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Round the Clock Medicare

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Round the Clock Medicare

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									                                Round the Clock Medicare
                Investing in After Hours GP Services (IAHGPS) Program

                           PROGRAM GUIDELINES
                                    Round 3: 2007-08
                               (RECENTLY CONCLUDED)


ABOUT THE PROGRAM

Background

Australia has a world-class health system, underpinned by a strong network of general
practice that is the first line of treatment for illness and injury.

The Government’s long-term goal is to ensure that as many people as possible have access to
quality and convenient GP services. Part of achieving that goal is to extend the reach of
general practice around the clock.

Announced in 2004, the Round the Clock Medicare: Investing in After Hours GP Services
(IAHGPS) Program supports the growth of after hours general practice through three funding
components:
   • Supplementary Grants;
   • Operating Subsidies; and
   • Start up Grants.

Together these funding components encourage the development of new after hours services
and assist existing services to maintain and enhance the GP care they currently provide in the
after hours period. The funding components target areas of “community need” where
establishment or extension of after hours services will have the support of the local GP
community without placing unfair competition pressure on existing services.

This is the third annual round of all three funding components in the IAHGPS Program.


Availability

Broadly speaking, funding through the IAHGPS Program is available to, and applications are
invited from:
    • organisations or groups of local GPs working together or under the sponsorship of the
        local Division of General Practice;
    • Medical Deputising Services; or
    • consortia made up of groups of local GPs and/or Divisions of General Practice
        working in partnership with other health service organisations in the local
        community.

Funding under the IAHGPS Program is offered on a competitive basis.



                                          -1-
Eligibility

Eligibility for the IAHGPS Program covers a number of elements:
    • the business structure of the group, organisation or consortium wishing to apply for funding;
    • the service delivery model designed to meet identified needs;
    • a commitment to quality of care;
    • a commitment to strive for sustainability of the service, both in workforce and financial terms;
        and
    • the capacity to improve continuity of care between the after hours services and the patient’s
        usual GP or health care providers.

Business Structure

Groups of local GPs working together or under the sponsorship of the local Division of
General Practice, Medical Deputising Services operating a clinic, or groups of local GPs
working in partnership with other health service organisations in the local community, are all
eligible to apply for support under the IAHGPS Program, as are consortia made up of any or
all of the abovementioned groups.

Service Delivery Models

There is no ‘one size fits all’ model of after hours service provision. After hours services
should:
     • meet local community needs
     • take into account workforce availability
     • take into account geographic, demographic and other factors likely to influence the
         after hours service’s long term viability.

Proposals are more likely to be successful if they clearly identify a service delivery model
which will significantly improve the community’s access to after hours services, beyond
what is currently available. Proposals that extend the customary hours of a service by a
couple of hours, or that offer care to only a specific group or groups within a community, are
unlikely to be supported.

Proposals for service delivery models that can be established quickly (e.g. within 6 months) are
more likely to be supported over proposals which include longer implementation periods.
Similarly proposals that have no administration cost or that keep administration costs to a
minimum are more likely to be supported than those that have a higher proportion of
administration costs in relation to costs that directly support after hours access.

Exemptions under Subsection 19 (2) of the Health Insurance Act 1973 are not available under
the IAHGPS Program. Service delivery models which require such an exemption, for example
to pay for professional services, will therefore not be considered for funding. [A ‘professional
service’ is defined as a service (other than a diagnostic imaging service) to which a Medicare
Benefits Schedule (MBS) item relates, being a clinically relevant service that is rendered by or
on behalf of a medical practitioner.]




                                          -2-
Commitment to Quality

All applicants will be expected to demonstrate a commitment to quality in all aspects of their
new or enhanced after hours service. Applicants will be expected to be accredited, or have
indicated a commitment to undergo accreditation, against standards relevant to their
organisation, for example:

   •   Existing services (general practices, dedicated after hours clinics and Medical
       Deputising Services) will be required to demonstrate evidence of their accreditation
       status against the RACGP Standards for General Practices 3rd Edition with
       supplementary explanations for after hours care services.
   •   New services will need to register for accreditation within 12 months of
       commencement of funding and attain accreditation within 18 months of registration.
   •   Divisions of General Practice are to be accredited against one of three sets of
       standards identified under the national quality and performance system for the
       Divisions of General Practice network.

