Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme Retention

1 Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme

Retention Component

Programme Guidelines

Revised May 2010 Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme Retention Component

This document explains the operation of the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme with respect to the retention component and may be cited as the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme – Retention Component Guidelines. The Guidelines have effect from the date of approval by the Minister for Health (the Minister) and are subject to amendment by the Programme Delegate from time to time (an up-to-date copy of the Guidelines is available from www.health.gov.au/omps). Decisions under the Programme will be made on the basis of the Guidelines in force at the date of the decision.

2 Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme Retention Component

Table of Contents

of 14 Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme Retention Component

2 Defined Terms The following terms are defined and have the meaning given below whenever they are used in these Guidelines. Applicant means a medical practitioner who is applying to join the Programme. Approved Applicant means an Applicant approved by the Delegate for participation in the Programme at an Approved Location. Approved Location means the practice site or sites in an Outer Metropolitan Area, Area of Consideration or other practice site as nominated by an application for the Retention Component under Part 7 of these Guidelines and for which a Delegate has granted approval for the purposes of providing medical services under the Programme. Area of Consideration means an area which meets the criteria described in Part 5 of these Guidelines and is declared by a Delegate to be an eligible area. Practices located within this area become Approved Locations under the Programme and retain this status while the area continues to meet the criteria noted above. Delegate means the Programme Delegate as appointed by the Minister for the administration of the Programme. Department means the Australian Government Department of Health. Fellowship means Fellowship of the Royal Australian College of General Practitioners (FRACGP) or of the Australian College of Rural and Remote Medicine (FACRRM). Guidelines means the Guidelines for the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Programme – Retention Component. Medicare Australia means Medicare Australia of the Department of Human Services, formerly the Health Insurance Commission of the Department of Health. Medical practitioner means a general practitioner who is neither a vocationally recognised medical practitioner nor a Fellow of the RACGP who was registered with a State or Territory Medical Board before 1 November 1996 and, in addition, who is not subject to sections 19AA or 19AB of the Health Insurance Act 1973. Non-vocationally recognised medical practitioner means a medical practitioner who is neither a vocationally recognised medical practitioner nor a Fellow of the RACGP who was registered with a State or Territory Medical Board before 1 November 1996 and, in addition, who is not subject to sections 19AA or 19AB of the Health Insurance Act 1973. Other medical practitioner means a medical practitioner who is neither a vocationally recognised medical practitioner nor a Fellow of the RACGP who was registered with a State or Territory Medical Board before 1 November 1996 and, in addition, who is not subject to sections 19AA or 19AB of the Health Insurance Act 1973. Outer Metropolitan Area means “the part of the State capital city Statistical Division (using the 2001 Australian Standard Geographic Classification definition) that lies outside the 1991 Urban Centre (UCL) area of the capital city”. The definitions are derived from the Australian Bureau of Statistics (ABS) publication 1216.0. Participating Medical Practitioner means a medical practitioner who has been approved by the Delegate for participation in the Programme at an Approved Location. Programme means the Outer Metropolitan (Other Medical Practitioners) Retention Component. Programme address means the address at which all communications to the Department regarding the Programme are to be addressed as detailed in Part 19 of these Guidelines. RACGP means the Royal Australian College of General Practitioners.

