In part 11 of Croakey’s election series, we examine the future of divisions of general practice, which are facing considerable uncertainty, no matter the election result.
Kristin Michaels, CEO of the Eastern Ranges GP Association in Victoria, says that regardless of the election outcome, divisions of general practice are charged for reform.
Kristin Michaels writes:
Divisions of General Practice are funny organizations. Not ha, ha funny, but funny as in nothing is quite like them. They’re still relatively young in organizational terms, with the oldest having been around for 16-17 years.
This places them firmly in the realm of the difficult teenager, but the Health Minister is asking them to grow up, move out and take on adult responsibilities. Or in government speak, be part of health reform and become Medicare Locals.
Of course many Divisions are already firmly ensconced in this space. They plan, coordinate and deliver health services in both metropolitan and rural areas for both State and Federal governments, and have been doing so for quite some time. These children are ready for grown up, academic life.
Others still live at home, relying primarily on the limited Commonwealth Divisions of General Practice funding stream. However, like the good parents they are, the Commonwealth Government is providing all its kids with the best opportunities it can offer; the opportunity to change, transform….and not lose all their funding.
So in Division of General Practice land people are talking. Talking about reform, talking about the role of general practice in that reform, talking about change and leadership and most of all talking about Medicare Locals.
First they say how much they hate the name, then they lament the lack of detail in the policy, and then they move on to what it will mean in their patch of the world. However, this is not a small-minded conversation, this is a conversation of great strength and possibility. People are actually optimistic about change. And we all know that for people who work in health, as for teenagers, optimism can often be in short supply.
At the end of last week, 109 of the 111 Divisions in Australia (and 8 State Based Organisations) met in Melbourne to discuss the reform and prepare for the transition to Medicare Locals.
The overriding theme was of one of commitment to reform, whatever the result on 21 August.
The doctors and health professionals in the room were focused on solutions, primarily because it was agreed that the current system is unsustainable. In this regard the desire for reform is bipartisan, and that is possibly all that has kept it alive in an election campaign that has been forcefully focused on anything but health.
In Victoria, the State Government has played hard ball, refusing to sign up to a Health Agreement that they don’t intend to pursue. In many ways this is a luxurious position to be in; one that has a recognized role in negotiations with the Commonwealth, a structured format for those negotiations to take place, and some chips to play with.
For Divisions of General Practice the place at the table has been hard won by the Australian General Practice Network (AGPN). As a Member of AGPN, I am grateful for their leadership, their proximity to the debate and for their role in championing the capacity of Divisions of General Practice in the face of many nay-sayers.
In Victoria in particular, we are ever-conscious of the State investment in community health and always cognisant of the perception of Divisions of General Practice as a craft-driven group. Many people seem to feel very uncomfortable about power in the health system being held by GPs.
But the reality is that this is not a one-way game we are playing here. Not only are there multiple players across the health, social and community sector involved, they are all part of the community that owns the resource that is the Divisions of General Practice. What emerges from the Divisions over the next few years needs to be built for the community they serve. And that community includes social, welfare, community and health agencies working with, and being accountable to, their local people.
There is an opportunity here to bring together the best elements of what currently exists; to make the whole greater than the sum of the parts. For Divisions of General Practice, the challenge is to use this authority to change to seek better conditions, better coordination and ultimately better care for their communities.
The destination is clear, but the map is not. We all have a role in working out how to cross the boundaries we all encounter in the health sector. This direction can’t be achieved in isolation, and it can’t be achieved if we lose the momentum that has been created by the opportunity for change.
Alignment across the sector is imminent. It can be felt, if not seen. People in health are aligned for change with the purpose of improvement. It’s like a little election campaign of its own, and people are clearly voting for revolution. Well, a sensible, evidence-based revolution, which is about as riotous as we get in health. Meanwhile the Divisions wait, and the States jostle for position, and the nation votes for our next Federal Government.
So if Labor isn’t returned on Saturday and Medicare Locals go the way of the ETS, will the Divisions breathe a sigh of relief?
Probably not. The momentum of reform will still exist, the capacity is there, and the need for action is compelling.
The question is whether Divisions of General Practice can lead the charge without Commonwealth funding to do so.
I believe they can, because in the end it won’t be about the path to power, but about what you do with it once you have it, and we will be accountable to our communities of consumers and service providers alike.
For now, as easy as it is to dive into the debate and unpick the policy, the best thing we can do is to stand back and focus on the strength of the intent to reform.
To see the previous posts in the Croakey election series:
http://blogs.crikey.com.au/croakey/2010/08/13/beyond-the-election-horse-race-kicking-off-a-health-policy-series/
http://blogs.crikey.com.au/croakey/2010/08/13/a-comprehensive-analysis-of-election-health-policies/
http://blogs.crikey.com.au/croakey/2010/08/13/kellie-bissets-insightful-analysis-of-election-health-policies-dont-miss-this-piece/
http://blogs.crikey.com.au/croakey/2010/08/15/where-is-the-vision-in-health-policy/
http://blogs.crikey.com.au/croakey/2010/08/15/how-do-the-major-parties-stack-up-on-general-practice-policy/
http://blogs.crikey.com.au/croakey/2010/08/16/the-govt-opposition-get-a-big-fat-f-when-it-comes-to-obesity-control/
http://blogs.crikey.com.au/croakey/2010/08/16/what-we-need-in-the-last-week-of-the-campaign/
http://blogs.crikey.com.au/croakey/2010/08/17/how-should-we-judge-election-health-policies/
http://blogs.crikey.com.au/croakey/2010/08/17/you-may-as-well-kiss-goodbye-to-real-health-reform-whoever-wins/
http://blogs.crikey.com.au/croakey/2010/08/18/on-health-the-contrast-between-labor-and-the-liberals-is-stark/
I have never been a big supporter of Divisions AS THEY HAVE BEEN – far too many and hence too small and not genuinely accountable to their local communities. Many good people involved but a silly organisational structure and inadequate average funding per Division that stymies any real action. So yes change is needed.
The biggest change I want to see? Recognition that the Divisions of the past have not done enough to help in “closing the gap”. Whatever monies they or their successors do get post election, they need to do much more to support the Aboriginal community controlled sector in their efforts to deliver culturally secure services. And they also need to ensure that the services under the Divisions’ control or influence pay much more attention to cultural security.