What's new?

August 2013

The Department of Human Services Compliance Program for 2013-15 has been released.

Practice Nurse Incentive Program (PNIP)

What is the Practice Nurse Incentive Program?

The Practice Nurse Incentive Program (PNIP) provides incentive payments to practices to support an expanded and enhanced role for nurses working in general practice.

The PNIP simplifies funding arrangements under the previous Practice Incentives Program (PIP) Practice Nurse Incentive and six of the Medicare Benefits Schedule (MBS) practice nurse items.

The PNIP will also include:

  • support for accredited practices to employ an Aboriginal Health Worker instead of, or in addition to, a practice nurse (Registered Nurse or Enrolled Nurse)
  • support for practices in urban areas of workforce shortage, Aboriginal Medical Services and Aboriginal Community Controlled Health Services to employ an allied health professional, such as a physiotherapist, dietitian or occupational therapist, instead of, or in addition to, a practice nurse and/or Aboriginal Health Worker
  • a rural loading of up to 50 per cent based on the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA)
  • a loading for Aboriginal Medical Services and Aboriginal Community Controlled Health Services, and
  • a one-off $5000 incentive to support eligible non-accredited practices to become accredited.

Eligibility

General practices across Australia, including those in urban areas, Aboriginal Medical Services and Aboriginal Community Controlled Health Services, may be eligible for an incentive to offset the costs of employing a practice nurse. One of the eligibility requirements is that your practice is accredited under the current Royal Australian College of General Practitioners (RACGP) Standards for general practice.

The PNIP is managed by the Australian Government Department of Human Services on behalf of the Department of HealthExternal link and Department of Veterans' AffairsExternal link (DVA).

Payments will be paid to eligible general practices that apply for the PNIP. More information on the PNIP can be found in the Practice Nurse Incentive Program guidelines.

The PNIP guidelines

Access the guidelines in either PDF or RTF format:

Privacy and consent for the PNIP

Practices and GPs need to give their consent for a number of the PNIP components.

Any practice participating in the PIP can consent to Human Services using its practice information, including its Standardised Whole Patient Equivalent (SWPE) for the purposes of the PNIP.

GPs at the practice also need to give consent for Human Services to use their MBS billing data or service data for the PNIP calculations. Human Services cannot use information supplied for the PIP for the purposes of the PNIP without your consent. This is inline with Human Services’ obligations under Section 14, Information Privacy Principles of the Privacy Act 1988 (the Act), specifically Principle 2— Solicitation of personal information from the individual concerned (IPP2) and Principle 10—Limits on use of personal information (IPP10).

In accordance with IPP2, the original privacy note on the Practice Incentives Program application (IP001) form [PDF, 550Kb]PDF reader required (formally form 2745) is:

Privacy note
The information on this form will be used to assess the practice's eligibility to receive payments under the PIP and/or the GPII and is required by Medicare to perform functions under service arrangements made under the Medicare Australia Act 1973. Information, including personal information, provided on this form may be disclosed to the Department of Health, other relevant agencies or as authorised or required by law.

In accordance with IPP10 of the Act, Human Services cannot use information for a purpose other than that for which it was collected, unless the individual the information relates to provides consent for that use.

Consent from a PIP practice

Giving consent lets us use the following PIP information for a purpose other than that for which it was collected:

  • Human Services can use the practice's SWPE already in use for the PIP, and
  • Human Services can use the practice details provided for the PIP.

The PNIP Online application process will auto fill all these details, including summary details of the current GPs. The PNIP Online is accessed through the Health Professional Online Services (HPOS).

PIP practice details

When a PIP registered practice provides consent for the PNIP, they are consenting to the use of the following information:

  • practice name and main address
  • eligibility details such as accreditation, public liability insurance and indemnity insurance
  • bank account details
  • contact details
  • location details
  • ownership details
  • GP summary details (name and provider number only—explicitly excludes provider consent)
  • associated documents
  • comments, and
  • SWPE (for the PNIP calculations).

Note: the use of provider information to calculate the PIP SWPE is summarised at practice level—the provider can't be identified. Therefore provider consent is not needed to use the practice SWPE.

Consent from a GP

PIP registered practice

During the application process, when a PIP registered practice consents to the use of practice details for the purpose of the PNIP, a list of GPs is displayed on PNIP Online. Each GP needs to provide consent for the practice to use their MBS billing data.

