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Some reports from a recent primary health care conference – and who is standing for the Australian Medicare Local Alliance board

An update from NZ’s Grahame Jelley was added to this post on August 30

When the new board for the Australian Medicare Local Alliance is announced (due in mid-Sept sometime), it will be interesting to do an analysis of the membership, based upon professional discipline/background, and how many of the directors could be seen as representing the wider community rather than health sector interests.

(I’m guessing it will provide another reason to be sceptical of the seemingly never-ending stream of protests that GPs are being left out of primary health care reform. Every time I hear another outcry “GPs must remain at the heart of primary health care”, I wait, usually in vain, for someone to respond that “the community’s needs must be at the heart of primary health care”).

It will also be interesting to see how many of the directors could be counted as having expertise in under-served areas, such as Indigenous health, rural and remote health or the disadvantaged urban areas. It will also be interesting to see how many have a background in public health and working across sectors in a health-in-all-policies sort of approach.

A list of the 12 candidates for the five positions and their bios can be found at the bottom of this post and more detail is here.  Another director will be appointed by the board to ensure a skills mix, to bring the total number to nine. Forty-five Medicare Locals get one vote each (these are the MLs that registered by the close of register date), and three of the current directors have been appointed to the AML Alliance board: Arn Sprogis, Jim McGinty, and Paul Geyer.

Meanwhile, on related themes, below are some pertinent observations from a non-random sampling of those who attended the World Health Care Networks conference in Cairns recently. I asked for their top three take-home headlines, observations or reflections from the event.

These can be summarised (according to the headlines I’ve put on their pieces):

  • Funding arrangements aren’t aligned with our goals
  • Leverage the network
  • Systemic approach needs to harness tribalism and new communications options
  • On the importance of communications and community-based diagnosis
  • Important to engage GPs, communities and industry, and to support developing countries 
  • Connections count
  • The changing nature of networking
  • Innovation requires an openness to change
  • Some sacred cows are holding us back.

During my very brief time at the conference, some of the discussions highlighted the seemingly unbridgeable gulf between what the evidence and commonsense suggests should happen in primary health care, and what the political environment and professional lobby will allow.

Just for the record, when I asked the contributors below for their conference reflections, I didn’t realise that the timing of publication would coincide with the AML Alliance voting, and nor did they realise this (that it would take me so long to get the post compiled).

The post below includes comments from some of the candidates. In the interests of fairness, if other candidates would like to add any reflections to the post, please get in touch.

Likewise, if others who attended the conference would like to add their reflections, please add as comments on the post (it takes just a few moments to register at Croakey to be able to do this), or send me an email.

(Declaration: I presented on the potential for social media in primary health care reform, and the conference paid for my travel/accommodation costs).

***

Funding arrangements aren’t aligned with our goals

Mark Foster, CEO, Hunter Medicare Local

Australia is one of the few countries where the government is increasing expenditure on health. The huge pressure that is being applied in other countries like the UK to contain health expenditure in the face of increased demand and cost of care is our future.

This can only be achieved by strengthening primary care but in Australia:

  • Our State and Commonwealth funding streams are a structural barrier the development of integrated models, and realizing efficiencies
  • Reforms to optimize the efficiency and outcomes of our investment in the MBS and PBS appear to be off the table
  • Equity of access to services, and improved population health outcomes are goals of our health reform process but will be a major challenge in Australia under these funding arrangements.

There was a widely held view at the conference that global budgets managed at a regional level, and capitation arrangements are characteristics of health funding systems best able to achieve these goals.

***

Leverage the network

Di O’Halloran, Chair of the Western Sydney Medicare Local

1. Maximise and demonstrate gains as an individual ML but think like a primary health care system.

Share ideas and learnings, pick up and implement others’ successes, give full access and support to those who might want to use your initiatives – ie stand on one another’s shoulders.

2. The need for an agreed national vision, values, policy framework, operating principles and priority outcomes to guide MLs – and everyone else, in progressing reform.

The current COAG process is our best opportunity to reclaim the lost potential for major reform, and it lies in the hands of a small number of Commonwealth and state health department leaders. They need to get past the multiple barriers, get people behind their proposed ways forward, and then persuade govt (this one and the next) to be brave. If they fail, we will flounder for years to come.

3. A REAL commitment from government to move decisively towards block funding rather than endless rounds of discontinuous, micro-managed program/grant funding.

No one expects an immediate and massive shift, but the process could be started with defined ‘chunks’ eg for high risk chronic care managed in partnership by MLs and LHDs.   This is where the principles and policy framework become critical.  If MLs and LHDs have a clear framework, then they are able to work within it, with the flexibility to redesign systems and reallocate resources in ways that are currently either not possible or immensely difficult.