Retention means the maintenance of practice by a non-vocationally recognised medical practitioner in an outer metropolitan Approved Location. Statistical Local Area (SLA) means the base spatial unit used to collect and disseminate statistics other than those collected from the Population Censuses. SLAs are based on the boundaries of incorporated bodies of local government where these exist. Further information on SLAs and other Australian Standard Geographic Classification definitions can be found in the Australian Bureau of Statistics publication 1216.0. 3 Scope and Objective of the Outer Metropolitan Retention Component 1.1 The outer metropolitan areas of Australia’s capital cities have undergone considerable growth, putting increasing pressure on services provided by general practitioners. 1.2 The Australian Government’s Outer Metropolitan Other Medical Practitioners (OMPs) Retention Component (the Programme) is one component of the More Doctors for Outer Metropolitan Areas Measure designed to address the shortage of general practitioners in the outer metropolitan areas of Australia’s capital cities. 1.3 In particular, the objective of the Programme is to encourage the Retention of non-vocationally recognised medical practitioners already practising in Outer Metropolitan Areas. 1.4 Medical practitioners who are approved to participate in the Programme and are currently enrolled in a pathway to Fellowship or assessment for Fellowship, will be eligible to receive the higher Medicare Benefits Schedule (MBS) rebates for services provided at an Approved Location(s). 1.5 The higher MBS rebates are only available for medical services provided in the Approved Location pertaining to the Participating Medical Practitioner. The lower (A2 level) MBS rebates will apply for services provided by that Participating Medical Practitioner at locations that have not been approved for the purposes of this Programme. 1.6 A Delegate of the Minister within the Department will administer the Programme. 4 Relevant Legislation 1.1 The Programme operates as a Commonwealth administrative scheme and was created by the Minister as an exercise of the Executive Power of the Commonwealth. The Department administers the Programme. Participation in the Programme is prescribed under the Health Insurance (General Medical Services Table) Regulations 2002 of the Health Insurance Act 1973 for the purpose of payment of MBS rebates at standard vocationally recognised general practitioner rates.

5 Outer Metropolitan Area 1.7 For the purposes of this Programme ‘Outer Metropolitan Area’ means: “the part of the State capital city Statistical Division (using the 2001 Australian Standard Geographic Classification definition) that lies outside the 1991 Urban Centre area of the capital city”. The definitions are derived from ABS publication 1216.0. 1.8 Use of these boundaries has allowed the Outer Metropolitan Area to include locations which have experienced growth since 1991, as well as semi-rural and peri-urban localities. 6 Areas of Consideration 1.9 Certain areas within an inner metropolitan SLA, or an entire inner metropolitan SLA may be declared Areas of Consideration for the purpose of the Outer Metropolitan OMPs Programme. 1.10 Areas of Consideration are those SLAs located in an inner metropolitan area which are experiencing workforce shortage similar to their bordering Outer Metropolitan Area(s). Such areas are declared to be Areas of Consideration provided they meet a number of additional requirements outlined in clause 5.3. 1.11 An inner metropolitan area can be declared to be an Area of Consideration where that area is demonstrably experiencing a workforce shortage and meets one or more of the following requirements: it is generally continuous with the existing Outer Metropolitan Area; it forms a band adjacent to the inner boundary of an Outer Metropolitan Area; it is situated within a growth corridor adjacent to the outer metropolitan boundary; or it is situated near the outer metropolitan boundary and exhibits an ‘island effect’, i.e. where an area of low population is surrounded by areas with much higher populations. 1.12 A Delegate may consider submissions on proposed Areas of Consideration which meet the conditions in clause 5.3 and has the authority to declare or revoke status as an Area of Consideration. 1.13 A Delegate has the authority to declare an Area of Consideration on the basis of special circumstances, not otherwise mentioned in these Guidelines, where those special circumstances are supported by evidence for which an objective assessment of the need for additional doctors within a specified area could be made. 1.14 The use of Areas of Consideration provides the Programme with flexibility to enable it to respond to the needs of those inner metropolitan areas bordering Outer Metropolitan Areas as defined for the purposes of this Programme. 1.15 The Department maintains a list of Areas of Consideration and reviews it on a regular basis. 1.16 Applications from doctors proposing to access the higher MBS rates at an Area of Consideration will be assessed in the same manner as applications to access the higher MBS rates at an eligible Outer Metropolitan Area.

