Primary Health Services Toolkit Aboriginal and Torres Strait Islander Initiatives January 2019 Central and Eastern PHN

Disclaimer

The information in this kit is not a substitute for independent professional advice, and expert or legal advice should be sought from competent professional persons as appropriate. Central and Eastern Sydney PHN does not accept liability for any injury or loss or damage incurred by the use of or reliance on the information in this kit.

Source: • Practice Incentives Program Indigenous Health Incentive Guidelines – February 2014 • Closing the Gap within your service for Aboriginal and Torres Strait Islander Patients – Practice Guidelines Sept 2013 – Eastern Sydney Medicare Local • Sutherland Division of General Practice – Practice Training July 2011

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Table of Contents

Topic Title Page

1 Background NSW Statistics and Local Health 4 Issues

2 The General Practice Environment Customer Service 5 - 6

Asking Patients about Cultural 7 Status

Recording cultural background 7

How to ask the question on cultural 8 - 9 status

Additional information about asking 10 patient on Indigenous status

3 Patient Records Medical Director 11 Best Practice Non – computerised practices

4 Health Assessment for Aboriginal and Torres Components, Eligible practitioners, 12 Strait Islander People (MBS Item 715) Restrictions

5 Supporting Primary Care Providers to Coordinate Chronic Disease Management

Practice Incentives Program (PIP) Indigenous Health Incentive (IHI) 13 - 15

Applying for the PIP Indigenous 16 Health Incentive

Patient Registration and Re- 17 registration

Requirements for the Indigenous 18 Health Incentive

PBS Co-payment – Access to 19 - 20 cheaper or FREE Medicines

6 Frequently Asked Questions 21

7 CESPHN Programs Care Coordination and 22 - 23 Supplementary Services (CCSS) Program

Outreach Worker Program 24

HealthPathways – Sydney 25

8 Appendices 26

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1. BACKGROUND

NSW

There are an estimated 216,176 (Census 2016) Aboriginal and Torres Strait Islander people living in NSW, comprising one third (33.3%) of the total Aboriginal and Torres Strait Islander population of 649,171 within Australia.

The Central and Eastern Sydney PHN (CESPHN) region has five Aboriginal communities, all part of the Nation.

These are: (Bediagal); Gadigal; Wangal; ; Dharawal (language)

In the CESPHN region an estimated 13,479 reside in the area. The Indigenous population as a proportion of the total population is concentrated in the Local Government Areas (LGAs) of:

• Botany Bay: n=819; • Marrickville: n=1,178; • Randwick: n=1,700;

In absolute numbers, the largest Indigenous population resides in the LGA Sydney: n=2,180 and the smallest in Strathfield LGA: n=103.

Local health issues identified:

Health care access such as:

• Affordability

• Availability

• Appropriateness / responsiveness

• Utilisation

Chronic conditions such as:

• Cardiovascular disease

• Kidney disease

• Diabetes

• Cancer

• COPD

• Asthma

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2. THE GENERAL PRACTICE ENVIRONMENT

Making your service inviting to Indigenous Australian community members and acknowledging different health needs will increase health service accessibility opportunities and help to close the gap for patients who identify as being of Aboriginal or Torres Strait Islander decent.

What does a patient look at before entering a service? They consider whether the service appeals to them and whether they will feel welcome there.

The practice reception desk and waiting area are where patients obtain their first impression of your practice. Aboriginal and Torres Strait Islander Australians often have different concepts of health and illness from those of the general population. Recognising that there are cultural differences is important in providing good quality care for the indigenous community.

It is essential to provide an environment that is welcoming to the Aboriginal community to aid in making these patients feel safe and secure. This will assist in encouraging patients to identify their cultural status and disclose health concerns, which in turn will increase access to health services.

There are some simple ways of communicating to Aboriginal and Torres Strait Islander people that they are welcomed and within a safe environment:

• Display Aboriginal and / or Torres Strait Islander artwork or icons (e.g. Aboriginal flag) in visible locations within the practice such at or around the reception desk.

• A sign at your front desk acknowledging the traditional owners of the land in which you are working.

• A sticker for your front window saying: “Our service is proud to support Closing the Gap initiatives for Aboriginal and Torres Strait Islander people”

These stickers are available from the Central and Eastern Sydney PHN

• Provide a child friendly environment e.g. toys and books

• Provide drinking water to patients who may have had a long walk and no transport available to them.

• Offer assistance with any follow up appointments that may need to be made or referrals to other primary or allied health service providers

• Obtain health promotion information appropriate for Aboriginal and Torres Strait Islander patients. The PHN can assist with this, and there is also a plethora of information available online

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Customer Service

Reception staff maintain the front line for each general practice and thus they are integral to providing a good first impression on patients attending the practice. Because of this, it is important for these staff members to be aware of specific cultural issues and barriers that limit Aboriginal and / or Torres Strait Islander patients from attending mainstream health services such as general practice.

Following are some tips to assist reception staff in providing culturally appropriate customer service to Aboriginal and Torres Strait Islander patients:

• Ask all patients of their cultural status and record in medical software

• Allow the patient to have family members present if desired. When inviting family or community members to accompany a patient, ensure the patient fully consents to their attendance and that the community/family members are fully aware of the need for confidentiality

• Provide gender appropriate staff where possible, for both male and female patients, especially regarding pap smears, sexual health checks, pregnancy checks, antenatal care and postnatal care

• All reception staff should be aware of the services provided to Aboriginal and Torres Strait Islander patients including vaccinations, Aboriginal Health Assessments, the Indigenous PIP, PBS program, Coordinated Care Supplementary Services Program and Outreach Worker Program

• All reception staff should be aware of the billing protocol provided to Aboriginal and Torres Strait Islander patients such as bulk billing and Indigenous Health Incentive item number

• The practice may need to assist some patients with completing forms

• If you have a Practice Nurse, they can complete the clinical information with advice from the patient in an interview style. Or, a family or support person may be present and can assist with the forms

• When the patient contacts the practice for their first appointment, remind them to bring their Medicare Card with them

• Encourage all staff in the practice to attend Aboriginal and Torres Strait Islander Cultural Awareness programs

Given the known access barriers to health services, by patients of Aboriginal and Torres Strait Islander descent (including transport and any past negative or judgmental experiences), if a patient calls in looking for an opportunistic appointment it may well be for something urgent or of a sensitive (shame) nature.