If we also have the ability to truly build capacity in GP and PHC – then we can achieve more faster.  To use an RACGP policy I wrote long ago, ‘systematic investment in teams, teaching, (advanced skills) training, technology and infrastucture, with priority givento the aeas of highest sociology-economic and health need, regardless of geography’.  The Medical Home concept and principles are now gaining traction at both levels of Govt – this is potentially  a key strategy.

4. Overall, strong positive reinforcement of the ‘rightness’ of the move to MLs given the strength of international evidence and emerging PHC best practice.

This paper that I did for the RACGP as part of a previous health reform task force has some relevant background.

***

Systemic approach needs to harness tribalism and new communications options

Emil Djakic, current AML Alliance board member, former chair, the Australian General Practice Network

Systems are  required in health. Globally and Australia should take an interest broader than the OECD countries for learnings.

Professional Tribalism should be accepted as a fact and worked with rather than trying to force uniformity of thinking and acting. Effective teams can have diverse tribes .

Information now moves differently. Innovation is evolving out of need and opportunity. Our systems need to understand this and adapt to  the utilisation of new communication options to deliver the desired positive health outcome.

***

On the importance of communications and community-based diagnosis

Tony Lembke, Chair North Coast NSW Medicare Local Board, and a retiring AML Alliance board member

The potential scope of work for Medicare Locals in combating disadvantage is huge.

NATSEM estimates that the savings from closing the gap in chronic disease management (between advantaged and disadvantage) would save $8 billion yearly. Prof Helen Keleher urges us to seek out the hotspots of poor health. Why? What can be changed? What capacity have we to act?

Prof Jan De Maeseneer quotes the Marmot review which advocates ‘proportionate universalism’ to reduce health inequality.

Sometimes we need to make a community diagnosis, rather than an Individual diagnosis Eg obese child -> build more playgrounds. We need new training for health care providers – as well as experts and professionals they need to be change agents and leaders.

Communicating the story is one of the key issues for Medicare Locals. Prof Clare Jackson reminds us that unless you’ve seen something 4-7 times you haven’t seen it.

Melissa Sweet (through a dreadful lurgy) encourages us to embrace new media, and create an online healthwatch for communities – turning health data into stories that matter (Note from ed: I hope to write more about this idea at Croakey shortly).

And Hunter shared a fantastic example of using modern media for improving patient self management in their YouTube video Understanding Pain.

Johnny Marshall told us about the NHS approach to Equity and Excellence: Patient Empowerment, Improving Outcomes, Empowering Frontline Clinicans. He reminded us of the unique role of general practice. Where does the accountability stop for GPs? They are responsible when the patient is standing in front of them – and also when they aren’t. I wish I had come up with that line. He told us that it is a brave man who will redesign the kitchen without consulting the main person that uses it!  And he warned us that If we imagine the future based solely on the evidence then we are destined to live in the past.

Hal Wolf from Kaiser told us that integrated care has been around for a long time in the US – for pets.

Dr Jason Cheah reminds us that my integration is your fragmentation, one of the five laws of integrated care.

***

Important to engage GPs, communities and industry, and to support developing countries

Tony Hobbs, a GP from Cootamundra who chaired the external reference group of the National Primary Health Care Strategy

All OECD countries are grappling with the challenge and opportunity that an organised primary health care approach delivers in terms of improved access, equity & sustainability & how best to achieve the right policy settings in their environment.

Judith Smith spoke of the need to keep refining PHC systems: the tension was around how best to do this as part of a reform agenda: she suggested that the UK experience was that it was undertaken too often & she felt that we had waited too long in Australia. She also spoke of the need to maintain GP engagement as a critical factor in the success of the MLs agenda here in Australia.

Jan de Maeseneer gave some excellent examples of how local approaches to PHC can impact on the social determinants of health. He also spoke passionately about the opportunities/responsibilities of PHCOs in the OECD countries to support similar organisations struggling to make a difference in developing countries.

Presentations from Jason Cheah & Hal Wolf spoke to the critical role of ICT as an enabler in the drive to more coordinated, connected care.

Melissa Sweet’s presentation challenged us to be forward-thinking in our use of social media to better connect with our populations in all that we do as MLs.

Feyi  Akindoyeni and Mark Boutros from Kreab Gavin Anderson Worldwide led us in a challenging workshop in the opportunity of MLs to engage industry in support of our PHC agenda.

***

Connections count

Jason Trethowan, CEO Barwon Medicare Local

• The international speakers reinforced the need for greater connections between the primary health care sector and the social determinants of health.

• Despite the great presentation from Melissa on the potential the digital society presents, the Medicare Local network is still too conservative and confused about the value social media offers. Having said that, the WHCN conference of 2012 could be viewed as the awakening for our newly formed network to think seriously about how social media can enhance the community’s awareness and engagement with local primary health care services.

