Love me, tender, love me true, all my dreams fulfilled.
For my darlin' I love you, and I always will.
Love Me Tender, Cinemascope Films, 1956

Two of the North Coast Primary Health Network’s tenders for the delivery or services to North Coast GPs and their patients have closed in the last month

The first contract is for an organisation, or organisations, to provide educational services to primary care practitioners from the Tweed to Port Macquarie. These services are directed at medical practitioners, nurses, allied health practitioners and pharmacy and focus on the NCPHN’s target areas for the next triennium.

The contract is thought to best suited to large educational organisations that have the capacity to cover both the large footprint of the NCPHN and to deliver quality programs for health professionals with diverse interests and responsibilities.

Local medical practitioners are hoping that the funding will allow the return of the nascent clinical societies in the Richmond Valley that were first started by the NCPHN when funded under its prior arrangements.

The tender documents have been removed from the NCPHN’s tendering portal as is standard tender practice and no further information is available from the NCPHN while it works its way through its commissioning cycle.

The NCPHN’s Exercise as Medicine tender has also closed recently. The aim of the project was to get a select group of chronic disease patients from a select group of North Coast practices to engage in a regular exercise program.

The project is novel in that the practices will be paid a success fee for those patients who improve on performance measures over a six month period. This payment is available every six months if the patient improves from their previous baseline and is in addition to the usual start up and service delivery funds of the project.

Health funders have long preferred paying for outcomes rather than activity and this project will be watched closely around the country.

Some, however, have expressed concern that they are taking on significant risk if they are relying on payments that are dependent on the actions of others. The financial incentives to take on such a project will need to be very high to justify the risk and many practices have chosen to not apply.

Some practices have expressed concern that these bonus payments will be viewed as a money making venture for the doctors and not focussed on achieving the best for the patient. There could be a temptation to skimp on service delivery to maximise profit.

There is the also potential to game the system by “pulsing” the health of the patient to achieve the bonus payments on every second round of the six month cycle of the project.

Exercise as medicine is a long term undertaking and requires a long term approach if the benefits from this important intervention are to be achieved. The Exercise as Medicine project goes for three years and its continuation beyond that will depend on its success. Clearly, however, a sustainable approach is required.

Many GPs are confused by these changes to patient care and the strange new world of the tender. At this early stage few are keen to swipe right.