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There are plenty of tasks that can and should be performed by the patient’s regular GP rather than anyone else – such as chronic disease management, care plans, chronic wound care, etc. Note that the proposal involves a nominated GP, but it includes any other practitioners and staff working within the same practice.

While there is some advantage to VPE in terms of better data to government, the main advantage is in providing an opportunity for targeted funding to a nominated GP for care best provided by the regular GP. It can also serve to prevent inappropriate care, e.g. the patient who goes into a practice once for an acute need and ends up with a care plan.

What is planned is not a mandatory, capitated system like in the United Kingdom (UK). There are many ways to do patient enrolment and there are no plans to copy the flawed UK model. Rather, the Australian model is voluntary (patients can still visit any other GP for consultations) and, instead of capitation, the plan is to use enrolment to ‘unlock’ access to extra item numbers and potentially other payments, such as wound care consumables.

So, there will be no payment purely for enrolling a patient, which is actually a potential flaw in the plan – I have argued for a small administrative payment to the practice to cover the additional costs of helping patients enrol, but government insists they will ensure sufficient benefit in enrolling to make this unnecessary.

There are a few other flaws in the model as currently proposed, although not fatal ones. The enrolment process, at least initially as designed by Services Australia, is a rather clunky one. I have put pressure to integrate it with our practice software, and to also ensure obtaining consent for those in residential aged care facilities (RACFs) is practicable.

The major problem, however, is how remarkably little incentive there currently is to enrol most patients. You will gain access to extended telephone consults for enrolled patients – but how often will most of us need this, at least in metro areas?

There will also be a payment scheme for looking after hospital ‘frequent flyers’ – a nice idea, but again, a very small group.

Next year, there will be additional block payments for looking after patients in RACFs – most welcome, but yet again, a relatively small group. Enrolled patients will only be able to get care plans from their nominated GP – but those not enrolled will be able to obtain them from any GP.

I think some of this is deliberate, and there is an intent to pilot enrolment with relatively small numbers and expand from there. That may be okay, but if not done well and appropriate additional incentives are not added, the program risks stalling, disenchantment and failure. This would be a shame, as in fact it can deliver significant benefit for us and our patients, as well as cost effectiveness for government – and, as proposed, carries little risk of devolving into a capitated system or other major problems.

My message at present is to watch this space – and consider enrolling patients who will potentially benefit. Government is consulting with us, and the AMA is working productively together with the RACGP and ACCRM to ensure MyMedicare does deliver benefits, and that these do ramp up over time as promised.

This article first appeared in the July-August Medicus magazine.