•  The greatest value for Barwon Medicare Local was to appreciate the Health Pathways system developed in Canterbury and later adopted by the Hunter Medicare Local. The Barwon region has unacceptable waiting times for many specialist services but not necessarily because of limited workforce but because the primary health care system has yet to reach its “connected” potential.

***

The changing nature of networking

Johnny Marshall, GP, former chair of the National Association of Primary Care, and an advisory member of the NHS Commissioning Board Authority Future Design Group. And blogger

It’s a small, small world…….when you are networked!

My reflection on the 2012 WHCN Conference is that the importance of being networked remains as high as ever but the nature of that networking continues to change.

Personalised, high quality healthcare services are delivered through informed, empowered patients and their families having productive interactions with prepared proactive practice teams, particularly with respect to chronic care. One key element of supporting this interaction is a networked electronic health record that is available wherever the patient is seeking health advice.

Engaging the population in their health and healthcare planning requires better networking between professionals and people. It is worth giving some thought as to how we might use social media to connect better on both of these fronts.

Professional networks that support multidisciplinary team working require clinicians that can span the boundaries between different professional tribes. In order to support this type of networking clinicians need support to develop the right leadership styles and skills.

• More reading here.

***

Innovation requires an openness to change

Vahid Saberi, CEO of the North Coast NSW Medicare Local

(An edited version of his blog)
Day 1.

After the welcome to the conference, the first speaker was Hon Mark Butler, Minister for Mental Health and Ageing. He emphasised that MLs are right at the centre of Government’s ambition for PHC reform. He also mentioned, in breaking the professional silos and connecting care – the result will be greater than the sum of the parts.

A question from the floor to the Minister was whether the Government was going to take some risks and give flexible funding to MLs so that they can be innovative, rather than clip our wings with a short term (annual now) project funding approach and mentality.

I think it is good that the fact that if  MLs are to be innovative and truly local, shackles have to be removed and MLs allowed to be creative through more flexibly funding is getting airplay.

Minister Butler mentioned that it was crucial that the lived experience of MLs – and how we improve care and make economic sense – be told. This will answer the sceptics, he said.

Singapore Primary Health Care (PHC) experience was presented by Dr Jason Cheah, CEO, Agency for Integrated Care. This was a comprehensive look at the various Primary Health Care (PHC) models and approaches across the world – the good, the average and the not so effective.

Below I note some of the ground he covered that might be of interest.

Denmark established a fully paperless medical record system in 1990s. The system is fully linked and fully electronic. This has facilitated care integration. All GPs and PHC services are linked – though not all hospitals.

Geisinger Health System, Pennsylvania, USA is a leader in Advance Medical Home or Proven Care Model. Obama care, the new legislative care in US, embraces the advanced medical home concept. Geisinger pays for performance rather than fee for service.

The other model of interest is the Swedish PHC model. It is called Jonkoping – Integrated care.  Holistic team based care.

Singapore, based on what we heard, seem to be having a well-planned and systematic approach to the reform of the health system and strengthening PHC.  Integrated care is the new approach.

What is integrated care?

Patient centred; team provision; across boundaries; partnership between providers (long term trust); system based care.

What is required for good integrated care is care pathways- so everyone knows what the other is doing. The challenge with care pathways is that most patients, with chronic disease, have multiple care needs – and therein is the challenge.

Dr Judith Smith, Director of Policy, Nuffield Trust UK, talked on “How far have PHOs developed globally?”.

For Primary Healthcare Organisations to be effective they require clarity of purpose and expectation. The ongoing involvement and participation of GPs is crucial. GPs need to believe that MLs will significantly improve: quality of care for patients; income; quality of the working day; and respect from peers.

She emphasised the need to get the incentives right. This is crucial. Policy makers have to think carefully about levers and incentives for change within and beyond primary health care. Policy prods are essential.

Primary Healthcare Organisations have the capacity and ingenuity to move centre stage and address the integrated care challenge. MLs have to lead the change. Leadership is important.

PHC reform (the MLs) needs time. International experience shows that it takes a long time to bring about real change – and setbacks are inevitable. The major risk for MLs is not being given the time for the organisation to evolve and mature – be subjected to serial re-organisation, which seems to be what has happened in UK.

Judith also mentioned that experience shows that given the nature of the work it can mean that governance and organisational arrangements will not be neat.

Prof De Maeseneer and  Prof Helen Keleher talked about, and explored, the equity concept. An interesting set of data (Belgium) was shown related to the impact of education on life expectancy. A direct correlation between education and life expectancy. Morbidity figure also show that education has a direct impact on morbidity rates – case in point Diabetes – for both men and women.

So my question (Vahid) is what is our involvement with the education sector given that there is direct relationship between education and incarceration as well?

Prof De Maeseneer suggested that we need to involve the community in all steps of design, delivery and evaluation of care. And importantly, personal care and community action go hand in hand – we cannot have one without the other.

