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.”