After Hours Incentive

The After Hours Incentive aims to support general practices to provide their patients with appropriate access to after hours care.

After hours periods

For PIP the complete after hours period is:

  • outside 8 am to 6 pm weekdays
  • outside 8 am to 12 noon on Saturdays, and
  • all day on Sundays and public holidays

The complete after hours period is broken into:

  • sociable after hours period – 6 pm to 11 pm weeknights
  • unsociable after hours period – 11 pm to 8 am weekdays, hours outside of 8 am and 12 noon Saturdays, and all day Sundays and public holidays

Cooperative arrangements

For the purposes of the PIP, an after hours cooperative is defined as general practices working together to provide care to patients outside the normal opening hours of their practices. General Practitioners (GPs) from the participating practices must provide all of the care for the cooperative.

Eligible cooperative arrangements must make sure notes of consultations and information about the care provided are sent back to the practice. This must occur in a timely manner that is suitable to both parties, where patient consent has been obtained. For patients with a digital health record in the My Health Record system, this record may be used to transfer this information through an event summary.

Medical Deputising Services

Medical Deputising Services are organisations which directly arrange for medical practitioners to provide after hours medical services to patients of Practice Principals during the absence of, and at the request of, the Practice Principals. For the purposes of the PIP a Medical Deputising Service is not considered to be a general practice.

Core eligibility requirements

To be eligible for the PIP After Hours Incentive, practices must meet the following core eligibility requirements:

  1. Be registered for the PIP and meet the requirements for the payment level claimed for the entire quarter before the payment month
  2. Provide after hours care for patients in accordance with the RACGP Standards for general practices
  3. Clearly communicate after hours arrangements to patients, including information available within the practice, on the practice website or through a telephone answering machine

Payments

Payments are based on the Standardised Whole Patient Equivalent (SWPE). This is a measure of practice size and includes a weighting factor for the age and gender of patients. As a guide, the average full-time GP has a SWPE value of around 1,000 SWPEs annually.

Practices can only qualify for one payment level. The levels are not cumulative. Payments for each level are capped at a maximum of 20,000 SWPE per eligible practice.

Eligible practices may be entitled to one of the following payments.

The table below shows payments and eligibility requirements of the PIP After Hours Incentive.

Payment level and amount After hours period Care provider

Level 1 Participation

$1 per SWPE

Complete after hours period Formal arrangements in place with other providers, including Medical Deputising Services, to ensure access for practice patients.

Level 2 Sociable after hours cooperative coverage

$4 per SWPE

Sociable after hours period Participating general practice in cooperative arrangement, including minimum hourly participation requirements.
Unsociable after hours period Formal arrangements in place with other providers, including Medical Deputising Services, to ensure access for practice patients.

Level 3 Sociable after hours practice coverage

$5.50 per SWPE

Sociable after hours period Participating general practice.
Unsociable after hours period Formal arrangements in place with other providers, including Medical Deputising Services, to ensure access for practice patients.

Level 4 Complete after hours cooperative coverage

$5.50 per SWPE

Complete after hours period Participating general practice in cooperative with other general practices, including minimum hourly participation requirements.

Level 5 Complete after hours practice coverage

$11 per SWPE

Complete after hours period Participating general practice.

How payments are made

The PIP After Hours Incentive is paid retrospectively.

Practices need to maintain eligibility for the entire quarter before the payment month, including the ‘point in time’ date, to be eligible for the quarterly payment. The ‘point in time’ date is the last day of the month before the next payment quarter. For example, to be eligible for a November payment, practices must maintain eligibility from 1 August up to and including the ‘point in time’ date of 31 October.

Read more about how PIP payments are calculated.

The table below shows the payment dates, the 'point-in-time' eligibility assessment date and the months eligibility must be maintained for.

Quarterly payment month ‘Point in time’ eligibility assessment date Months eligibility must be maintained for
February 31 January All of November, December and January
May 30 April All of February, March and April
August 31 July All of May, June and July
November 31 October All of August, September and October

Payment Levels

Level 1 Participation Payment

To be eligible for the Level 1 Participation Payment, practices must have formal arrangements in place to ensure that practice patients have access to care in the complete after hours period (hours outside of 8 am to 6 pm weeknights, hours outside of 8 am to 12 noon Saturdays, and all day Sundays and public holidays).

The practice doesn’t have to provide the care itself if it has formal arrangements in place for patients to access care through a third party.

Third party arrangements may involve:

  • other practices
  • after hours services
  • Medical Deputising Services (MDSs)
  • after hours cooperatives

The arrangements must make sure notes of consultations and information about the care provided are sent back to the practice in a timely manner that is suitable to both parties, where patient consent has been obtained. For patients with a digital health record in the My Health Record system, this record may be used to transfer this information through an event summary.

