Flexible Fund Guidelines

Practice Incentives for

General Practices Fund

Final as at

January 2014

Structure of this document.

This document is in three parts:

Part A: Practice Incentives for General Practices Fund OverviewPart B: Incentive payments component of the FundPart C: Grant component of the Fund

Together they comprise the Fund Guidelines.

PART A: Overview of the Practice Incentives for General Practices Fund

A.1 Fund BackgroundThe Australian Government is introducing a new, flexible way to fund many of the nation’s health priorities, better reflecting the more responsive, connected health system it is creating as part of its reform agenda.

Under this strategy, a number of existing health programs are being consolidated within larger, flexible Funds. This will reduce red tape, increase flexibility and more efficiently provide evidence based funding for the delivery of better health outcomes in the community. The Practice Incentives for General Practices Fund (the Fund) is one of these flexible Funds.

In the 2011-12 Budget, the Australian Government allocated funding of around $1.055 billion over four years to the Fund.

The Fund consolidates the activities of several existing Practice Incentives Program (PIP) initiatives and the General Practice Immunisation Incentive (GPII) Scheme and will provide a larger, flexible funding pool predominantly for incentive payments to general practices or Indigenous health services or general practitioners (GPs).

The Fund can also be used to support targeted grants or one-off activities and some procurement activities.

A.2 Fund ObjectiveThe Objective of the Fund is to better support general practice activities that encourage continuing improvements and quality care, enhance capacity, and improve access and health outcomes for patients. The Fund will reflect national health priorities and allow responsiveness to existing and emerging health challenges.

A.3 Fund ValueThe total value of the funds available under the Fund is $1.055 billion over four years from 2011-12.The Department of Health will determine the final allocation between incentive payments and grants and procurements but, initially, it is anticipated that approximately $3 million per annum will be reserved for grants and procurements with the remainder being allocated to incentive payments. Only a small amount is proposed to be used for procurements.

A.4 Changes to GuidelinesThe Fund Guidelines may be varied from time-to-time by the Australian Government as the needs of the Fund dictate. Any amendments will be made available to applicants for grants and other participating parties as required.

PART B: Incentive payments component

B.1 IntroductionThe Fund consolidates the activities of several existing PIP initiatives and the GPII Scheme and will provide a larger, flexible funding pool for incentive payments to general practices or Indigenous health services or GPs.

B.2 Fund PrioritiesThe Fund Priorities have been designed to reflect current national health priorities and may be adapted over time to adequately address emerging health needs.Incentive payments to general practices and GPs will be made to support the following Priorities (in alphabetical order):

Chronic disease managementTo encourage general practices and GPs to better manage patients with a chronic disease. The existing PIP incentives that fall under this Priority are the PIP Asthma Incentive and the PIP Diabetes Incentive.

Practice capacity and infrastructureTo support general practices and GPs to make quality infrastructure improvements including encouraging practices to keep up to date with the latest developments in eHealth. The existing PIP incentives that fall under this Priority are the PIP eHealth Incentive, the PIP Quality Prescribing Incentive and the PIP Teaching Incentive.

Primary health care for Aboriginal and Torres Strait Islander peoples and other disadvantaged groupsTo encourage general practices to better manage the clinical care of Aboriginal and Torres Strait Islander patients, and other disadvantaged groups. The existing PIP incentive that falls under this Priority is the PIP Indigenous Health Incentive.

Primary health care for older AustraliansTo support general practices and GPs to provide quality care for older Australians including those in Commonwealth-funded Residential Aged Care Facilities, and those with dementia. The existing PIP incentive that falls under this Priority is the PIP Aged Care Access Incentive.

Primary health care in rural AustraliaTo support general practices and GPs in rural and remote Australia in providing quality primary care. The existing PIP incentives that fall under this Priority are the PIP Procedural GP Payment and the PIP Rural Loading.

Prevention and early detectionTo encourage general practices and GPs to undertake activities that focus on early detection and prevention of disease. The existing incentive programs that fall under this Priority are the GPII and the PIP Cervical Screening Incentive.

