As with most developed countries, Australia’s health system is under ongoing pressure due to increasing health costs and rising rates of chronic disease. The good news is that there is enough research and data available, from both national and international sources, to provide clear direction for our future primary health care policies.
In short, the research overwhelmingly shows that our best chance of meeting future health care challenges is to develop a strong, high performing and universally accessible primary health care system.
The bad news, however, is that some key primary health care research and information services have had their funding cut by the current Government. These programs provide vital information and support for researchers working in the area of health services research and directly inform the development of policies and programs in this area.
In the following update on the status of these important primary health care research and information programs, Dr Lesley Russell challenges the primary health care research community (and interested others) to stop being complacent about the future of these organisations and to advocate for their continuation.
Lesley Russell writes:
This is a brief follow-up to my piece in Croakey about the failure of the Turnbull Government to make any announcement about the future of the Primary Health Care Research, Evaluation and Development (PHCRED Strategy) and the implications of this for the Australian Primary Health Care Research Institute (APHCRI), located at ANU, the Primary Health Care Research Information Service (PHCRIS), located at Flinders University, and funding for primary health care research generally.
While I have not been privy to any specific information about decisions made or being made by the Commonwealth Government, I have picked up the following (I am unable to vouch for its accuracy):
- APHCRI will not receive any further funding and will close its doors on December 21, 2015. The National Centre for Geographic and Research Analysis in Primary Care (GRAPHC) has been transferred to the Research School of Population Health at ANU and the School has received some modest, short term funds to assume the management of those Centres for Research Excellence and research streams which have continuing funding (in some cases for up to two more years).
- PHCRIS has been funded for a further six months.
- Responsibility for primary health care research within the Department of Health has been moved from the primary care branch to the branch that manages the NHMRC and the MRFF. This apparently involves only one FTE. Note that an Assistant Secretary to head up the Health and Medical Research Branch has not been named following the departmental reorganisation.
- It seems that a decision about future federal support for primary health care research has yet to be made; it is likely contingent on work around the 2016-17 Budget so an announcement may not be forthcoming before May 2016.
- There are some indications that primary health care research – or at least its management – will be a contestability program. The implications of this are manifold and varied.While my original article was well read (shared 28 times on Facebook and Tweeted 112 times) only the Australasian Association for Academic Primary Care spoke out in support. There was no response from professional and academic organisations, politicians or even the very researchers who have been funded over the years under the PHCRED strategy. Obviously I am not a disinterested bystander, but it is disappointing that there is a level of complacency about the future of something as central to an effective, efficient and sustainable health care system as primary health care research, evaluation and implementation.
Dr Lesley Russell was previously a Visiting Fellow at APHCRI
I am deeply concerned that at a time when the Commonwealth Government is seeking input to health care reforms, it is dismantling those organisations that are required to support strong evidence based primary health care.
We have seen massive cost and time waste and loss of continuity with the transition from Medicare Locals to PHNs. Those that were performing well and have been refunded lost considerable impetus when they had to re-apply for their contracts. Those that were not performing well have been replaced by new organisations that may take many years to build capacity. The decisions about contracts for General Practice specialist training appear to be have been based primarily on financial rather than quality imperatives and the changes in this sector will risk the solid gains of previous years in attracting graduates to a career in General Practice. This is compounded by the loss of the PGPPP rotations compromising the opportunity to ensure that all future sub-specialists have insight into the practicalities of primary medical care and reducing the number of Junior Medical Officer placements available for graduates of Australian Medical Schools.
PHCRIS and APHCRI have supported Primary Health Care research and we have seen a slow but steady growth in the capacity for research in this area through targeting funding, support of the annual PHCRIS Conference and support for networks including the national Practice Based Research Network. At a time when integration of health services is being supported by State governments, the Patient Centred Medical Home is widely being advocated as a new model for Australian General Practice and changes in the funding of primary health care are being actively considered by government and supported by the professional organisations, building and supporting capacity to investigate the evidence for these initiatives is critical. This is not the time to be dismantling what capacity we have built in Australian academic General Practice.
