Practice Incentives Program After Hours Incentive

Incentive to support general practices to provide their patients with appropriate access to after hours care.

After hours periods

Practices to ensure their patients have access to care throughout the after hours periods.

For the Practice Incentives Program (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 further broken into:

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

Formal arrangements

Some payment levels don’t require the practice to provide care themselves if formal arrangements exist for patients to access care through a third party. Third party formal arrangements may include:

  • other practices
  • after hours services
  • medical deputising services (MDS), and
  • after hours cooperatives

Formal arrangements between a practice and a third party must be outlined in a formal document which is agreed to and signed by all practices participating in the arrangement. All details of this arrangement must be included in the document including what level of after hours service will be provided by the third party. This document must be produced on request.

Formal arrangements must make sure consultation notes and information about the care provided are sent back to the practice, with patient consent, by the next day. Patients’ digital health records in the My Health Record system may be used to transfer this information through an event summary.

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 the care for the cooperative.

A cooperative arrangement must be outlined in a formal document, which is agreed to and signed by all practices participating in the cooperative arrangement. All details of this arrangement must be included in the document, including the level of after hours service and minimum hours that will be provided by each participating practice. This document must be produced on request.

Eligible cooperative arrangements must make sure consultation notes and information about the care provided are sent back to the practice, with patient consent, by the next day. Patients’ digital health records in the My Health Record system may be used to transfer this information through an event summary.

Medical Deputising Services

Medical Deputising Services (MDS) operate in the after hours period and 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.

An MDS is not eligible to receive the PIP After Hours Incentive as they are not considered to be a general practice.

A PIP practice may have a formal arrangement with a third party care provider, such as an MDS, to ensure their patients have access to care in the after hours period.

Eligibility

Requirements for all payment levels

To be eligible for the PIP After Hours Incentive, practices must meet the following eligibility requirements regardless of the payment level claimed:

  • be registered for the PIP
  • provide after hours care for patients in accordance with the Royal Australian College of General Practitioners (RACGP) Standards for general practices
  • maintain eligibility for the entire preceding payment quarter, 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
  • practices must clearly communicate after hours arrangements to patients with information on display in the practice and visible to patients when the practice is closed. Practices must also advise patients of the after hours arrangements through a telephone answering machine and on the practice website if they have one
  • the arrangements must also be clearly communicated and registered in the National Health Services Directory. Practices may also elect to update state and territory or other local health service directories

Additional requirements for payment levels 1-4

Where a cooperative or formal third party care arrangement is applicable, practices must also meet the following requirements:

  • The practice arrangements must make sure notes of consultations and information about the care provided are sent back to the practice, with patient consent, by the next day. Patients’ digital health records in the My Health Record system may be used to transfer this information through an event summary.
  • Practice arrangements must be outlined in a formal document which is agreed to and signed by all parties participating in the arrangement.
  • All details of the arrangement, including third party after hours care providers and the level of after hours service that will be provided, must be included in the signed document. This document must be produced on request.

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 annually.

Practices can only qualify for 1 payment level. The levels are not cumulative. Payments for each level are capped at a maximum of 20,000 SWPE per eligible practice annually.

The PIP After Hours Incentive is paid quarterly.

The table below shows the payment dates and the point-in-time eligibility assessment dates.

Quarterly payment month Point-in-time eligibility assessment date
February 31 January
May 30 April
August 31 July
November 31 October

Payment levels

Eligible practices may be entitled to 1 of the following payment levels.

Level 1 Participation Payment

To be eligible for the Level 1 Participation Payment, practices must have formal arrangements in place to ensure 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
  • MDS, and
  • after hours cooperatives

The formal arrangements must make sure notes of consultations and information about the care provided are sent back to the practice, with patient consent, by the next day.

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 where GP care is provided during the sociable after hours period by an MDS 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. These are the minimum number of hours that must be provided to the cooperative and can be averaged over the payment quarter.

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

Practices don’t need to remain physically open to provide care during the after hours periods. 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, with patient consent, by the next day.

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

Practices participating in a cooperative arrangement are not eligible for this payment.

Patients must 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, providing GP care through local arrangements outside of the practice, such as local hospital arrangements, is 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.

Practices don’t need to remain physically open to provide care during the after hours periods. 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 arrangements for the unsociable hours coverage must make sure notes of consultations and information about the care provided are sent back to the practice, with patient consent, by the next day.

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 where GP care is provided by an MDS 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. These are the minimum number of hours that must be provided to the cooperative and can be averaged out over the payment quarter.

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 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 health care centres

Practices don’t need to remain physically open to provide care during the after hours periods. 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, with patient consent, by the next day.

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).

Under this payment level, practices must provide after hours care during the complete after hours period. Third party arrangements including practices participating in a cooperative or arrangements with an MDS are not eligible under this payment level.

Patients must 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 5 to 7, localised or practice based nurse triaging by telephone or face to face by a registered nurse or nurse practitioner, is also acceptable, as long as practice patients have access to a practice GP where clinically appropriate. A localised nurse triaging arrangement may include, but is not limited to, triaging by a registered nurse at the emergency department at the local hospital.

