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    Thanks Melissa

    As one Division having the current intent on evolving our company structure (NFP, limited by guarantee), we are taking the issue of governance and membership as the highest priority. One aspect of governance that should not be ignored is the objects outlined in the company’s constitution. The objects outline the reason for the company’s existence and is what guides the Board in the development of their strategies for management to carry out.

    In terms of accountability, a Medicare Local will be not unlike other NFP companies who are accountable to members, funders and stakeholders. The level and type of accountability will vary. I don’t think Australia is ready for an NHS style where there was originally 302 statutory PCTs established or indeed their current 300+ GP consortia. Getting that signed off by State governments in any COAG process would be virtually impossible!

    In the end, the value must be evident in the community and consumer drive and influence will be essential. There are many good points in which the Consumer Health Forum puts forward and should be used when planning for Medicare Locals. Additionally, health is an outcome and we all know that other sectors such as transport, education and local government play an important role in influencing the social determinants of health. So when it comes to Medicare Local accountability for improving health outcomes as part of healthy community reports, this will be interesting to see what the KPIs will be. This highlights How a Medicare Local will need to be evident in their openness to genuine partnership. For instance, in our community, if a Medicare Local can improve the health and Wellbeing of our Aboriginal population that will be a big tick. However, the only way to achieve this will be through genuine partnership.

    The company objects will need to reflect the strong links with community.

    Look forward to further discussion. Thanks.

    Jason Trethowan
    CEO, GP Association of Geelong

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    The question “who is going to own Medicare Locals?” is flawed and lacks a basic and fundamental understanding of companies limited by guarantee (CLBG). CLBG do not have a share capital like all private and most public companies do. That is members do not have any sort of financial ‘stake’ in the equity of the CLBG because there are no shares. Boards of CLBG need to act in the best interests of members but the answer to who owns a Medicare Local is – no one. A better question is why would anyone want to become a member of a Medicare Local? What benefits are there? Those involved in setting up ML’s would do well to have a good answer to this – and there would be some good ones.

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    This is a crucial question. As stated, the existing Divisions are pseudo-GP interest groups being asked to move into the 21st Century by considering the consumer as their primary concern. Old governance models may not suffice. Our local Network has ‘open’ membership (free) with 40% GPs with a GP dominated Board. The future ML is likely to amend membership to ‘organisations’ rather than individuals but who knows. As you rightly state, there is precious little detail and the Invitation to Tender is not even out yet (fat chance of starting by July 1!).
    I think the structure should be defined in the Contract and should allow for Equal representation on the Board of consumers, provider organisations and practitioners. It would be sooo encouraging to see the consumer have a genuine voice in proceedings rather than the thinly-veiled concessions to self-interest that we usually see.


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