SSWAHS = SWSLHN + SLHN and the Medicare Locals - 20

First Medicare Local applications accepted, after-hours care funding fast-tracked

22nd Feb 2011

Staff writers all articles by this author

4 comments

THE Federal Government has today begun accepting applications from GP divisions and primary care organisations to form its new Medicare Locals (MLs).

Meanwhile, new guidelines for establishing MLs, released by Prime Minister Julia Gillard as part of the Invitation to Apply process launch, have been welcomed by the AGPN as further clarifying the roles the new organisations will play in ongoing health reforms.

AGPN chair Dr Emil Djakic said the guidelines announced today by Ms Gillard and Minister for Health and Ageing Nicola Roxon provided "tangible steps for the network as it transitions from the divisions of general practice program" to MLs.

"Now that the [Invitation to Apply] criteria have been released, the divisions of general practice across Australia can work with their partners in the primary health sector to formulate their respective ML proposals," he said.

The praise, however, follows recent criticism by Dr Djakic that the Gillard Government risked stymieing health reform by increasing the number of MLs after the expansion was announced as part of its health reform and funding deal with the states.

Dr Djakic had expressed concerns that raising the number of MLs beyond the planned 57 risked diluting the provision of services, resulting in weaker, less effective organisations.

The Gillard Government has allocated a total of $477 million over four years to establish the national ML network to replace the existing divisions of general practice.

The first group of Medicare Locals is scheduled to begin operating from 1 July.

According to a joint statement by the ministers, the new guidelines aim to provide support to GPs and improve patient care as well as developing locally focused services based on community needs.

Ms Gillard urged primary health care organisations to apply to become MLs through the invitation process.

GPs have meanwhile welcomed the government's announcement that it will fast-track plans to reform funding for after-hours care also announced as part of its health reform agreement with the states.

The changes may entitle practices to receive greater funding for providing after-hours care as the government has delayed the phasing-out of Practice Incentive Program (PIP) payments for after-hours consultations until 2013.

Tags: Medicare locals, AGPN, Emil Djakic, after-hours, PIP

Comments:

ed
22nd Feb 2011
6:10pm

A new name but the same old rubbish that divisions have promoted. The divisions were created to help old GPs find jobs which paid a cushy salary for no work. It also paid useless administrators to draw up programs such as"better communication with aborigines". Treat the aborigine as a human and he bleeds just like anybody.

TIBOR
22nd Feb 2011
7:21pm

The Division of General Practices have unfortunately paved the way for the establishment of the Medicare Locals, with expanded memorandum of understanding, beyond general practice run preventative community activities, with the intended incorporation of wider community representation, pharmacies, nurses and other health sectors.

The Divisions were perceived by the RACGP as having poor managerial abilities and fluctuating general practitioner staff membership. How Locals will implement and improve preventative health measures, access to hopital service and specialist sectors is rather vague. But what is obvious, they will be extensions of the government health departments at more so called specific local levels. But will they be more efficient and cost effective then the present system? To my mind and to others it appears to be another tier, requiring a whole lot of administrators, accountant, employees and governances. It is true the Divisions were fairly useless in their community preventative tasks and no real measurement were undertaken, but I cannot see the Locals doing any better. One of their aims is to provide after hours services. But if the doctors are continually poorly remunerated, then they will not have the workforce. Perhaps they think nurses and phamacists making house call is the answer. I just wonder. No matter what, Divisions are out and Locals are in! The GP's, so called, in this press release, who have been said to apparently 'welcomed the government' announcements' I would like to know their affiliations.