If you are pre-booking an appointment for Aboriginal or Torres Strait Islander patients, it may be appropriate to reserve a long appointment to see the doctor as assistance with filling out forms (e.g. housing, Centrelink) may be needed or advice or education for more than one health reason. Extra time should be allowed for first appointments to allow the doctor time to build rapport and trust with the patient.

As with all patients, prospective costs should be explained to the patient before they see the GP or any treatment is commenced. If possible, follow up appointments and referrals should be made before the patients leave the practice.

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Asking patients about cultural status

Research evidence shows that where general practices take action to improve their identification processes, there is a corresponding increase in the numbers of correctly identified patients. There are sensitivities and concerns in some areas about the issue of identification and that ‘asking the question’ and recording the answer may require IT and procedural support.

Reasons for under identification of Aboriginal and Torres Strait Islander patients:

• Lack of awareness and training of staff

• Staff reluctance to ask the question

• Client refusal to answer the question

• Staff perceptions about Aboriginal and Torres Strait Islander clients not wanting to disclose their status

• Lack of privacy when answering the question

• Minimal checking/validating of data and follow up of missing information

• Inadequate data management systems

At practice level, identifying Aboriginal and Torres Strait Islander status is a necessary condition for participation in the Closing the Gap initiative. Without practice awareness, a patient who is of Aboriginal or Torres Strait Islander origin cannot benefit from various measures in the Australian Government’s Indigenous Chronic Disease Package. To register for the PIP IHI, general practices must ask all patients if they identify as being of Aboriginal or Torres Strait Islander origin, using the national standard identification question, and must record this in the appropriate place in the medical record.

Recording cultural background

Practices in all clinical settings should work toward identifying and recording the cultural background of all patients since this background can be an important indication of clinical risk factors and can assist GPs in providing relevant care.

Recording Aboriginal and Torres Strait Islander status The standard indigenous status question is:

‘Are you of Aboriginal or Torres Strait Islander origin?’

Three standard response options should be provided to clients to answer the question (either verbally or on a written form):

o No o Yes, Aboriginal o Yes, Torres Strait Islander

For patients of both Aboriginal and Torres Strait Islander origin, both ‘Yes’ boxes should be marked. Alternatively, a fourth response category may also be included if this better suits the data collection practices of the agency or establishment concerned:

o Yes, both Aboriginal and Torres Strait Islander

If the question has not been completed on a returned form, this should be followed up and confirmed with the client.

Sometimes practice teams feel concerned that obtaining Aboriginal or Torres Strait Islander status can be perceived as discriminatory. However, the information is very important because of the different health needs of Aboriginal and Torres Strait Islander people.

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How to ask the question on cultural status

• Staff responsible for registering a patient should ask the Indigenous status question when the patient is first registered with the service

• This question should be asked of all patients, irrespective of appearance, country of birth or whether the staff know of the client or their family background. The question should be placed within the context of other questions related to cultural background, such as country of birth and main language spoken.

• The practice may wish to collect this information as part of a patient questionnaire and preface questions on cultural background by explaining that such information helps the practice provide appropriate healthcare.

• Staff should be encouraged to collect information from all patients in a professional and respectful manner, without anticipating or making assumptions about the patient’s identity or about how the client is likely to react or respond to any given question.

Should staff feel an explanation is necessary, the following statement is suggested:

‘The collection of the following information will assist in the planning and provision of appropriate and improved health care and services’

• All patients, whether Aboriginal, Torres Strait Islander or non-Indigenous, have the right to self- report their Indigenous status, rather than have their status assumed and recorded on their behalf.

• To refrain from asking any client the Indigenous status question is an act of discrimination which infringes upon the patient’s right to respond to this question for themselves.

• Given that the question should be asked correctly, consistently and uniformly of all patients, staff should not attempt to modify the standard question in any way. Changing the question’s wording, even slightly, has the potential to alter the question’s meaning, and this may in turn influence the client’s response.

There are some situations, when the patient will be unable to answer the question. In these instances, it is acceptable for certain others – such as a close friend, relative or member of the household – to be asked the question and to answer the question on the patient’s behalf if they feel confident to provide accurate information.

The practice may wish to seek information on cultural background from existing patients through a simple mechanism such as an update-your-information questionnaire.

The question of identity? Because…

Best Practice – Follow the RACGP Guidelines

EVERYONE – Everyone is asked the question

Confidential – All personal information is protected by a strict Privacy Act

All of practice approach

Understanding of barriers

Sensitive

Explain – the why, what and how the information is used

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If a patient wants to know ‘why’ they are being asked a question on their cultural status

The following are several responses that may assist in explaining to patients the reasons for asking the Indigenous status question.

• The Indigenous status question is one of several questions related to a patient’s origin and demographic characteristics that are asked of all patients who attend a health service, enroll with Medicare or are involved in the registration of a birth or death.

