Practice Nurse Incentive Program (PNIP) Change Management
Support Project
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2
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3 Change Management Process Awareness What is the PNIP Allaying
concerns What does this mean for the day-to-day work I do? Will the
practice be financially viable? Will patients be worse off?
Opportunities Recognising broader scope of practice New business
models Introduction of new services Business planning and
implementation Develop new processes Enhance the role of the
practice nurse Who is responsible for implementing the changes?
Review and monitor How has the change affected the practice? Have
our responses to the changes been effective? Are patient needs
being met?
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4 Awareness Change is not new [insert Pictorial representation
of all the financing changes that have occurred from peters GP
financing module]
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5 How has nursing in general practice been funded? Variety of
funding mechanisms including - Practice nurse - Practice Incentive
Payment (PN PIP) Range of PN MBS rebates Contributions to GP MBS
items Contribution to PIP and SOP outcomes Increased throughput
(and therefore income) for GPs from nurses giving care and
performing tasks on their behalf
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6 Some issues with current practice nurse funding Insufficient
amount paid for PN MBS and PIP to ensure reasonable nurse to GP
ratio Remuneration does not recognise differing skills and
qualifications of nurses Unduly complicated Nursing roles shaped by
MBS items largely restricted to a series of tasks, rather than as a
response to local population health needs Item numbers dont
effectively fund comprehensive care Perverse incentive for high
throughput rather than quality of care (nursing rebates are not
increased with time spent). Contribution to GP Health Assessments
doesnt recognise highly skilled clinical expertise PIP subsidy not
available everywhere
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7 Awareness - Practice Nurse Incentive Program
www.medicareaustralia.gov.au/pnip Is my practice eligible? Minimum
Qualifications of practice nurses and health professionals How does
my practice apply for the PNIP? What evidence does my practice need
to provide at the time of application? Eligibility requirements
Accreditation requirements Incentive Payments Rural Loading
Calculation of payments Calculation of a full time practice nurse
Calculation of a full time GP Calculating the SWPE Value Practices
without an historical SWPE Aboriginal Medical Services and
Aboriginal Community Controlled Health Services What if my practice
is financially disadvantaged by the introduction of the PNIP?
Department of Veterans Affairs loading How payments are made
Practice Nurse Incentive Program audit
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8 10993 10994 10995 10996 10998 10999 PN item numbers going:
Incentive Payments Payments under the PNIP are calculated
quarterly. Payments will be stratified with one incentive equating
to: $25,000 per annum, per 1,000 SWPE where a Registered Nurse
works at least 12 hours 40 minutes per week; and $12,500 per annum,
per 1,000 SWPE where an Enrolled Nurse or Aboriginal Health Worker
works at least 12 hours and 40 minutes per week. Awareness -
Practice Nurse Incentive Program
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9 MBS Items remaining Brief Health assessments701 Standard
Health assessments 703 Long Health assessments705 Prolonged Health
assessments 707 PN Chronic disease check10997 Antenatal check16400
4 year old health checks10986 GPMP & TCA Reviews732
Spirometry11506 ECGs11700 Aboriginal Health Check715 ASTI Health
Check Follow Up 10987 GPMP721 TCAs723
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10 Awareness - Nursing roles and nursing services Patient Carer
Organiser Agent of Connectivity Problem Solver Quality Controller
Educator
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11 Addressing concerns Practice NursesPractice ManagersGeneral
Practitioners Value of the PN Impact on patient Impact on PN jobs
Impact on clinical services Impact on GP income Staff configuration
Practice income Business case Staff configuration
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12 Creating Opportunity
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13 Opportunities Practice Nurse roles
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14 Impact of PNIP on nurse roles Removal of for and on behalf
of Recognition of the broader role of the practice nurse
Opportunity to expand the scope of nursing services (i.e CDM,
telehealth)
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15 Scope of Practice A professions scope of practice is the
full spectrum of roles, functions, responsibilities, activities and
decision-making capacity that individuals within that profession
are educated, competent and authorised to perform.
www.anmc.org.au
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16 Business Planning & Implementation An Introduction to
General Practice Financing Learning objectives: 1.Describe key
financing mechanisms used to fund general practice activities.
2.Describe how these mechanisms have been used to fund general
practice activities in Australia. 3.Outline some of the ways that
current financing mechanisms influence nursing employment in
general practice, and analyse some of the opportunities new funding
mechanisms present for nurses in general practice. 4.Apply
knowledge learnt about general practice financing to reflect on how
the new general practice financing mechanisms may create
opportunities and challenges in practice settings.
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17 Business Planning & Implementation How will the PNIP
affect my practice revenues? What opportunities does the PNIP
present for our practice to work differently?
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18 Business Planning & Implementation Business Planning
toolkit contents How will the PNIP directly affect my practice
revenues? Old practice revenues associated with the outgoing items
New practice revenues under the PNIP Change in practice revenues if
we do nothing What opportunities does the PNIP present for our
practice to work differently? Taking advantage of opportunities
under the PNIP Appendix ABusiness case template Appendix BBusiness
case scenarios Medicare ready reckoner:
http://www.medicareaustralia.gov.au/provider/incentives/pnip/calculator.jsp
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19 Business Planning & Implementation Brainstorming
questionsPotential opportunities What are the opportunities to
better meet the needs of patients e.g., access, choice? What are
the opportunities for the practice nurses to make a greater
contribution to enhancing service quality and safety? What are the
opportunities for the practice nurses to help the team to work more
efficiently or increase the number of patients seen? What other
opportunities are there to improve health outcomes, practice income
or job satisfaction?
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20 Business Planning & Implementation Tangible benefits $
Increased nurse-derived income Increased net income Intangible
benefits Professional satisfaction Increased recruitment and
retention Increased training and development opportunities Sense of
value
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21 Review Bhuyan, A., A. Jorgensen, and S. Sharma. 2010. Taking
the Pulse of Policy: The Policy Implementation Assessment Tool.
Washington, DC: Futures Group, Health Policy Initiative, Task Order
1.
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22 Feedback on PNIP implementation Are patients still getting
the health care and nursing services that they need? Are they
getting better service under the PNIP? Are they getting
less/reduced quality service under the PNIP? Why do you think this
is? Are public health priorities being met? Are nursing services
still being delivered in a safe way to patients that need those
services? Why or why not? What other impacts, at the community
level are you seeing as a result of the PNIP?
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23 Next Steps Check APNA website for resources Discuss your
learning and ideas with practice members Questions relating to the
program = contact Medicare Australia Questions relating to nurses
specifically = contact APNA Website:
www.apna.asn.au/pnipwww.apna.asn.au/pnip Email:
[email protected]@apna.asn.au