Practice accreditation for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) – Practice Stream 012-10010010

The Australian Commission on Safety and Quality in Health Care (the Commission) is responsible for managing a number of national accreditation schemes, including the NGPA Scheme.

Under the NGPA Scheme, general practices accessing the PIP and/or the WIP - Practice Stream must be assessed by an approved accrediting agency. The approved agencies are:

• Australian General Practice Accreditation Ltd (AGPAL)
• Quality Practice Accreditation Pty Ltd (QPA) - formerly General Practice Accreditation Plus (GPA)
• The Australian Council on Healthcare Standards (ACHS)
• Global-Mark (GMARK)

Advisories for the NGPA Scheme

An advisory is a formal communication issued by the Commission to accrediting agencies and general practices. Advisories provide guidance and direction on the interpretation and/or assessments under the NGPA Scheme. Advisories are periodically reviewed to ensure they remain current.

More information is available on the Commission’s website.

Practices participating in the PIP and/or WIP - Practice Stream must be accredited or registered for accreditation to be eligible.

Registered for accreditation - a practice is registered for accreditation with an accrediting agency and working to meet the requirements of the RACGP Standards for general practices. If registered for accreditation, practices must achieve accreditation within 12 months of being approved the PIP/WIP - Practice Stream to remain eligible for payments. If the practice participates in the WIP- Practice Stream and is PIP consenting, the 12-month period is from the approval date in PIP, unless the approval date in WIP - Practice Stream is earlier.

Accredited - independent recognition that a practice meets the requirements of the Royal Australian College of General Practitioners (RACGP) Standards for general practices.

Accreditation must:

• meet the RACGP Standards for general practices
• be provided by an approved accrediting agency approved under the National General Practice Accreditation Scheme

Other types of practice accreditation, such as Medical Deputising Services (MDS) and After Hours Medical Services, are not eligible.

Practices must be accredited at the point in time date of each relevant payment quarter to be eligible for the quarterly payment. The point in time date is the last day of the month before the quarterly payment.

For example:

A practice was approved for the PIP on 29 July 2022 and was registered for accreditation. The practice must achieve accreditation within 12 months (29 July 2023) to remain in the program. They did not achieve accreditation until 10 August 2023.

The practice is not eligible for the August 2023 quarterly payments.

This is because the point in time date for the August 2023 payment quarter is 31 July 2023. The practice was not accredited on this date.

An approved accrediting agency will provide a certificate to the practice certifying it is either:

• registered for accreditation as a general practice, or
• accredited as a general practice

The Resources page has a link to a list of approved accrediting agencies.

Practices must provide their accreditation certificate or registered for accreditation certificate to Services Australia (the agency) when they apply, and when the practice relocates, amalgamates or changes ownership.

Certificates must include, but are not limited to, the following information:

• the name of an approved accreditation agency under the NGPA Scheme
• accreditation type (accredited or registered for accreditation)
• practice, trading or company name
• physical practice location
• registration number (the unique identifier issued by the accrediting agency) / for accrediting practices, the certificate number (the unique number issued by the Australian Commission on Safety and Quality in Health Care
• the name of standards used to assess the practice’s accreditation status:
• For example: RACGP Standards for general practice standards 5^th Edition
• the date the period of accreditation begins (start/commencement date)
• the date the period of accreditation ends (end/expiry date)

Note: the accreditation standard for PIP and WIP - Practice Stream must be for general practice.

Practices do not need to provide evidence of ongoing accreditation unless the agency requests it.

Accreditation data from accrediting agencies will be uploaded into PIP and WIP - Practice Stream Online systems on a monthly basis. This upload does not include registered for accreditation data. The registered for accreditation data is only entered when the practice applies for the program(s).

Practices cannot update their accreditation through Health Professional Online Services (HPOS).

Practices must keep records of their accreditation for 6 years for compliance purposes.

Practices that do not achieve accreditation within 12-months of approval in the program(s), are not eligible for payments. This is regardless of whether an extension to the registration period has been granted by the accrediting agency. Practice payments will be automatically held and the three quarter rule will apply.

If a practice achieves accreditation after the 12-month period:

• they are not eligible for quarterly payments where they were not accredited at the payment point in time (PIT) date
• payments will re-start from the next payment quarter where the practice is accredited at the payment PIT date

Additional practice branches that provide more than 3,000 Medicare Benefits Schedule (MBS) services per annum must:

• be accredited, or be registered for accreditation in their own right, to be eligible to participate in the PIP and/or the WIP - Practice Stream
• achieve accreditation within 12 months after they reach 3,000 MBS services per annum

It is the practice’s responsibility to monitor their own MBS services and comply with eligibility requirements. The number of MBS services for each additional practice branch is available on each PIP payment advice.

