Continuing the Croakey discussion about how the new primary health care organisations to be known as Medicare Locals will work….
Michael Moore, CEO of the Public Health Association of Australia, writes:
The politics of health expenditure over the last couple of decades has been overwhelmingly on hospitals, emergency departments and elective surgery waiting lists that provide the fodder for opposition parties in the political arena.
It is great that Scott White and GP Access are taking seriously the transition from a Division of General Practice to a genuine primary health care organisation.
As part of the national health reform agenda, the focus has turned from hospitals to what GPs and other health professionals can achieve within the remit of the Medicare Locals. The emphasis has been in areas such as better treatment, coordination, delegation, education and management of resources. It is good that the growing role that nurses, pharmacists and other allied health professionals can play is also being appropriately recognised.
However, the focus on the establishment of the Medicare Locals as alternative Primary Health Care Organisations (PHCOs) to the Divisions of General Practice raises the questions about what real change will take place.
The Primary Health Policy of the Public Health Association of Australia (PHAA) suggests that an effective primary health service will include a multidisciplinary range of services and programs that is well beyond the current emphasis on the role of GPs.
Such services will be accessible, equitable, culturally respectful, safe, effective and efficient. The approach will include prevention and health promotion and should empower the population to prevent risk behaviours and more effectively self-manage chronic conditions. The view of public health professionals focuses on improving health of populations rather than individuals.
Although there is an an excellent report from The Preventative Health Taskforce, action is needed not just on tobacco, alcohol and obesity but on a range of other public health measures.
There are still remote communities within Australia that do not have appropriate environmental health and in some cases even lack appropriate clean water and sanitation over a century and a half after John Snow identified their importance. Prevention also includes focussing on healthy rather than unhealthy behaviours, disease prevention and the myriad of challenges in the area of environmental health.
What is clear is that there is substantial overlap between the two areas with many professionals playing a very significant role in both.
What is not so clear within the context of the Medicare Locals is how the challenge will be met to marry an appropriate focus on the individual with a sensible focus on populations.