B.3 Roles and responsibilities

Minister:Within the overall Priorities and Objective of the Fund, the Minister has the authority to make changes to the incentive programs under the Fund to best meet the Priorities and to determine the eligibility requirements for the incentive programs.

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In urgent or unforeseen circumstances the Minister can introduce new incentive programs and/or waive eligibility criteria for the incentive programs.

Department of Health (the Department):The Department will have overall responsibility for implementing and managing the incentive payments component of the Fund and the payments will be administered by the Department of Human Services (Human Services).

The Department will be responsible for managing the incentive payments component in accordance with the Memorandum of Understanding (MOU), Business Practice Agreements (BPA) and Business Rules between the Department of Health and the Department of Human Services.

The Department will be responsible for ensuring that any documentation relating to the incentive payments component is in accordance with the Fund Objective.

Department of Human Services (Human Services):Human Services will be responsible for administering the incentive payments component of the Fund, including making payments to general practices and GPs. Human Services will administer the incentive payments component on behalf of the Department under the MOU, BPA and Business Rules.

The responsibilities of Human Services include:

Assessing general practices and GPs applying for payments under the incentive payments component of the Fund.

Processing forms relating to the incentive payments component of the Fund including the PIP and GPII application, and patient registration forms.

Creating and maintaining appropriate computer systems to administer the payments under the incentive payments component of the Fund.

Processing payments for the incentive payments component of the Fund. Maintaining relevant online systems. Collecting data around the incentive payments component of the Fund; Managing relevant helplines. Managing audits of general practices and GPs participating in the incentive payments

component of the Fund. Communicating with general practices and GPs about the incentive payments component of

the Fund. Providing payment statements to practices and GPs participating in the incentive payments

component of the Fund. Publishing quarterly news update regarding the incentive payments component of the Fund. Publishing guidelines for the incentive payments component of the Fund.

General Practices and General Practitioners:General practices and GPs will be responsible for applying through Human Services for the individual payments available under incentive payments component of the Fund and meeting the relevant eligibility requirements of the incentive programs.

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PIP Advisory Group:The PIP Advisory Group consists of representatives from the medical profession and will provide advice to the Department on the development and implementation arrangements relating to the incentive payments component of the Fund. The Terms of Reference for the PIP Advisory Group are included in the PIP Advisory Group Member Guidelines.

B.4 TimeframesThe Fund is an ongoing initiative commencing on 1 July 2011 and will continue until 30 June 2015.

The timeframes for the individual incentive programs vary. Unless otherwise specified, any new incentive programs will have a fixed four year period. If appropriate, an evaluation will be undertaken before the incentive program ceases to inform the future arrangements for the incentive program. Practices will be provided with as much notice as possible prior to any changes to the incentive programs.

B.5 EligibilityAccess to the incentive payments component of the Fund will predominantly be for general practices, GPs and/or Indigenous health services. General practices or Indigenous health services accessing incentive payments under the Fund must be accredited or registered for accreditation and meet the eligibility requirements of each of the individual incentive programs in which they are participating.

B.6 Funding PrinciplesAny new incentive must meet the Objective and Priorities of the Fund.

The Department will also assess any proposed new incentive programs against the following Principles to assist in determining whether it should be funded.

Fits with National PrioritiesProposed incentive programs should be consistent with the national health priorities.

Quality ImprovementProposed incentive programs should encourage a change or improvement in general practice rather than fund activities that are already common practice.

Most appropriately pursued through general practiceProposed incentive programs should be more appropriately pursued through general practice than through other health facilities such as hospitals and specialised clinics.

Administratively simpleProposed incentive programs should be designed so as not to impose an unnecessary administrative burden on practices. However, in some instances it may be necessary for new administrative requirements to be adopted to facilitate best practice care.

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Cost effectiveProposed incentive programs should be compared with existing programs and alternative funding models to ensure that the incentive is the most cost effective method of engendering change and improved outcomes.

DuplicationProposed incentive programs should be considered in light of existing government initiatives/programs to ensure financial incentives are not being duplicated.

Applies to general practiceThe incentive programs should generally be targeted towards general practices and Indigenous health services. However, payments may be targeted to GPs if deemed appropriate.

