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REPLACING Medicare Locals with Primary Health Networks represents a golden opportunity to address problems in the health system — provided there is cooperation between all levels of government, GPs and health organisations, according to GPs and health policy experts.
Associate Professor Suzanne Robinson, director of health policy and management at Curtin University, told MJA InSight that GPs were the “cornerstone of primary care” and that some Medicare Locals “did a great job in engaging general practice”.
However, she said the Primary Health Networks (PHNs) and GPs needed to work together with state governments and other health providers to “really focus on the needs of the patient population”.
Professor Robinson was commenting on research published this week in the MJA which found that the experience of Medicare Locals provided valuable lessons for the new PHNs in Australia. (1)
The researchers conducted a qualitative study based on interviews with key staff members from five Medicare Locals and five Local Health Networks (LHNs) in South Australia. A total of 34 interviews were completed in 2014.
The researchers, who admitted their results might not be generalisable to other states and territories, said that during the short period that Medicare Locals existed in South Australia, they were “successful in identifying local needs and building good relationships with a range of stakeholders and health providers, particularly GPs and allied health professionals”.
“Our study reports examples of such collaborations, and provides some lessons that may assist PHNs during and after their establishment”, they wrote.
However, they said fostering networks of the kind that Medicare Locals established was a complex and time-consuming venture.
“This underlines the need for rigorous evaluation of any health care reforms, and for assessing the extent to which the reforms have helped to improve levels of equity, effectiveness, efficiency, quality and sustainability”, they wrote.
Associate Professor Gawaine Powell Davies, CEO and senior research fellow at the University of NSW’s Centre for Primary Health Care and Equity, said the research demonstrated the importance of collaboration.
He told MJA InSight that a big challenge ahead for PHNs would be trying to engage with general practice on a large scale.
“There are a lot of GPs out there. Some are enthusiastic, some are not interested, and some are hostile [about engaging with PHNs]”, Professor Powell Davies said.
“There’s also no organisational structure between general practices — so it’s going to be like herding cats”, he said.
However, while PHNs did represent a chance to move towards a tighter and more organised system, “to expect them to be able to solve all the systemic problems [in the health system] is naive”, Professor Powell Davies said.
Professor Stephen Duckett, director of the Grattan Institute’s Health Program, told MJA InSight that another likely danger for PHNs was potential interference and micromanagement by the federal government, when “PHNs should be focused on responding to the needs of local communities, not Canberra”.
Professor Duckett said the primary objective of all PHNs should be addressing the growing burden of chronic illness, which “the current health system is not responding to”.
“This will involve innovation and thinking of ways to build relationships between primary and secondary care”, he said.
Dr Arn Sprogis, chair of the Australian Medicare Local Alliance, agreed, telling MJA InSight that the management of chronic illness was clearly “the single biggest challenge facing health care”.
However, Dr Sprogis said that so far the PHNs lacked clarity, and their goals and direction were vague.
“What are they? Who are they for? What are the deliverables, and when will we see these deliverables?”
Dr Sprogis said the key deliverable should be to improve chronic care as quickly as possible, which would reduce the number of hospital admissions.
“I don’t think we need a geological age to achieve a deliverable. If there is focus and clear understanding, we could achieve this in a year.”
However, Professor Robinson said that it would be difficult to demonstrate effectiveness around changes to hospital admissions within the 3-year funding window of the PHNs.
“This short time frame could also take the focus away from prevention and promotional activity.”
Professor Robinson said that, overall, PHNs faced a tough task, but also provided a great opportunity.
“There needs to be a political will that cuts across the tiers of government and the political parties, as well as a commitment to invest and support PHNs over the longer term.”
(Photo: Global Health)
Many Divisions (and Medicare locals after them) provided a lot of services that GPs and particularly their staff used. Coordinating local CME for GPs and practice staff, assisting with many aspects of practice management accreditation, liasing with state health services and helping navigate new initiatives. Health promotion and assistance for disadvantaged groups. Many Medicare locals also assisted with patient care – particularly in our area employing counsellors and psychologists.
I wonder if the GPs who made negative comments checked with their practice staff or in fact made themselves aware of the services provided by their local network.
