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Rural Classification and Health Workforce Incentives Presentation to General Practice Issues Group 19 June 2009 Sharon Kosmina, RWAV Christine McDonald,

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Presentation on theme: "Rural Classification and Health Workforce Incentives Presentation to General Practice Issues Group 19 June 2009 Sharon Kosmina, RWAV Christine McDonald,"— Presentation transcript:

1 Rural Classification and Health Workforce Incentives Presentation to General Practice Issues Group 19 June 2009 Sharon Kosmina, RWAV Christine McDonald, GPV Jane Sheats, VHA

2 Presentation Overview  New Classification system and related 2009 budget initiatives  Impact on:  GP Training  Recruitment  Retention  Practice Funding  Support Agencies  Health Services

3 Classifications and 2009 Budget  New Remoteness Areas classification from 1July 2009  Changes to GP Training  General Practice Rural Incentives Program from 1 July 2010  Scaling of Rural Health Workforce Program from 1 July 2010  Rural Primary Health Services

4 ASGC-Remoteness Areas Classification  In 2008, Minister Roxon said that RRMA to be reformed so that “incentives and rural health policies respond to current population figures and real need”  Geographical classification only  Fewer categories and weighted to remoteness on national basis  Information on AGSC + Area Locater + Fact Sheets:

5 Victorian areas by RRMA

6 Victorian areas by ASGC RA

7 RRMA v RA: Indicative Vic GP Numbers More than 50% of rural GPs were RRMA 5 More than 80% rural GPs are now Inner Regional Data sources: Metro: PHCRIS, Division report 2006-07. Rural: RWAV Annual MDS survey, RRMA 3-7, November 2008

8 Impact of Changes in Classification  Commonwealth claims no losers –2400 GPs across Australia eligible for incentive payments (many in Inner Regional areas) –GPs who otherwise lose will retain incentives-unclear for how long.  Definition of rurality –Little change in Victoria –Metro still Melbourne and Geelong; Rural- the rest –Some RRMA 1 locations become RA 2 locations  Program eligibility criteria and funding formula –Unclear- yet to flow through many programs  Victoria is Metropolitan and regional, with little remote  Will not access larger remote incentives

9 GP Training  Supply of GP Registrars set to increase 20092010201120122013 594675700812  GP Training to change to RA classification  New Rural GP Registrar incentives now same as GPs  More PGPPP places, but not likely in Victoria  GPET to also manage PGPPP from Jan 2010 and new incentives for registrars  Sliding scale introduced for HECs payments and changes to scholarship programs in favour of remoteness

10 General Practice Rural Incentive Program RA After 0.5 yr1 yr2 yrs3 yrs5+ yrs RA 1 RA 2 $2,500$4,500$7,500$12,000 RA 3 $4,000$6,000$8,000$13,000$18,000 RA 4 $5,500$8,000$13,000$18,000$27,000 RA 5 $8,000$13,000$18,000$27,000$47,000 Replaces Rural Registrar Incentives Program and Rural Retention grants

11 Comparison GP Registrar Incentives Current-RRIPNewImplications RRMA 3-7 placements. Rural and General pathways Placements to be based on RA from 1 July 2009 GPET mapping placements from RRMA to RA. Incentives on sliding scale over 3 years based on GPARIA categories GPRIP using RA categories More registrars to be eligible. Significantly less $$ but paid over longer period Rural pathway same as general pathway RRIP After 3 yrs: Cat A: $ 60,000 Cat B: $ 105,000 Cat C: $ 150,000 GPRIP After 3 Yrs: RA 2: $14,500 RA 3: $31,000 RA 4: $44,500

12 Implications  More GP Registrars  Significantly reduced rural incentives, but paid over longer time to more registrars  No incentive for registrars to train in more remote locations within categories eg Ararat and Ballarat receive the same amount  GPET to now be responsible for PGPPP, GP Training and Registrar incentives- better alignment of programs WILL RURAL TRAINING LOSE OUT WITH THESE CHANGES?

13 Recruitment  Classification changes Impact on many recruitment programs- yet to know full extent  Strategies centre on financial and length of service incentives  More city GPs and registrars encouraged to train and work in the country  Little incentive for non-resident IMGs

14 New Relocation Incentives To FromRA 2RA 3RA 4RA5 Major Cities $15,000$30,000$60,000$120,000 Inner Regional $15,000$30,000$60,000 Outer Regional $15,000$30,000 Remote $15,000 New Relocation Incentives  Sliding scale rewards city doctors moving to more remote locations  Rural locations gain incentives and outer metro lose incentives  No relocation $ for IMGs coming from overseas Current Outer Metro Inner to Outer Metro Existing Practice- $30,000 New Practice- $40,000 Rural None

15 IMG Moratoriums - Current RRMARLRP Australia Five Year Scheme Victoria RRMA 4-7 with DWS Five Year Scheme Other States RRMA 4-7 with DWS 310 years 4 5 Years5 years 510 years5 Years4-5 years 610 Yearsna3-4 years 710 years5 years2-3 years New RA 1- 29 years 37 years 46 years 55 years IMG Service Obligations

16 Rural Recruitment programs ProgramCurrentNewImplications Five Year Scheme RRMA 4-7 with DWS To cease? To be replaced by new service obligations Service obligations increased to 6-9 years depending on RA classification – incentive is reduced RLRP RRMA 4-7 and RRMA 3 with DWS Remain RRMA or change to RA? To be RA 2-5? With or without DWS? Moratoriums will reduce for Vic RLRP doctors. International Recruitment Program RRMA 3-7 with DWS. RHWA contract to 30 June 2009 Program will continue Remain RRMA or change to RA? To be RA 2-5? If not RA 2-5, number of eligible locations will reduce significantly

17 Implications for Vic Locations Melbourne and Geelong No incentives or moratorium benefits Outer metro lose incentives Will lose doctors to RA 2-5 areas if incentives work however Outer Metro relocation incentives, which were at higher $$, had limited effect Regional Cities and RA 2 locations New relocation incentives at RA 2 levels and possible one year moratorium reduction under RLRP Regional locations potentially more attractive than smaller surrounding small towns? Eligibility for MBS rural incentives? RA 3, 4, 5 New relocation incentives rewarding remoteness Reduced moratoriums on sliding scale Might have higher incentives, but will doctors be recruited there?