Day 2:

The day started at 7.30 am with a session on community engagement and finished at 8.30 with a session on e-health.

The vogue word used by all speaker was ‘meso’!

Take away messages from the day: change is inevitable. It must happen. There is much work out there. Hope is not a strategy. We actually need to make it happen.

Phillip Davies, Prof Health Systems and Policy, UQ: Is answer to fragmentation, integration or Networking?
The definition of integration is varied. There is no accepted definition. Divisions of GP were given the role of integration, although their genesis was more about the GPs desire for collegiality.

The KPI for MLs makes no mention of integration. Although this is their major task. Finance and information are key to integration. Money matters. But when it comes to MLs they have very little influence on the finances – and a small fraction of the health budget. So how will we achieve the holy grail of integration.

We can network till cows comes home,  we will not address the integration issue. Fund holding is key to integration. There are some aspects of fund holding that is possible to move to ML quickly.

Melissa Sweet: Primary Health Care at the digital revolution
If you are interested in leading your community you should be active in the cyber social spaces – eg  twitter. Understand and use the significant power of social media for good and giving power to people.

MLs could establish fund raising platforms. To do this we have to be digitally engaged. Proposal: Health watch website (local and then national – aggregating the best local info).

Some good examples of guidelines: Justice Health Victoria. The US Defence guide to social media was also recommended (from the floor).

Mr Hal Wolf, Sn Vice President and COO, Kaiser Permanente, the Permanente Federation US: Expenditure does not mean better health. US spent 48% of the world’s armament budget. US health care cost double the army budget! US has among the lowest health outcomes in developed world. With this back drop we see the PHC reform bringing the large improvements.

Kaiser is a capitated model.  There are small incentives in the capitated model which is based on region or special outcomes. Kaiser’s intention is to be number one in every quality category in the nation. This is a source of pride and achievement – the  relentless drive to be the best. More money and bonus is not the driver or incentive. Staff are salaried and are avoid national averages. You don’t come to Kaiser to make a lot of money. The goal is to be fairly paid for good performance. Our hope is that our staff will stay with us throughout their career.

The challenge is for doctors to reorient to a team based approach.

Innovation is key. Anyone – anytime, anywhere. Innovation is something we must be open to. Can’t say I am open to innovation as long as I don’t have to change.

Data is completely worthless. Turn it into information it startes getting useful.  Then turn it into knowledge and finally clinical utility – now we are cooking with gas! Use of Big data in designing care – especially population health. Adding care data to social data – Social exhaust data. If everyone on Google is looking for cold remedy we know the flu is out there.

Implement of electronic records will initially slow you down and will cost.

Focus on hospital bed day per 1000 is a financial issue. We have to figure out ways to keep people healthier and find ways to keep people out of hospital.  The healthcare costs are not sustainable in almost all developed countries.

***

The importance of “community diagnosis” and other take homes (this comment was added on August 30)
Grahame Jelley, Bay of Plenty District Health Board, NZ

There were a number of key messages for me, around integration, community diagnosis, using big data, and authenticity in community consultations.

Dr Jason Cheah used a slide of 9 laws of integration (Leutz w 1999 and 2005) and this has stuck a significant chord within our Planning and Funding arm where I work, and has been used as an underpinning principle in a recent regionalisation discussion.

The presentations from Jan De Maeseneer on what is possible with a “community diagnosis” is surely a template for further social engagement by the health systems we work in.

I was most moved by his presentation of health in the developing world and have been spreading the word around “inequality by disease”. I believe this is a significant risk and particularly pertinent as we explore the challenges of obesity and diabetes in the coming years.

A notable comment: “Pulling off the trick of developing clinically led organisations working in the public interest”.

We utilise a performance and management team within our Planning and Funding environment, and the concept of “Big Data” as proposed by Hal Wolf has struck the team as something that could contribute to their view of data and performance management.

There are some local examples, I believe, where larger businesses are utilising this form of data review to influence marketing and investment strategy. I do not have specific examples but have heard this anecdotally.

Dr Johnny Marshall – “No decision about me without me “

“What responsibility do I have as a clinician when the patient is not in front of me? – when they are in hospital, away from home, with another provider? I need to have an overall view and contribution to their care “

Dr Brian Evoy: You think you are getting grassroots but you are actually getting astro turf” in relation to community engagement process.

“The primary care organisation needs to convince the GP that it delivers a benefit to both the GP and their community/patients.”

***

Some sacred cows are holding us back

AML Alliance statement

World Health Care Networks (WHCN) hosted its second conference in Cairns, Australia in July 2012. Co-hosted by AML Alliance and GPNZ, the conference offered international delegates the opportunity to explore the challenges facing the health care sector in Australia. This included discussion of the role that networks can play in facilitating linkages between stakeholders to enhance health outcomes through comprehensive primary health care (PHC).