7 Eligible Practices 1.17 Eligible practices are those practices that are located in the Outer Metropolitan Areas of Australia’s capital cities, the entire area of Darwin and declared Areas of Consideration for the purpose of the More Doctors for Outer Metropolitan Areas Measure. 1.18 Eligible practices include other practice sites which the Delegate has declared as being eligible for the Programme because the majority of patients of the practice are drawn from Outer Metropolitan Areas or Areas of Consideration. An individual practice may be declared eligible if the practice: is experiencing long term difficulties recruiting medical practitioners; draws the majority of its patients from Outer Metropolitan Areas or Areas of Consideration; is within very close proximity to the outer metropolitan boundary; is located within an inner metropolitan area that meets one or more of the requirements listed in clause 5.3; or can demonstrate other special circumstances, for example, if the community it services has a large indigenous population. 1.19 The Delegate may consider submissions for practices in inner metropolitan areas to become eligible practices, and will take as the prime consideration whether the majority of patients of the practice are drawn from Outer Metropolitan Areas of Consideration (refer to Part 5 for a complete list of criteria). The Delegate may, if circumstances change, revoke a practice’s eligibility. 8 Nomination of Approved Location 1.20 An Applicant shall nominate, for the purposes of the Programme, a proposed practice location(s) in an Outer Metropolitan Area or an Area of Consideration at the time of applying for the higher MBS rebates through the Programme. 1.21 Once approved by a Delegate, the proposed location will become an Approved Location for the participating practitioner for the purpose of the Programme. 1.22 A participating doctor may change their Approved Location for another eligible location with the approval of the Delegate. 1.23 If a location becomes ineligible after a doctor is approved for that location, the doctor will remain eligible for the Programme at that location. 1.24 A doctor approved under previous Programme arrangements will remain eligible for the Programme at their Approved Location and may nominate additional or alternative locations under the Programme with the approval of the Delegate. 1.25 A Participating Medical Practitioner may work at more than one Approved Location, provided the medical practitioner is approved by a Delegate to work at the additional location(s).

9 Eligible Medical Practitioners 1.26 The More Doctors for Outer Metropolitan Measure has been designed so as not to undermine programmes aimed at reducing medical workforce shortages in rural areas. The Retention Component is primarily aimed at doctors already committed to outer metropolitan practice. 1.27 Medical practitioners wishing to apply for participation in the retention component of the Programme must satisfy the following eligibility criteria: be currently non-vocationally recognised and were registered with a State or Territory Medical Registration Board before 1 November 1996; be not subject to Medicare Provider Number restrictions under sections 19AA or 19AB of the Health Insurance Act 1973; be currently in general practice in an outer metropolitan Approved Location area; and be currently enrolled in a course based pathway to Fellowship (FRACGP) or assessment for Fellowship. 10 Confirmation of Approval to Participate in Programme 1.28 Medical practitioners will be informed by the Delegate of the outcome of their applications to the Department for participation in the Programme. This advice will generally be provided within 28 days of receipt of an application. 1.29 Successful Applicants will be advised in the form of an approval letter which confirms: the Approved Location(s) for the purpose of the Programme; the start and end date for accessing the higher MBS rates at the Approved Location(s); the participant’s obligation to adhere to the Guidelines; the participant’s obligation to notify the Department of any variation to practice that would affect their participation in the Programme; and the participant’s obligation to report any milestones in relation to the achievement of FRACGP. 11 Retention Conditions 1.30 Under this Programme, retention in an Approved Location may either constitute: practice in a full-time capacity at that location; or practice in a part-time capacity at that location. 1.31 A medical practitioner under this Programme may practise in both an inner metropolitan area as well as in an outer metropolitan Approved Location. The higher MBS rebates available through this programme will only apply for services performed at the approved outer metropolitan location(s). 1.32 A Participating Medical Practitioner may work at more than one practice under this Programme, however, services must be provided at the location(s) approved by the Delegate for that medical practitioner in order to attract the higher rebate under this Programme.