Note: consent is only required for this purpose when the GP worked at the practice during the period 01/08/2010 to 31/07/2011. If the GP start date at the practice is on or after 01/08/2011, consent is not required because the GP will not be included in the calculation of financial disadvantage.

A GP can give consent at any time and the MBS service data will be included in the calculation for the practice's next payment.

While all current GPs will auto fill in the GP details summary, the practice can also indicate whether the provider will be giving consent through PNIP Online, HPOS email, by fax or by post.

If a PIP registered practice only wants to be assessed for the incentive payment and not top- up payments, historical GPs do not need to be added to the GP details summary screen or to the paper based PNIP application form.

Non-PIP registered practice

A practice that is not registered for the PIP will need to provide the consent of its current GPs to use the GP's data in the PNIP SWPE calculation. This SWPE value impacts the level of incentive payment the practice will receive.

If the GP does not consent, the practice's PNIP SWPE will be based on the GPs who have provided consent for the use of their MBS service data.

Annual DVA loading

A GP must provide consent for their MBS service data for services provided to DVA Gold Card holders to be included in the calculation of the practice's annual DVA loading.

If the GP does not provide consent for the use of their MBS service data information, those DVA services can't be included in the calculation of the DVA loading.

Quarterly confirmation statements

If a GP does not provide consent they will not be listed on the practice's quarterly confirmation statement (QCS). Information on the QCS is included in the Practice Nurse Incentive Program guidelines.

PNIP payments

There are five payment types under the PNIP.

1. Incentive payment

The level of incentive payment a general practice will be entitled to depends on the practice’s SWPE value and the hours worked by practice nurses at the practice.

The PNIP will provide incentive payments to eligible practices of:

  • $25,000 per year, per 1000 SWPE where a Registered Nurse works at least 12 hours 40 minutes per week, and
  • $12,500 per year, per 1000 SWPE where an Enrolled Nurse works at least 12 hours and 40 minutes per week.

Incentives will be capped at five per practice, meaning that practices will be eligible to receive up to $125,000 per year to support their practice nurse workforce. More information on the calculation of payments can be found in the Practice Nurse Incentive Program guidelines.

To be eligible to receive the incentive payment, a practice must:

  • meet the RACGP definition of a general practice
  • be accredited or registered for accreditation against the RACGP Standards for general practice and be fully accredited within 12 months of joining the PNIP
  • maintain practice accreditation
  • have current public liability insurance
  • make sure all practice GPs have current professional indemnity cover
  • employ or otherwise retain the services of eligible practice nurses (RN) and/or Aboriginal Health Workers (AHW) and/or allied health professionals (AHP)
  • employ or retain the services of a GP (including less than one full-time GP), and
  • make sure all RNs, AHWs and AHPs are covered by the appropriate professional indemnity insurance arrangements required by the Australian Health Practitioner Regulation Agency (AHPRA) or by the professional’s registration body.

2. Top-up payment

Top-up payments will be available for accredited practices receiving the incentive payment for the first three years of the PNIP to make sure that practices are not financially disadvantaged by the end of the PIP Practice Nurse Incentive and/or the six removed MBS practice nurse items and any associated bulk billing items. Top-up payments will be paid until 31 December 2014. Applications for top-up payments closed on 30 June 2012.

A GP can still give consent at any time and the MBS service data will be included in the calculation for the practices next payment.

3. Grandparenting payment

Grandparenting payments will be available for non-accredited practices that are not eligible for the incentive payment, for the first three years of the PNIP to make sure practices are not financially disadvantaged by the removal of the six MBS practice nurse items and any associated bulk billing items. Grandparenting payments will be paid until 31 December 2014. Applications for grandparenting payments closed on 30 June 2012.

A GP can still give consent at any time and the MBS service data will be included in the calculation for the practices next payment.

4. Accreditation assistance payment

To be eligible for the one-off accreditation assistance payment, a practice must be registered for accreditation against the RACGP Standards for general practice and meet the other eligibility requirements as detailed in the Practice Nurse Incentive Program guidelines. In addition, the practice must join the PNIP, provide proof of registration for accreditation and become accredited within 12 months of joining the PNIP.

5. DVA loading

Practices that are eligible for the PNIP and provide GP services to DVA Gold Card holders will be eligible for a yearly, per veteran payment. These practices will be identified by Human Services and paid in August each year.