Introducing a New Incentive ProgramThe Minister has the authority to introduce new incentive programs under the Fund.

The Department will develop implementation arrangements in consultation with the PIP Advisory Group and other relevant stakeholders for consideration by the Minister.

B.7 ProbityThe Australian Government is committed to ensuring that the processes for making incentive payments meet acceptable standards of probity and are in accordance with any incentive program-specific guidance.

Probity issues to be addressed include, but are not limited to, conflict of interest, confidentiality and protection of personal information.

Conflict of InterestA conflict of interest may exist, for example, if an applicant or any of its personnel or a member of the PIP Advisory Group:

has a relationship (whether professional, commercial or personal) with a party who is able to influence the development or implementation arrangements (e.g. a departmental officer);

has a relationship with, or interest in, an organisation, which is likely to interfere with or restrict the applicant in carrying out the proposed activities fairly and independently; or

has a relationship with, or interest in, an organisation from which they will receive personal gain as a result of the introduction of new incentive programs.

Members of the PIP Advisory Group will be required to declare, existing conflicts of interest or that to the best of their knowledge there is no conflict of interest that would affect the independence of or prevent the member from participating in the Advisory Group.

Where a member of the PIP Advisory Group subsequently identifies that an actual, apparent, or potential conflict of interest exists or might arise in relation to participation in the PIP Advisory Group, the Department must be informed in writing immediately. The member must not exercise his/her Advisory Group responsibilities until the Department has determined and advised the member how the conflict will be managed.

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Confidentiality and Protection of Personal InformationIt is a Commonwealth requirement that all confidential information and personal information are kept confidential. This will require parties to:

comply with the Privacy Act (1988) (‘the Privacy Act’), including the 11 Information Privacy Principles (IPPs), as if it were an agency under the Privacy Act, and the National Privacy Principles (NPPs);

refrain from engaging in direct marketing (s 16F of the Privacy Act), to the extent that the NPP and/or s 16F apply; and

impose the same privacy obligations on any subcontractors it engages to assist with a project for which the funds are provided.

Application forms for incentive programs under the Fund include confidentiality and protection of personal information clauses to protect general practice and GP information. Any documentation developed for the incentive programs will take into account confidentiality and protection of personal information.

Members of the PIP Advisory Group are required to sign a ‘Deed of Undertaking in relation to Confidential Information and Conflict of Interest’ form, which outline members’ responsibility to the Department in regards to confidentiality.

B.8 Processes for Accessing the FundGeneral practices and GPs will need to meet the eligibility requirements of the individual incentive programs and apply for the incentive programs through Human Services, which makes payments on behalf of the Department.

General practices and GPs are able to use the PIP and GPII Online system to securely apply for the incentive programs, and maintain practice and provider details. General practices and GPs can also complete a paper-based application form available from Human Services.

B.9 Decisions

Fund Underexpenditure:Funding allocations will be monitored throughout the year with potential underspends identified. Under expenditure may be used to fund unsolicited proposals or one-off grants where such proposals will meet the Objective and Priorities of the Fund. Information about one-off grants can be found in Part C of the Fund Guidelines.

The Minister may also direct underspends to other Priorities and incentive programs within the Fund.

Where appropriate, the Department will consult with the PIP Advisory Group and other relevant stakeholders on possible uses of any underspend.

Complaint HandlingComplaints relating to the incentive programs available through the Fund, must be lodged in writing to Human Services by the authorised contact person or the owners of the practice. Human Services will respond to the complaints in writing.Details of the requirements for lodging complaints about the grant or procurement components of the Fund are provided in Parts B and C.

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B.10 Conditions of Funding for Incentive Payments

Incentive Payment ArrangementsGeneral practices, Indigenous health services and/or GPs will be required to meet the eligibility requirements of the incentive programs in which they are participating.

Payments will be made by Human Services to practices and GPs meeting the eligibility requirements. General practices and GPs must inform Human Services if they are no longer eligible for an incentive payment within 14 days of ceasing to meet the eligibility requirements.

Human Services will audit practices in accordance with their compliance program to ensure practices are meeting the eligibility requirements of the incentive programs in which they are participating.

