GP Component Guidelines

To be eligible for the GP Component, medical practitioners must provide primary care services in rural and remote locations, and meet the continuous service requirements.

Eligible locations are those within categories RA2-5 of the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system.
Check your RA status

Eligible services are listed as clinical services from the following sections of the Medicare Benefits Schedule Book:

• Category 1 – Professional attendances
• Category 2 – Diagnostic procedures and investigations
• Category 3 – Therapeutic services
• Category 7 – Cleft lip and cleft palate

Eligible services do not include optometry, dentistry, pathology and diagnostic imaging services. Bulk billing items 10990, 10991 and 10992 are also excluded.

Two systems are used to calculate incentive payments. They are:

System	Applies to
Central Payments System (CPS)	Medical practitioners who bill Medicare for their services. Payments are based on Medicare records of eligible services provided in eligible locations.
Flexible Payments System (FPS)	Medical practitioners who provide services outside the Medicare billing system (eg Royal Flying Doctor Services) which are not adequately reflected in Medicare records. Payment calculations will be based on number of sessions. To be assessed under the FPS, medical practitioners must contact the Rural Workforce Agency in the State or Territory in which they provide services.

Rural Workforce Agencies

Incentive payments to medical practitioners are scaled according to location (the practice’s RA location), practice time (length of time medical services have been provided in rural and remote locations) and clinical workload. The table below sets out the maximum payment available to medical practitioners practising in rural and remote localities.

RA Location	Practice Time in Rural and Remote Location
	0.5 year	1 year	2 years	3-4 years	5+ years
RA2(Inner Regional)	-	$2,500	$4,500	$7,500	$12,000
RA3(Outer Regional)	$4,000	$6,000	$8,000	$13,000	$18,000
RA4(Remote)	$5,500	$8,000	$13,000	$18,000	$27,000
RA5(Very Remote)	$8,000	$13,000	$18,000	$27,000	$47,000

Medical practitioners become eligible for an initial payment on completion of the appropriate qualifying period listed in the table below, provided they meet the continuous service requirements.
Note: This does not apply to medical practitioners eligible for grandparenting arrangements, or to medical practitioners ‘transitioning’ from the Registrar to the GP component of GPRIP.

RA	Frequency of payments
RA2	On completion of 4 active quarters
RA3	The first payment is made on completion of 2 active quarters. The second payment is made on completion of an additional 2 active quarters. Thereafter, payments are made on completion of 4 active quarters.
RA4
RA5

Quarters under the GP Component are set out below:

Quarters	Months
March quarter	January, February, March
June quarter	April, May, June
September quarter	July, August, September
December quarter	October, November, December

Eligible services in ‘active’ quarters count towards annual service. An ‘active’ quarter is one where the value of Medicare billed items:

• for eligible services
• provided by the approved medical practitioner
• in eligible locations
• meets the active quarter threshold of $4,000.
  

Where a medical practitioner works across different RA categories within an active quarter, the payment rate is based on the category with the highest value of Medicare billed services.

Medical practitioners whose clinical workload is confirmed by Medicare records as having met the annual payment threshold of $80,000 will receive the maximum annual payment.
For 6 monthly payments in RA3-5 locations, the maximum payment will be received where the clinical workload is confirmed by Medicare records as having reached $40,000 or higher (ie half of the annual payment threshold).

The continuous service requirements are 4 active quarters in every 8 quarters.
To maintain eligibility under the GP Component, medical practitioners must meet these requirements.
Medical practitioners who are inactive for more than 4 quarters in every 8 will need to re-start the qualifying period for that location (unless they’ve applied for and received approval for extended leave through the relevant RWA).

Payments are calculated in 3 steps:
Step 1: Calculate the medical practitioner’s Major Eligible Category for each active quarter and the Maximum Annual Payment Rate.
Step 2: Calculate the medical practitioner’s Activity Level Percentage.
Step 3: Multiply the Maximum Annual Payment Rate by the Activity Level Percentage. This equals the Payment Amount.

Example – Dr Example has received payments for his first year on GPRIP. He then spent the following year working between an RA3 and an RA4 location.

