Many thanks to Fran Baum for this overview of recent discussion on the innovative idea of community-owned primary health enterprises.
Professor Fran Baum writes:
On 2nd October a workshop was held in Adelaide to introduce the idea of community-owned primary health enterprises.
The idea is the brain child of Tony McBride and Rod Wilson who both have a wealth of experience as CEOs in the Victorian Community Health and NGO sectors.
Their premise is that many GP practices are being taken over by the corporate-for-profit sector and that a feasible alternative model would be for community not-for-profit organisations to run primary health care services.
The workshop in Adelaide was supported by the South Australian Council of Social Service (SACOSS) and the Southgate Institute.
Around 30 people attended from NGOs, Medicare Locals, community groups, State-government funded health services and local governments. Ross Wormsley (CEO, SACOSS) and I provided some policy background to primary health care in Australia and stressed the troubled position of PHC that has been brought about by Commonwealth and State cost shifting and the resultant severe cut backs to community health services in SA.
The audience provided accounts of what these cut backs had meant in their communities and bemoaned the loss of community health promotion and community development work in their communities.
Tony McBride provided examples of community run health services. The shining stars were the Victorian Community Health Services of which there are 90, 38 of which are independent companies limited by guarantee.
These vary in size but most have between 100 and 300 multidisciplinary staff. They provide generalist services and also a range focused on specific populations including older people, homeless people and CALD populations. Their income comes from myriad government sources which are not well-co-ordinated. About 30% include GP services which are funded from Medicare.
Tony also spoke of the West Belconnen Health Co-op operating on Canberra’s northern fringe which has been developing a health and well-being centre since 2004. The co-op was set up as a result of a partnership between the community, the Australian and ACT governments and businesses in response to the lack of affordable GPs and other health services in Canberra’s less well-off suburbs.
Its business model is based on bulk billing through Medicare rebates, fee-for service other services and rental income from co-located services. Families can join for an annual fee of $70 or $35 for health care card holders and are then bulk billed for their services through the year.
Tony also spoke of the Aboriginal community controlled sector which most people at the workshop appeared to agree, is a great model for mainstream Australia too. These services are firmly based in a comprehensive model of PHC and offer medical and a range of other clinical services and also take action on the determinants of health and ensure their services are culturally respectful.
The hard-nosed part of the workshop was led by Rod Wilson. He took the audience through sample financial models discussing how Medicare payments from consultations and practice incentive payments (PIP) can be used to support a primary medical service. His key point was that – the for-profit corporations are using these payments so why shouldn’t community not-for profit organisations or co-operatives also do so?
For me the important part of the discussion was about how the primary medical service could be part of a broader comprehensive primary health care service which is able to undertake disease prevention and health promotion activities using group programs and community development.
It is this work that has been cut back severely in South Australia partly because it isn’t the stuff of headlines but is crucial in supporting communities to remain healthy.
Many members of the audience also expressed the desire to see GP services as part of a broader effort. Ways this could be done would be through adding GP services to existing work of NGOs who do take a community development approach or through developing community owned services which would develop and seek funding for their health promotion work.
There was consensus though that this funding should not be short term project funding but sustained funding which was guaranteed over ten-year cycle subject to the organisation demonstrating measures of success for their work.
Blending the strengths of the Aboriginal community controlled model and the West Belconnen Co-op could be a great way of establishing effective community health services which really respond to the health needs of their community rather than producing the profits of companies!
I take my hat off to Tony McBride and Rod Wilson for seeing beyond the current primary health care policy mess, which has seen cost-shifting and short-termism dominate policy decision making, to suggesting a means by which community-control of GP services and possibly comprehensive PHC could become a reality for many communities.
It would bring more affordable primary medical and other health professional services and, with a little creativity, be a means of extending the community health model across Australia.
• Fran Baum is Matthew Flinders Distinguished Professor & ARC Federation Fellow, Director, Southgate Institute for Health, Society & Equity at Flinders University
