GPs appear to be largely in favour of a proposal for the government to pay for accreditation. But will the government play ball?
The commodification of general practice accreditation risks making the entire scheme virtually meaningless – which is why one prominent GP and accreditation provider is calling for the government to step in.
Last week, GP-owned accreditation provider Quality Practice Accreditation (QPA) put out a paper arguing for the government to take on the burden of paying for GP practice accreditation, rather than the practices themselves.
QPA founder and NSW rural GP Dr Paul Mara was involved in the development of the GP accreditation and standards scheme in the 1990s and told The Medical Republic that the purpose of accreditation had shifted over the last 26 years.
“The majority of accreditation out there is done for a different purpose,” he said.
“It’s done to get a market advantage by having a certificate, or it’s done to assure quality of services or, say, for export. You’re seeing this accreditation right across the board, but there’s not a lot of accreditations where the government is saying, ‘Okay, you get accredited, here’s your money. Here’s a lot of money’.
“I think this changes the agenda.
“What actually happens, or can potentially happen, is that wherever you’ve got this large amount of money [changing hands] based on accreditation, then it’s just natural that there will be attempts to influence the outcomes of that decision-making process.”
Before the rise of corporate GP chains, one accreditation client would normally represent one practice. Where a single practice could not exert a great deal of pressure, a conglomerate was a different story.
“A large corporate group [now], for example, might have 20, 30, 60, 100 or more practices,” Dr Mara said.
“It’s well recognised in accreditation literature that that poses significantly more risks in terms of the impartiality.”
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Because there were multiple accreditation agencies competing on price, Dr Mara said, bigger practice groups could often negotiate to pay lower fees.
“By definition, if you’re discounting one of those groups, then that means that the smaller practices have to pay more,” he said.
“It’s just mathematics. There is no cross-subsidisation model anymore that’s actually [being applied].”
While all of these shifts had been occurring in the background for some years, Dr Mara said the 2025 Medicare investments had turned accreditation reform into an “imperative”.
The introduction of the bulk billing PIP – eligibility for which was contingent on a practice either being accredited or working toward accreditation – “increased the stakes considerably”.
“What I’m seeing personally out there is whilst the government has a proposal that 90% of practices will fall under this bulk billing program by 2030, that’s probably going to happen earlier,” Dr Mara said.
“In fact, I suggest it would happen at the middle of next year. Practices are falling over to get onto that program, and it raises a few questions.
“The first is that, okay, GPs are now getting 6.25% of the total value of their eligible services and the practices are getting 6.25% [through the BB PIP] – but what are the GPs actually going to contribute, individually, into the accreditation program? That’s a question that needs to be answered.
“But it’s also the case that it raises the stakes considerably. So, you get accredited, you get all these benefits, but where’s the accountability?”
The government had a responsibility to taxpayers to ensure that its funds – in this case the BBPIP – were going toward the intended purpose.
For this reason, Dr Mara believed that the government would take an interest in picking up the tab for accreditation.
“If you have a scheme that doesn’t have credibility, then on what basis are we distributing potentially billions of dollars to practices on?” he asked.