• The collection of Indigenous status is necessary for the practice to register for initiatives such as the Indigenous PIP and PBS Co-Payment Measure which assist Aboriginal patients to access health assessments and medicines.

• All personal information is protected by a strict Privacy Act – the use of personal information for reasons other than the purpose for which it was collected is strictly prohibited, unless the client’s consent is given.

Should a patient request a more detailed explanation of where the data will go or the ways it may be used, staff may wish to refer the client to the Australian Institute of Health and Welfare website www.aihw.gov.au or the Australian Bureau of Statistics website www.abs.gov.au

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Additional information about asking patients about indigenous status

If the patient is a child under 15 years of age

Where the patient is a child under 15 years of age, the parent or guardian is asked to declare the patient’s Aboriginal and / or Torres Strait Islander status on their behalf.

If the patient or guardian is not available, a close relative, friend or another member of the household accompanying the child should be asked to provide this information.

If the accompanying adult is unable to provide this information, the child’s parent/guardian should be contacted as follow-up to establish the Aboriginal and/or Torres Strait Islander status of the child.

If the patient is too ill to be questioned or is unable to respond to questions

Where the client is unable to respond to standard questions because they are too ill, unconscious or incapable due to a psychiatric condition or dementia, in the first instance the staff member should ask the patient’s carer, relative or any other person accompanying the patient who knows the patient well and is confident of providing accurate information.

The response by this person should always be verified with the patient when they have recovered sufficiently to be able to answer the question themselves.

If a patient objects to the question or declines to answer

Where a patient objects to the question or declines to answer, they should be informed of their rights to decline to answer the Indigenous status question and be advised that their level of care and access to services will not be affected if they choose not to answer the question.

While staff have a duty to collect and record Indigenous status information from all patients as correctly as possible, they are not obliged to convince a disgruntled, upset or unwilling patient to respond to the question.

Furthermore, while staff have a duty, if queried, to explain to clients why this question is being asked, they are not obliged to justify the use of the standard question.

If the patient chooses not to answer the question ‘correctly’

There may be occasions where a patient of a service is known to staff as an Aboriginal or Torres Strait Islander person, yet chooses not to report as such in response to the Indigenous status question. Conversely, there may be occasions where a known non-Indigenous patient chooses to report themselves as Aboriginal or Torres Strait Islander in response to this question.

If a patient wishes to change their previously recorded Indigenous status

All patients should have an opportunity to confirm or update any previously recorded person information on a regular basis, including confirmation or alteration of their recorded Indigenous status.

The most convenient approach, particularly in general practice settings, is to routinely provide clients with a copy of their personal details for verification, allowing an opportunity for patients to correct or update their Indigenous status.

Any changes should be received without comment and patients should not be required to provide a reason for changing their recorded Indigenous status.

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3. PATIENT RECORDS

Practices need to record each patient’s Aboriginal and/or Torres Strait Islander status in the demographic section of your medical software.

Recording this information is essential for planning and managing the care of Indigenous patients. In particular, recording Indigenous status is necessary for registration to the Australian Government PIP and PBS Co-payment measure.

Medical Director

a) For a new patient

• CLICK Open • In the pop-up box SELECT New • TICK the ATSI box and select the appropriate status

b) For an existing patient

• CLICK Open • In the pop-up box SELECT type in patient name • Click open • CLICK patient details • TICK the ATSI box and select the appropriate status

Best Practice

a) For a new patient

• Click on the ‘Add new’ button from the open patient screen • The new patient prompt screen will appear • A patient’s Aboriginal and/or Torres Strait Islander status can be recorded in the ETHNICITY box in the left column of this prompt screen • When the information has been recorded, click ‘Save’

b) For an existing patient

• CLICK ‘Open’ • Select ‘Demographics’ (F10) – the patient demographics prompt screen will appear • A patient’s Aboriginal and/or Torres Strait Islander status can be recorded in the ETHNICITY box in the left column of this prompt screen • When the information has been recorded, click ‘Save’

Practices without clinical software

For practices that are not computerised, it is recommended you record one of the following categories for every patient;

• Aboriginal origin • Torres Strait Islander origin • Both Aboriginal and Torres Strait Islander origin • Neither Aboriginal nor Torres Strait Islander origin • Not stated / inadequately described

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4. HEALTH ASSESSMENT FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE (MBS ITEM 715)

The aim of this MBS health assessment is to help ensure that Aboriginal and Torres Strait Islander people receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause morbidity and early mortality.

For the purpose of this item, a person is an Aboriginal or Torres Strait Islander person if they, or their parent or carer, identify them as being of Aboriginal or Torres Strait Islander descent.

The MBS health assessment for Aboriginal and Torres Strait Islander people covers the full age spectrum, and should be used for health assessments for the following age groups:

• Aboriginal and Torres Strait Islander children who are less than 15 years’ old • Aboriginal and Torres Strait Islander adults who are aged fifteen years and over but under the age of 55 years • Aboriginal and Torres Strait Islander older people who are aged 55 years and over

Components of the Health Assessment

The health assessment includes an assessment of the patient’s health, including their physical, psychological and social wellbeing. It also assesses what preventative health care, education and other assistance should be offered to the patient to improve their health and wellbeing.

Eligible practitioners

This MBS health assessment item may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).

The medical practitioner may only undertake the health assessment, after the patient, their parent or carer, has been given an explanation about what is involved and has given their consent.

Restrictions on providing the MBS Health Assessment

This health assessment is an annual service. The minimum time allowed between services is nine (9) months. Medical practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (i.e. the patient has an acute problem that needs to be managed separately from the assessment).