18 Victoria overall  Change of RRMA to RA classification need to be RA2-7 or Victorian locations will lose substantial access to recruitment  Depends on effectiveness of incentives and the responsiveness of urban doctors to relocate  More difficult to recruit non resident IMGs to rural Victoria, which is dependent on IMGs;  Will heavily rely on marketing Victoria and HWA initiatives; very little other incentives for IMGs or recruitment WILL THESE CHANGES GET GPs TO AREAS WHERE THEY ARE NEEDED IN VICTORIA?

19 Retention  GPRIP payments to apply from 1 July 2010  Retention centres on incentives  All areas from RA2 to RA5 are eligible for retention packages on a sliding scale  All qualified doctors in the eligible regions qualify provided they meet minimum Medicare requirements.  Many new areas in Victoria qualify

20  Revised Retention grants

21 Potentially Eligible GPs GPAria category Inner Regional Major City Outer RegionalRemote Grand Total Ineligible714240756 A20919228 B66135201 C33336 D22 Grand Total989222751223 RWAV RRMA 3-7 GPs, Nov 2008

22 Comparison After 5 Years GPARIARRP payments after 5 years RAGPRIP Payments after 5 years Cat A0RA 2$34,000 Cat B10,000RA3$62,000 Cat C$45,000RA4$89,500 Cat D$80,000RA5$140,000 Cat E125,000

23 Retention- Implications  Substantial increase in number of eligible GPs in Victoria  Significant increases in retention payments  No comprehensive focus on factors other than incentives to retain GPs

24 Practice MBS incentives CurrentNewImplications Rural loading for PIP Practices in RRMAs 3–7 15-50% depending No changeIf RRMA 1 or 2  RA2 = no benefit Uncertainty about longer term Practice Nurse Subsidy $7 per SWPE p.a. to practices & AMSs in RRMAs 3–7. Capped at $35,000 p.a. No changeAs above Item 10991 $8 per consultation to bulk bill concession card holders & under 16 No change As above Seen as a critical item for many GPs given high level of concessional payments in rural areas.

25 Support Agencies: Divisions ProgramCurrentNewImplications Divisions funding $0 per person: RRMA 1 $2.47 per person: RRMA 7 Population weighted by area RA2 – 0.5 RA3 – 1.0 RA4 – 1.5 Likely loss of rural component for RRMA 5  RA2 Workforce Support for Rural GPs Subsidy of 29,200 - $54,700 depending on rural load No change for 2009-2010 Will be reviewed for value for money + for efficiency. Expect change for 2010-2011 MAHS$3, 770,783 total funds for Victoria 2007- 2008 Rural Primary Health Services Program Division funds end December 2009

26 Support agencies: RWAV RWAV RRMA 3-7 Current contract concludes June 2010. Can include new RA locations but more remote priority New contract to be negotiated during 2009-10 Demands of new RA2 for recruitment & retention support Demands of former RRMAs 4 & 5 to support new models

27 Impact on Health Services  Small rural HS linked to GPs  Burden on A&E departments  Loss of health services weakens community viability

28 Accident & Emergency  Lack of access to GPs  Regional & subregional HS are funded  Local health services not funded to provide A&E  GPs on-call 24/7  Workload increased over summer months  REP Payment to VMOs inadequate  Nursing staff EBAs  Regional hospitals struggle

29 Health Service Concerns Increased load on remaining clinicians Lose specialist/proceduralist servicesLose specialist/proceduralist services Lose ability to train junior doctors or OTDsLose ability to train junior doctors or OTDs Lose of variety in clinical workloadLose of variety in clinical workload Lose skills of clinicians and staff Lose rural GP

30 Changes to programs  Rural Primary Health Services  Regional Health Services  More Allied Health Services  Multi Purpose Centres  Building Healthy Communities in Remote Australia  New program starts 1 Jan 2010  Uncertainty creates recruitment and retention problems

31 Summary  System in transition, with the end point not yet known eg recruitment programs, MBS items, WSRGP, ROMPS  Winners: –GPs who stay in rural areas –RRMA 1 locations who become RA 2 –Regional cities access to some programs  Losers: –Outer metro areas –Rural incentives for GP Registrars –Former RRMA 5 locations with no competitive advantage to Regional cities –RRMA 2 (Geelong) not helped –IMGs, especially non resident IMGs  What about population and need in classifications? Are we targeting the wrong locations?  Heavily reliant on incentives that currently have little evidence basis for success

32 Conclusion Having health workers in remote or rural areas (or any area) relies on two interlinked factors: (a) Factors that influence the decision or choice of health workers to come to, stay in or leave those areas, and (b) The extent to which health system policies and interventions respond to these factors. WHO Background Paper to Expert Meeting Geneva, 2009

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