Conference delegates heard how the combination of the global financial crisis and the ‘silver tsunami’ – the increasing aged population – are adding further pressure on stretched health systems. PHC can be the solution, but the question within many countries is how to organise general practice – the nub of PHC delivery – with other providers and agencies to provide an inter-sectoral approach to care.

Also featured was international progress in PHC developments since the last (2010) conference including:  the emergence of Divisions of Family Practice in Canada; the shift from Primary Care Trusts (PCTs) to GP commissioning in the UK; Medicare Locals in Australia; and the development of hybrid primary care organisations (PCOs) in New Zealand. Melissa Sweet also described the critical role of social media in harnessing community advocacy and influencing health policy.

A recurring theme heard in the conference was that progress in shifting PHC from curative to preventive and from practice-to system-based approaches is often stymied by ‘sacred cows’. In Australia in particular this includes fee-for-service (FFS) funding models. International networks, such as WHCN, allow health and social service leaders to share their knowledge, expertise and experiences to show us that such sacred cows can be sacrificed for a greater good. For example, we heard how New Zealand, previously a traditionally FFS service-based GP system, has moved to capitation and performance payments with full engagement by GPs.

The WHCN conference is an important aspect of the WHCN movement, a global forum for the exchange of ideas and knowledge between health care networks to share the issues and solutions to comprehensive PHC delivery. The next WHCN conference will be held in 2014 and will focus on the Australasian issues.

***

Tweet-reporting

Scott White, Hunter Medicare Local

***

*** 

Who wants to help shape the future of primary health care? The AML Alliance board candidates
(More info here)

GP Dr Emil Djakic,  (Current board member)
Primary care transformation has been at the heart of my contribution to the creation of the Medicare Local Network and the AML Alliance company. That work was driven by policy from the Divisions Network and now will get the chance to be put into action in this new environment. I seem my role as a GP with governance experience as crucial to delivering this agenda.

My past leadership of a process was a challenge but the new setting is the real work just starting to help progress health care in this country.

***

Dr John Kastrissios (Current board member)
I am nominating for a Board Director position with the AML Alliance because I am committed to the development of healthy communities with access to high-quality integrated primary health care. I believe we can build organisations that support these objectives.

I have demonstrated skills relevant to the role of a director with the AML Alliance with experience in effective governance, health policy development, advocacy to government and clinical leadership.

I am currently Board Chair of Greater Metro South Brisbane Medicare Local (a first tranche ML), a Director on Metro South Hospital and Health Board, and a Director on the General Practice Queensland Board. I was also previously a Director/Board Chair of the SouthEast Primary HealthCare Network for many years.

I currently own and work in general practice as a Principal in a group practice.

In 2008 I was the recipient of the John Aloizos Medal for outstanding individual contribution to the Australian General Practice Network.

***

Dr Michael Nolan (current board member)

Health reform is a time of turbulent change. AML Alliance needs strong board leadership which is strategic, innovative, experienced in organisational change and keenly involved in future development of an evolving health system. The evolution of AGPN to AML Alliance has been guided by people with a shared vision for improved health outcomes for our local communities. I have been fortunate to be part of that evolution through innovative national projects such as Building on Quality and several E – Health projects.

My thirty years in general practice entailed running a multidisciplinary practice team, aged and palliative care, after hours work and private hospital patients. Coupled with my board director roles in local, state and national General Practice organisations I have developed the skills the knowledge and the drive for the role of AMLA Director.

As a Board member I bring extensive experience in governance. The feedback from board reviews and fellow directors is that I am an active contributor to strategy, give strong ethical and honest views and have strong understanding of risk and finance. I have been fortunate to sit on and chair the governance board subcommittees of AGPN and GPV.

As a passionate GP I believe that my profession is integral to the success of a reorientation of the system but recognise that we are only a part of primary care and that there is an urgent need to have better integration with the broader system. I am proud to have been part of this journey but recognise that this is only the beginning of the development of a better kind of Primary Health Care.

***
Leanne Raven

Leanne is the national CEO of SIDS and Kids Australia, a not-for-profit health promotion charity dedicated to saving the lives of babies and children during pregnancy, birth, infancy and childhood and supporting bereaved families.

Prior to joining SIDS and Kids over 5 years ago, Leanne was a self-employed strategy and management consultant with executive and senior management experience in health, education and public administration. Over the past 25 years Leanne has undertaken many leadership roles within health, health professional regulation, human services, education, disability, community and family services.

As a fellow of the Australian Institute of Company Directors she currently holds directorships on the Eastern Melbourne Medicare Local, DASSI, the Windermere Foundation and ISPID (International Society for the Study and Prevention of perinatal and Infant Death. She was past Chairman and Director of the Australian Nursing Council and ENBIS Pty Ltd, a computer software marketing business. Other previous board member positions include the International Stillbirth Alliance, Eastern Ranges GP Association, Scott Street Children Centre and the Faculty Board of Medicine, Dentistry and Health Sciences at the University of Melbourne.

