GPACI at six months: Progress marred by complexity

• What is it? The GPACI is a $112 million, four-year program launched on 1 July 2024, tied to MyMedicare, incentivising GPs and practices to deliver proactive care to aged care residents.
• Who benefits? Aged care residents receive enhanced primary care, while GPs and practices earn payments for meeting service requirements like regular visits and care planning.
• Why was it implemented? It aims to address unbillable primary care work, improve health outcomes, and promote continuity of care for aged care residents through MyMedicare.

The General Practice in Aged Care Incentive (GPACI), launched on 1 July 2024, marked a significant shift in how primary care is delivered to residents of aged care homes across Australia.

Backed by a $112 million investment over four years, the initiative aims to enhance proactive, coordinated, and continuous care for older Australians through the MyMedicare platform. Now, six months into its implementation, early insights reveal a program with strong uptake but significant challenges, particularly around administrative complexity and general practitioner (GP) dissatisfaction.

The GPACI has seen impressive early adoption, surpassing the Commonwealth’s expectations. The Department of Health, Disability and Ageing projected 89,000 patients would register in the first year, yet by November 2024, over 82,000 aged care residents were enrolled, with more than $14.3 million disbursed to practices and providers.

This figure is on track to exceed the projected 97,000 registrations by the end of year two. Additionally, the Department’s Early Insights from the General Practice in Aged Care Incentive report highlights a 25 per cent increase in eligible care planning services in the first six months compared to the same period in 2021–2024, signalling early progress in delivering proactive care.

However, this promising start is overshadowed by significant hurdles. GPs have voiced frustration with the program’s structure, particularly its reliance on MyMedicare and the administrative demands it imposes. The sentiment among many in the sector is that while the initiative’s intent – to address unbillable and unpaid primary care work in aged care – is commendable, its execution has fallen short.

A key issue raised in the report is the administrative complexity of the GPACI. The dual registration process – requiring patients to be enrolled in both MyMedicare and the Incentive – has been described as “overly burdensome” by surveyed GPs and practices.

For many residents in aged care, who often lack the capacity to register themselves, the responsibility falls to practices or carers, many of whom also struggle with the process. The report notes that navigating the PRODA system for registration is time-consuming and prone to errors, a stark contrast to the simpler administrative requirements of the former Practice Incentives Program General Practice Aged Care Access Incentive (PIP GP ACAI).

The service delivery requirements further complicate matters. To qualify for payments, GPs must provide at least 10 eligible services annually, including two care planning items and eight regular visits, with specific quarterly stipulations. While this structure aims to ensure consistent care, many GPs find the tracking and reporting requirements cumbersome, with complex rules around payment calculations adding to the frustration.

Another challenge highlighted in the report is the disruption of therapeutic relationships when residents enter aged care. Only 20 per cent of residents retain their previous GP upon admission, undermining the goal of continuity of care. This issue is compounded by the perception that the GPACI model may favour larger practices with greater resources to manage administrative demands, potentially leaving smaller practices and those with fewer aged care patients at a disadvantage.

The report also points to the need for greater recognition of aged care as a multidisciplinary speciality. It recommends promoting the role of GP registrars and other care team members, such as nurse practitioners and allied health professionals, in delivering services under the Incentive. This could help build a sustainable workforce for aged care, addressing long-term capacity issues.

Effective communication and support have been lacking in the program’s early stages. The Department developed information kits and resources, but the report indicates that few GPs accessed them, and those who did found them inadequate. Primary Health Networks (PHNs), tasked with supporting practices, faced delays in receiving funding and unclear expectations, limiting their ability to provide timely assistance. The report recommends clarifying the role of PHNs and strengthening their engagement to better support GPs during the rollout.

The report’s early considerations offer a roadmap for refining the GPACI. Simplifying the registration process and reducing administrative burdens are top priorities to encourage broader participation.

The report also suggests exploring non-financial incentives, such as professional development opportunities, to boost GP engagement. Additionally, acknowledging the role of multidisciplinary care teams could foster a more sustainable workforce, while enhanced PHN support could bridge gaps in implementation.