Step 1 - In order to determine his major eligible category and maximum annual payment rate, the following factors are taken into account:

	QTR 1	QTR2	QTR3	QTR4
Billing in RA3	$2,884.65	$2,884.65	$3,884.65	$3,461.58
Billing in RA4	$5,769.30	$5,769.30	$2,884.65	$11,538.60
Major Eligible Category (ie. where most billing occurred)	RA4	RA4	RA3	RA4
Max Annual Payment	$13,000	$13,000	$8,000	$13,000

Therefore, Dr Example’s maximum payment entitlement for the four quarters is:
($13,000 + $13,000 + $8,000 + $13,000)/4 = $11,750

Step 2 - Following this, the medical practitioner’s activity level percentage is determined:

For example:

	QTR 1	QTR2	QTR3	QTR4
Total billing per quarter	$8,653.95	$8,653.95	$6,769.30	$15,000.18

The activity level percentage is calculated as follows:

$8,653.95 + $8,653.95 + $6,769.30 + $15,000.18 = $39,077.38

$39,077.38/ $80,000* x 100 = 48.8%
* remembering that $80,000 is the maximum annual payment threshold.

Step 3 – Calculate the payment amount. This is done by multiplying the maximum payment amount ($11,750) by the practitioner’s activity level percentage (48.8%) as follows:

$11,750 x 48.8% = $5,734.00

Therefore, Dr Example would receive $5,734.00 for his second year of activity under the GP retention component of GPRIP. Please note that this is a basic example and each payment situation is unique. For specific information regarding individual payments medical practitioners are encouraged to contact DHS or the Department.

Where billing periods are completed in different RA categories, an average payment rate is calculated based on the RA category for each quarter with the highest value of billed service activity.
When qualifying for their initial payment under GPRIP, if a medical practitioner has any quarter within their first 2 active quarters classified as a Major Eligible Category RA2, a one year payment will be triggered, even if there are more remote locations (ie RA3 to RA5) in the period.

Medical practitioners who bill Medicare services will have their clinical workload automatically assessed each quarter while they are working towards their first or second installment. The Department of Human Services (DHS – formerly Medicare Australia) will advise and provide payment to medical practitioners when an installment is due.

The FPS applies to medical practitioners who provide services outside the Medicare billing system that are not adequately reflected in Medicare records eg Royal Flying Doctor Services.
The FPS assists medical practitioners in 3 broad categories:

• Medical practitioners who would have received CPS payments, but a period of acceptable leave has caused them to lose accrued eligibility.
• Medical practitioners providing eligible services through alternative forms of employment not captured under the CPS.
• Medical practitioners in isolated communities receiving minimal payments under the CPS that do not accurately reflect their workload.

To be assessed under the FPS, medical practitioners must contact the RWA in the State or Territory in which they provide services.
The FPS is available to medical practitioners in accordance with the following geographical locations:

Alternative employment
RA2-5	Medical practitioners working for the Royal Flying Doctors Services and medical practitioners working for Aboriginal Medical Services.
RA4-5	State salaried medical practitioners providing primarily primary care services, and medical practitioners performing procedural services to private patients in a hospital setting.
Top up provisions
RA4-5	Assists medical practitioners where their activity is not adequately captured under the CPS for reasons such as: excessive travel time to provide outreach services time spent providing population health work in Aboriginal communities the provision of essential services to a relatively small community.
Leave clustering
RA4-5	Medical practitioners working in remote communities under contract arrangements are entitled to cluster their leave, up to four months at the end of their contract, without compromising their accrued eligibility.

Leave provisions under the GP Component allow for up to 4 quarters of leave in every 8 quarters. Leave in excess of 4 quarters without permission may result in payment rates reverting to the base level (ie 6 month or one year payment level for the location).

Medical practitioners requiring leave for a period greater than 4 quarters should apply to the RWA in the State or Northern Territory they provide services in, as extended leave in excess of 12 months is possible under the FPS.

The table below sets out the length of time medical practitioners may be eligible for leave under the FPS.

Payment system	Length of leave	Justification
Flexible Payment System	4 quarters (12 months)	None required
	6 quarters (18 months)	Upskilling and secondary training
	8 quarters (24 months)	Maternity leave

These leave provisions enable medical practitioners who miss out on CPS payments to access their retention payments through the FPS. Once the leave period is finished and practitioners have returned to work and completed four active quarters, they will need to apply for incentives through the FPS with the relevant RWA to ensure that they are assessed at the correct year level. Any questions about this process should be directed to the RWA in your relevant State or Northern Territory.

Periods of leave in excess of 18 months for upskilling and secondary training, and 24 months for maternity leave (where permission has been granted) will result in the medical practitioner reverting back to the base payment amount (ie payment at the 6 month or one year level) regardless of time spent previously in that location.
Where exceptional circumstances exist, applications for periods of leave in excess of 8 quarters (24 months) must be submitted through the relevant RWA to the Department of Health and Ageing (the Department) for consideration. Exceptional circumstances will be reviewed on a case-by-case basis in order to ensure that medical practitioners are not unfairly disadvantaged due to circumstances beyond their control. Such circumstances will be reviewed by the Department, and may be referred to the GPRIP Advisory Body for consideration.

