2.3 Financial and business implications
‘In addition to the many professional benefits nurses can bring to
general practice, there are also financial benefits, which in turn
assist practices to employ a nurse. Federal government funding
initiatives that should be taken into account when planning to
use a nurse in general practice include the Practice Incentives
Program practice nurse incentive, the practice nurse MBS item
numbers, and the Chronic Disease Management MBS items.
Practice Incentives Program
The Practice Incentives Program (PIP) aims to recognise general
practices that provide comprehensive, quality care, and that
are accredited or working towards accreditation against the
Royal Australian College of General Practitioners Standards for
General Practices.
The PIP is part of a ‘blended payment’ approach to general practice funding — that is, payments made through the
program are in addition to other income sources for GPs and
the practice, such as patient fees and Medicare rebates.
PIP payments are mainly dependent on practice size, which is based on patients seen, rather than on the number of
consultations performed. A rural loading is also paid to practices
in rural and remote locations.
Practices may spend their payment as they wish, though the usual taxation rules apply.
The PIP PN incentive payment targets areas where patient
access to medical services is limited, such as rural and remote
communities and urban areas with workforce shortages. The
payment is available to eligible practices in Rural Remote
and Metropolitan Area classifications 3–7 (since 2001) and
in urban areas since 2003. The initiative aims to improve the
quality and accessibility of primary care to people living in these
communities by increasing the capacity of general practices
through the employment of a nurse.
The number of nurse sessions required to receive the incentive payment is calculated using the practice’s Standardised Whole
Patient Equivalent (SWPE). The SWPE is a measure of practice
size that is independent of the number of services provided to
patients, with standardisation applied for age and sex.
Regardless of practice size, however, a practice must employ or retain the services of a nurse for a minimum of two sessions
per week, averaged over each PIP payment quarter. A minimum
session time for the purposes of this initiative is 3½ hours. The
employment requirement increases by one session for each
additional 500 SWPEs, rounded down.
For eligibility criteria and more information see the Medicare Australia website http://www.medicareaustralia.com.au/providers/incentives_allowances/pip/new_incentives.htm
or call the PIP Inquiry Line on 1800 222 032.
MBS items for services provided by a practice nurse
On 1 February 2004, the Australian Government introduced new
Medicare rebates for a practice nurse to provide immunisation and wound management services for and on behalf of a GP. Additional items for Pap smears (February 2005), Pap smears
and Preventive Health Checks and Antenatal Care (November
2006) have since been added to the Medicare Benefits Schedule
(MBS).A new practice nurse MBS item for chronic disease
care is to be introduced in May 2007. All vocationally registered
and non-vocationally registered GPs are eligible to claim these
item numbers. Below is a summary of the practice nurse item
numbers. For further information visit the Medicare Australia
website at http://www.medicareaustralia.gov.au/
| MBS item number |
Description |
Comments |
| Immunisation |
| 10993 |
Immunisation provided by a practice
nurse for and on behalf of a GP |
Cannot be claimed for mass immunisations |
| Wound management |
| 10996 |
Wound management is provided by a
practice nurse for and on behalf of a GP |
Cannot be claimed if the person is an admitted patient of a
hospital or day hospital |
| Cervical screening
and preventive health
checks for women |
| 10998 |
Cervical smear performed by an
appropriately trained practice nurse |
All practice nurses taking Pap smears should have
undertaken an accredited training program |
| 10999 |
Cervical smear performed by a practice
nurse on a woman between ages of 20
and 69 who has not had a Pap smear in
the last four years |
|
| 10994 |
Cervical smear and preventive checks
undertaken by a practice nurse |
Services must include a Pap smear and at least one
preventive check from the following:
— checks for sexually transmitted infections (including
— chlamydia)
— taking of a sexual and reproductive history
— advice on contraception
— breast awareness education
— advice on post natal issues
— continence advice and education |
| 10995 |
Cervical smear and preventive health
checks performed by a practice nurse
on a woman between ages of 20 and
69 who have not had a pap smear in the
last four years |
Services must include a Pap smear and at least one
preventive check from the following:
— checks for sexually transmitted infections (including
— chlamydia)
— taking of a sexual and reproductive history
— advice on contraception
— breast awareness education
— advice on post natal issues
— continence advice and education |
| 16400 |
Antenatal service provided by an
appropriately trained midwife, nurse or
registered Aboriginal Health Worker for
and on behalf of a GP or a specialist or
consultant physician |
Can be provided at or from a practice location in regional,
rural or remote areas (RRMA 3-7)
Cannot be provided in conjunction with another
antenatal attendance item (same patient, same
practitioner, same day)
A maximum of 10 services are payable per pregnancy |
Please note that Medicare bulk-billing incentives (MBS items
10990 or 100991) can be claimed in conjunction with the
immunisation, wound management, Pap smear, and Pap smear
and preventive checks items (but not the antenatal care item).
Enhanced Primary Care
The Enhanced Primary Care (EPC) program was introduced by
the Commonwealth Government in 1999 to support:
• improved coordination of care for people with chronic conditions and complex care needs
• increased preventative care for older Australians
• a framework for a multidisciplinary approach to health care through a more flexible, efficient and responsive match between services and
• the patient’s needs.
In July 2005, new Chronic Disease Management (CDM) items
were introduced to the MBS to replace EPC items for care
planning. These new items provide Medicare rebates for GP
management plans and team care arrangements and a review
of these services. The initiative means that, for the first time,
GPs and patients have access to Medicare rebates for preparing
and reviewing GP management plans for patients with chronic
medical conditions. For patients requiring multidisciplinary
clinical care, the initiative makes Medicare rebates available
for GPs coordinating team care planning and review services.
These CDM items apply to the treatment of people with
asthma, cancer, arthritis, diabetes, heart disease, mental illness
and other chronic conditions. A practice nurse may work in
conjunction with a GP in undertaking the requirements for the
CDM items.
Nursing in General Practice Business Case Models
The Australian General Practice Network has formulated business case models to provide general practice with ‘real
life’, user-friendly case studies, demonstrating the financial
implications and benefits of employing a practice nurse.
First prepared in 2003, the business case models have undergone a number of revisions, and were most recently
revised in December 2005 to reflect the introduction of the
Medicare Chronic Disease Management items.
Business case models for large and small, urban, rural and solo GP practices are available, and different nurse utilisation models
have been used to show general practices how this reflects on
the financial performance of the practice.
The examples used in these models indicate that it is financially viable for a practice to employ a nurse, and some of the models
demonstrate that having a nurse available at the practice can
significantly add to practice income. The practices interviewed
for this study indicated that these financial benefits were in
addition to a range of other advantages that flowed from having
a nurse employed by or contracted to the practice.
The AGPN business case models can be accessed via the website on http://www.adgp.com.au/site/index.cfm?display=4002
Business Case Studies Package (downloads/pdfs)
Business Case Studies Cover Pages
Business Case Studies: Large Rural(Revised December 2005)
Business Case Studies: Large Urban (Revised December 2005)
Business Case Studies: Small Rural (Revised December 2005)
Business Case Studies: Small Urban (Revised December 2005)
Business Case Studies: Solo Rural (Revised December 2005)
Business Case Studies: Solo Urban (Revised December 2005)
Case Studies: Metropolitan Practices
Case Studies: Rural Practices
Addendum (Produced February 2005)
Further information may also be found on state based organisation websites, which can be accessed by following the
links in the AGPN directory located at http://www.adgp.com.au/site/index.cfm?display=301
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