The DVA loading will be calculated by determining the number of Gold Card holders who receive an ‘in rooms’ consultation in an eligible practice during each year. An amount will be paid for each DVA Gold Card holder, regardless of the practice location, nursing qualifications or the number of nurses per practice. There are no limitations on the number of DVA loadings paid per practice.

Where a Gold Card holder chooses to use more than one practice each year, the DVA loading will be divided across the practices based on the percentage of total consultation fees paid.

Applying for the PNIP

Practices can apply for the PNIP and supply supporting documentation though PNIP Online.

To safeguard practice and GP information, PNIP Online will be available as part of HPOS. HPOS offers improved access to Human Services' online services for health professionals through a single entry point.

When applying online, practices may need to supply extra information using the forms below.

Practices can also apply using the PNIP application form [PDF, 424Kb]PDF reader required.

If you need any assistance completing the PNIP application form call 1800 222 032** 8.30am to 5.00pm Australia Central Standard Time, Monday to Friday.

External user guide

An external user guide is available to help practices complete the PNIP application online. Please view the Practice Nurse Incentive Program (PNIP) Online [PDF, 2.0Mb]PDF reader required guide for further information.

To apply for payments through PNIP Online, practice owners and authorised contact persons must have a Public Key Infrastructure (PKI) individual certificate. To register for a PKI individual certificate you need to complete an application form.

If practice owners or authorised contact persons already have a PKI certificate and require assistance with installation, access or other technical difficulties, they can contact the eBusiness Service Centre on 1800 700 199**.

Practice and GP information will be kept secure by limiting system access only to people who have a PKI individual certificate that has been linked to the practice. To do this, the PKI individual certificate's unique (10 digit) Registration Authority (RA) number must be recorded against the practice's PNIP Online system.

A practice that does not have internet or PKI individual certificate access through HPOS may request a hardcopy of the application form by calling 1800 222 032**.

Business Development Officers

If you are experiencing difficulty using your PKI certificate or aren't sure where to begin, Human Services has a network of experienced Business Development Officers (BDOs) in all states and territories that can help you.

BDOs can help you and your practice with PKI applications, installation and advice in face-to-face appointments. If you are interested in having a BDO visit your practice call 1800 700 199**

Practices with multiple locations

Practices with multiple locations can apply to join the PNIP as a single practice, provided the eligibility requirements are met. Practices will need to nominate the main practice location when completing the PNIP application form [PDF, 424Kb]PDF reader required. The main practice location should be the location that provides the highest number of MBS services each year. Additional practice locations are known as practice branches.

Practices with multiple practice branches will only be regarded as a single practice where one or more of the doctors practising at the main location also practices at one or more of the other locations. More information on practices with multiple locations is in the Practice Nurse Incentive Program guidelines.

Practice accreditation

Accreditation is available through two approved organisations—the Australian General Practice Accreditation Ltd (AGPAL), and the Quality Practice Accreditation Pty Ltd through the General Practice Australia (GPA) Accreditation plus program.

Under the accreditation process, practices initially register for accreditation and then undertake an accreditation cycle that involves:

  • self-assessment against agreed standards
  • peer review surveys (practice visits) of the practice's organisation and facilities, and
  • a continuous quality improvement cycle.

A practice is considered accredited on successful completion of the peer review survey. It is the responsibility of the practice to tell Human Services when they have been fully accredited.

Practices must be accredited within one year of the date they join the PNIP and maintain accreditation to remain eligible for the PNIP.

For more information on accreditation, go to:

Australian General Practice Accreditation Ltd (AGPAL)
Call: 1300 362 111*
Website: Australia General Practice Accreditation websiteExternal link

Quality Practice Accreditation Pty Ltd
through the General Practice Australia (GPA) Accreditation plus program
Call: 1800 188 088*
Website: General Practice Australia websiteExternal link

Administration of payments

When the PNIP payments are made

Payments will be calculated and paid retrospectively on a quarterly basis.

Payments are made by Electronic Funds Transfer (EFT) to the account nominated by the practice in the PNIP application form, and do not attract Goods and Services Tax (GST).

To qualify for payments, practices must have lodged their application for the PNIP by the 'point in time' date. The 'point in time' date corresponds to the last day of the month before the next PNIP quarterly payment. The quarterly payment months, 'point in time' dates and payment periods are provided below.

Practices are eligible from the date of approval not from the date of lodgement.