The MBS health assessment item is not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

See appendices for more information and: • Department of Health Fact Sheet on Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715) • Health Assessment Patient Brochure

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5. SUPPORTING PRIMARY CARE PROVIDERS TO COORDINATE CHRONIC DISEASE MANAGEMENT

The Australian government is providing payments through the Practice Incentives Program (PIP) Indigenous Health Incentive to support general practices and Indigenous health services to provide better health care for Indigenous Australians. This includes best practice management of chronic disease.

Practice Incentives Program (PIP) –

Indigenous Health Incentive

The PIP Indigenous Health Incentive provides financial incentives to support general practices and Indigenous Health Services to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease.

Practice Eligibility:

To be eligible for the PIP Indigenous Health Incentive sign-on payment, the practice must:

• Participate in the Practice Incentive Program (PIP)

• To be eligible for the patient registration and outcomes payments, the practice must:

 Be signed on for the PIP Indigenous Health Incentives, and  Meet the relevant requirements for these payments

Payments:

The PIP Indigenous Health Incentive has 3 components, summarised below:

Component Payment Activity required for payment

1. Sign-on payment $1000 per practice One-off payment to practices that agree to undertake specified activities to improve the provision of care to their Indigenous patients with a chronic disease

2. Patient registration $250 per eligible patient A payment to practices for each Indigenous per calendar year patient aged 15 years and over, registered with the practice for chronic disease management

3. Outcomes payment Tier 1: Payment to practices for each registered $100 per eligible patient patient for whom a target level of care is per calendar year provided by the practice in a calendar year

Tier 2: Payment to practices for providing the majority $150 per eligible patient of care for a registered patient in a calendar per calendar year year

See appendices for: • Practice Incentives Program Indigenous Health Incentive and Pharmaceuticals Benefits Scheme Co-Payment Measure Practice Application form

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Explanation of payments:

1. Sign on payment

A one-off sign-on payment of $1000 is made to practices that register for the PIP Indigenous Health Incentive. The payment is made to practices in the next quarterly payment following sign-on.

To sign-on for the PIP Indigenous Health Incentive, practices are required to:

• Agree to receive consent to register eligible Aboriginal and/or Torres Strait Islander patients for the PIP Indigenous Health Incentive and/or the Pharmaceuticals Benefits Scheme (PBS) Co- payment Measure

• Create and use a system to make sure Aboriginal and Torres Strait Islander patients aged 15 years and over with a chronic disease are followed up e.g. recall and reminder system, or staff actively seeking patients to make sure they return.

• Undertake cultural awareness training within 12 months of joining the incentive (see Cultural Awareness Training – page 17)

• Annotation of PBS prescriptions for Aboriginal and Torres Strait Islander patients participating in the PBS Co-payment Measure from 1 July 2010

2. Patient Registration payment

A patient registration payment of $250 is made to practices for each Aboriginal and/or Torres Strait Islander patient who:

• Is a ‘usual’ patient of the practice

• Is aged 15 years and over

• Has a chronic disease

• Has had, or been offered a health assessment for Aboriginal and/or Torres Strait Islanders

• Has a current Medicare card

• Has provided informed consent to be registered for the PIP Indigenous Health Incentive by completing the patient consent part of the Indigenous Health Incentive and PBS Co-payment Measure patient registration and consent form. (practice to send to Department of Human Services or completed patient registration online via HPOS)

The patient registration payment is paid once per patient, per calendar year for patients registered between 1 January and 31 October. If a patient is registered for the first time in November or December of a year, they’ll be registered from 1 January to 31 December of that year, as well as for the following year. Practices will receive on patient registration payment of $250 in the February payment quarter of the following year (see Table 2). A practice will not receive a patient registration payment for a patient who is already registered for that calendar year with another practice.

Practices can check if an eligible patient is currently registered with their practice by either:

• Using HPOS to access the practice’s list of registered patients, or • Phoning PIP on 1800 222 032

Table 2: Patient Registration Payment

Date Registered Registration Period Patient Registration Payment - $250 1 January to 31 October 1 January to 31 December In the next quarterly payment 1 November to 31 December 1 January to 31 December of February of the following year that year, and 1 January to 31 December of the following year

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When registering a patient using the paper form, practices must send or fax the completed Indigenous Health Incentive and PBS Co-payment Measure patient registration and consent form to the Department of Human Services. The form must be received no later than 7 days prior to the relevant ‘point-in-time’ date so the practice can receive a patient registration payment the following quarter.

A list of patients registered at the practice during the quarter for the PIP Indigenous Health Incentive will be provided as part of the practice’s PIP quarterly payment advice. The Department of Human Services will also contact practices directly if a patient can’t be registered for any reason.

3. Outcomes payment

There are two tiers of outcomes payments available each calendar year for each registered patient. Outcomes payments are based on MBS services provided from 1 January to 31 December of each year the patient is registered. Outcomes payments are only made to PIP practices that are signed on for the Indigenous Health Incentive.

Practices may be eligible for either, or both, outcomes payments even if the patient is currently registered for the PIP Indigenous Health Incentive at another PIP practice.

Tier 1: Outcomes payments are paid in the quarter after the required services have been provided.

A payment of $100 per patient is made to practices that:

• Prepare a GP Management Plan (GPMP) (MBS item 721) or coordinate the development of Team Care Arrangement (TCA) (MBS item 723) for the patient in a calendar year, and

• Undertake at least one review of the GPMP or the TCA (MBS item 732) during the calendar year, or

• Undertake two reviews of the patient’s GPMP or TCA (MBS item 732) during the calendar year or

• Contribute to a review of a multidisciplinary care plan for a patient in a Residential Aged Care Facility (MBS item 731) twice during the calendar year

The recommended frequency for preparing a GPMP or coordinating a TCA, allowing for variation in patients’ needs, is once every two years, with regular reviews (recommended six monthly).

