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Practice Nurse Incentive Program (PNIP) Change Management Support Project

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3 Change Management Process Awareness What is the PNIP Allaying concerns What does this mean for the day-to-day work I do? Will the practice be financially viable? Will patients be worse off? Opportunities Recognising broader scope of practice New business models Introduction of new services Business planning and implementation Develop new processes Enhance the role of the practice nurse Who is responsible for implementing the changes? Review and monitor How has the change affected the practice? Have our responses to the changes been effective? Are patient needs being met?

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4 Awareness Change is not new [insert Pictorial representation of all the financing changes that have occurred from peters GP financing module]

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5 How has nursing in general practice been funded? Variety of funding mechanisms including - Practice nurse - Practice Incentive Payment (PN PIP) Range of PN MBS rebates Contributions to GP MBS items Contribution to PIP and SOP outcomes Increased throughput (and therefore income) for GPs from nurses giving care and performing tasks on their behalf

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6 Some issues with current practice nurse funding Insufficient amount paid for PN MBS and PIP to ensure reasonable nurse to GP ratio Remuneration does not recognise differing skills and qualifications of nurses Unduly complicated Nursing roles shaped by MBS items largely restricted to a series of tasks, rather than as a response to local population health needs Item numbers dont effectively fund comprehensive care Perverse incentive for high throughput rather than quality of care (nursing rebates are not increased with time spent). Contribution to GP Health Assessments doesnt recognise highly skilled clinical expertise PIP subsidy not available everywhere

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7 Awareness - Practice Nurse Incentive Program www.medicareaustralia.gov.au/pnip Is my practice eligible? Minimum Qualifications of practice nurses and health professionals How does my practice apply for the PNIP? What evidence does my practice need to provide at the time of application? Eligibility requirements Accreditation requirements Incentive Payments Rural Loading Calculation of payments Calculation of a full time practice nurse Calculation of a full time GP Calculating the SWPE Value Practices without an historical SWPE Aboriginal Medical Services and Aboriginal Community Controlled Health Services What if my practice is financially disadvantaged by the introduction of the PNIP? Department of Veterans Affairs loading How payments are made Practice Nurse Incentive Program audit

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8 10993 10994 10995 10996 10998 10999 PN item numbers going: Incentive Payments Payments under the PNIP are calculated quarterly. Payments will be stratified with one incentive equating to: $25,000 per annum, per 1,000 SWPE where a Registered Nurse works at least 12 hours 40 minutes per week; and $12,500 per annum, per 1,000 SWPE where an Enrolled Nurse or Aboriginal Health Worker works at least 12 hours and 40 minutes per week. Awareness - Practice Nurse Incentive Program

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9 MBS Items remaining Brief Health assessments701 Standard Health assessments 703 Long Health assessments705 Prolonged Health assessments 707 PN Chronic disease check10997 Antenatal check16400 4 year old health checks10986 GPMP & TCA Reviews732 Spirometry11506 ECGs11700 Aboriginal Health Check715 ASTI Health Check Follow Up 10987 GPMP721 TCAs723

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10 Awareness - Nursing roles and nursing services Patient Carer Organiser Agent of Connectivity Problem Solver Quality Controller Educator

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11 Addressing concerns Practice NursesPractice ManagersGeneral Practitioners Value of the PN Impact on patient Impact on PN jobs Impact on clinical services Impact on GP income Staff configuration Practice income Business case Staff configuration

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12 Creating Opportunity

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13 Opportunities Practice Nurse roles

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14 Impact of PNIP on nurse roles Removal of for and on behalf of Recognition of the broader role of the practice nurse Opportunity to expand the scope of nursing services (i.e CDM, telehealth)

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15 Scope of Practice A professions scope of practice is the full spectrum of roles, functions, responsibilities, activities and decision-making capacity that individuals within that profession are educated, competent and authorised to perform. www.anmc.org.au

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16 Business Planning & Implementation An Introduction to General Practice Financing Learning objectives: 1.Describe key financing mechanisms used to fund general practice activities. 2.Describe how these mechanisms have been used to fund general practice activities in Australia. 3.Outline some of the ways that current financing mechanisms influence nursing employment in general practice, and analyse some of the opportunities new funding mechanisms present for nurses in general practice. 4.Apply knowledge learnt about general practice financing to reflect on how the new general practice financing mechanisms may create opportunities and challenges in practice settings.

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17 Business Planning & Implementation How will the PNIP affect my practice revenues? What opportunities does the PNIP present for our practice to work differently?

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18 Business Planning & Implementation Business Planning toolkit contents How will the PNIP directly affect my practice revenues? Old practice revenues associated with the outgoing items New practice revenues under the PNIP Change in practice revenues if we do nothing What opportunities does the PNIP present for our practice to work differently? Taking advantage of opportunities under the PNIP Appendix ABusiness case template Appendix BBusiness case scenarios Medicare ready reckoner: http://www.medicareaustralia.gov.au/provider/incentives/pnip/calculator.jsp

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19 Business Planning & Implementation Brainstorming questionsPotential opportunities What are the opportunities to better meet the needs of patients e.g., access, choice? What are the opportunities for the practice nurses to make a greater contribution to enhancing service quality and safety? What are the opportunities for the practice nurses to help the team to work more efficiently or increase the number of patients seen? What other opportunities are there to improve health outcomes, practice income or job satisfaction?

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20 Business Planning & Implementation Tangible benefits $ Increased nurse-derived income Increased net income Intangible benefits Professional satisfaction Increased recruitment and retention Increased training and development opportunities Sense of value

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21 Review Bhuyan, A., A. Jorgensen, and S. Sharma. 2010. Taking the Pulse of Policy: The Policy Implementation Assessment Tool. Washington, DC: Futures Group, Health Policy Initiative, Task Order 1.

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22 Feedback on PNIP implementation Are patients still getting the health care and nursing services that they need? Are they getting better service under the PNIP? Are they getting less/reduced quality service under the PNIP? Why do you think this is? Are public health priorities being met? Are nursing services still being delivered in a safe way to patients that need those services? Why or why not? What other impacts, at the community level are you seeing as a result of the PNIP?

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23 Next Steps Check APNA website for resources Discuss your learning and ideas with practice members Questions relating to the program = contact Medicare Australia Questions relating to nurses specifically = contact APNA Website: www.apna.asn.au/pnipwww.apna.asn.au/pnip Email: admin@apna.asn.auadmin@apna.asn.au