Leanne is passionate about building strong brands that connect with the public and growing businesses which are purpose driven. Managing change without pain and working within organisations to build capacity is one of her strengths and she has a strong interest in building the capacity of primary health care through working with the professionals who provide the services to the community.

She has qualifications in science, business and education with a Masters degree in nursing studies. Leanne is currently preparing for her PHD studies on social entrepreneurship with a particular emphasis on building community capacity.

As a mother of two teenage sons she is in touch with the realities of juggling the demands of a career and family. She resides in Melbourne with her husband and two boys.

***

Chris Renshaw

Chris Renshaw has extensive experience at senior management and CEO level in the Health and Community Services sectors spanning 28 years. He has demonstrated and extensive expertise in executive management, financial management, human resource management, primary health care, acute health care, indigenous health, community development, stakeholder engagement, rural and remote service delivery, strategic planning, corporate governance, innovative program development and government interface. The following is an outline of his experience across four Australian states and territories over nearly 30 years.

Disability Services Sector: Held Director and CEO positions in NGO’s in South Australia, Northern Territory and Regional Victoria.

Acute Health Sector: Held CEO position within the hospital sector in South Australia. Indigenous Health Sector: Held CEO positions within the Aboriginal Medical Service sector

in the Northern Territory, Kimberley and the Pilbara (current) regions of Western Australia.

Government Sector: Held Director position within government focusing on co-morbidity clients and indigenous stakeholders with Department of Family and Community Services in South Australia.

Government Relationships: Chris has long established networks with government health agencies at both state level in SA, WA, NT and Victoria as well as at the Commonwealth level.

Current Relevant Appointments:

Chairman Pilbara Regional Aboriginal Health Planning Forum

Director Kimberley Pilbara Medicare Local

Pilbara Representative WA State-Wide Aboriginal Health Planning Forum

Pilbara Representative Aboriginal Health Council of Western Australia Strategic

Planning Committee

Chairman Newman NGO Reference Group

Formal Qualifications: Chris holds Formal qualifications in Management, Quality Assurance, Finance and Community Development.

In addition Chris has spent the majority of this time working in regional and remote Australia and brings significant experience relating to the unique challenges in the delivery of services in these regions.

Of particular relevance is his extensive experience in the Indigenous Health Sector, particularly his role in leading the sector in the development of WA Medicare Locals.

 ***

Philip Davies

Professor of Health Systems & Policy, University of Queensland, School of Population Health (Part-time)

  • Knowledge Broker, Partnership Centres for Better Health (Senior Principal Research Scientist), National Health & Medical Research Council (Part- time)
  • Self-employed consultant in health systems, policy & governance (Part- time)

The AML Alliance is not simply AGPN ‘re-badged’. It requires new attitudes and skills. I would bring those to the Board through my strengths in strategic thinking and communication, sector knowledge, stakeholder engagement and capacity to work effectively with governments.

The Alliance needs a renewed focus on serving its members: providing support and counsel; facilitating collaboration; and fostering shared learning. It should respond to MLs, not dominate or dictate to them.

The Alliance must also be the authoritative and respected voice of MLs across Australia. That means it must listen to what MLs are saying and conscientiously reflect their diverse views. It must also strive constantly to work productively with Federal and State/Territory Governments: to be responsive to their expectations but also to stand firm when those expectations conflict with the interests of MLs and the communities they serve.

My governance and work experience equips me well to address those challenges.

I served on the Board of GPpartners (formerly Brisbane North Division of General Practice) from November 2009 to June 2011 and was elected to become a founding Director of Metro North Brisbane Medicare Local. I am also a Director of Rural Workforce Agency Victoria and served on the Boards of the Cooperative Research Centre for Aboriginal Health and National Blood Authority. I am a former Partner in Coopers & Lybrand (now PwC) and a Fellow of AICD.

I have worked in health for over 30 years and have a deep understanding of health policy and policymaking processes. Between 2002 and 2009 I was a Deputy Secretary in the Australian Government Department of Health and Ageing with responsibility for primary care in general and the Divisions of General Practice Program in particular. My other areas of responsibility included pharmaceutical benefits and the Office for Aboriginal and Torres Strait Islander Health.

 ***

Dr Sue Page

With over 20 years’ experience as a rural GP VMO and particularly as national President of the Rural Doctors Association, I have an intimate understanding of the challenges that lie ahead in medico-politics and population demographics across a variety of jurisdictions. My background includes a number of finance and governance roles including NRDGP Director, being inaugural AHAC Chair and now NNSW LHD Board Member, and with roles in Quality & Safety including membership of the Clinical Excellence Commission Board and the NSW Mental Health Sentinel Events Review Committee.

