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extreme weather events
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global health
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WHO
health
Healthcare and health reform
abortion
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Australian Medical Association
cancer
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Choosing Wisely
chronic diseases
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Cochrane Collaboration
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conflicts of interest
death and dying
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infectious diseases
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international medical graduates
journal articles
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medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
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naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
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#CTG10
#NTRC
Acknowledgement
cultural safety
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Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
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Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
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environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
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illicit drugs
injuries
legal issues
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media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
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Health memo to COAG part three: here’s a way forward in the critical area of primary health care

Continuing Croakey’s series highlighting critical health reform issues in the lead-up to COAG’s last meeting of the year, to be held in Brisbane next Monday, we now turn the spotlight to primary health care.

Professor Gawaine Powell Davies, CEO and Director of the Centre for Primary Health Care and Equity at the University of NSW, writes:


“COAG will be hearing the Commonwealth proposals for health care reform. For primary health care, this is a once in a decade (or two) chance to build a proper primary health care system.

Some of the proposed reforms are easy to imagine, especially those relating directly to patient care. We can all imagine having ‘Superclinics’ as a ‘one stop shop’ with full access multi-disciplinary care, or registration with a particular provider or practice so that people with chronic conditions can get consistent care.

It is much more difficult to be clear about the next level up – the Primary Health Care Organisations. These are seen as regional organisations with the responsibility for ensuring that people have equitable access to primary health care, with funding to commission or provide services to fill gaps across primary health care.

There are many unanswered questions here.  What will their scope will be – all of primary health care or just general practice? Who is equipped to take on this brave new role and who they should be responsible to? What of those who are not represented in these organisations? The answer to questions like this will help determine whether we have a well coordinated system that focuses on the needs of the population, or a slightly less tragic version of the current mess.

Here the legacy of a divided system of health care comes to haunt us. Very few individuals or organisations have a comprehensive view of primary health care – they have been too long on one side or another of the Commonwealth-state divide.

If, as some expect, the government encourages Divisions of General Practice to change into Primary Health Care Organisations, it faces a dilemma: keep a narrow, extended general practice view of primary health care and lose the broader view of primary health care, or ask the re-badged Divisions to manage something that is, for most of them, way beyond their experience – and perhaps lose contact with their general practice constituency in the process.

One way out of this dilemma is create a new type of organisation: one which has not individual clinicians but organisations as members: the local Division, community health, local council and perhaps a local NGO or two.

Charged with planning primary health care for their area, they could between them cover the full spectrum of primary health care, each bringing its particular experience to the task. Membership would reflect local circumstances and programs the local needs, but they would have a common charter of ensuring equitable access for all the citizens in their area.

When these evolved and took on new responsibilities, they would have the full spectrum of primary health care experience to draw on.

We await the Commonwealth’s proposals to COAG with bated breath.”

Comments 1

  1. Tim Woodruff says:

    Such a new regional organisation unencumbered by the history of the development of Divisions is precisely what we have suggested in our paper PUTTING HEALTH IN LOCAL HANDS:SHIFTING GOVERNANCE AND FUNDING TO REGIONAL HEALTH ORGANISATIONS, available to read in full at http://cpd.org.au/paper/putting-health-local-hands.
    Additionally, this proposal gives the organisation the responsibility to spend all funding for the region, distributed to it on a needs based formula. Without having responsibility for funding decisions, a regional organisation will not be able to facilitate the changes required to improve primary care. But central to this proposal is the availability of data on health status and health expenditure to lever the appropriate changes in the region.
    Tim Woodruff
    Doctors Reform Society

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