The practice must also ensure that the after hours arrangements are effectively communicated to patients and employees and register the arrangements in the National Health Service Directory. Practices may also elect to update state and territory or other local health service directories.

To be eligible for this payment, arrangements must be outlined in a formal document which is agreed to and signed by both parties. This document must be produced for auditing purposes if required.

Level 2 Sociable After Hours Cooperative Coverage Payment

To be eligible for the Level 2 Sociable After Hours Cooperative Coverage Payment, practices must:

  • participate in a cooperative arrangement that provides after hours care to practice patients in the sociable after hours period, 6 pm to 11 pm weeknights, and
  • ensure formal arrangements are in place to cover the unsociable after hours period, 11 pm to 8 am weekdays, hours outside of 8 am and 12 noon Saturdays and all day Sundays and public holidays

The cooperative must meet the definition of a cooperative as outlined in these guidelines.

Participation in a cooperative arrangement that involves the provision of GP care during the sociable after hours period by a Medical Deputising Service (or other non-general practice organisation) is not acceptable under this payment level.

To be eligible for this payment practices must provide the minimum levels of care towards the cooperative as indicated below.

The table below shows the average annual SWPE level of a practice and the minimum levels of care requirements.

Average annual SWPE level of practice Minimum number of GP hours that must be provided to the cooperative
0 to 2,000 5 hours per week
2,001 to 5,000 10 hours per week
5,001 and above 15 hours per week

The cooperative arrangement must allow practice patients to receive care directly from a GP. This may include:

  • telephone based advice
  • telehealth based services
  • home visits
  • in-practice consultations, or
  • consultations at hospitals or other local health care centres

Where clinically appropriate, and when deemed safe and reasonable, face to face contact between the GP and patient is expected to occur.

Consulting with new patients in the sociable after hours period is at the practice’s discretion.

Both the cooperative arrangement for sociable after hours coverage and the formal arrangement for unsociable after hours coverage must make sure notes of consultations and information about the care provided are sent back to the practice. This must occur in a timely manner that is suitable to both parties, where patient consent has been obtained. For patients with a digital health record in the My Health Record system, this record may be used to transfer this information through an event summary.

The practice must also ensure that the after hours arrangements are effectively communicated to patients and employees and register the arrangements in the National Health Service Directory. Practices may also elect to update state and territory or other local health service directories.

To be eligible for this payment, arrangements must be outlined in a formal document which is agreed to and signed by both parties. This document must be produced for auditing purposes where required.

Level 3 Sociable After Hours Practice Coverage Payment

To be eligible for the Level 3 Sociable After Hours Practice Coverage Payment, practices must:

  • provide after hours care to practice patients directly through the practice in the sociable after hours period (6 pm to 11 pm weeknights), and
  • ensure formal arrangements are in place to cover the unsociable after hours period (11 pm to 8 am weekdays, hours outside of 8 am and 12 noon Saturdays and all day Sundays and public holidays)

Practices cannot participate in a cooperative to be eligible for this payment.

Patients must be able to receive care directly from a practice GP. This may include:

  • telephone based advice
  • telehealth based services
  • home visits
  • in-practice consultations, or
  • consultations at hospitals or other local health care centres

In rural and remote areas, Rural, Remote and Metropolitan Areas (RRMA) classification 3 to 7, the provision of GP care through local arrangements outside of the practice, such as local hospital arrangements, will be acceptable as long as practice patients have access to a practice GP. These arrangements must also ensure that consultation notes and information about the care provided are sent back to the practice.

Where clinically appropriate, and when deemed safe and reasonable, face to face contact between the GP and patient is expected to occur.

Consulting with new patients in the sociable after hours period is at the practice’s discretion.

The formal arrangement must make sure notes of consultations and information about the care provided are sent back to the practice in a timely manner that is suitable to both parties, where patient consent has been obtained. For patients with a digital health record in the My Health Record system, this record may be used to transfer this information through an event summary.

The practice must also ensure that the after hours arrangements are effectively communicated to patients and employees and register the arrangements in the National Health Service Directory. Practices may also elect to update state and territory or other local health service directories.

To be eligible for this payment, arrangements must be outlined in a formal document which is agreed to and signed by both parties. This document must be produced for auditing purposes where required.

Level 4 Complete After Hours Cooperative Coverage Payment

To be eligible for the Level 4 Complete After Hours Cooperative Coverage Payment, practices must participate in a cooperative arrangement that provides after hours care to practice patients for the complete after hours period (hours outside of 8 am to 6 pm weeknights, hours outside of 8 am to 12 noon Saturdays, and all day Sundays and public holidays).

