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Rural Classification and Health Workforce Incentives

Rural Classification and Health Workforce Incentives. Presentation to General Practice Issues Group 19 June 2009 Sharon Kosmina, RWAV Christine McDonald, GPV Jane Sheats, VHA. Presentation Overview. New Classification system and related 2009 budget initiatives Impact on: GP Training

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Rural Classification and Health Workforce Incentives

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  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:http://www.doctorconnect.gov.au/internet/otd/Publishing.nsf/Content/RA-intro

  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 • 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 Replaces Rural Registrar Incentives Program and Rural Retention grants

  11. Comparison GP Registrar Incentives

  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 • 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

  15. IMG Service Obligations

  16. Rural Recruitment programs

  17. Implications for Vic Locations

  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 RWAV RRMA 3-7 GPs, Nov 2008

  22. Comparison After 5 Years

  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

  25. Support Agencies: Divisions

  26. Support agencies: RWAV

  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

  30. Changesto 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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