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Department of Health’s tightly constrained, highly managed budget inhibits innovation – Duckett 

Health Minister Greg Hunt has nominated primary health care as one of the pillars of the Australian health system and recently appointed a panel of experts to advise on the development of a 10 year primary health care plan.

The Minister has not indicated what role the Primary Healthcare Networks (PHNs) are likely to play in this plan but the address, below, by Dr Stephen Duckett, might give him and the Primary Health Reform Steering Group some useful ideas.

Dr Duckett gave the address last week in his role as Chair at the AGM of the Eastern Melbourne Primary Health Network (EMPHN).  One of his key messages was the need for changes to the way in which the Federal Government funds PHNs in order to support innovation and flexibility in the delivery of primary health care.


Stephen Duckett writes:

What the public is asking from our primary healthcare system is changing. People are living longer and there is a greater burden of chronic disease especially associated with mental health, and overweight and obesity. Changing workforce engagement means there are fewer family carers for our elderly and for people with injury, ill health or disability.

Yet despite these changes in needs and context, our primary care system arguably hasn’t changed much in 50 years. The same model of fee-for-service practice dominates. Sure we have had some really important changes over the last 50 years, including the introduction of Medicare in 1984. We have bulk billing now, which didn’t exist in 1969. General practices are larger now too, but there is still a significant proportion of one and two person practices.

Four years ago Primary Health Networks (PHNs) were developed to integrate our primary care system, with the emphasis on the word system. The old model of mono-disciplinary practice, loosely connected with referral networks, is not where the future model needs to be. Indeed, the old model is already changing, but it is our job to help the system change faster and to support GPs, community health, hospitals and other providers to make this change.

Working on multiple fronts

We are working across five broad fronts to achieve this change, and we have set very audacious transformative goals about what we are trying to do. In essence, we want, with our partners, to build a better primary care system, so people in eastern and north-eastern Melbourne have better health experiences and better health outcomes.

We want to improve the primary care and secondary care interface. We want to expand services, filling in the gaps. This latter can only be done in line with the funding priorities of the Commonwealth Government, which provides us the overwhelming amount of our funding. We have to carefully target that funding so it does not duplicate existing services, but builds better relationships within the primary care system in our community and is sustainable in the longer term.

Over the last 12 months our focus has been on finalising our Strategic Plan for 2020 to 2025. Many of you were engaged in the consultations to develop this plan. We are now engaged on the much harder task of implementation – and many of you have been part of the implementation consultations as well. We’re attempting to make serious and significant change in each of the five domains of our plan. Watch this space – Will it be 2020, 2021 or 2022 when we axe the fax?

We are also improving our commissioning processes. We have done this by improving the efficiency of what we do, and we are now looking closely at how we approach commissioning with our partners. In the next couple of years there will be a greater emphasis on relationship commissioning to help build the capacity of the primary care system in our region. We are hoping to develop a more collaborative mindset with our partners.

Hindered by budget processes

None of this is easy! We are hindered in our processes by the tightly constrained, highly managed budget that we have to work with. There are some positive signs that the Commonwealth Department of Health recognises that its current control processes inhibit innovation, and are not consistent with the broader directions of the PHN program nationally. We are actively engaged in discussions about improving the monitoring of our performance, especially the data we need to evaluate how primary and secondary care interface, and how this balance changes over time.

Whilst we only have a tiny amount of spare cash to kick-start the big changes we want to make, the Board has allocated funding to identify where and how our journey should start. Many of our partners are already wanting to be in this journey with us, which is really welcome.

What we’re talking about is not something that is going to happen tomorrow. This is something that is happening for the longer term as it’s a big transformative journey that we are embarking on. It will be an exciting one, and one which we are convinced will lead to improvements in health and health care across our region.

We look forward to you being part of that journey.