Solidarity
26th Feb 2011
6:33am

"Transition" is a noun. It cannot possibly be a verb.
This quote from Dr Djakic "Now that the [Invitation to Apply] criteria have been released, the divisions of general practice across Australia can work with their partners in the primary health sector to formulate their respective ML proposals," sounds just like Kevinruddspeak . Australians, read "1984" - your Government is wasting every penny to establish dictatorship and call it "freedom" or "better services". Then take to the streets to get rid of these Marxist drones.

ed
28th Feb 2011
7:25pm

News release 2 years in advance: 28 Feb 2013:

Nicola dropped from Cabinet. Applies to WHO for job. Appointed Secretary Useless Projects, WHO by Ban Kee Moon. Now a resident of Geneva. Holds dinner parties for Drs given a Medicare Local. Medicare locals collapse because of a shortage of doctors. Witch doctors from Africa and Barefoot Doctors from China invited to join Nicola's folly

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 19

Doctors want reassurance on Medicare Locals fund-holding

1st Mar 2011

Caroline Brettingham-Moore all articles by this author

1 comment

THE Gillard Government has come under fire for failing to consult GPs about the fund-holding role of Medicare Locals (MLs), with doctors now calling for reassurances that the new bodies will only be able to directly fund primary care services in cases of “severe market failure”.

Announcing the new guidelines for MLs, Prime Minister Julia Gillard last week flagged the new bodies would evolve to take on a greater fund-holding role.

“I also want to make sure that Medicare Locals over time become fund-holding organisations… so if there isn’t enough of a particular service available, Medicare Locals can make a difference to that,” she said.

AMA president Dr Andrew Pesce voiced concerns that MLs could end up using this type of funding mechanism to fund services that were already adequately provided by GPs via fee-for-service. He added that while the AMA supported fund-holding to provide services where there had been market failure, he was sceptical that MLs would quarantine funds only for such circumstances.

“The fact that the profession wasn’t involved in this discussion makes [the AMA] think that there is a likelihood that fund-holding models are being considered for other services,” Dr Pesce said.

But AGPN chair Dr Emil Djakic disagreed fund-holding would be used broadly by MLs.

“Fee-for-service is a very valuable asset in our system and works very well for a whole range of health issues, but doesn’t serve chronic disease as well as it should,” he said.

“Block funding to fill those gaps and address needs in communities is required.”

Professor Alistair Vickery, chair of the Perth-based Osborne GP Network, said more evidence was needed to determine in which circumstances fund-holding worked before enacting policy.

“We need to find what works and get evidence that a certain funding mechanism improves care,” he said.

Invitations for organisations to apply to become MLs were issued by the Government last week; the first 15 are expected to be operational by 1 July.

Tags: Fund-holding, Medicare Locals, Divisions of General Practice, AGPN

Comments:

TIBOR

1st Mar 2011
7:34pm

It was pretty obvious from the start that MLs were going to be fund-holding models. What surprises me is that the AMA supports it. I wonder if at the grass roots levels within the AMA, that they are aware of the policy. Perhaps they should reconsider their membership.

Under no circumstance should it be introduced, because it will be expanded and there will be no stopping it and fee for service could largely disappear for GPs and Specialists alike. There could become a two tier system, where MLs see the socially disadvantaged and the Private Doctors attended by the more discerning.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 18

Socrates says: "Almost one year on! This is still relevant, still do-able, and still to be done!"

Gillard can fix shattered mental health services

25th Jun 2010

Professor Patrick McGorry all articles by this author

2 comments

PRIME Minister Julia Gillard starts her new job faced with many challenges, but also with many opportunities. One of those opportunities is a unique set of circumstances that can enable profound change in mental health.

On Friday 18 June, then Prime Minister Kevin Rudd explicitly stated that mental health and aged care were the two next priority actions in healthcare. Less than a week later, at the exact time he was due to meet with the mental health sector to discuss ways of achieving progress in mental health, he was voted out of office.

But although mental health’s face time with the PM was gazumped by the ALP leadership battle, there is still momentum gathering for action on mental health reform.

Firstly, it helps that Julia Gillard is one of the politicians who “gets it” about mental health – something I observed first hand on her visits to the Orygen youth mental health service for which I work. But more importantly there are now political dynamics in play that are enablers of meaningful reform in mental health. Those enabling dynamics are greater sectoral unity, increased community support and “cut-through” to the national debate.