Quarterly payment month 'Point in time' assessment of eligibility Payment period
February 31 January 1 November to 31 January
May 30 April 1 February to 30 April
August 31 July 1 May to 31 July
November 31 October 1 August to 31 October

Payment calculations

Payments are calculated using Human Services and DVA data that is linked to the provider numbers specified on the practice's application form, and any subsequent amendments provided to Human Services. If, for example, you do not provide Human Services with details of new GPs, you will not receive payments associated with the services provided by these new GPs.

If a practice tells Human Services that it has changed its circumstances, either as a result of the quarterly confirmation statement or separately by the practice within 14 calendar days of the change in circumstances, its payment will be calculated based on the updated details.

Data will be excluded if any of the GPs in a practice do not consent to the use of their data for the purposes of calculating the practice's payment when completing the PNIP Individual GP details form. If GPs would like their data to be included at a later stage, they must advise Human Services in writing.

Calculating the SWPE value

The PNIP payments are based on a measure of the practice size, known as the SWPE value. The SWPE value of a practice is the sum of the fractions of care provided to practice patients, weighted for the age and gender of each patient. The average full time GP has 1000 SWPEs per year.

If your practice is an existing PIP practice and you have provided consent for Human Services to access your PIP information, the existing PIP SWPE value will be used in determining the SWPE value for the PNIP.

New practices, practices not participating in the PIP, and PIP practices that don't give Human Services consent to access their PIP information, will not have a SWPE value and will be given an initial start up SWPE value of 1000.

It takes approximately six payment quarters (18 months) from the time of joining the PNIP to establish a full SWPE value. From then, the calculated SWPE value will be used, even if it is lower than 1000. If during the 18 month period the practice's SWPE value is more than 1000, the actual SWPE value will be used to calculate payments.

Aboriginal Medical Services and Aboriginal Community Controlled Health Services

The SWPE values for Aboriginal Medical Services and Aboriginal Community Controlled Health Services will be increased by 50 per cent.

How the PNIP payments are made

Human Services will provide quarterly confirmation statements to all practices receiving incentive, top-up or grandparenting payments. Practices are required to confirm their details are correct on the quarterly confirmation statement before the payment can be released to the practice.

Practices will receive their quarterly confirmation statement via PNIP Online. If a practice does not have access to PNIP Online, Human Services will mail the practice's confirmation statement.

If a practice does not complete and return the quarterly confirmation statement by the 'point in time' for eligibility assessment, the practice's payment will be withheld until the next payment quarter.

Review of decision process

The PNIP has established a review of decision process. To request a review of decision, your practice's authorised contact person or the owner/s of the practice must write to Human Services within 28 calendar days of receiving the notice of the decision it would like reviewed.

The request must include the following details:

  • the name and address of the person requesting the review
  • the name and identification number of the practice
  • the decision to be reviewed, and
  • the grounds for requesting the review.

Human Services will reconsider its decision following the PNIP eligibility criteria and/or payment criteria used to make the original decision, and advise the practice in writing of the outcome of the review.

If a practice is not satisfied with the reviewed decision, the practice may request the decision to be considered by a formal review committee. Human Services will make these decisions on a case-by-case basis.

For more information on the review of decision process, call 1800 222 032** 8.30am to 5.00pm Australian Central Standard Time, Monday to Friday.

The PNIP Incentive Payment Ready Reckoner

The Department of Health and the Department of Human Services have developed the ready reckoner below that can be used to estimate the incentive amount a practice may be entitled to.

Frequently asked questions

I know my practice is not financially disadvantaged. Do I need to provide the consent of my GPs (current and historical)?

You will need the consent of your current GPs if you want to receive the DVA loading and have them listed on your QCS.

The consent of your historical GPs is only needed for your practice to be assessed for financial disadvantage.

I am a PIP registered practice—what happens if I do not provide consent on the PNIP eligibility check screen or at question 4 on the application form?

Without the practice's consent none of the practice details, including the SWPE and GP summary details, can be used and a start up SWPE of 1000 will be allocated to the practice.

For more information on PNIP

Email: pnip@humanservices.gov.auEmail
Mail: Practice Nurse Incentive Program,
GPO Box 2572, ADELAIDE SA 5001
Phone: 1800 222 032**
Fax: 1300 587 696

* Call charges apply.
**Call charges apply for mobile and pay phones only.

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Last updated: 4 October, 2013