Tier 2: Outcomes payment are paid in February each year

A payment of $150 per patient is made to the practice that provides the majority of eligible MBS services for the patient (with a minimum of any five eligible MBS services) during the calendar year. This may include the services provided to qualify for the Tier 1 outcomes payment.

If two for more practices provide the same number of eligible MBS services for a patient (with a minimum of any five eligible MBS services) in the calendar year, a Tier 2 outcomes payment will be made to each practice.

Eligible MBS items, for the purposes of this incentive, are those items commonly used in general practice which include, but are not limited to, attendances by GPs (items 1-51, 193, 195,197, 199, 601, 602, 603, 2501-2559, 5000-5067) and chronic disease management items.

For registering patients - see appendices for: • Practice Incentives Program Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Patient Registration and Consent form • Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co- Payment Measure Multiple patient registration and consent form

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Applying for the Practice Incentive Program (PIP) Indigenous Health Incentive

Practices can apply for the PIP Indigenous Health Incentive when they apply for the PIP:

• Through Health Professional Online Services (HPOS) at humanservices.gov.au/HPOS, or

• By completing the PIP application form available at this website location: humaservices.gov.au/healthprofessionals then Incentives and Allowances > Practice Incentives Programs > Forms and guidelines, and sending it with the required supporting documentation to:

Mail:

Incentive Programs Department of Human Services GPO Box 2572 Adelaide SA 5001

Fax:

1300 587 696

Practices already participating in the PIP can apply for the Indigenous Health Incentive:

• Through HPOS, or

• Completing the Indigenous Health Incentive application form at this website location: humanservices.gov.au/healthprofessionals then Incentives and Allowances > Practice Incentive Programs > Forms and guidelines and sending or faxing forms to the above address and fax number.

Notifying CESPHN once registered for the Indigenous Health Incentive (IHI)

Once a practice is registered for the IHI, the practice can choose to include their practice details on the CESPHN website. This list informs the community of those general practices that participate in the Indigenous Health Incentive PIP and PBS Co-payment Measure for Aboriginal and Torres Strait Islander patients. A consent form is included in this kit for general practices to complete and return to the PHN.

If you would like more information about inclusion on the CESPHN website or the consent form, please contact CESPHN at:

Kogarah office: Ph: 9330 9900 / Fax: 9330 9933 Ashfield office: Ph: 9799 0933 / Fax: 9799 0944 Email: [email protected]

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Patient Registration and Re-registration

Registering Patients

Practices must apply for the PIP Indigenous Health Incentive before patients can be registered. The patient must complete the patient consent section (Part B) of the Indigenous Health Incentive and PBS Co-payment Measure patient registration and consent form.

Practices should give patients a copy of the patient information sheet available at humanservices.gov.au/healthprofessionals then Incentives and Allowances > Practice Incentives Program > Forms and guidelines, and verbally explain the Indigenous Health Incentive and PBS Co- payment Measure.

The GP needs to be sure the patient understands the incentive before asking them if they want to register.

Practices can register patients in the following ways:

• Online through HPOS, at humanservices.gov.au/HPOS

If registering patients through HPOS, practices are not required to send or fax the form to the Department of Human Services. Patient consent must still be obtained from the patient using the patient consent section of the form. Practices must keep the form on file for audit purposes.

• Complete the Indigenous Health Incentive and PBS Co-payment Measure patient registration and consent form.

Once completing this form manually, the practice must send or fax the form to the Department of Human Services to receive patient registration payments. (see page 15 for address and fax details)

Withdrawal of patient consent:

Patients can withdraw their consent at any time by completing the Indigenous Health Incentive and PBS Co-payment Measure patient withdrawal of consent available form at the Department of Human Services. Practices must send or fax this form on behalf of the patient to Department of Human Services.

Re-registering Patients

At the end of each calendar year, practices need to re-register their patients for the following calendar year. Practices can re-register patients online through HPOS or by completing a new Indigenous Health Incentive and PBS Co-payment Measure patient registration and consent form. As part of the re- registration process patients must complete the patient consent section of the form.

When re-registering patients using PIP online via HPOS, practices do not need to send or fax the form to the Department of Human Services. Patient consent must still be obtained from the patient using the patient consent section of the form. Practices must keep the form on file for audit purposes.

Note: The IHI re-registration process does not apply to patients at risk of a chronic disease and who are already registered for the PBS Co-payment Measure only. The PBS Co-payment measure is a once only registration. If a patient develops a chronic disease, then the patient may be registered for IHI.

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Requirements for the Indigenous Health Incentive

Identification of Indigenous patients - For practices to register for this incentive, patients must self-identify to the GP or practice staff as being of Aboriginal and/or Torres Strait Islander origin. Patients do not need to provide evidence to support this. See “Ask how to ask question of Cultural Status”

Cultural awareness training – What are the cultural awareness training requirements for the PIP Indigenous Health Incentive?

To meet the cultural awareness training requirement, at least two staff members from the practice (one of whom must be a GP), must complete appropriate cultural awareness training within 12 months of the practice signing on to the incentive.

For the purpose of the PIP Indigenous Health Incentive, appropriate training is any that is endorsed by a professional medical college, including those that offer Continuing Professional Development (CPD) points, or endorsed by the National Aboriginal Community Controlled Health Organisation (NACCHO) or one of its state or territory affiliates. Examples of professional medical colleges include the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). Documentary evidence of completion of the training should be kept on file at the practice.

Appropriate training that has been undertaken up to 12 months prior to the practice signing on for the incentive will also be considered to meet this requirement. There are no specific time, length or method (face to face, online, distance education etc.) criteria associated with the cultural awareness training requirement, as long as it fulfils the components outlined above.

