The phrase ‘three streams’ has been floating around GP circles for months now. What does it mean?
Over the past three months, The Medical Republic has heard from five separate sources about a new policy or program being proposed by the Department of Health, Disability and Ageing. It’s known by the somewhat cryptic moniker “three streams”.
All sources wished to remain anonymous.
While each person who spoke to TMR had found out about the proposal in a slightly different way and knew slightly different details, they were all consistent about the core proposal.
If it goes through, they all insisted that it would fundamentally change the landscape of general practice.
All five sources described the policy proposal as being a new, three-tier funding structure for general practice.
The first stream would include practices that are universally bulk billing. This would remain virtually unchanged from the current settings, with practices bulk billing all patients for all regular consults and receiving the Medicare rebate, the bulk-billing incentive and the bulk-billing PIP payment.
The second stream would consist of mixed-billing practices.
Some sources were of the understanding that GPs at these clinics could privately bill regular patients but would be required to bulk bill under-16s and healthcare cardholders.
These clinics would continue receiving the bulk-billing incentives and the regular PIPs and WIPs.
The third stream would include mostly private clinics that wanted to retain the right to privately bill all patients if its GPs chose to.
These clinics would no longer be eligible to receive the PIP and WIP payments.
There are more aspects to the plan; some sources told TMR that there would be additional funding for allied health included in at least one of the streams.
Related
TMR’s sources all emphasised that this was still basically a proposal for a policy proposal, which is why it had not yet been made public.
What we know for certain is that the Department is currently bringing together consolidated advice from four Strengthening Medicare reviews – Review of General Practice Incentives, Review of After-Hours Primary Care Programs and Policy, Working Better for Medicare Review, and Unleashing the Potential of our Health Workforce: Scope of Practice Review.
The Review of General Practice Incentives and Scope of Practice Review both made recommendations to increase blended funding in primary care, to reduce the reliance on Medicare fee-for-service.
The group doing this work is technically an internal departmental taskforce, and as such does not have terms of reference.
It does have an expert advisory panel, though, with representation from the AMA, the Primary Care Business Council, the RACGP, the Australian Association of Practice Management, the Grattan Institute and the Rural Doctors Association of Australia.
TMR understands that the “three streams” proposal has been brought to this group.
“[The group has] undertaken a range of targeted consultations with health professionals, consumers, general practice owners and professional bodies to test reform options in response to the review recommendations,” a Department spokesperson told TMR earlier this year.
The spokesperson did not confirm whether there were any specific proposals that the group was looking into.