ReportingThe Department will develop relevant high level performance indicators for the incentive payments component of the Fund in consultation with the PIP Advisory Group. The Department will publicly report against the performance indicators on a regular basis.

EvaluationThe Department will, in consultation with the PIP Advisory Group develop an evaluation strategy for the incentive payments component of the Fund. The evaluation strategy will include incentive programs that existed prior to the establishment of the Fund and new incentive programs developed under the Fund.

Incentive programs that existed before the establishment of the Fund will be evaluated prior to the end of their planned funding period unless the measure is terminating early as a result of a decision of the Australian Government. Any incentive that does not have an end date of funding will be evaluated as part of a rolling program of evaluation. Existing incentive programs may be terminated, modified or continued based on the recommendations of an evaluation or as determined by the Minister in order to meet the Priorities and Objective of the Fund.

These arrangements will provide the flexibility to cease initiatives that are no longer required or to modify payment levels and requirements of particular incentive programs to be consistent with Government priorities and the available evidence.

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PART C: Grants

C.1 IntroductionThe Fund can be used to fund grants, which support the Objective of the Fund. At present there are targeted grants to support the immunisation activities provided by Medicare Locals and the Australian Medicare Local Network.

Grant rounds under the Fund will be conducted in accordance with the requirements of the Commonwealth Grant Guidelines (CGGs).

C.2 Available Grant FundsThe Department of Health will determine the final allocation between the incentive payments and grants and procurements but initially it is anticipated that approximately $3 million per annum will be available for grants.

C.3 Roles and responsibilities

Minister:The Minister for Health (the Minister) has the authority to approve grants and one-off activities that are consistent with the Objective of the Fund.

The Department:A Departmental Delegate may approve grants and funding for activities that are consistent with the Fund Objective, and within the delegation arrangements, such as the procurement of evaluation services.

For activities that are funded through targeted funding agreements, the Department will be responsible for managing the activities including:

Developing funding agreements or any alternative contractual arrangement. Monitoring the performance of projects to ensure the conditions of the contractual

arrangement are met. Assessing performance and financial reports, and undertaking follow up activity as

necessary. Making payments on acceptance of milestone reports as specified in the contractual

arrangements. Providing feedback to funded organisations on the overall project following the conclusion

of activities.

Funded Entity:A funded entity is responsible for the efficient and effective delivery of services in accordance with the obligations contained in any funding agreement or contractual arrangement entered into under the Fund. Funded entities are also responsible for:

Ensuring they meet the specifications of the funding agreement or other contractual arrangement.

Ensuring the project is managed in a cost effective and efficient manner. Maintaining contact with the Department and advising of any emerging issues that may

impact on the success of the project. Reporting on project performance and expenditure in accordance with the contractual

obligations. Assisting with evaluation activities as necessary.

C.4 TimeframesThe Fund is an ongoing initiative commencing on 1 July 2011 and will continue until 30 June 2015.

Specific activities under the grant arrangements will be funded and rolled out in line with agreed Australian Government timelines.

C.5 EligibilityAt present targeted grants are limited to the immunisation activities provided by Medicare Locals and the Australian Medicare Local Network. There are currently no open grant application processes under the Fund.

C.6 Funding formulaThe allocation of funding to Medicare Locals for immunisation activities is based on a funding formula that takes into account the characteristics of each Medicare Local, such as rurality and Aboriginal and Torres Strait Islander population.

C.7 ProbityThe Australian Government is committed to ensuring that the grant processes meet the acceptable standards of probity and are in accordance with the published guidelines.Probity issues to be addressed include, but are not limited to, conflict of interest, confidentiality and protection of personal information.

Conflict of interestA conflict of interest may exist, for example, if an applicant or any of its personnel:

has a relationship (whether professional, commercial or personal) with a party able to influence the development or implementation arrangements e.g. a departmental officer;

has a relationship with, or interest in, an organisation, which is likely to interfere with or restrict the applicant in carrying out the proposed activities fairly and independently.

Applicants for grants will be required to declare conflicts of interest as part of their applications.