‘Usual’ practice patients - Patient registration for the PIP Indigenous Health Incentive should only be undertaken by the patient’s ‘usual care provider’. This is the practice that has provided the majority of care to the patient over the previous 12 months and / or will be providing the majority of care to the patient over the next 12 months.

Patients must confirm they want the practice written on the Indigenous Health Incentive and PBS Co- payment Measure patient registration and consent form to be their usual care provider and the practice responsible for their chronic disease management.

Definition of a chronic disease - The PIP Indigenous Health Incentive uses the MBS definition of a chronic disease – a disease that has been, or is likely to be, present for at least six months. It includes but is not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke.

Chronic diseases that are key contributors to mortality for Aboriginal and/or Torres Strait Islander Australians are cardiovascular disease, diabetes, chronic respiratory disease, cancer and chronic kidney disease.

Aboriginal and/or Torres Strait Islander health Assessments - Conducting Aboriginal and/or Torres Strait Islander health assessments (MBS item 715) is a useful first step to make sure Aboriginal and/or Torres Strait Islander Australians get the best level of health care. It encourages early detection, diagnosis and intervention for common and treatable conditions that cause considerable morbidity and early mortality. Practices are encouraged to bulk-bill their Aboriginal and Torres Strait Islander patients to help improve affordability and access to care.

Eye health - Aboriginal and/or Torres Strait Islander Australians have a greater chance of eye disease, with common eye health problems including Refractive Error, Cataracts, Diabetic Retinopathy and Trachoma. As part of conducting the Aboriginal and/or Torres Strait Islander health assessment (MBS item 715), GPs should examine the patient’s vision, and ensure all patients with diabetes have an annual retinal examination. It is also recommended to check for Trachoma and conduct a Trichiasis check for patients who have grown up in remote communities or have a history of ‘sore’ or ‘watery eye’. It is important that if indicated, GPs refer the patient to appropriate follow-up services.

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PBS Co-Payment – Access to cheaper or FREE medicines

From 1 July 2010, the Australian Government have provided assistance with the cost of Pharmaceutical Benefits Scheme (PBS) medicines for Aboriginal and Torres Strait Islander patients living with, or at risk of, chronic disease. The assistance is in the form of lower co-payments, which are the amounts paid by patients for each PBS medicine.

The cost of medicines has been identified as a significant barrier to improved access to medicines for Aboriginal and Torres Strait Islander people. Access to PBS medicines is an important aspect of preventing and treating illnesses.

Patient eligibility

The PBS Co-payment Measure aims to help Aboriginal and/or Torres Strait Islander patients of any age who:

• Identify as being of Aboriginal and/or Torres Strait Islander origin

• Be of any age

• Have an existing chronic disease or chronic disease risk factor, and

• In the opinion of the doctor:

o Would experience setbacks in the prevention or ongoing management of chronic disease, if they didn’t take the prescribed medicine, and o Are unlikely to follow their medicines routine without help through the measure

Patient registration for PBS Co-payment Measure

Practices can register eligible patients for the PBS Co-payment Measure using the same Indigenous Health Incentive and PBS Co-payment Measure patient registration and consent form as for the PIP Indigenous Health Incentive. The patient is to complete the patient consent section in Part B of the form.

Once a patient has been registered for the PBS Co-payment Measure, they do not need to be re- registered. Patients remain registered unless they choose to withdraw from the measure by completing an Indigenous Health Incentive and PBS Co-payment Measure patient withdrawal of consent form. Practices must send or fax this form on behalf of the patient to the Department of Human Services for processing.

For multiple patient registrations and consent, complete the “PIP Indigenous Health Incentive and Pharmaceutical Benefits Co-Payment Measure Multiple patient registration and consent” form.

Participating practices must maintain patient records. This includes keeping copies of signed patient consent and patient registrations on file at the practice.

Submitting patient registrations

You can register patients by:

• Completing the required form and send or fax to the Department of Human Services • Website location humanservices.gov.au/healthprofessionals using your Medicare Public Key Infrastructure Certificate (PKI) to access Health Provider Online (HPOS).

Once a patient is registered, prescribers at participating general practices will use their software to annotate the patient’s PBS prescriptions to ensure patients receive their PBS medicines at a lower cost.

See appendices for the PBS Co-Payment Measure forms below: • Practice Incentives Program Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Patient Registration and Consent form • Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Multiple patient registration and consent form • Patient withdrawal of consent form

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Annotation of prescriptions under the measure

Once your patient is registered and you wish to confer the benefits of the measure to them, you will need to annotate their prescription to indicate that it is to be dispensed with co-payment relief. Upon presenting a correctly annotated prescription to a pharmacy for dispensing, your patient will be supplied with the medicine at the reduced cost.

Prescription writing software can automate the annotation process for eligible patients. GPs will be able to annotate PBS prescriptions with the CTG flag by activating a check box on the patient information screen in their prescription writing software. The annotation is NOT linked to personal details of your patient, or to you or your practice.

If practices don’t have the updated version of this software or don’t use this software, the GP can handwrite the annotation on the prescriptions. All that needs to be written is “CTG” and the GPs signature or initials. The annotation will need to be printed on the right hand side of the prescription to the right of the “patient’s name and address” area.

See appendices for: • Best Practice and Medical Director instructions for setting up CTG Co-payment Measure inside the clinical software.

PBS listings for Aboriginal and Torres Strait Islander people

To improve the capability of the PBS to better meet the needs of Aboriginal and Torres Strait Islander people, the Pharmaceuticals Benefits Advisory Committee evaluates and recommends the listing of medications specifically to help with their health needs. This list details all PBS items that are limited for prescription to Aboriginal and Torres Strait Islander people.