The cooperative must meet the definition of a cooperative as outlined in these guidelines.

Participation in a cooperative arrangement that involves the provision of GP care by a Medical Deputising Service (or other non-general practice organisation) is not acceptable under this payment level.

To be eligible for this payment practices must provide the minimum levels of care towards the cooperative as indicated below.

The table below shows the average annual SWPE level of practice and the minimum number of GP hours that must be provided to the cooperative.

Average annual SWPE level of practice Minimum number of GP hours that must be provided to the cooperative
0 to 2,000 18 hours per week
2,001 to 5,000 36 hours per week
5,001 and above 54 hours per week

The cooperative arrangement must allow practice patients to receive care directly from a GP. This may include:

  • telephone based advice
  • telehealth based services
  • home visits
  • in-practice consultations, or
  • consultations at hospitals or other local health care centres

Where clinically appropriate, and when deemed safe and reasonable, face to face contact between the GP and patient is expected to occur.

Consulting with new patients is at the practice’s discretion.

The cooperative arrangement must make sure notes of consultations and information about the care provided are sent back to the practice. This must occur in a timely manner that is suitable to both parties, where patient consent has been obtained. For patients with a digital health record in the My Health Record system, this record may be used to transfer this information through an event summary.

The practice must also ensure that the after hours arrangements are effectively communicated to patients and employees and register the arrangements in the National Health Service Directory. Practices may also elect to update state and territory or other local health service directories.

To be eligible for this payment, arrangements must be outlined in a formal document which is agreed to and signed by both parties. This document must be produced for auditing purposes where required.

Level 5 Complete After Hours Practice Coverage Payment

To be eligible for the Level 5 Complete After Hours Practice Coverage Payment, practices must provide after hours care to practice patients in the complete after hours period (hours outside of 8 am to 6 pm weeknights, hours outside of 8 am to 12 noon Saturdays, and all day Sundays and public holidays).

Practices cannot participate in a cooperative to be eligible for this payment.

Patients must be able to receive care directly from a practice GP. This may include:

  • telephone based advice
  • telehealth based services
  • home visits
  • in-practice consultations, or
  • consultations at hospitals or other local health care centres

In rural and remote areas (RRMA 3 to 7) the provision of GP care via local arrangements outside of the practice, such as local hospital arrangements, will be acceptable as long as practice patients have access to a practice GP. These arrangements must also ensure that consultation notes and information about the care provided is sent back to the practice.

Where clinically appropriate, and when deemed safe and reasonable, face-to-face contact between the GP and patient is expected to occur.

Consulting with new patients is at the practice’s discretion.

The practice must make sure the after hours arrangements are effectively communicated to patients and employees and register the arrangements in the National Health Service Directory. Practices may also elect to update state and territory or other local health service directories in addition to this.

Applying

Practices can apply for this incentive:

Obligations

The practice must:

  • nominate an authorised contact person who will confirm, on the practice’s behalf, any changes to information for PIP claims and payments
  • update the National Health Services Directory within 14 days of any change to after hours arrangements
  • substantiate claims for payment, including evidence of after hours arrangements
  • give information to us as part of the ongoing audit process to verify that the practice has met eligibility requirements
  • make sure information given to us is correct, and
  • advise us of any changes to practice arrangements

This can be done:

Compliance

The Department of Human Services may conduct both targeted and random audits of PIP practices to ensure that they are meeting the requirements outlined in these guidelines. This may include a review of practice documentation such as:

  • signed documentation relating to formal third party arrangements
  • evidence of participation in cooperative arrangements, including hours worked by practice GPs, or
  • evidence of after hours availability within the practice

Human Services may seek to recover payments if a practice is unable to provide evidence to verify that it meets the eligibility requirements.

Appeals

The PIP has an established appeals process. To ask for a review of a decision, the authorised contact person or the owners of the practice must write to us within 28 days of the date on the notice of the decision. We will review the decision and advise the practice in writing of the outcome.

More information

If you have questions about the PIP After Hours Incentive you can contact us.

Disclaimer: These guidelines are for information purposes only. While it is intended that the Australian Government will make payments as set out in these guidelines, the making of payments is at its sole discretion. The Australian Government may alter arrangements for the Practice Incentives Programme at any time and without notice.

The Australian Government does not accept any legal liability or responsibility for any injury, loss or damage incurred by the use of, reliance on, or interpretation of the information provided in these guidelines.

Page last updated: 2 March 2016

This information was printed Friday 30 September 2016 from humanservices.gov.au/health-professionals/enablers/after-hours-incentive It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.