Redefined accreditation could boost mobile care clinics

UPDATED*

Changes to the definition of general practice could boost the number of innovative medical services reaching patients in the aged, disability and homeless sectors, according to the RACGP.
 
The key update is that, while the spirit of general practice – comprehensive, patient-centred, continuous care – continues to be emphasised, having to see the entire range of ‘cradle to grave’ medicine at a traditional medical centre is not a necessity.
 
This means that many mobile medical services delivering much needed primary healthcare exclusively to assisted living facilities and homeless people may now be recognised as general practice services alongside those operating from a dedicated medical centre seeing a range of patient cohorts.
 
Accreditation for these primary care services can result in greater eligibility for Medicare incentive payments, which could lead to a growth in mobile clinics and an expansion of the services they offer vulnerable populations.

Dr Louise Acland, Chair of RACGP Expert Committee – Standards for General Practices, told newsGP an interpretative guide has been developed for accreditation agencies and surveyors when assessing non-traditional general practices.
 
‘Practices can also refer to this guide to help with the interpretation of the new definition, as well as the application of the definition against the Standards for general practices [5th edition],’ she said.
 
‘To be eligible for accreditation, the care provided by a general practice must be comprehensive and continuous, regardless of the practice’s patient cohort.

‘In determining this eligibility an accreditation agency may ask whether the practice is able to provide the general practice care its patient population might reasonably expect to receive from a GP.’
 
Dr Acland also advises that general practices, once acknowledged as meeting the definition, must still meet all mandatory indicators in the Standards to become accredited.
 
Melbourne-based GP Dr Gaveen Jayarajan, who runs a solo-GP mobile aged care clinic servicing multiple nursing homes on a full-time basis, is excited by the college’s updated definition.
 
‘It’s a great change and I’m so happy to see that the wheels are in motion,’ he told newsGP.
 
‘I feel that it will allow GPs to provide more mobile care, not just in aged care, but in disability and homeless populations.’
 
Dr Jayarajan conducts all of his face-to-face consultations with residents at aged care facilities, as opposed to at a traditional medical centre.
 
He has operated this ‘mobile clinic’ model for seven years and sees approximately 150 patients on a regular basis, ranging from weekly to monthly, depending on the severity and complexity of their medical conditions.
 
He says making the change from a traditional general practice to a mobile service focused exclusively on residential aged care visits has given him the flexibility to focus on a particular area, aged care, while allowing him to deliver individualised patient-centred care in an often complex area.
 
However, Dr Jayarajan has also been frustrated by the lack of acknowledgement by accreditation bodies, which subsequently led to him missing out on incentive payments.
 
He sees the revised definition as a crucial step towards being appropriately rewarded for delivering much needed primary care to the elderly, an often-marginalised population.
 
‘It can be difficult trying to balance nursing home visits with work in a traditional medical centre and a lot of people give up because of the inefficiency,’ Dr Jayarajan said.
 
‘It has previously seemed a bit unfair that we’ve missed out on accreditation and crucial incentive payments when we’re definitely doing general practice, just in a more complex setting often with more complex patients.
 
‘The change in definition is very significant as it potentially allows us [mobile clinics] to seek AGPAL accreditation and appropriate incentives consistent with the spirit of general practice.
 
‘For the first time, we could be eligible for up to $430 incentive payments per nursing home patient. This is money that could then be spent on more resources for our practice improving the overall efficiency, viability and sustainability of the service to the elderly.’
 
RACGP Vice President Associate Professor Michael Clements also welcomed the change, deeming it a key step in promoting inclusivity, equity and improved healthcare quality and access for all patients.
 
‘There are genuine general practices that offer an appropriate scope of practice that have unfortunately not been eligible for accreditation, such as outreach services for patients with a disability, or practices serving a specific patient cohort like those in aged care facilities,’ he said.
 
‘The college has launched this definition to help to achieve equity for those and similar practices.
The update aims to address these issues by broadening the definition, improving inclusivity, and ensuring equitable access to accreditation and associated programs.’
 
According to Associate Professor Clements, the updated definition will ultimately improve healthcare quality and access for all patients, especially those who are most vulnerable.
 
‘New and innovative services offering comprehensive, patient-centred, and continuous care should be encouraged and helped to meet those needs,’ he said.
 
‘For these practices, accreditation will also give access to more funding through MyMedicare and other Commonwealth-funded incentives … [making] these practices more financially viable.
 
‘The purpose of this change is to improve general practice access for patients and practice viability, while maintaining the Standards for general practices, so we’re also committed to a transparent process as the definition is implemented.
 
‘We encourage members and other stakeholders to provide feedback and collaborate with us as we implement the new definition.’
 
Importantly, the changes will not affect those practices who are currently accredited.
 
Feedback can be provided via standards@racgp.org.au. The updated definition is on the following page. For full context, visit the RACGP’s website on standards for accreditation.

*This article was updated at 4.50 pm on 4 April to include comments from Dr Louise Acland.
 
Log in below to join the conversation.

aged care definition of general practice mobile clinics