On the day that Julia Gillard replaced Kevin Rudd, leaders of the mental health sector presented the Government she will now lead with an agreed, common position. More than 60 signatories – virtually every key mental health body, including representatives of doctors, psychiatrists, psychologists, mental health nurses and social workers – made it clear to Government as to what needs to happen next.

Julia Gillard’s Government now has an unprecedented opportunity to work with a unified sector and can seize this opportunity by orienting policy around ending unequal access to quality care between mental and physical health.

Also on the same day that Julia Gillard was voted in to become Australia’s first female Prime Minister, her office was presented with a petition from 80,000 Australians asking her to take urgent action on mental health. These signatories were mobilised in just 48 hours and are an early expression of growing community awareness and concern about mental health.

GetUp!, which organised the petition, also published an Auspoll last month showing 83% of Australians would support a $500m p.a. package of investment to begin implementing the 12 mental health recommendations of the National Health and Hospitals Reform Commission.

Such an investment could be made immediately as a confidence-building measure by Government before working to develop the national reform program in mental health that is one of the core recommendations of the sector to Government.

That wider package of reform will involve a lot more money – probably a doubling of mental health’s share of the health budget (now 6%) to bring it close to or equal to its share of the health burden (13 per cent). This involves several billion dollars a year of public money and can only be accomplished with public support.

However, the national conversation on mental health as reflected in recent media coverage reflects a growing understanding that services are severely underfunded, that this is discriminatory and detrimental to Australian families and that sustained action to address these failings is needed.
Whisper it softly, but we may be close to a tipping point on mental health reform.

Comments:

Shikha

25th Jun 2010
5:49pm

The stumbling block, rate limiting step and bottle-neck to any such health reforms would certainly be the health minister, overlooked in this article. It was this very government and this cabinet and Madam Roxon's department that have deemed only qualified psychologists dish out mental health care under the Mental Health Plan guidelines. They have undermined and side-lined other workers in this area already carrying a large burden and caring for a great many patients, risking fragmentation of care and more burden on the already over-stretched system. Rearranging the proverbial deck chairs won't save this sinking ship under this governance. When the Minister won't listen to legitimate arguments about the flaws in the direction of health reform what difference does it make who's at the top and who she reports to? Nurse prescribing, nurse practitioners setting up next to GP's, midwife indemnity fiasco, superclinics, diabetes budget-holding and so on. Damage already done.

sickofpoliticians

5th Jul 2010
1:40pm

Its just such a pity that it takes a change in Prime Minister to forge us toward a so-called 'tipping point'. Realistically, whoever is in government, the system will still stink until someone with some sort of experience of the mental health system, reforms it. The first question we need to answer is 'How can the mental health system sustain itself when the need clearly outweighs what is given?'.

My name was one of the 80,000 handed to parliament. I did so because I have seen the system at work, I have experienced the frustration, the never-ending cycle because patients are over medicated and dependent. I have experienced the heart ache of carers who struggle to get their person a diagnosis, just so they will be eligible for the hundreds of badly planned out "programs" that the goverment has presented us with.

Spend some money on therapy, spend some money on more staff and start paying the people that work the hardest the money they need to be able to sustain the jobs they face on a daily basis. Spend some more money on research, and put Australia in the running to be best practice for mental health. Spend money to ensure that those who are caring for someone living with a mental illness feels supported. Spend some money to ensure that the person living with the illness can obtain a diagnosis quickly, and without mistake. Train the clinicians, careworkers and stop spening money without doing your research - if you have a spare $1.1 billion dollars lying around somehwere, before you spend the money, ask youself... Where do people need to money the most?

We are a nation of over-weight people already, lets not add increased rates of mental illness to that as well. Stop spending money on opening up Australia to other nations, fix the situation we have here, first! People are taking their own lives everyday, and we are all sitting here arguing about what to do next. Get is right Julia, get it done!