Sustainability

Evidence from the evaluation of existing after hours services receiving Commonwealth
funding indicates that self sustainability is generally achieved within 2-3 years of
commencement of the service.

Proposed models for new or enhanced after hours services should therefore be developed
with a view to the service becoming self-sustaining within the funding period.

This said, the IAHGPS Program recognises that there may be a need to provide longer-term
financial support, of a ‘top-up’ nature, to some services to ensure that they can remain
financially viable. Supplementary Grants, offered on a competitive basis, provide up to
$50,000 per annum for up to 2 years to assist services in this regard.

An assessment of progress towards sustainability will be an integral part of the regular
reporting and accountability requirements of the IAHGPS Program.

Continuity of Care

All applicants will be expected to include details of how their new or enhanced after hours
service will improve the integration/interface between their service and the patient’s usual GP
and/or the local hospital.

Priority Areas

While all eligible organisations and/or consortia are encouraged to apply, priority will be
given to proposals for new or enhanced clinic based after hours services in outer suburban,
regional and rural areas, in recognition of the particular challenges faced by those areas in
terms of access to GPs and other primary care services.

GP cooperatives, Divisions of General Practice and/or Medical Deputising Services are
encouraged to consider extending the reach of their existing services, or to establish new
services in areas they would not have considered viable previously, provided that there is
evidence of assured access to a local GP workforce. In locations where workforce
recruitment and retention is an issue, applicants would need to clearly demonstrate that an
after hours service will be sustainable.
                                          -3-
Proposals

Funding recipients will be selected on the basis of their written proposals. The format for
proposals is provided in the electronic application forms for each of the funding components.
These can be found at www.health.gov.au/tenders

Proposals for funding will be assessed on their merits against each of the stated selection
criteria. The selection criteria for each grant type are set out at the end of this document (see
Individual Funding Components) and in the application forms for each grant type.

Information provided should be of a quality and quantity that clearly demonstrates the
concept and merit of the proposal. The only attachments should be those sought as
supporting documentation relevant to the criteria. Attachments not included with the
application form will not be accepted.

Application forms with more than 20 pages of attachments must be lodged in hard copy.

The Application Form has been formatted using text boxes. To write in these boxes, click
your mouse over the text box and then type into it.

Budgets should be provided on the ‘whole of service’, and should also clearly establish the
contribution that the grant funding will make to the overall financial position of the proposed
after hours service. Budgets must be provided for each year of the anticipated funding period
and must itemise the budget items for which the grant funding will be used in each year of
funding.

Grant funding is not available to pay for work undertaken to develop your funding proposals or
any other retrospective expense.

Budgets should not include GST. Any funding agreements offered will include a GST
component.

If an application is incomplete or contains information that is considered false or misleading
it will be excluded from any further consideration for funding.

If lodging the proposal in hard copy, four (4) copies of the completed application form,
including all attachments, should be forwarded to:

   Round The Clock Medicare
   Department of Health and Ageing
   Locked Bag 3000
   Woden ACT 2606

Where lodging by email, the completed application form, and no more than 20 pages of
attachments, should be forwarded to:

   Supplementary Grants – IAHGPS.SG@health.gov.au

   Operating Subsidies and Start up Grants – IAHGPS.OSSUG@health.gov.au

Hand delivered or facsimiled proposals will not be accepted.

Expressions of interest will not be accepted.
                                           -4-
Closing date

The closing dates for applications are as follows:

       Supplementary Grants                          25 May 2007
       Start up Grants                               15 June 2007
       Operating Subsidies                           15 June 2007

Proposals received after the closing date will not be assessed, except where it can be
identified that Department is at fault in causing a delay in receipt.

Requests for extensions will not be granted.

All proposals received will be acknowledged in writing, shortly after the closing date.

Information in proposals will be treated as ‘Commercial-in-Confidence’.

All proposals become the property of the Commonwealth on lodgement.

Questions and Answers regarding the Round the Clock Medicare IAHGPS Program grants
application process can be found at www.health.gov.au/tenders. These will continue to be
available until 15 June 2007.

