Recent news that an expert advisory panel commissioned by the Federal Government to review general practice incentives had recommended a nebulous “new, simplified general practice payment architecture” to replace the WIP and PIP was met with concern from many GPs, especially as details of the proposal were scant.

Well, the panel of nine, which included three health economists, a nurse practitioner, a person with experience in general practice administration, someone with strategy/governance experience for a state health department, the deputy CEO of NACCO, a rural GP and a GP who is immediate past president Australian Professional Association for Transgender Health – and no representatives from the RACGP or ACCRM — fleshed out its recommendations to the Australian government earlier this month.

The final Review of General Practice Incentives report takes a softer approach than the consultation briefing paper had, walking back its previous proposal to scrap WIP payments straight away. But is it just a matter of time?

WIP to stay – for now

One thing on many minds has been the fate of WIP. The panel has recommended that in the short-term, the Workforce Incentive Practice – Doctor Stream and Workforce Incentive Practice –- Rural Advanced Skills Stream should be retained and refined, but within three years the government should look at the evidence and impact of redirecting WIP funding from providers to practices.

But should we be reassured?

The final report sets the scene by describing GP shortages, economic challenges and more people living with chronic conditions, concluding that “one solution has been around for decades”: “moving primary care away from excessive reliance on fee for service as the primary source of practice income.”

Yet little progress has been made despite this being recommended by every major review of the health system in the past 25 years, the report laments, pointing out that many other countries have moved to blended funding models.

What’s being proposed?

Currently, about 90% of practice income comes from fee-for-service payments, with the other 10% coming from incentives such as WIP and PIP. If the panel’s recommendations are adopted, the proportion from fee-for-service would decline to about 60% of practice income, on average.

“The remaining 40% is designed to allow other health professionals to join primary care teams and is not conceptualised as an alternative to fee-for-service income for the GP,” the report states.

“The intention is for fee-for-service payments to remain but as a smaller percentage of many general practices’ total revenue,” it explained.

An opt-in ‘Baseline Practice Payment’

Practices would be required to participate in MyMedicare to access this payment, as well as to provide comprehensive service delivery information and data. However, the panel emphasises that participation would be voluntary.

“GPs may also wish to continue with their current operating model. The panel believes that the change in primary care needs to happen, and each practice will need to assess if and when it feels comfortable making the shift,” the report said, noting that funding will play into practices’ readiness to embrace change, but was out of its scope.

Increase non-fee-for-service GP revenue

“Increasing the proportion of general practice revenue from non–fee-for-service payments from 10% towards 40% will provide practices the opportunity to be more flexible with how they fund their team’s time,” the report states, emphasising that the 40% is an average, and may vary between practices.

A 1:1 doctor to other health professional ratio

The ratio of GPs to other health professionals in a practice would shift to about one GP to one other health professional – a nurse and, potentially a pharmacist, physiotherapist, psychologist, social worker, dietitian or mix of provider which could include those without university qualifications such as health coaches.

So what does all this mean?

The report is now with the Federal Government for consideration. Many details remain to be seen.

The RACGP has said it’s happy the panel walked back its plans to phase out the WIP and PIP (though they still left the door open for that).

ACRRM said that while the final report was a clear improvement from the consultation briefing paper, potential risks remain – including the fate of WIP payments, which it said it would continue to advocate for – as well as recommendation that could disincentivise doctors from working in GP clinics.

“A major risk arising collectively from the recommendations which seek to encourage team care general practices is that these may inadvertently incentivise a structural shift towards business models for rural general practices which no longer aspire to include doctors in general practice clinics and see many rural families losing access to medical care.”

Heading toward a UK system?

Some say the writing is on the wall.

“Notwithstanding the delay, the current government is trying to take us down the path of the NHS,” says Dr Joe Kosterich, a WA GP and media commentator, explaining that in that system, GPs get paid a lump sum rather than fee for service. “That’s absolutely what they’re wanting to do because that’s an issue of cost control.”

“In this country, we’ve got an open-ended, uncapped system. People can go to as many doctors as they want, as often as they want and they cannot be prevented from doing so. This has plusses and minuses but works surprisingly well.”

“Ultimately, any time government wants to make changes to GP payments, there’s only one reason – and that’s to cap or reduce government outlays. At the very least to constrain growth in outlays. No matter how they dress it up, that’s always the aim. So whether you’re a contractor GP or an owner GP, if these changes go through, you are going to be worse off, because the aim is to save the government money,” Dr Kosterich says.