As national RDAA President I initiated a policy collaboration with key consumer groups ALGA, HCRRA, CWA and the NFF resulting in a ten point plan “Good Health to Rural Communities” which provided the blueprint for subsequent government policy including Medicare items for nurses. Working with Multidisciplinary organisations led to successful lobbying for workforce initiatives including the establishment of financial incentives and scholarships for allied health and dental students of rural origin; and the provision of funding for educational supports and service delivery incentives for procedural GPs. My advocacy continued in a variety of Ministerial appointments, Federal and NSW.

In my own region, as inaugural Director of Education at the UDRH I established a multidisciplinary training program which engaged 11 different universities and increased our student numbers from 100 per year to over 700. Then as Director of the North Coast Medical Education Collaboration I established the first tri-university medical program with 60 medical students placed across community and hospital sectors for 12 months. A key component was immersion in Aboriginal Health with students receiving Cultural Awareness program devised and delivered by local Elders, again a first, as well as placements within community and AMS based Aboriginal Health services.

Above all, I bring a passionate commitment to support the multidisciplinary Primary Health Care sector!

***

John Curnow

Mr John Curnow is a graduate of Macquarie University’s School of Logistics Management and has held a number of senior executive roles in various companies, including Coca Cola Amatil, where he served as managing director in their Hungarian and New Zealand operations. He has served on company boards in various countries and more recently, has been a board member for six years of the Barossa GP Network. Mr Curnow also served as treasurer for part of that period. He has extensive interests in the wine industry and consults on marketing and strategic leadership for various organisations. He has presented on these topics at a number of forums, including the Australian GP Network forum.

In John’s Words
“I bring a vision. We are provided with the greatest opportunity in two decades to help shape the direction of health care for the next generation of development. Divisions of General Practice provided the core or indeed the cornerstone for future development but that’s simply a start.

Our Medicare Local success will be determined by how well we expand on that opportunity. There is a better way of providing for expanding community needs. Our collective role is grasping that opportunity and creating the better way. We have, right now, pretty much a blank canvas. We have the seldom offered moment in time to paint a picture for health as we see it. It’s a moment that should not be wasted and a challenge that should not go unanswered.

The National Body’s role is not to direct or control the endeavour; it is to provide opportunity for the member Medicare Locals to grow into their ‘Go To’ roles, in providing exceptional health care to their individual communities.

My wish is to be part of that journey”

 ***

Alison Comparti 

I am an honest and straightforward person whose decision-making skills are constantly honed. I take every opportunity to provide stakeholder feedback for the organizations I represent. I listen, have an analytical mind, and enjoy a pro-active consultative approach to problem solving.

My family has lived rural Western Australia for more than 27 years. I am very passionate about enhancing the rural experience for health professionals. By attracting and retaining a well-qualified workforce to live and work in our rural areas, communities have the best possible access to inclusive health care. A registered nurse for the past 34 years I have worked in many areas of the health sector. I own my own business consultancy – facilitating and advising on governance, strategic planning, and team building. I am a court accredited Justice of the Peace, and a member of the Regional Development Australia (SW) Board, Chair of the SW Women’s Refuge, Director of SW (WA) Medicare Local and Chair of Membership and Governance Committee.

My experience with decision-making bodies is extensive and varied. I have served as the Shire President and Councilor of the Donnybrook Balingup Shire, Chair of SW Local Government Association, President of the Royal Association of Justices (SW Branch) and a board member of the Edith Cowan University Advisory Board, Country Shire Council’s Association, Southern Provence Regional Economic Development Organisation and the SW Development Commission. Health-related positions include the WA representative of the Health Consumers of Rural and Remote Australia, project consultant Southwest Medical Attraction Taskforce, national panel member of the Nursing and Allied Health Student Scholarship Scheme (part of SARRAH), board member of the Val Lishman Health Research Foundation, SW Medicare Local GP After Hours programme, the inaugural WA representative for the Rural Family Medical Network, and Silver Chain consumer group.
McMillan, Lindsay

I have an extensive career working across the primary health care sector at both an executive and non-executive level and bring the following key skills:

  • Excellent understanding of the primary health care sector with over 30 years’ of practical experience across community health services, disability and ageing.
  • Proven leadership skills with pragmatic experience running complex health, community and disability organisations
  • Expertise in building new business opportunities through leadership and innovative approaches to solving business challenges
  • Detailed governance experience as a board director and chairman. Board position including Inner East Melbourne Medicare Local (from Dec 2011), Melbourne East General Practice Network (from April 2008) and Whitehorse Division of General Practice (from March 2007).
  • Sound fiscal and strategic management skills including the ability to lead sustainable organisational growth and development
  • Stakeholder engagement skills with demonstrated experience working closely with various levels of government, including:

o Federal Ministerial appointment to the National Disability Advisory Council (NDAC), 1996 for a three year term. This appointment provided a wide range of encounters in understanding policy and relationships within State governments in managing disability services across whole of government.

o Two years’ experience in cooperative detailed relationships with Advisors, Ministerial staff, Federal Ministers on behalf of MS Australia

Excellent professional networks across community, government and corporate Australia.