Applying for More Than One Subsidy or Grant

To ensure the maximum number of after hours services can be supported, no after hours
service will be able to receive more than one grant at the same time under either the IAHGPS
Program or the After Hours Primary Medical Care Program (AHPMC Program).

This does not prevent services from seeking to secure funding under the IAHGPS Program
towards the end of their existing AHPMC Program funding period. If successful, IAHGPS
Program funding would not commence until the conclusion of the existing AHPMC Program
funding arrangements.

Similarly, services coming to the end of existing IAHGPS Program funding may be eligible
to apply for further assistance for example, under the Supplementary Grant component of the
IAHGPS Program. If successful, additional funding would not commence until the
conclusion of the existing funding arrangements.

Depending on eligibility requirements, applicants may apply for assistance under more than
one of the IAHGPS Program funding components at a time. However, a proposal will not
receive support through more than one funding component at a time.

Where applicants choose to apply simultaneously for more than one of the IAHGPS Program
funding components, they will need to complete and lodge separately (including by separate
emails) the relevant application form for each component of the Program under which
funding is sought.




                                          -5-
Assessment

Grants/subsidies are offered on a competitive basis with separate assessment processes
established for each of the funding components. In each process a Panel will assess
proposals against the selection criteria. Details on the weighting of each criterion are
provided under the individual funding component descriptions later in this document.

All selection criteria are considered essential. Proposals must meet a minimum benchmark
in each selection criterion, and a total score of at least 60 points out of a possible 100
points to be considered eligible for funding.

For each funding component, proposals will be ranked according to their score out of 100
and grants/subsidies will be allocated against this ranking, starting with the proposals with
the highest score.

In assessing the proposals, the Department reserves the right to have regard to such other
matters as it regards as relevant.

It is anticipated that assessment processes for the individual IAHGPS Program funding
components will be completed within twelve weeks of the closing date for applications.
However, if a higher number of applications than anticipated is received, the assessment
process may take longer. An approval process follows the assessment process and may take
several weeks. Please note that the Department will not provide any feedback on the
progress of individual applications during the assessment and approval processes.

All applicants will be notified in writing of the outcome of their application following the
assessment and approval process. Feedback to unsuccessful applicants will be available on
request in the period immediately following notification of the outcome of proposals.

Contracting

Funding agreements will be offered to preferred applicants in line with the following
principles:

   •   Funding offered will be based on the amount sought in the application but no more
       than the advertised amount available for the specific grant being sought.
   •   Funding offers will be valid for a period of 4 months from date of offer for
       Supplementary Grants and for a period of 6 months from date of offer for Start up
       Grants and Operating Subsidies. The Department reserves the right to extend or
       withdraw funding offers beyond these periods.
   •   The funding recipient signing the funding agreement must be a legal entity with the
       capacity to make an enforceable agreement on behalf of those submitting the
       proposal.
   •   Payment of funds under funding agreements will be linked to progress against
       activities as agreed in funding agreements.

The maximum timeframes over which funding will be provided vary across the three
IAHGPS Program funding components. Details of these timeframes are provided under the
individual funding component descriptions later in this document.




                                          -6-
Reporting Framework

As part of the contractual arrangements, all successful applicants will be required to complete
regular reports. These reports will provide the Department with, amongst other things,
information on service activities, achievements against the stated aims and objectives of the
service and expenditure of grant/subsidy funds.

Templates for activity and financial reports and for data collection will be provided.
Reports will contribute to the ongoing evaluation of the IAHGPS Program.

Evaluation

Successful applicants will be required to assess the impact of funding received on their after
hours service as part of the reporting process and participate in an external evaluation of the
IAHGPS Program. These requirements will be included in any funding agreement offered.




                                           -7-
INDIVIDUAL FUNDING COMPONENTS

Operating Subsidies

Objective
The objective of the Operating Subsidies component of the Investing in After Hours GP
Services Program is to increase the availability of quality after hours services through
subsidising new or recently established, well-located after hours GP clinics and Medical
Deputising Services wishing to establish clinic based after hours services.