SSWAHS = SWSLHN + SLHN and the Federal-State Health Reforms

Dysfunctional relationship is causing chaos

22nd Feb 2011

Professor Kerryn Phelps all articles by this author

I have to admit to a frustrating sense of déjà vu with the recent COAG reform discussions.

The Commonwealth-State rela­tionship is like many dysfunctional relationships. Some of the danger signs that you are in a dysfunctional relationship are:

• Your needs are not met in one way or another

• Being there is not what you want but you are afraid to leave

• It seems there is always something to fix in the relationship

• One partner holds most of the power.

It seems like forever that we have been hearing about attempts – feeble and more robust – to sort out the quagmire that is the Commonwealth-State arrangement which attempts to fund and govern our health system.

There was a brief glimmer of hope when Kevin Rudd came out guns blazing declaring a determi­nation to clear this up or else. But all to no avail.

So dysfunctional it remains, but I suspect that this unhealthy arrangement is here to stay as there is a good reason why a relationship like this is kept dysfunctional. It means there is always someone else to blame for any inadequacies or problems.

The Prime Minister Julia Gillard made the most of a $16 billion “handshake, in principle but short on detail” deal. That in itself has an ephemeral air about it which sets off my bullshit detector. And it speaks volumes that the Health Minister Nicola Roxon was nowhere to be seen either on the day or in the announcements that followed.

The proposed COAG reforms are supposed to deliver new beds, relief for waiting lists and local con­trol. It’s anyone’s guess if any of these outcomes will actually happen once the Premiers and (eventually) any actual hospitals get to see any detail, let alone any extra funding.

How could there be a hope of anything more than tepid agreement from the Premiers on the day? For a start, the briefing proposal went out on Friday for a Sunday meeting. No state health bureaucracy could hope to decipher the implications of a complex funding change in effectively 24 hours.

Especially when it came with the prospect of yet another layer of bureaucracy and red tape to administer a proposed new national pool of hospital funding.

Previous attempts at health system reform so far have not exactly been a raging success.

‘Medicare locals’ carries no proof that they will deliver more for primary care or patient outcomes.

The admission that GP super clinics were rolled out before any analysis was done about existing GP services in these areas shows an alarming trend to ideo­logy before practicality or fiscal responsibility.

And what happened to the promised preventive health agency? Lots of rhetoric, but where is the action?

A large problem is the chronic malaise that is the Commonwealth-State relationship. I wonder what this all means to our patients, to our ability as GPs to provide best practice primary care and facilitate timely and high quality hospital care. More importantly, how will these proposed reforms help keep our patients out of hospital by keeping them well?

I see nothing in these announcements for general practice and broader community-based primary care.

And yet therein lies the only long-term answer to the much larger question about the future of next-generation public health and healthcare delivery.

Professor Kerryn Phelps

GP, Conjoint Professor, Faculty of Medicine, University of New South Wales

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 17

Are we getting the right primary care policies?

7th Mar 2011

Dr Steve Hambleton all articles by this author

2 comments

JUST about everybody wants to see practical achievable reform in primary healthcare. Things can and should be done better. With the right policies and proper support for GPs, it is achievable.

But are we getting the right policies? Judging by the reaction from health professionals – not only GPs – the Government does not seem to be getting much bang for its primary care reform buck.

In the same way that GP super clinics have failed to spark the imagination of health professionals or patients, it looks like Medicare Locals are getting similarly poor reviews. And I think the criticism for the most part is justified – and not just for the lack of detail or clarity of the proposals.

The Government seems convinced that Medicare Locals will somehow take the pressure off emergency departments (EDs). Wrong. This simply will not happen. The ED problems are there because of bed block, not Category 4 or Category 5 patients. Besides, many of these patients should not be seen by a GP in any case. They are appropriately seen in the ED and often need admission.

The ability of Medicare Locals to help ‘join up’ the health system has been severely compromised by the change in the balance of healthcare funding back to almost the status quo.

There should be a single funder. The previous reform arrangements were not perfect either, but at least the Commonwealth was taking more responsibility.