Whether the new structure does as good a job is yet to be seen – personally I think they are too large.
The first task of our local PHN was the setting and running of our new Government Superclinic. This clinic has not been welcomed by the local GP community. It pushes traditional General Pratice aside and starts the “race to the bottom” because we cannot compete in terms of infrastructure or funding. Fee for service doctors have found their hands firmly held up behind their back to compete. Their second task was to sidestep After hours care completely and use a phone message referencing the local GPs to take the load.
Hardly a good start towards workng together. In this rural community GPs are doing a pretty good job of managing chonic disease, thanks . I am sceptical the PHN will add anything.
I am surprised at the negative comments from others. I am a primary health care nurse and I have found the educational, networking and targetting of local needs by Medicare Locals invaluable. I work in a rural general practice co-owned by my GP husband who makes a pretty good living from what he does while my professional peers and I receive a relative pittance to support the work of the GPs in all areas of their work. I tire of hearing GPs talk about how hard done by they are financially when PNIPs plus item numbers associated with the work of primary health care nurses (GPMP/TCA preparation and reviews, health assessments and 10997) generously supports the employment of nurses in general practice with most of the proceeds going into the pockets of the GPs.
The PHN structure has significantly centralised the previous functions of diverse Divisions of Gentral Practice and less diverse Medicare Locals. The latest model seems to have repositioned GP’s at the centre of the model, a departure from the earlier reform which sought to expand control to allied health and consumers in shaping the future design of primary health care in Australia. The fact there is a clear sense of estrangement towards the new model from the stakeholders this new structure is meant to support so early may be a lingering reaction of the impact of the changes to the Divisions structure. While this may be overcome by repositioning GPs at the centre of primary care, consideration of engaging and including critical stakeholders at the margins such as the Aboriginal Community Controlled sector will be required to make real advances to the existing and emerging challenges ahead
I have yet to learn the real nature of “Medicare Locals” or know what they did, because certainly, they were not involved with / engaged with / or communicate effectively with the GP community and the new organisation is likely to be simply a matter of rearranging the deckchairs on the Titanic. Same old , same old.
Sorry,… but for the amount of $$$ that were awarded to this white elephant MLs, I’m afraid that it has just given birth to a look-alike offf-spring.
AND
what are they doing about the crisis in General Practice with a freeze on Medicare GP rebates for the next 5 years. Governments on both sides have lost the plot, thumbed their noses at GPs when it comes to general practice and the service that GPs provide to the community… it simply cant go on this way.
YET, millions are squandered on these pseudo-organisations that produce little or no add on benefit to GPs.
What a disgrace.
I feel like it is the Emporer’s new clothes, that everyone seems to support the idea of PHNs, MLs etc. Frankly as a GP in SA I think the best thing would be to close down the system, take the money saved and spend it on pateint care services. If the PHNs disappeared tomorrow, it would have zero impact on my practice. I don’t know what they do anyway. The ML before it fell into the same category, and the Division before that was only marginally better but would have had no impact should that have ceased to exist.
Let’s stop pretending that there is something worthwhile and effective going on and see things as they really are.
I have no confidence in PHN’s having seen numerous organisations come and go. Like all Government bureaucracies it’s always about them and never a partnership. GP’s won’t gain any benefit. Supporting the coal face so we can survive doesn’t even occur to them. If you want GP’s to co-operate come out to practices and talk to us and see what we do. Try to establish some rapport and mutual goodwill. It’s called networking. Unfortunately you will have to go to each practice individually as our GP network was disbanded by Government when Divisions were replaced by Medicare Locals. One thing we won’t do is fill in forms for you just because you request them. We are not on salary and only earn a living by seeing patients. So if you are not helping us do our job, FORGET IT. I am certainly not going to do your job for you.
Rather than only interviewing staff of Medicare Locals, interviewing those clinicians and organisations that the MLs were supposed to be collaborating with would have given a more accurate picture of the situation. In reality, many GPs felt very disengaged with the MLs, and I have personally spoken to dozens of SA GPs, rural and urban. It was regrettably rare for them to express any positive comment about the MLs, and I was trying to put the ML’s case a lot of the time. I’d suggest that these results are not generalisable to South Australia either.