12 Pathway to Fellowship (FRACGP) Conditions 1.33 It is a requirement of the Outer Metropolitan OMPs Programme that a Participating Medical Practitioner be either enrolled in a course based pathway leading to Fellowship or enrolled in assessment for Fellowship. 1.34 In line with this, the Delegate will require written evidence from the Applicant of enrolment in a Fellowship pathway or assessment for Fellowship. 1.35 The RACGP can be contacted for assessment advice or more information on the Fellowship pathways at the contact details below: The Royal Australian College of General Practitioners Phone: 1800 331 626 Website: The Royal Australian College of General Practitioners (www.racgp.org.au) Email: RACGP ([email protected]) 1.36 The Delegate has discretion to vary any aspect of the conditions outlined above. 13 Access to Higher MBS Rebates 1.37 Once the Delegate has approved an Applicant for participation on the Programme, the Department will notify Medicare Australia of the doctor’s participation in the Programme and Approved Location details to enable access to MBS rebates at the higher (A1/A11) level at the Approved Location. Medicare Australia will provide written notification of the effective date for accessing Medicare Benefits at the higher rebate level. 1.38 Should a medical practitioner cease practising at an Approved Location altogether, access to the higher MBS rebates will not continue for this Approved Location. 1.39 In the event that a medical practitioner wishes to access the higher MBS rebates in another practice in an Outer Metropolitan Area or Area of Consideration, a new application must be submitted by the medical practitioner in writing to the Delegate. 1.40 If approved, the Department will confirm the new Approved Location details. Medicare Australia will provide written notification to the Participating Medical Practitioner of the effective date for accessing the higher MBS rebate level at the new Approved Location. 14 Termination of Approval to Participate in Programme 1.41 The Delegate may terminate the participation of a medical practitioner in this Programme if the Delegate considers that a Participating Medical Practitioner is not fulfilling the requirements of these Guidelines or of the approval letter. 1.42 The Delegate will attempt to notify the Participating Medical Practitioner affected by this decision at least 14 days prior to a decision taking effect to give the affected medical practitioner the opportunity to provide written comment or evidence to the Delegate outlining why participation in the Programme should not be terminated. The medical practitioner will be required to respond within 28 days of receiving the correspondence.

1.43 The Department will proceed to terminate the participating doctor’s participation in the Programme if: the medical practitioner does not respond within 28 days of the notice; or the medical practitioner fails to take action within 28 days of the notice; or the Department is not satisfied with the medical practitioner’s response; or the medical practitioner notifies the Department of inability to meet requirements of these Guidelines or the approval letter. (Refer to Part 21 Rights of Appeal.) 1.44 In its correspondence with the doctor, the Department will set out the grounds for terminating the doctor’s participation in the Programme and cessation of access to the higher MBS rebates at the Approved Location(s). 15 Safe Working Hours 1.45 Participating Medical Practitioners must comply with all relevant State occupational health and safety legislation in relation to the work of medical practitioners. In addition, Participating Medical Practitioners should comply with the recommendations contained in the Australian Medical Association’s National Code of Practice – Hours of Work, Shiftwork and Rostering for medical practitioners. 16 Delegate’s Discretion 1.46 The Minister will appoint Delegates who have full discretion to make decisions on all matters in relation to the administration of the Programme, including, but not limited to: approval of locations under the Programme; approval of medical practitioners onto the Programme; termination of medical practitioners from the Programme; the medical practitioner’s progress with achieving Fellowship; consideration of special circumstances for practices in inner metropolitan areas that are adjacent to Outer Metropolitan Areas, particularly where the practice or area does not meet the standard requirements for an Area of Consideration as specified in clause 5; liaison with Medicare Australia regarding the maintenance of the Programme; investigating a Participating Medical Practitioner’s compliance with the Programme and complaints about the conduct of Participating Medical Practitioners and other persons in relation to the Programme; and special consideration in relation to Participating Medical Practitioners who are unable to remain compliant with the requirement of the Guidelines due to exceptional circumstances. 17 Monitoring and Review 1.47 The Programme will be evaluated by the Department as appropriate. If there have been changes in the supply of doctors in inner metropolitan areas, an evaluation may lead to changes in the areas from which doctors may access the higher MBS rebates and the listing or de-listing of ‘Areas of Consideration’. 1.48 Medical practitioners participating under this Programme prior to such a review will not be affected and will continue to access the higher MBS rebates at a previously Approved Location. Medical practitioners in these circumstances must continue to be enrolled in a Fellowship pathway or assessment for Fellowship and comply with all other conditions of these Guidelines and approval letter.

