Where is the outrage about this threat to primary health care?

Primary health care research in Australia is about to be dealt a major blow, warns health policy analyst Dr Lesley Russell.

The Primary Health Care Research, Evaluation and Development (PHCRED) Strategy and two related agencies – the Australian Primary Health Care Research Institute and the Primary Health Care Research and Information Service – are heading for the chopping block.

But where are the cries of protest?

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Lesley Russell writes:

It’s a recognised and international mantra that primary care is a vital part of an integrated and sustainable healthcare system (and primary health care is vital to a health system).**

Health Minister Sussan Ley has highlighted the Australian Government’s commitment to primary care as part of building a sustainable Medicare and improving health outcomes.

But now it appears that the key driver for research and building research capacity in this area – the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy – is about to disappear.

Unless an announcement of renewed federal support for PHCRED or a replacement is made within the next eight weeks, this major source of funding for primary health care research and the two agencies linked to it – the Australian Primary Health Care Research Institute (APHCRI) and the Primary Health Care Research and Information Service (PHCRIS) – will cease to exist.

Valuable expertise and institutional memory have already been lost and the policy-related research and information funded and collated over more than a decade will eventually languish, unpromoted and forgotten, in archived websites.

This is not because this health services research and communication area is deemed unwanted, inappropriate or poorly conducted, but rather, as has become so often the case with this government, it has not been deemed important enough to require attention.

So far this is happening without interest or protest from those who will be most affected.

How could we get to this situation?

A major factor has been the low profile and unsung success of PHCRED.

While the media eagerly promote stories of new cancer discoveries and, most recently, the need to review MBS items, there is little attention to equally valuable research that shows how increased primary care can keep Indigenous patients with diabetes out of hospital and saves $12 for every $1 spent, the factors that affect the geographical mobility of GPs, or how to improve care coordination for people with intellectual disabilities who live in rural areas. This Research Portrait highlights some recent studies.

PHCRED has been funded in three phases since 2000. Phase Three (2010-14) focused on the priority areas of the National Primary Health Care Strategy, specifically:

• Improving access and reducing inequity;
• Better management of chronic conditions;
• Increasing the focus on prevention; and
• Improving quality, safety, performance and accountability.

Yet despite this remarkable longevity in an area directly relevant to the vitality and sustainability of the healthcare system, many people who work in healthcare (and perhaps even the Minister herself?) know little of the work that PHCRED has supported.

The research that APHCRI supports and develops through Centres of Research Excellence (CREs), research streams, workforce training, and national and international collaborations is specifically driven by the healthcare needs of the Australian community ,with the goal of directly informing the development and implementation of health policies and services (and vice versa).

Direct lines of communication have been built between researchers, research translators and policy makers, specifically the Department of Health. It is important to note that one of APHCRI’s core objectives is to develop and embed consumer and community participation at all stages and at every level of primary health care research.

PHCRIS is funded to undertake a broad range of knowledge translation, sharing and exchange activities. This includes the annual Primary Health Care Research Conference, which will also disappear with the demise of PHCRED.

An independent evaluation of PHCRED Phase Three took place between late 2013 and early 2014 (APHCRI submission here). While this has not been publicly released, it is understood to have strongly recommended its continuation. However, it makes sense that after 15 years this is done with a fresh approach, to ensure that the substantial volume of research previously funded is actually utilised.

To this end, beginning in 2014, APHRI, with input from PHCRIS, commenced a broad consideration of new models of operation focussed on implementation and facilitating the increased uptake of research outcomes into primary health care policy and practice, thereby maximising the health and well-being of the Australian community from an evidence base. The options developed have been positively received by all stakeholders – but have not led to any action.

Although the APHCRI contract ends in December, a number of commissioned research projects (including CREs) will not be complete until 2016/2017, and one will conclude in July 2018.

The necessary funds have been set aside to meet these commitments and contingency plans are being put in place with APHCRI’s host, the Research School of Population Health at ANU, to ensure that the remaining research contracts are appropriately monitored and final reports are disseminated.  These plans will come into effect should there be no renewed funding for APHCRI or a successor organisation with these functions.

But the reality is that, in the absence of a new PHCRED Strategy, the research results from this unfinished work will go nowhere, except on to a website.

At a time when it is most needed, there is a very real possibility that there will be no future mechanism for a dedicated effort to fund and implement primary health care research.

It will be left to compete for NHRMC and possibly MRFF funds on the basis of researchers’ interests, rather than the needs of stakeholders, consumers and policy makers.

It’s a sad story. Is it too late to achieve a happy ending?

• Dr Lesley Russell was a Senior Research Fellow at APHCRI. September 30 was her last day on the APHCRI staff. She will remain as a Visiting Fellow through December 2015.

• On Twitter, follow @LRussellWolpe

** Note: The differences between primary care and primary health care are too often blurred in Australia – but arguably the goals of the PHCRED Strategy are directed to primary health care.