Confidentiality and Protection of Personal InformationIt is a Commonwealth requirement that all confidential information and personal information are kept confidential. This will require each funded entity to:

comply with the Privacy Act (1988) (‘the Privacy Act’), including the 11 Information Privacy Principles (IPPs), as if it were an agency under the Privacy Act, and the National Privacy Principles (NPPs);

refrain from engaging in direct marketing (s 16F of the Privacy Act), to the extent that the NPP and/or s 16F apply to the funded entity; and

impose the same privacy obligations on any subcontractors it engages to assist with the project.

The contractual arrangement with funded entities imposes obligations on the funded entity with respect to special categories of information collected, created or held under the Agreement. The

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funded entity is required to seek the Commonwealth’s consent in writing before disclosing confidential information.

The specific clauses governing the confidentiality provisions of any grant process will be contained in the contract that will form part of the grant documentation available to applicants.

C.8 Processes for Accessing the FundThe process for accessing targeted grants or unsolicited proposals will be determined on a case by case basis but will be consistent with the Fund and Grant Guidelines and the principles of the Commonwealth Grant Guidelines.

C.9 DecisionsThe Minister or Departmental Delegate will consider the extent to which targeted grants and one off grants will make an efficient, effective, ethical and economical use of Commonwealth resources, as required by Commonwealth legislation, and whether any specific requirements will need to be imposed as a condition of funding.

Funding approval is at the discretion of the Minister or Departmental Delegate.

C.11 Complaint handlingThe Department’s Procurement and Funding Complaints Handling Policy (the Policy) applies to complaints that arise in relation to a procurement or funding process. The Policy covers events that occur between the time the request documentation is released publicly and the date of contract execution, regardless of when the actual complaint is made. The Department requires that all complaints relating to a grant or procurement process must be lodged in writing. Further details of the policy are available at the 'About Us' page on the Department’s internet site.

C.12 Conditions of Targeted Grants

Contracting arrangementsEntities offered grants will be required to enter into a funding agreement or other form of agreement with the Commonwealth (represented by the Department). A copy of the proposed contractual arrangement will form part of any material that is made available to applicants.

Details of all grants will reported in accordance with the requirements of the Commonwealth Grants Guidelines and other reporting obligations applying to the Department. This will include being listed on the Department’s website.

Payment arrangementsPayments will be made on the achievement of agreed milestones subject to the provision of:

a tax invoice for the amount of the payment evidence of meeting the obligations of the funding agreement

Where payments are linked to the achievement of specific milestones, payments will only be made after the Department is satisfied that those milestones and associated obligations of the funding agreement or contractual arrangement have been met.

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Reporting requirementsFunding recipients will be required to provide progress reports on the agreed milestones. These progress reports may include funding acquittal requirements. The timing of progress reports will be negotiated as part of the funding agreement. The format and framework for providing progress reports will take into account the size, cost and relative risks of the initiative/project being undertaken by the funding recipient.

MonitoringThe funding recipient will be required to actively manage the delivery of the project. The Department will monitor progress against the funding agreement or contract through assessment of progress reports and by conducting site visits as necessary.

EvaluationThe Department will from time-to-time evaluate the grants provided under the Fund to determine whether they are effective in achieving the intended policy objective and are an efficient use of public monies. Funding recipients will be required to provide information to assist in this evaluation for a period of time, as stipulated in the funding agreement or contract, after the funding has been provided.

C.13 ProcurementsAny procurement undertaken for work directly related to the Objective of the Fund will be undertaken in accordance with the requirements of the Commonwealth Procurement Rules , and will be consistent with the Objective and Priorities of the Fund. The requirements for procurements will be included in the documentation made available to prospective tenderers.

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Glossary of Terms

ApplicantsMeans any entity that applies for funding under the flexible Fund.

Departmental DelegateMeans an officer of the Department authorised under the Chief Executive Instructions to exercise a delegation or make a decision relating to the Fund.

Human ServicesMeans the Department of Human Services

Funded entityMeans any entity that has been successful in a grant process under the flexible Fund.

General practiceMeans general practices and Indigenous Health Services.

GPIIMeans the General Practice Immunisation Incentive

PIPMeans the Practice Incentives Program

Practice Incentives for General Practices Fund (The Fund)As described in Section 1 of these Guidelines.

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