18 Accuracy of Information and Misuse of Medicare Provider Number 1.49 Information must be accurate and kept up to date. 1.50 Participating Medical Practitioners must ensure that the information provided to the Department in their respective applications is accurate and current. 1.51 Participating Medical Practitioners must advise the Department of any change in circumstances which is relevant to continued eligibility for the Programme. 1.52 Such notification of change should be made in writing to the Delegate. 1.53 If it is discovered that a Participating Medical Practitioner has provided incorrect information in an application or at any other time, or has failed to advise of a change in circumstances relevant to their participation in the Programme, the Delegate may terminate the medical practitioner’s participation in the Programme (see Part 13 of these Guidelines). Misuse of Programme Medicare Provider Number 1.54 Participating Medical Practitioners should note that misuse of the Medicare Provider Number allocated under this Programme, such as for services provided at a location other than the Approved Location, may constitute an offence under Part VII of the Health Insurance Act 1973 rendering the medical practitioner liable to the sanctions and penalties provided for in the Act. 19 Withdrawal from Programme 1.55 Participating Medical Practitioners may withdraw from participation in the Programme at any time by forwarding written notice of their intention to withdraw to the Department (see communication address in Part 19 of these Guidelines). 1.56 The Department will reply to the Participating Medical Practitioner confirming the doctor’s withdrawal from the Programme. 1.57 Sufficient notice should be provided to enable timely cessation of the higher MBS rebate payments at an Approved Location. 20 Communicating with the Department 1.58 All written communication for the purposes of an application for participation in the Programme, updating of information, or for any other purpose related to participation in, or management of, the Programme must be directed to the Programme address as follows: The Delegate- More Doctors for Outer Metropolitan Areas Measure Department of Health MDP 152 GPO Box 9848 CANBERRA ACT 2601 Email: omps ([email protected])

1.59 General enquiries regarding the Programme may be directed to the any of the above contact details. Any formal application must be sent in writing to the above mailing address. 1.60 The Delegate will consider all written submissions that are received at this address.

21 Application Process 1.61 Medical practitioners seeking to participate in the Programme must complete the Programme application form which is available by contacting the Department (contact details provided in Part 19). 1.62 Completed applications and supporting documentation including written evidence of current enrolment in a pathway or assessment for attaining GP Fellowship, should be forwarded to the Delegate in the Department at the address provided in Part 19. 1.63 The Delegate will assess applications for eligibility in accordance with requirements set out in these Guidelines and in the Health Insurance Act 1973. 1.64 The Delegate may exercise discretion when making a decision in relation to individual applications. 1.65 The Department may seek further information from the Applicant, particularly if the Department is not satisfied that the doctor has provided all the necessary documentation to assist in determining eligibility for the Programme. 1.66 Incomplete applications will be placed on hold until the Department receives the complete documentation. 1.67 The Delegate will inform Applicants of the outcome of their applications generally within 28 days of receipt of the application. Refer to Part 9 for information on confirmation of approval to participate in the Programme. 1.1.1 Successful Applicants will receive an approval letter confirming the Approved Location(s) for the purpose of the Programme and the approved medical practitioner’s obligations under the Programme. 1.68 Once the approval letter is received, if required and not already done so, the Approved Applicant must submit an application to Medicare Australia for a Medicare Provider Number which is specific to the Approved Location practice address. 1.1.2 A copy of the approval letter from the Department must be included with the Medicare Provider Number application form. For further information on the provider number application process and forms, contact the Medicare Australia Provider Eligibility Section on 132 150. 22 Rights of Appeal 1.69 The Programme operates as an administrative scheme established by the Minister and does not rely on specific legislation. This means that it is not possible to apply to a tribunal to review the Delegate’s decision because tribunals can only exercise jurisdiction that is specifically conferred by legislation. Similarly, the Administrative Decisions (Judicial Review) Act 1977 does not apply to the Delegate’s decisions, as they are not made under an enactment. The Programme does, however, make provision for internal merits review of decisions. 1.70 Unsuccessful Applicants may apply for a reconsideration of the decision made by the Delegate to refuse participation in the Programme. In doing so, unsuccessful Applicants are required to provide evidence to convince the review Delegate that they meet the eligibility requirements of the Programme and/or that the decision was unreasonable. 1.71 The decision of the Delegate will have effect until a different decision is made by a review Delegate. The review Delegate has final discretion in this matter.