The fact is that there is no momentum any longer for any parts of our health system to come together because the funding keeps going to separate silos. There is the hospital money silo. There is the community services silo. There is the GP and related primary care silo. The aged care silo. The Indigenous care silo. And so on.

We do not have a health system. We have health systems – totally disconnected. We will know that we have real health reform when they have all been re-connected.

At its most recent meeting, the AMA Council of General Practice agreed that there are gaps in Australia’s population health coverage that need to be identified and targeted, but I don’t see that the proposed structure under the COAG Agreement will make it any easier. It is frustrating.

The collection of data by Medicare Locals is also problematic. The ‘monitor and provide feedback’ approach to the performance of primary healthcare providers is also problematic. It does not reflect the reality of private general practice.

Blindly putting your faith into GP Super Clinics being the saviours of primary care cannot be supported either, especially as they are so badly located and so lacking in planning and consultation.

They have the capacity to backfire badly on the Government.

Providing infrastructure grants and supporting the GPs who are already committed to their communities would be a much smarter investment – economically and politically.

Governments seem wedded to Medicare Locals and they are already in the process of being established, but these are not the primary healthcare organisations that were envisaged by the National Health and Hospitals Reform Commission.

Given this political reality, it is up to us – the AMA and the medical profession – to do all we can to shape and influence this policy so it actually delivers tangible benefits to patients and communities and supports hardworking GPs.

The AMA is pushing heavily for medical practitioner involvement in the governance of Medicare Locals to avoid repeating the bureaucratisation of primary care that we saw in public hospital care.

The priority for general practice is to build on the chronic disease management gains that have been made and to promote teaching in general practice to support the next generation of doctors.

The current system is not completely broken. We are getting some of the best health outcomes in the world, but we do need further support and it has to be the right support.

The Government is not helping its cause by using terms such as fund-holding and managed care or by continuing to allow the hint of role substitution to linger in the primary care reform debate.

The Government must heed the profession’s warnings, or Medicare Locals could soon be a distant memory.

Comments:

John Wellness
7th Mar 2011
4:29pm

I agree with many of Dr Hambleton's diagnoses. The original GP Superclinic Policy put out by Kevin Rudd and Nicola Roxon in June 2007 had so much promise. Admittedly reducing ED visits was always unlikely to happen and interestingly no-one seems to understand that good proactive primary health care could reduce the number of Category 1-3 patients (strokes, heart attacks and diabetes for starters) but the preventative angle looked promising. Sadly the bureaucrats failed to bring preventative care into the decision-making process and the superclinics presenting at two national conferences barely mention it. This is simply because existing "illness" funding will not allow multidisciplinary preventative care. The location of the Superclinics too has been inept. At a time when there are lots of areas needing services to help meet population growth needs putting them in established areas was simply woeful. Putting them on hospital grounds will work directly against keeping patients out of hospitals.

The Medicare Locals don't look like being very different. Giving the inside track to divisions of general practice is unlikely to generate new ideas and new ways of delivering care. When nearly 1/3 of the total burden of care is preventable by lifestyle improvement that there is so little attention given to looking at new ways of preventing chronic disease is scandalous. The primary health sector could make a huge difference if its funding system could lead to new forms of practice and program delivery. Just don't hold your breath waiting for proper reform.
John Wellness

Detracter
7th Mar 2011
5:56pm

We have a Health Care System built around Disease Management rather than Disease Prevention so you can get funding and administration set ups for diabetics but nothing for the obese person they were for the last twenty years.
Western medicine is falling apart financially as we keep diseased people alive and dependent upon us for ever increasing decades. Politicians have by nature a three year thinking cycle ,so every bureaucratic strategy they come up with in their Health Care tent, such as Superclinics in marginal seats, is aimed at getting themselves out of that boggy tent onto drier more publicly recognised land such as the environment or climate change.
We doctors are in an elite group of highly intelligent articulate people who are trained primarily to think differently to the rest of the population, and secondarily with technical and practical skills unreachable by the rest of the community.
We have a responsibility to actively change the health agenda away from the money for disease formula, to a health prevention formula. The health agenda is quickly moving away from and diluting our clinical skills, and a doctors hand on the abdomen in the middle of the night in former years is now being replaced by a nurse with a MRI scan request.
Our society is not training enough doctors of our standards as it is easier and cheaper to import them, so we as a group need to actively get into the health care debate and challenge and re-educate the politicians, media and general public. We need to stop being seen as a group always whinging about money and repaint ourselves as the caring intelligent professionals our patients see us as.
We need to take control of the Health Care debate away from the politicians and run it ourselves.
Detracter