I call on the Turnbull government to review the trajectory established by the Abbott government and to salvage and support what we have left of Primary Health Care organisations so that we can participate effectively in the renewal of the Australian health care system.
Dr Russell is correct that the future of primary health care research in Australia is under threat. Primary health care is essential for an equitable, effective and financially sustainable health system. The fact that Australia spends about 9.4% of GDP on health while the US spends 17.1%, and our health outcomes are better, is in no small part because of the contribution of primary health care. Research that informs both policy and practice is essential to drive innovation, quality and sustainability in primary health care. It can also save money, as decisions made in primary care have important consequences for the rest of the system. An example of this, highlighted in the AAAPC submission to the McKeon Review of Medical Research, was the UK DIGEM randomised trial of blood glucose monitoring for diabetic patients who were not using insulin. This study showed there was no gain from routine monitoring. The trial cost (£0.5M) was a small fraction of the costs of monitoring (£100M/ year in the UK), and would have paid for itself within a few weeks of publishing.
The prolonged uncertainty about the future of the PHCRED strategy has been damaging to the sector and the impending loss of APHCRI and uncertainty over the longer term future of PHCRIS are further blows. These organisations perform essential enabling roles. Talented and dedicated researchers are being forced to leave the sector and the gains from nearly 15 years of investment in capacity building are at risk.
Finding sufficient funding for primary health care research through the NHMRC is not a viable option. Most NHMRC funded PHC research falls under the broad description of health services research, but this accounts for only 5% of NHMRC funding. The NHMRC chief executive officer Professor Anne Kelso, speaking at the 2015 Primary Health Care Research Conference, acknowledged that this is a small proportion. Without major change to how the NHMRC functions this is unlikely to grow substantially, and may even decline.
In 2014 the NHMRC funded only seven project grants and two partnership grants related to primary health care funded nationwide. In 2015 there was no NHMRC grant review panel which specifically had responsibility for reviewing primary health care applications as part of its role and the outcomes of the funding rounds were dismal for primary health care.
Other countries seem to understand the importance of applied health research, including primary health care research. The United Kingdom invests in applied health research via the National Institute for Health Research, while Canada has a specific Institute of Health Services and Policy Research plus substantial funding from the Canadian Institutes of Health Research. The United States funds clinical effectiveness research through the Patient-Centered Outcomes Research Institute.
The conclusion seems inescapable that Australia needs a funding agency whose specific focus is applied health research. The creation of such a body could be funded from the initial $1 billion investment in the Medical Research Future Fund. This would be a local first step for the Future Fund as research funded by such an agency would contribute to identifying the savings in the health care system needed to grow the Future Fund over time.
Thanks to Jenny and Nick. I am not involved directly with universities at present but stopped around the time PHCRED was introduced ?2000ish. I am very active in learning with registrars and students and use the same nternet as my source. I was not aware of these funding changes or any outputs from these initiatives. This may be my problem but I suspect it is more to do with others.
I see Trish Greenhalg as the archetypical primary care academic of our times, creating, interpreting and summarizing research for others. Motivating me and informing me. It is now part of the job to get information out there so oth es can access it. Not expecting this to be an add on provided by another agency.
I do want to have more research in primary care – there is so much to do. I am not sure how to fund it. I am very interested in what the next steps are and I think we need to team up with a philanthropic agency to coordinate the answer. No government money!
Primary health care is a responsibility of government; primary health care research is the responsibility of government.
This is quite disturbing news so thank you to those who are bringing attention to the issues.
Turning to private money is exactly what this government want us to do. Of course private money has a role but the day government take their hands completely off steering primary health care, buttressing primary health care and promoting primary health for its population is the day I do not want to witness.
There is always a middle path – lets find it.
At the time when research into health systems and health services is most needed- that is, when primary care institutions are being reformed and asked to take on big ‘system’ roles; when review into Primary Health Care and into the full range of MBS items is underway, and when the appetite exists for re-thinking funding models to get better processes and outcomes, the only program that specifically supported primary care research has been dumped- as Lesley Russell says- for some, the doors close at the end of the academic year; for others, there is a 6 months extension, for what precise purpose is unclear. The PHCRED program has provided funding for health services research for the last 12 years, and provides the h