Today was the deadline for public comment on the Government’s recently released discussion paper outlining the roles and functions of the new primary health care organisations (PHCOs) to be known as Medicare Locals.
The National Rural Health Alliance argues that Medicare Locals, like the local hospital networks, should be structured around local communities of interest. It is also keen to see the first group of PHCOs include at least one merged Medicare Local and local hospital network to demonstrate the benefits of such coordination in underserved rural and remote areas.
A key question is whether Medicare Locals will enable us to move towards more of a primary health care system and less of a medical model of care. This is unlikely if the current incentives continue, according to this interesting reflection by Professor Chris Ham, the chief executive of the King’s Fund in the UK, who recently delivered the keynote address at the Australian General Practice Network National Forum 2010 in Perth.
He writes of how Australia rewards GPs for contacts with patients rather than continuity of care, and encourages over investigation and discourages the use of other clinicians. “The result is that doctors undertake work that could be better done by others because financial incentives may trump professional judgement about the best way of providing care,” he says. “Resistance by some GPs to moves by the government to provide public funding for nurse practitioners in primary care illustrates the strength of medical protectionism in Australia.” Ouch!
Meanwhile, health economist Professor Gavin Mooney is concerned that the voice of the Aboriginal community controlled health sector is not being heard in planning for Medicare Locals.
Gavin Mooney writes:
A few years ago, together with two Aboriginal colleagues, I wrote about institutional racism in the Australian health care system.
In the last few months, reading some of the documentation around on the new Medicare Locals (or PHCOs) from the Department of Health and Aging, the Minister and the Australian General Practice Network (AGPN), it is evident that today such institutional racism is alive and well.
Indeed, it is being built into the future of these PHCOs. In the current discussions on primary health care for the future in this country, the Aboriginal Community Controlled sector and its voice are being ignored.
The concern of that sector at not being invited to be engaged adequately in deliberations about the PHCOs is reflected in a recent media release here in the west from the Aboriginal Health Council of WA. That states for example: “We are alarmed that there has been so little effort made by the Minister and the Divisions of General Practice to involve our sector.”
I do not think this is sour grapes on their part. I share that view. The views of the Aboriginal community controlled sector are not being sought and not being heard by the Minister, by the Department or by the AGPN.
The reason? The new PHCOs are being seen as just bigger if fewer GP Divisions, with a few bells and whistles (which have been forced to be?) added on. This is reflected in the fact that all 15 of the new PHCOs are to be GP Divisions-based and according to the recent discussion paper from the Department on Medicare Locals the rest will be “largely” Divisions-based.
In her speech to the APGN Forum in Perth 10 days ago, this Divisions-focus was confirmed by the Minister.
As one example (but there are many) in that speech, she stated that her Department was engaging consultants “to develop a funding formula that will enable funding for Medicare Locals to be fairly distributed, taking into account the needs of different parts of Australia”.
According to the Minister the only body that the Government will consult “before finalising the funding formula“ is … the AGPN! No others seemingly and certainly no mention of consulting the Aboriginal community controlled sector on this funding formula.
But then, as the funding formula, according to the Minister, is to take into account only differences geographically (“the needs of different parts of Australia”) and there is no mention of the differing cultural needs of Australians, such as the special cultural needs of Aboriginal Australians, then maybe she feels no need to run the funding formula past the community controlled sector.
The discussion document is similarly neglectful of the community controlled sector.
Yes, it lists that sector as one of several with appropriate “skill-sets” that “complement those offered by the Divisions of General Practice Network”. But where is the recognition beyond “skill-sets” of the need to embrace the cultural base of the community controlled sector? Where is the acknowledgment that AMSs already often have the breadth of primary care that Divisions currently lack and which PHCOs are being asked to embrace?
It is noteworthy that the AGPN has set out some good principles, including on equity and on Aboriginal health, in its ‘blueprint document’ on PHCOs.
It is most unfortunate, however, that when AGPN comes to the operational end of things, as in its paper on a framework for PHCOs,both equity and Aboriginal issues are sadly neglected. When push comes to shove, the principles in the AGPN blueprint document thus turn out to be empty rhetoric.
There is still time for Minister Roxon and for AGPN to think again.
There remains a wonderful opportunity to build an exciting, fair and inclusive primary care sector in Australia. This needs to start with the idea of caring for patients and their health, sharing the vision with all relevant parties, including the Aboriginal community controlled sector, and embracing more firmly both equity and the social determinants of health.
Indeed I’d like to switch the letters round and have PHCOs become COPHs – Caring Organisations for People’s Health, even if not in name at least in principle and practice.
I suspect that is what Australian citizens want. It is just a pity they are not being asked.
Professor Gavin Mooney writes:
A few years ago, together with two Aboriginal colleagues, I wrote about institutional racism in the Australian health care system http://www.mja.com.au/public/issues/180_10_170504/hen10112_fm.html
In the last few months, reading some of the documentation around on the new Medicare Locals (or Primary Health Care Organisations – PHCOs) from the Department of Health and Aging, the Minister and the Australian General Practice Network (AGPN), it is evident that today such institutional racism is alive and well.