1.72 The review Delegate will contact the Applicant if insufficient information has been provided by the Applicant, or the review Delegate proposes to use information not provided by the Applicant. 1.73 It is recommended that doctors seeking reconsideration supply additional information in support of their case. Any further information must be submitted to the review Delegate within the time limit specified by the review Delegate, or, if no time limit is set, within 28 days of the date of the review Delegate’s letter. 1.74 There is no impediment to an unsuccessful Applicant making a fresh application at any time. 23 Privacy 1.75 Personal information within the meaning of the Privacy Act 1988 may be provided to the Department by medical practitioners seeking participation on the Programme. 1.76 In addition to any other uses of the information that are authorised by law, personal information will also be used for the administration of the Programme. Consequently, the Department may exchange information with Medicare Australia for the purposes of administering, monitoring and revising the Programme. 1.77 Consent for use of personal information for marketing and promotional purposes: 1.1.3 Occasionally, the Department may require doctors’ personal information for the purpose of marketing and promoting the More Doctors for Outer Metropolitan Areas Measure. The information required for these activities are generally the doctor’s name and the name and address of the practice to which the doctor is relocating. 1.1.4 In addition, the doctors’ contact phone number and email address may be provided to the body conducting the promotion so that they may make direct contact with the Participating Medical Practitioners. 1.1.5 In accordance with the provisions of the Privacy Act 1988, the Department will only disclose this information with the doctor’s consent. The information will not be publicly disseminated. 1.1.6 Doctors who are approved to participate in the associated Relocation Incentive Grant Programme will be provided the opportunity to agree or disagree to the disclosure of their personal information for the purpose of marketing and promoting the Programme at the time of applying for the grant. 1.1.7 Doctors who provide their consent may be contacted by a representative from the Department of Health or a promotional organisation to confirm their participation in publicity campaigns for the More Doctors for Outer Metropolitan Areas Measure. Doctors who have not provided their consent may be contacted at a later time by the Department to seek their consent. 1.1.8 The Medicare Provider Numbers of Participating Medical Practitioners will not be included in any promotional or marketing activities conducted by, or on behalf of, the Department.

24 Reviews, Evaluation and Surveys 1.78 The Department from time to time conducts reviews and evaluations of its programmes. As part of those processes, doctors may be contacted by officially engaged reviewers seeking their participation in surveys or key informant interviews. Participation in such activities will be voluntary. 25 Further Information on the Retention Component- Outer Metropolitan OMPS Programme 1.79 Information on the Retention Component may be obtained by contacting the Department by visiting the programme’s website (www.health.gov.au/omps). 1.80 Information on currently eligible Outer Metropolitan Areas and Areas of Consideration is available by viewing the capital city maps on (www.doctorconnect.gov.au). Information on whether particular locations are eligible may be obtained by emailing the practice’s street address to omps ([email protected]).