Improve the capacity of general practice to deliver culturally appropriate primary care services
• Foster collaboration and support between mainstream primary health care and the Indigenous health sectors, and
• Increase awareness and understanding of Closing the Gap measures relevant to primary health care

Practice Incentives

There are a number of CTG incentives available to practices that are accessed through the Practice Incentive Program (PIP) Indigenous Health Incentive. These include a $1000 up front payment for signing on to the incentive, $250 per registered patient over the age of 15 years who is registered for chronic disease/risk of chronic disease management per calendar year, and tier level payments available for providing target levels of care including the development of a GP management plans and the provision of follow up care.

Patient Benefits

Once an initial Aboriginal and Torres Strait Islander Health Assessment (MBS Item 715) is completed at the practice, the patient is then eligible for 10 follow up services provided by a Practice Nurse or Aboriginal Health Worker (MBS Item 10987), and 5 allied health consultations (Items 81300 – 81360) per calendar year. Development of GP Management Plans and/or Team Care Arrangements entitles the patient to a further 5 follow up and allied health services.

Additionally, patients who have or are at risk of a chronic disease and may have trouble adhering to medication regimes can be prescribed subsidised medications through the PBS Co-Payment Measure. This measure allows GP’s to annotate scripts so that patients can receive medication at either the concession rate or completely free of cost depending on their current concession status. This makes it possible to substantially reduce the cost of vital medication for Aboriginal and Torres Strait Islander patients.

Practice Obligations

Practices must:

• Have/develop an active mechanism for identifying Aboriginal and Torres Strait Islander patients.  The national standard method of obtaining this information is asking “are you of Aboriginal or Torres Strait Islander origin?” (Any patient who self-identifies as being of Aboriginal and Torres Strait Islander origin is eligible for the abovementioned benefits, simply record their answer as stated)
• Be accredited or become accredited within 12 months of signing on to the PIP Indigenous Health Incentive
• Be registered for the Practice Incentive Program (PIP)
• Have one General Practitioner and one other staff member undertake cultural awareness training within 12 months of signing onto the PIP Indigenous Health Incentive (RACGP are currently developing online units that satisfy this component, General Practice North can also assist in providing high quality local cultural awareness training)
• Get the patient to sign consent and registration forms

Websites and Resources

• PIP IHI Application
• PIP Multiple Patient Registration Form - NEW
• PIP IHI Patient Consent
• PIP IHI Registration
• PIP IHI Patient Withdrawal
• PIP IHI Calculator - this resource has been developed by the Moreton Bay General Practice Network to assist practices to calculate Medicare income derived from IHI payments.  The relevant MBS Items needed for Tier One and Tier Two payments are also included.
• Frequently Asked Questions and Overview - this resource has been developed by Adelaide North East Division of General Practice
• Setting up MD3 for PBS Co-payment
• Setting up Best Practice for PBS Co-payment
• RACGP Practice Fact Sheet - Indigenous Identifiation Standards

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