Indeed it is being built into the future of these PHCOs. In the current discussions on primary health care for the future in this country, the Aboriginal Community Controlled sector and its voice are being ignored.
The concern of that sector at not being invited to be engaged adequately in deliberations about the PHCOs is reflected in a recent media release here in the west from the Aboriginal Health Council of WA http://www.ahcwa.org.au/ That states for example: “We are alarmed that there has been so little effort made by the Minister and the Divisions of General Practice to involve our sector.”
I do not think this is sour grapes on their part. I share that view. The views of the Aboriginal community controlled sector are not being sought and not being heard by the Minister, by the Department or by the AGPN.
The reason? The new PHCOs are being seen as just bigger if fewer GP Divisions, with a few bells and whistles (which have been forced to be?) added on. This is reflected in the fact that all 15 of the new PHCOs are to be GP Divisions-based and according to the recent discussion paper from the Department on Medicare Locals the rest will be “largely” Divisions-based http://www.yourhealth.gov.au/internet/yourHealth/publishing.nsf/Content/MedicareLocalsDiscussionPaper/$FILE/Discussion%20Paper.pdf
In her speech to the APGN Forum in Perth 10 days ago http://www.gpnetworkforum.com.au/__data/assets/pdf_file/0017/32462/OPPORTUNITIES-AND-CHALLENGES-FOR-DIVISIONS-OF-GENERAL-PRACTICE-FROM-HEALTH-REFORM.pdf this Divisions-focus was confirmed by the Minister.
As one example (but there are many) in that speech, she stated that her Department was engaging consultants “to develop a funding formula that will enable funding for Medicare Locals to be fairly distributed, taking into account the needs of different parts of Australia”.
According to the Minister the only body that the Government will consult “before finalising the funding formula“ is … the AGPN! No others seemingly and certainly no mention of consulting the Aboriginal community controlled sector on this funding formula.
But then, as the funding formula, according to the Minister, is to take into account only differences geographically (“the needs of different parts of Australia”) and there is no mention of the differing cultural needs of Australians, such as the special cultural needs of Aboriginal Australians, then maybe she feels no need to run the funding formula past the community controlled sector.
The discussion document http://www.yourhealth.gov.au/internet/yourHealth/publishing.nsf/Content/MedicareLocalsDiscussionPaper/$FILE/Discussion%20Paper.pdf
is similarly neglectful of the community controlled sector.
Yes, it lists that sector as one of several with appropriate “skill-sets” that “complement those offered by the Divisions of General Practice Network”. But where is the recognition beyond “skill-sets” of the need to embrace the cultural base of the community controlled sector? Where is the acknowledgment that AMSs already often have the breadth of primary care that Divisions currently lack and which PHCOs are being asked to embrace?
It is noteworthy that the AGPN has set out some good principles, including on equity and on Aboriginal health, in its ‘blueprint document’ on PHCOs http://www.agpn.com.au/__data/assets/pdf_file/0013/21451/20091127_pap_Australian-PHCOs-Blueprint-FINAL-Graphic-designed.pdf
It is most unfortunate, however, that when AGPN comes to the operational end of things, as in its paper on a framework for PHCOs, http://www.ccdgp.com.au/site/content.cfm?page_id=57887¤t_category_code=5934&leca=230 both equity and Aboriginal issues are sadly neglected. When push comes to shove, the principles in the AGPN blueprint document thus turn out to be empty rhetoric.
There is still time for Minister Roxon and for AGPN to think again.
There remains a wonderful opportunity to build an exciting, fair and inclusive primary care sector in Australia. This needs to start with the idea of caring for patients and their health, sharing the vision with all relevant parties, including the Aboriginal community controlled sector, and embracing more firmly both equity and the social determinants of health.
Indeed I’d like to switch the letters round and have PHCOs become COPHs – Caring Organisations for People’s Health, even if not in name at least in principle and practice.
I suspect that is what Australian citizens want. It is just a pity they are not being asked.
***
More recent posts about Medicare Locals:
Previous posts in this discussion:
Helen Keleher
http://blogs.crikey.com.au/croakey/2010/10/12/a-call-for-healthy-action-beyond-medicare-locals/
Mark Harris
http://blogs.crikey.com.au/croakey/2010/10/13/plenty-of-challenges-ahead-for-medicare-locals/
Michael Moore
http://blogs.crikey.com.au/croakey/2010/10/13/and-some-more-questions-about-medicare-locals/
Jennifer Doggett
http://blogs.crikey.com.au/croakey/2010/10/15/engaging-consumers-in-health-policy-and-programs-what-does-the-evidence-say/
Sebastian Rosenberg
http://blogs.crikey.com.au/croakey/2010/10/15/mental-health-and-medicare-locals-so-many-questions-so-many-challenges-ahead/
Tony McBride
http://blogs.crikey.com.au/croakey/2010/10/18/how-to-engage-consumers-some-advice-for-medicare-locals/