To access the current listing go to: http://www.pbs.gov.au/info/publication/factsheets/shared/pbs- listings-for-aboriginal-and-torres-strait-islander-people

Involvement of medical specialists in the PBS measure

The PBS measure recognises that medical specialists are key members of the multi-disciplinary team necessary for the effective management of an Aboriginal and Torres Strait Islander patient’s chronic disease.

To ensure continuity of a patient’s care, medical specialists are eligible to annotate ‘CTG’ (Closing the Gap) prescriptions for eligible Aboriginal and Torres Strait Islander patients under the measure when they are:

• Providing services at a non-remote (urban or rural) Indigenous Health Service; or

• Treating an eligible patient that has been referred by a GP from a PIP Indigenous Health Incentive practice or participating Indigenous Health Service

When referring eligible patients, GPs have been asked to indicate to the medical specialist that the patient is eligible to receive more affordable PBS medicines under the measure. For example, a GP may use the following words or similar in their referral:

“John Citizen is eligible for extra assistance with the cost of medicines. To ensure he is able to access this, please annotate the top of any prescriptions with the letters ‘CTG’ and initial or signature”.

Registration for the PIP Indigenous Health Incentive and the PBS Co-payment Measure are independent of each other. A patient can choose to participate in the PBS Co-payment Measure and choose not to participate in the PIP Indigenous Health Incentive, or vice versa.

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6. FREQUENTLY ASKED QUESTIONS

Patients with a mental health condition

Patients with mental health conditions may be eligible to access the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative (Better Access Initiative). The initiative was introduced in November 2006 to provide early intervention by general practitioners (GPs), psychiatrists, psychologists and appropriately trained social workers and occupational therapists to improve support for patients with mental health disorders in the primary care setting.

If a GP assesses a patient as having a mental health disorder, and as a consequence prepares a GP Mental Health Treatment Plan (MBS item 2700, 2701, 2715 or 2717), then the patient may be eligible for up 10 MBS rebate able services through the Better Access scheme or up to 18 Access to Allied Psychological Services (PSS) Medicare rebated services per calendar year

If a patient is diagnosed by their GP with a chronic disease and complex care needs, and as a consequence prepares a GP Management Plan and Team Care Arrangements (MBS Items 721 and 723), the patient may be eligible to receive up to five allied health services per calendar year.

Where the patient has a mental health condition as well as significant co-morbidities and complex care needs requiring team based care, the GP can use both a GP Management Plan and Team Care Arrangements; and GP Mental Health Treatment Plan.

Patients with multiple chronic conditions are eligible for a single GP Management Plan and, if those multiple conditions result in complex needs requiring care from a multidisciplinary team (team care), the patient will also be eligible for the Team Care Arrangement service.

Can patients get financial assistance with hospital issued prescriptions if they are enrolled for the PBS Co-payment Measure?

Answer: The Indigenous Chronic Disease Package (ICDP) and the PBS Co-payment measure focus on improving chronic disease management in the primary care setting. The ICDP does not include any measures to support activities in the acute care setting such as hospitals, but rather, it seeks to ensure that primary care practices have the resources they need for preventing, diagnosing, treating and managing chronic disease in their Aboriginal and Torres Strait Islander patients. Hence, prescriptions resulting from acute presentations at public hospitals are not included in the PBS Co-payment Measure.

What evidence do patients need to provide to confirm they are Aboriginal or Torres Strait Islander origin?

Answer: No documentary evidence is required. Patients are required to self-identify as being of Aboriginal and/or Torres Strait Islander origin for the purposes of the incentive, to reduce the administrative burden for both patients and practices. This is consistent with a number of other Government programs for Aboriginal and Torres Strait Islander people.

Does a patient have to withdraw their registration with their previous practice and register with our practice, in order to receive outcomes payments?

Answer: No. Practices may be eligible for either or both outcomes payments, even if the patient is currently registered at another PIP practice. However, a patient does need to be registered for the PIP Indigenous Health Incentive in order for the services provided to that patient to be counted in the calculation of outcomes payments. PIP Indigenous Health Incentive outcome payments are not linked to the practice a patient registers with. Outcome payments will be automatically calculated by Medicare Australia and paid to eligible practices, regardless of whether the patient is registered at that particular practice. This payment structure takes into account patient mobility, and also recognises those practices providing the majority of care to Aboriginal and Torres Strait Islander patients.

As patient re-registration is required each calendar year, if a patient’s usual practice changes, the patient can register with their new practice in the following calendar year.

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7. CESPHN ACTIVITIES AND PROGRAMS TO SUPPORT YOUR ABORIGINAL AND/OR TORRES STRAIT ISLANDER PATIENTS

Central and Eastern Sydney PHN (CESPHN) activities:

CESPHN has several activities planned to meet the objectives of the Department of Health, which are tailored to meet local needs including:

• Promotion of the program to community organisations through a range of methods

• Collaborating with Aboriginal health organisations to identify and address barriers to accessing primary care services

• Promoting general practice as a valid, trustworthy and accessible first point of contact for Aboriginal health needs

• Assisting general practices to manage specific Aboriginal health needs and issues at the local level

• Providing support to general practices on methods to encourage Aboriginal Australians to self-identify when accessing primary care services

• Coordinating education events for general practitioners, practice staff and other primary health care providers, including cultural awareness training and quality improvement activities

Integrated Team Care

CESPHN has an Integrated Team Care which oversees the programs directly assisting Aboriginal and Torres Strait Islander people.