Overview
The Government is providing Operating Subsidies of up to $200,000 (GST exclusive) a year.
The number of Operating Subsidies available in Round 3 (2007-08) is not yet determined but
is expected to be similar to the number made available in Rounds 1 and 2.

Operating Subsidies are provided on a recurrent basis for up to three years. The need for
funding will be reviewed periodically via progress reports during the funding period.

Subsidies will be provided for operating costs associated with:
   • establishing a dedicated clinic based after hours service;
   • significantly extending an existing standard hour clinic based service into the after
       hours period; and
   • a Medical Deputising Service establishing a clinic based after hours service.

These costs include ongoing staffing and running costs but exclude the purchase of assets and
payment of professional services (as defined on page 2 of these Program Guidelines).

After hours services are expected to achieve financial sustainability within the funding
period. Where there is a demonstrated need for additional support to remain viable beyond
the maximum three year funding period, after hours services may be eligible to apply for
further assistance through the Supplementary Grant component of the IAHGPS Program.

Eligibility
There are two overriding conditions to an after hours service receiving an Operating Subsidy.
It must have documentary evidence:
    • of support of the local GP community; and
    • that it does not compete unfairly with existing practices offering after hours services in the
        area.

Who Can Apply?
Applications are invited from:
   • organisations or groups of local GPs working together and/or under the sponsorship
       of the local Division of General Practice;
   • Medical Deputising Services; or
   • consortia made up of groups of local GPs and/or Divisions of General Practice
       working in partnership with other health service organisations in the local
       community.

What is a ‘recently established’ After Hours GP clinic?
A ‘recently established’ after hours GP clinic is defined as having commenced after hours
service operations in the current location since 15 June 2004. Applicants must include
evidence that the after hours service meets this definition.
                                          -8-
What is a ‘well-located’ clinic?
Factors that may help determine whether a service is ‘well-located’ include:
   • patient access after hours:
               central location for target patient population
               proximity to population centre (e.g. new housing estate)
               public transport
               parking

   •   safety and security:
               physical access (e.g. for aged patients, prams or wheelchairs)
               lighting
               security
   •   access to other after hours health services:
               hospital Emergency Department
               diagnostic imaging
               pathology
               pharmacy

Co-located clinics
Where the (proposed) after hours service is a clinic located in a public or private hospital, the
proposal needs to explain how the clinic would relate to existing hospital services, (for
example, Emergency Department) and the nature and level of contribution (whether cash or
in-kind) to be provided by the hospital. Where relevant, co-located clinics must operate in
accordance with the Australian Health Care Agreements.

What is a ‘significant extension’ to an existing standard hour service?
A ‘significant extension’ would generally be considered as an extension of 24 hours or more
per week beyond existing standard hour service levels.

Selection Criteria
There are five key selection criteria for Operating Subsidies. The weighting of each criterion
in calculating a score out of a possible 100 is indicated. These are:
        1. A Justified Service Delivery Model (20%);
        2. Demonstrated Community Need (20%);
        3. Demonstrated Support for the Proposed Service Delivery Model (20%);
        4. A Justified Business Case (30%); and
        5. Demonstrated Capacity to Implement and Manage the Proposed Service Delivery
            Model (10%).




                                           -9-
Start up Grants

Objective
The objective of the Start up Grants component of the Investing in After Hours GP Services
Program is to assist existing general practices and dedicated after hours clinics wishing to remain
open after hours and mobile Medical Deputising Services wishing to establish clinic based after
hours services.

Overview
The Government is providing Start up Grants of up to $200,000 (GST exclusive) over two
years on a one-off basis. The number of Start up Grants available in Round 3 (2007-08) is not
yet determined but is expected to be similar to the number made available in Rounds 1 and 2.

Start up Grants will be provided to support:
    • extension of an existing standard hour service into the after hours period;
    • extension of a dedicated after hours service;
    • a mobile Medical Deputising Service to establish a clinic based after hours service.

The Start up Grants will assist after hours services to get established in the period before a
strong cash flow develops from Medicare and other income. Funding may be used, for
example, to help to obtain premises, purchase equipment or recruit staff. Funding cannot be
used to pay for professional services (as defined on page 2 of these Guidelines).