If a practice relocates, it will need to submit an accreditation certificate that includes the new practice address.

The practice must provide a copy of their new accreditation certificate to the agency within 6 months of relocating. Practice payments are placed on hold until the certificate is provided and the three quarter rule will apply.

Program management will monitor this and take the appropriate action.

When a relocated practice provides a new accreditation certificate and payments are on hold because of the relocation:

• the payment hold must be removed, and
• the details added to the Payment Release Request spreadsheet for program management to release any held payments

To be eligible for withheld payments, the dates on the new accreditation certificate must cover the point in time (PIT) date of the quarter in which the practice relocated and the PIT dates for any withheld payment quarters. For more information about accreditation requirements for a practice relocation, see The National General Practice Accreditation Scheme.

The practice name on an accreditation certificate must match either the registered practice name, company name or trading name. If the practice name changes where a sale of the practice has occurred, it will need a new accreditation certificate with the new practice name.

The practice must provide a copy of their new accreditation certificate to the agency within 6 months of the date of sale. Practice payments are placed on hold until the certificate is provided and the three quarter rule will apply.

Program management will monitor this and take the appropriate action.

Registered for accreditation

When a practice that is registered for accreditation requests an extension to the 12-month period to achieve accreditation since joining the program(s):

• They must be advised to send an email, outlining the reason for the request and providing any supporting documents:
• Supporting documents could include information from their accrediting agency (for example, an email confirming a cancelled assessment)
• the practice should not be advised to seek additional information from their accrediting agency
• the request must be escalated to Local peer Support (LPS) via PaNDA
• the email request from the practice and any supporting documents must be included
• Program management will work with the Department of Health and Aged Care to consider these requests on a case by case basis
• Do not upload extended registered for accreditation details
• a comment must be added to the practice profile

Extensions to registration details that are not recorded by Program Management should be removed and escalated to LPS via PaNDA for further assessment.

Program management will:

• co-ordinate the approval process with Department of Health and Aged Care
• if approved, arrange for any held payments to be released
• record approved extension to registration dates and add comments to the practice profile

Accredited

Practices can only get extensions to their accreditation in extenuating circumstances. The Resources page has a link to the Commission’s webpage. This contains information about the NGPA Scheme and the latest advisory for extensions to accreditation.

Practices seeking extensions must contact their accrediting agency and provide evidence of their extenuating circumstances for assessment. Accrediting agencies must refer all requests for extensions to the Commission. Neither Services Australia nor the accrediting agency have the authority to grant extensions.

Practices that have not allowed sufficient time to finalise administration of accreditation decisions will not be given an extension to their accreditation. Accrediting agencies cannot backdate or change the date of commencement for the new cycle to maintain continuous accreditation.

If practices are granted an extension to their accreditation by the Commission, program management will:

• update the new accreditation details in PIP Online
• determine payment eligibility to release any withheld PIP & WIP - Practice Stream quarterly payments

Gaps in accreditation:

• are not automatically identified by the PIP and WIP - Practice Stream Online systems
• are only identified by a Service Officer during usual work processes or program management during the monthly accreditation data upload process

If the point in time date(s) for relevant quarter(s) is not covered by the new certificate, this is considered a gap in accreditation. Escalate to LPS via PaNDA for further investigation and escalation to program management.

Program management will place the practice payments and hold and send a letter to the practice regarding the gap in their accreditation and advise what they need to do if they do not agree with the decision.

Practices will get reminders to renew their accreditation from their accrediting agency.

Practices are not eligible for payments if their accreditation status changes from accredited to registered for accreditation. The Service Officer and/or program management must place the practice payments on hold and the three quarter rule will apply.

For example, this may occur if the practice relocates or changes accrediting agencies.

If a practice then achieves accreditation and remains approved in PIP and/or WIP - Practice Stream:

• the practice is not eligible for quarterly payments where they were not accredited at the point in time (PIT) date of each payment quarter
• payments will recommence from the next payment quarter where the practice is accredited at the PIT date

Escalate changes to a practice’s accreditation status to LPS via PaNDA for further investigation. Program management will advise Service Officers what the next steps are, such as contact with the practice or recovery of payments.

Service Officers can only remove an accreditation record for practice relocation, amalgamation or an incorrect accreditation update by another Service Officer.

If the Service Officer needs to remove the accreditation details for any reason other than above, it must be escalated to LPS via PaNDA for further investigation..