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What are the implications of the new primary health care organisations?

In The Australian today, Adam Cresswell describes the Government’s drip by drip approach to health policy release as “water torture”. I’m sure plenty of people would agree with him.

Meanwhile, amid the deluge of COAG sweeteners, how to make sense of it all?

Professor Mark Harris, Executive Director of the Centre for Primary Health Care and Equity at the University of NSW, has been taking a considered look at yesterday’s announcement on primary health care organisations. He writes:

“The announcement of the establishment of primary health care organisations across Australia provides a key missing piece of the health reform jig-saw puzzle.   This is a key element of the draft Primary Health Care (PHC) strategy and provides a potential mechanism for the integration of Commonwealth and State funded primary health care services in the health reforms.

The announcement is short on details. 

However, the release signals that these organisations will be built from the existing Divisions network and have functions that include ensuring that allied health care is provided for patients with chronic conditions, increasing collaboration between a range of PHC professionals, identifying and filling gaps in access to PHC, providing better transition of care out of hospital and into aged care and delivering health promotion and preventive programs targeted to risk factors in communities.

The release also indicates that the PHCOs will take responsibility for delivering services transferred from the states to the Commonwealth.

These signal some major changes from the way in which most Divisions of General Practice have operated in the past.

The new organisations will have a much greater focus on providing or contracting community and allied health services and facilitating care delivery especially for those with chronic disease.   They will need to have a range of models for achieving this.  While some private allied health providers have been able to operate on a fee for service basis, the work of other PHC providers including aged and early childhood nurses, social workers, occupational therapists, health promotion workers etc is ill suited to this model.

Also there are examples of ‘market failure’ on the provision of allied health services where those most on need may be less likely to get access.  A more targeted approach to service provision is likely to be required to ensure equity of access by disadvantaged groups.

One concern about the announcement of the Commonwealth taking full responsibility for PHC has been that a new barrier will be created between hospital and PHC services.  This announcement indicates that this concern has been at least heard.

However, improving the transition from hospital care will require a major effort by hospitals as well and PHC, and there will need to be incentives on both sides to make this work.

Another concern has been the place of public health and health promotion services and programs in the new order.  The Commonwealth clearly sees PHCO’s taking on at least part of this function especially in chronic disease prevention.  However, they will need to be sufficient scale to make this work effectively and to attract skilled staff.

For PHCOs, form will need to follow function. There will need to be a significant transition in the current governance structures of Divisions – not only to broaden their representation (including a range of PHC professionals and community representatives) but also in their accountability.  They will need to have sufficient expertise and capacity to plan, commission and manage a more diverse range of health services and programs than in the past.

In this transition it will be important not alienate GPs or other health providers (there has already been concerns expressed about GPs being “corralled into a new structure”).”

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