 ***

Dr Lindsay McMillan

I have an extensive career working across the primary health care sector at both an executive and non-executive level and bring the following key skills:

· Excellent understanding of the primary health care sector with over 30 years’ of practical experience across community health services, disability and ageing.

· Proven leadership skills with pragmatic experience running complex health, community and disability organisations

· Expertise in building new business opportunities through leadership and  innovative approaches to solving business challenges

· Detailed governance experience as a board director and chairman. Board position including Inner East Melbourne Medicare Local (from Dec 2011), Melbourne East General Practice Network (from April 2008) and Whitehorse Division of General Practice (from March 2007).

· Sound fiscal and strategic management skills including the ability to lead sustainable organisational growth and development

· Stakeholder engagement skills with demonstrated experience working closely with various levels of government, including:

o Federal Ministerial appointment to the National Disability Advisory Council (NDAC), 1996 for a three year term. This appointment provided a wide range of encounters in understanding policy and relationships within State governments in managing disability services across whole of government.

o Two years’ experience in cooperative detailed relationships with Advisors, Ministerial staff, Federal Ministers on behalf of MS Australia

· Excellent professional networks across community, government and corporate Australia.

***

Dr Di O’Halloran

Health system reform will inevitably continue as system pressures continue to rise. In this unstable environment, Medicare Locals will aim to be a major influence on next phase reforms. The AMLA’s most immediate challenge is therefore to influence governments such that Medicare Locals are rapidly potentiated, and their impact on reform is optimised. Closely linked to this is the necessity to maintain general practice leadership, engagement and support within both the AMLA and Medicare Locals, while advancing our expanded responsibilities.

I believe I have the skills to contribute to the AMLA Board, gained through experience in divisional, Medicare Local, government advisory and statutory bodies, NGO and professional settings at all system levels. My skills relate to:

  • Extensive policy and strategic analysis, planning and development experience in multiple settings in relation to general practice, primary health care (PHC), and health system reform;
  • Fifteen years corporate governance experience via director positions including GPET, RACGP, WSDGP, WentWest-WSML and WSLHD Boards;
  • Extensive primary health care sector experience, with a deep understanding of its nature, function, relationships, interfaces and potential for change, and a history of successful innovation and integration;
  • Sound government relationships with health departments at both levels, with effective advocacy and development of new policy, strategic directions, and new initiatives (eg HealthOne, now NSW policy);
  • Extensive stakeholder engagement experience through divisional-ML initiatives, with HealthOne creating multiple opportunities to build strong GP-Community Health partnerships delivering true patient centred ‘wrap around’ care.

Qualifications and Positions

MB.BS, FRACGP, MPHEd, FAICD
Chair, Western Sydney Medicare Local
Member, Western Sydney Local Health District Board
Conjoint Professor, Department of General Practice, University of Western Sydney Chair, RACGP Presidential Task Force on Health Reform
Immediate Past Chair, NSW General Practice Advisory Council

***

David Fuller

With over 30 years experience working on major community transformation and development projects my last project was the concept development, planning and establishment of the Science, Research & Technology Precinct known as the Innovation Campus, for the University of Wollongong (UOW). I’m currently Director of Strategic Projects within the Vice-Chancellor’s Unit at UOW and I’m working on several projects including two community medical precinct projects.

I have professional experience in Executive Management, Governance, Policy, Strategic Planning, Project Direction, Marketing and Education. I have a passion for strategic vision, inspirational leadership, bold advocacy & local innovation. I have worked extensively with rural, remote and urban communities, both nationally and internationally (11 years in SE Asia and Melanesia) and always strive to achieve exceptional and tangible results for stakeholders.

My current governance duties include an international (UNESCO registered NGO) and two national level boards as well as several local peak bodies, including the Illawarra-Shoalhaven Medicare Local. As an experienced and enthusiastic company director with broad experience I can bring a fresh perspective to strategic thinking, planning & decision making processes.

I am committed to:

Medicare Locals delivering better connected and more equitable care to their communities with measurable and tangible improvements to services and wellbeing.

AMLA maintaining a fiercely independent and apolitical position supporting more flexibility to better meet the health care needs of our diverse nation.

AMLA playing a leading role in the transformation required within the health care system by empowering people who deliver services and those who receive them, building better relationships and engagement across traditional divides.

AMLA creating a robust national environment in which communities and clinicians can meet the present challenges but also have confidence and encouragement to pioneer innovative approaches tailored to local needs.

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