These programs include:

• Care Coordination and Supplementary Services Program (CCSS)

• Outreach Worker Program

See on the following pages information on these programs and how general practices can refer to them.

Contact the Integrated Team Care on 9799 0933 for more information on these programs.

Practice Support

Our Practice Support team can assist you with general practice enquiries regarding the Aboriginal and Torres Strait Islander health programs and the Indigenous Health Incentive.

CESPHN offers Cultural Awareness Training for General Practice and Allied Health staff. To find out when the next training session might be, please contact the Practice Support team.

Central and Eastern Sydney PHN

Tower A, Level 5, 201 Coward St • Mascot NSW 2020 Email: [email protected] Website: www.cesphn.org.au

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Care Coordination and Supplementary Services Program (CCSS)

This program is for Aboriginal and Torres Strait Islander people. Care coordinators work with the GP to help coordinate the patients care, organise and communicate with appropriate health service providers and may be able to provide some financial assistance for clients to access required health services.

Care coordinators are clinically trained and qualified staff who can:

• Work with clients to help them understand and manage their health needs

• Let clients know about and connect them in with community based services

• Assist with organising the right health services for the client

• Coordinate, and if needed pay for travel to and from appointments

• Coordinate payment for specialist doctors and other allied health services e.g. physiotherapist, podiatrist, diabetes educators

Who this service is for?

Aboriginal and/or Torres Strait Islander people who:

• Currently have a chronic disease such as: diabetes, cancer, renal, heart or respiratory disease and

• Have a doctor within the CESPHN catchment region

Cost of service:

There is no cost to the patient for any of the services care coordinators provide

Referral

The doctor should complete an Aboriginal health assessment (MBS 715) or GP Management Plan (GPMP) with the patient before referring to this program.

A referral form for GPs to complete is available in word or template format at: https://www.cesphn.org.au/programs/practice-support-and-accreditation/templates

GPs should fax the referral form to 9009 0690 (this is a secure fax number).

See appendices for: • Care Coordination and Supplementary Services Program (CCSS) Patient Brochure • Care Coordination and Supplementary Services Program (CCSS) – Referral form

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Outreach Worker Program

An Outreach Worker can help with:

• Assisting patient registration with medical practice staff • Provide practice assistance to clients to:

 Attend doctors’ appointments

 Access other health services as required including follow up care, specialist services and coordination of care • Provide feedback to clients on a range of available services including:

 Closing the Gap Incentive

 Aboriginal and/or Torres Strait Islander health assessments

 the PBS Co-payment Measure • provide clients with health information to support culturally appropriate healthy lifestyle choices • assist clients with collection of prescribed medicines and information from pharmacists • assist clients with completing forms (if needed) and communicating with medical staff • distributing information and resources to the local community about available services and encouraging contact with primary health care services in the area • providing additional information about other relevant Closing the Gap programs and how to access them including: • tobacco programs, health and wellbeing programs

Cost of service?

The outreach worker service is free and confidential.

Where can the outreach worker see a client?

In some circumstances the outreach worker may arrange to visit clients in their home. They can also arrange to meet clients at a health service premises or somewhere appropriate.

Referral

A client can be referred to the Outreach Worker program by:

• Self-referral • Clients doctor (GP or AMS) • Clients specialist • An Aboriginal health worker • A family member • Another service or organisation

A referral form for GPs is available in word or template format at: https://www.cesphn.org.au/programs/practice-support-and-accreditation/templates

GPs should fax the referral form to 9009 0690 (this is a secure fax number).

See appendices for: • Outreach Worker Patient Brochure • Outreach Worker – Referral form

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HealthPathways - Sydney

HealthPathways is an online health information portal for General Practitioners, to be used within patient consultations. It provides information on how to assess and manage medical conditions, and how to request timely input from specialist services.

The name HealthPathways reflects the referral lines or ‘pathways’ which connect patients to the right care, at the right place and with the right healthcare provider.

HealthPathways is primarily used by GPs, but is also available to specialists, nurses and allied health professionals, connected with Central and Eastern Sydney PHN (CESPHN) and Sydney Local Health District SLHD).

How will HealthPathways benefit patients?

HealthPathways is designed to improve patient outcomes by ensuring they receive the right treatment and experience shorter waiting times.

For more information and access to HealthPathways Sydney, contact the team on 8752 4939.

See appendices for: • HealthPathways – Sydney information sheet

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8. APPENDICES / RESOURCES:

Resources include

• Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Practice Application form • Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Patient Registration and Consent form • Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Multiple Patient Registration and Consent form • Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-payment Measure Patient Withdrawal of Consent form • Health Assessment for Aboriginal and Torres Strait Islander people - (MBS Item 715) • Patient Information Sheet – Closing the Gap on Indigenous Health Outcomes • CESPHN Information Sheet – Implementing Closing the Gap • CESPHN Information Sheet – Steps to MBS Claiming pathways for Aboriginal and Torres Strait Islander Patients • CESPHN – Best Practice CTG Co-payment Measure • CESPHN – Medical Director CTG Co-payment Measure • CESPHN – Referral form – Care Coordination and Supplementary Services Program (CCSS) • CESPHN – Referral form – Aboriginal Outreach Worker Program • Care Coordination and Supplementary Services (CCSS) - Patient Brochure • Outreach Worker – Patient Brochure • Health Pathways – Information sheet • Closing the Gap Scripts – Patient Brochure • Consent Form – Practice Incentives Program Indigenous Health Incentive (PIP – IHI) and Pharmaceutical Benefits Scheme (PBS) Co-payment Measure

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Central and Eastern Sydney PHN acknowledges the traditional custodians of the land on which we work.

Central and Eastern Sydney PHN is a business unit of EIS health ABN– 68 603 815 818

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