Where there is a demonstrated need for additional support to remain viable beyond the
maximum two year funding period, after hours services may be eligible to apply for further
assistance through the Supplementary Grant component of the IAHGPS Program.

Eligibility
There are two overriding conditions to an after hours service receiving a Start up Grant. It
must have documentary evidence:
    • of support of the local GP community; and
    • that it does not compete unfairly with existing practices offering after hours services in the
        area.

Who Can Apply?
Applications are invited from:
   • organisations or groups of local GPs working together and/or under the sponsorship
       of the local Division of General Practice;
   • Medical Deputising Services; or
   • consortia made up of groups of local GPs and/or Divisions of General Practice
       working in partnership with other health service organisations in the local
       community.

Where Can the Service be Located?
Priority will given to proposals for after hours clinics in areas where there is a clear
community need for additional care after hours. It is anticipated that these areas will be
primarily, but not exclusively, outer suburban and regional areas.




                                          - 10 -
Co-located clinics
Where the (proposed) after hours service is a clinic located in a public or private hospital, the
proposal needs to explain how the clinic would relate to existing hospital services, (for
example, Emergency Department) and the nature and level of contribution (whether cash or
in-kind) to be provided by the hospital. Where relevant, co-located clinics must operate in
accordance with the Australian Health Care Agreements.

Selection Criteria
There are five key selection criteria for Start up Grants. The weighting of each criterion in
calculating a score out of a possible 100 is indicated. These are:
        1. A Justified Service Delivery Model (20%);
        2. Demonstrated Community Need (20%);
        3. Demonstrated Support for the Proposed Service Delivery Model (20%);
        4. A Justified Business Case (30%); and
        5. Demonstrated Capacity to Implement and Manage the Proposed Service Delivery
           Model (10%).




                                          - 11 -
Supplementary Grants

Objective
The objective of the Supplementary Grants component of the Investing in After Hours GP
Services Program is to assist established after hours services to meet their marginal costs and
so keep them financially viable.

Overview
The Government is providing Supplementary Grants of up to $50,000 (GST exclusive) on a
recurrent basis for up to two years. The number of Supplementary Grants available in Round
3 (2007-08) is not yet determined but is expected to be similar to the number made available
in Rounds 1 and 2.

The Grants will assist established after hours services to meet expenses where there is a
demonstrated need for additional support to remain viable.

Supplementary Grants may be used, for example, to:
   • provide incentives for GPs to participate on after hours rosters; and
   • provide assistance for support staff.

Supplementary Grants cannot be used to undertake developmental work (for example
research, draft proposals, convene meetings etc), for the purchase or lease of vehicles or
major medical equipment, or to pay for professional services (as defined on page 2 of these
Guidelines).

Where there is a demonstrated need for further assistance beyond the two year funding
period, after hours services can apply for a further Supplementary Grant.

Eligibility
A condition for an after hours service receiving a Supplementary Grant is that the service
does not compete unfairly with existing practices offering after hours services.

Who Can Apply?
Where they are operating an established rostered after hours clinic based or call-out service,
applications are invited from the following:
   • local general practices;
   • co-operatives or groups of local GPs working together and/or under the sponsorship
       of the local Division of General Practice; and
   • Medical Deputising Services.

Where Can the Service be Located?
Priority will given to proposals for after hours services in outer suburban and regional areas.




                                          - 12 -
Co-located clinics
Where the after hours service is a clinic located in a public or private hospital, the proposal
needs to explain how the clinic relates to existing hospital services, (for example, Emergency
Department) and the nature and level of contribution (whether cash or in-kind) being
provided by the hospital. Where relevant, co-located clinics must operate in accordance with
the Australian Health Care Agreements.

Selection Criteria
There are four key selection criteria for Supplementary Grants. The weighting of each
criterion in calculating a score out of a possible 100 is indicated. These are:
    1. Justified Service Delivery Model (25%);
    2. Demonstrated Community Need (25%);
    3. Sound Methodology for Utilising the Supplementary Grant (25%); and
    4. An Appropriate and Well-Defined Budget (25%).




                                          - 13 -

								
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