From 1 July 2010, grandparenting arrangements apply to medical practitioners who received payments under the previous RRP, or who had accrued activity in eligible General Practice Accessibility and Remoteness Index of Australia (GPARIA) locations, but were yet to receive RRP payments.
Payment rates are assessed under both GPRIP and RRP, and the medical practitioner is paid whichever of the payments is the higher.
Payment schedules under GPRIP grandparenting arrangements depend on individual circumstances prior to the transition to GPRIP on 1 July 2010.
For individual information on payment calculations, contact DHS on 1800 010 550.

• Grandparenting only applies to medical practitioners who received or were working towards an RRP payment prior to 1 July 2010 (ie providing services in GPARIA A to E locations).
• Medical practitioners must continue to satisfy the GPRIP continuous service requirements.
• Grandparenting arrangements will continue up to and including the June quarter 2013.
• Whilst grandparenting arrangements remain in place, the dual assessment continues each year, until such time as the medical practitioner becomes eligible for a higher payment under GPRIP OR ceases to qualify for a payment under RRP.
• At this time the medical practitioner will transition to GPRIP GP Component rules and payment rates.

Registrars with Australian General Practice Education and Training (AGPT) are paid under the Registrar Component until attaining Fellowship of Royal Australian College of General Practitioners (RACGP) or Australian College of Rural and Remote Medicine (ACRRM), or upon completion of all advanced training placements as approved by General Practice Education and Training (GPET). On completion of training, DHS, as advised by GPET and the Department, will make a final pro rata payment under the Registrar Component. Following this, practitioners are given an ‘end date’ for their Registrar training. This information is transmitted to DHS and the Department, who will ascertain a new annual payment point based on when the practitioner began training and receiving incentives.

The length of time Registrars receive payments under the Registrar Component is accrued and contributes to the payment rate (year) on transition to the GP Component.

Newly Fellowed medical practitioners continuing to work in an eligible location will receive a ‘transition payment’ providing they meet the continuous service requirements. Continuous service requirements for the ‘transition’ year are based on 4 active quarters out of 8 quarters – including both Registrar and GP activity. This payment is calculated by the Department on advice received from the DHS on the practitioners billing activity and payment and training history.

Upon receiving a transition payment under the GP Component, the medical practitioner will be set on the CPS, and the assessment of eligibility and activity will be conducted by DHS.

Each transition payment is unique, and based upon the medical practitioner’s training and payment history. For more information about individual circumstances medical practitioners should contact the Department at GPRIP@health.gov.au.

Payments under GPRIP are not subject to Pay As You Go (PAYG) withholding tax.
Recipients must, however, declare incentive payments for tax purposes, and are advised to seek advice from their financial adviser, accountant or the ATO regarding their own tax arrangements.

Medical practitioners may be eligible to apply for the Rural Relocation Incentive Grant (RRIG) while receiving payments under the GP Component, if they are considering a move to a more remote location than where they have been providing services over the past 12 months. Please note, medical practitioners must apply and be approved for a RRIG prior to relocating in order to be eligible to receive incentives under the relocation component of GPRIP.
See the RRIG Guidelines.
Registrars enrolled with GPET are not eligible for payments under the GP Component.

Medical practitioners who bill Medicare services do not need to apply as eligibility is automatically assessed and payments made by DHS. Medical practitioners will receive notification of eligibility from Medicare Australia and will be requested to submit a GPRIP Bank Details form in order to receive the payment.
Get the GPRIP Bank Details form (PDF).

Medical practitioners who do not bill Medicare services will need to contact the RWA in their State or the Northern Territory and make arrangements to be assessed under the Flexible Payments System.

For more information or help on GPRIP: GP Component:

• call DHS on 1800 010 550
• email the Department of Health and Ageing at GPRIP@health.gov.au
• contact the relevant Rural Workforce Agency:
  • Northern Territory - General Practice Network Northern Territory (08) 8982 1000
  • South Australia – Rural Doctors Workforce Agency South Australia (08) 8234 8277
  • Western Australia – Rural Health West (08) 6389 4500
  • Tasmania – Health Recruitment Plus Tasmania (03) 6334 2355
  • New South Wales - New South Wales Rural Doctors Network (02) 4924 8000
  • Queensland – Health Workforce Queensland (07) 3105 7800
    Victoria – Rural Workforce Agency Victoria (03) 9349 7800