Other non-prescribed circumstances for a localised nurse triaging arrangement can be submitted for consideration of eligibility on a case by case basis.

The use of the nurse triaging telephone services operating at a national or state and territory level won’t be considered an eligible arrangement for Level 5 Complete After Hours Practice Coverage Payment. This includes:

  • Healthdirect Nurse Triage Service in New South Wales, the Australian Capital Territory, Tasmania, South Australia, Western Australia and the Northern Territory
  • Nurse on Call in Victoria, and
  • 13 HEALTH in Queensland

Practices don’t need to remain physically open to provide care during the after hours periods. Where clinically appropriate, and when deemed safe and reasonable, face-to-face contact between the GP and patient is expected to occur.

The notes for triage provided by a nurse outside the practice must be sent back to the practice by the next day.

Table of payments and eligibility requirements

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

Payment level and amount After hours period Care provider
Level 1 Participation

$1 per SWPE

Complete after hours period
  • outside 8 am to 6 pm weekdays
  • outside 8 am to 12 noon on Saturdays, and
  • all day on Sundays and public holidays
Formal arrangements in place with other providers, including MDS, to ensure access for practice patients.
Level 2 Sociable After Hours Cooperative Coverage

$4 per SWPE

Sociable after hours period
  • 6 pm through to 11 pm weeknights
Participating general practice in cooperative arrangement, including minimum hourly participation requirements.
Unsociable after hours period
  • 11 pm through to 8 am weekdays
  • hours outside of 8 am and 12 noon Saturdays, and
  • all day Sundays and public holidays
Formal arrangements in place with other providers, including MDS, to ensure access for practice patients.
Level 3 Sociable After Hours Practice Coverage

$5.50 per SWPE

Sociable after hours period
  • 6 pm through to 11 pm weeknights
Participating general practice.
Unsociable after hours period
  • 11 pm through to 8 am weekdays
  • hours outside of 8 am and 12 noon Saturdays, and
  • all day Sundays and public holidays
Formal arrangements in place with other providers, including MDS, to ensure access for practice patients.
Level 4 Complete After Hours Cooperative Coverage

$5.50 per SWPE

Complete after hours period
  • outside 8 am to 6 pm weekdays
  • outside 8 am to 12 noon on Saturdays, and
  • all day on Sundays and public holidays
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
  • outside 8 am to 6 pm weekdays
  • outside 8 am to 12 noon on Saturdays, and
  • all day on Sundays and public holidays
Participating general practice.

Applying

Practices can apply for this incentive:

Practices with a non-prescribed circumstance for a localised nurse triaging arrangement can apply for the Level 5 Complete After Hours Practice Coverage Payment in writing to be considered as part of an eligible model of care. Applications are considered on an individual basis.

Applications and requests for consideration of an after hours localised nurse triage arrangement can be faxed to 1300 587 696.

Obligations

In addition to meeting the eligibility requirements for the incentive, the practice must:

  • nominate an authorised contact person to confirm, on the practice’s behalf, changes to information for PIP claims and payments
  • ensure the information in the National Health Services Directory is current at all times
  • keep documentary evidence, including evidence of after hours arrangements, to support claims for payment
  • give information to the Department of Health (Health) as part of the ongoing audit process to prove that the practice has met eligibility requirements
  • make sure information given to us is correct, and
  • tell us about any changes to practice arrangements at least 7 days before the relevant point-in-time date

Practices can update their details:

Rights of review

The PIP has a review process for program decisions. To ask for a review of a decision, the authorised contact person or owners of the practice must complete the Practice Incentives Review of decision form and submit it to us within 28 days of receiving the decision. We’ll review the decision and advise the practice in writing of the outcome.

Practice Incentives Program audits

Health conducts audits of PIP practices each year to ensure practices are meeting the requirements outlined in these guidelines. This may include a review of practice documentation. If requested, practices must provide evidence to support their eligibility and claims for payments.

  • signed documentation relating to formal third party arrangements and/or the cooperative agreement
  • evidence of participation in cooperative arrangements, including hours worked by practice GPs
  • evidence of after hours availability within the practice
  • evidence the after hours services are clearly communicated to patients, or
  • if the after hours was provided by a third party, evidence that the service was provided and the information given to the practice

For the purpose of Health’s audits, practices must retain practice documentation for a period of 6 years. If a practice is unable to provide evidence to verify that it meets the eligibility requirements or substantiate its claims for payments, Health may seek to recover past payments up to and including 6 years.

Contact us

For more information about the PIP After Hours Incentive contact the Practice Incentives Program.

Disclaimer

These guidelines are for information purposes only and provide the basis upon which PIP payments are made. While it is intended that the government will make payments as set out in these guidelines, the making of payments is at its sole discretion. The government may alter arrangements for the PIP at any time and without notice.

The 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: 15 November 2016

This information was printed Friday 9 December 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.