There is much to praise in the federal government’s plans, announced yesterday, to improve the care of people with diabetes by establishing a system of voluntary enrolment with general practices.

The idea of people with living with chronic conditions (including diabetes) being encouraged to enrol with, and obtain services from, a nominated primary care practice has a great deal to commend it. There are the obvious attractions of a more enduring relationship between patients and the people who deliver their health care.

The plan to offer annual “lump sum” payments to cover the costs of those patients’ primary care services represents a bold, and many would argue long overdue, move away from Medicare’s historic reliance on face-to-face consultations with doctors.  It could do a great deal to foster more innovative use of non-medical staff and may even open up the door to telephone or web-based services — all of which are models of care delivery that Medicare has effectively precluded.

The announcement also suggests that practices will be eligible for additional performance-related payments if they can provide better care and improve health outcomes.

For the first time Medicare will pay for achieving outcomes rather than simply incentivising activity per se.

All in all, a very positive move but — as was also said about the announcement of plans for a national health and hospitals network — the devil really is in the detail.

It’s not clear from today’s announcement whether the proposed annual payments are intended to cover all an individual’s MBS-eligible primary care services, or just those associated with their diabetes.

The former would expose practices to significant, and probably unacceptable, financial risk and seems far too fundamental a change to the basic premise of Medicare.

On the other hand, the latter creates the very real challenge of defining what is, and what is not, diabetes related. People with diabetes are more likely to suffer from a variety of other conditions (or to face more severe symptoms when affected by such conditions).

Will the lump sum be expected to cover all or some of their “excess” use of services as an indirect consequence of their diabetes?  It is also possible to imagine a less than wholly scrupulous practice enrolling patients, collecting the appropriate lump sum payments and then determining that none of their subsequent visits are diabetes related and claiming additional fee-for-service Medicare benefits.

Questions of choice will also doubtless arise. If a patient has enrolled with practice A for her diabetes care then chooses to visit practice B will her visit still be MBS-eligible?  Even if it is diabetes related?  The intention is clearly that practice A should accept full responsibility for that patient’s diabetes related care but how is practice B to know that such an arrangement is in place?

And what of co-payments?  Once a lump sum payment has been made are all subsequent services (or all subsequent diabetes-related services — assuming they can be identified) to be bulk-billed?  If not, receptionists could face an interesting challenge in explaining to patients why they can’t obtain  a Medicare subsidy for this week’s (diabetes related) consultation when they were able to claim for last week’s (non diabetes related) consultation.

Others will doubtless find more devilish details — and there can be nothing more frustrating to those tasked with reform than living in a world where every glass seems permanently to be half-empty.

Perhaps there is a case for greater clarity in announcements of such significance.

It will certainly be a pity if this genuinely good and innovative proposal is lost in a mire of nit-picking criticism.

*Philip Davies is Professor of Health Systems and Policy at the University of Queensland’s School of Population Health and a former deputy secretary at the Department of Health and Ageing