SSWAHS = SWSLHN and mental health in the Southern Highlands

Socrates says: "It's great that the National AMA is prepared to put forward the case for more funding, but not all mental health services are provided from general practices in this country."

If we are to have a more egalitarian mental health service we do need to engage the other parts of the private sector in the treatment and support of persons with a mental illness.

Likewise, we need to ensure that part of the funding goes to support the carers of the persons with the mental illness. Mainly because they provide the 24/7 care and support to the person and not the clinicians in the private or public health sectors.

Finally, let's ensure that the public health sector has the finances and the staffing levels to provide a better mental health service to the persons with the mental illness. The level of mental health beds available in the state of NSW is currently abysmal, with one of the highest populations and the lowest number of available beds per 100,000 in the country. With the changes in the state's parliament it's time for a new broom to sweep away the dinosaurs who have held back NSW from taking the lead in improving mental health outcomes for people with a mental illness.

As far as the Southern Highlands is concerned I hope that the new broom sweeps through the Concord Hospital Centre for Mental Health and removes some of the incompetents there.


Mental health needs more funding, services: AMA

29th Mar 2011

Andrew Bracey all articles by this author

1 comment

THE AMA has called on the Federal Government to provide $5 billion in funding to expand, better resource and coordinate mental health services.

The money would be used over four years to increase MBS rebates for GP consultations relating to mental health issues, to better reflect the complexities involved and meanwhile support public campaigns to reduce the stigma attached to mental illness.

The call came as the association today unveiled its latest position statement on mental health which included a range of priority areas for government action in mental health policy.

The AMA plan also backed previous calls by mental health campaigners including Professor Patrick McGorry to expand the number of community-based youth mental health Headspace centres and the number of Early Psychosis Prevention and Intervention Centres.

Phone counselling services would also be expanded under the AMA plan.

AMA President Dr Andrew Pesce said that Australians with a mental illness deserved to have ready access to quality individualised mental healthcare.

"This requires a significant expansion of services, intervention and support across the whole continuum of care for people with mental illness," Dr Pesce said in a statement.

"This also requires a significant funding boost to address the gaps in our current mental health services and enable the delivery of comprehensive, integrated and coordinated mental health services for all people who may develop an acute or chronic mental illness at any stage of their lives."

The AMA's position statement, which also discusses the need for greater government action across areas such as prevention, early identification and intervention, community-based care as well as acute and sub-acute care, can be accessed at: http://ama.com.au/node/6524

Comments:

Bibiana
29th Mar 2011
4:53pm

It is great to see AMA taking a strong stand in pushing the Federal Government for more injecting more funding into mental health services at Primary Care level. It was Oct 2008 at the WONCA Conference in Melbourne that WHO launched their report "Integrating Mental Health into Primary Care - A Global Perspective". In the report it provided 7 good reasons for such integration. On top of the list is 'the burden of mental disorders is great'. In my view as a consumer, the most important reason is 'Primary care for mental health promotes RESPECT OF HUMAN RIGHTS'. This is in-line with AMA's call for more funding to support campaigns to reduce the stigma attached to mental illness.
I recently attended a mental health forum 'What happened to mental health under Gillard?' in Sydney, one of the speakers was Prof Ian Hickie. He highlighted his 'Love and Hate' relationship with the Federal Government (and all the PMS and Health Ministers involved). The current government is exhausted in fixing too many unpopular policies (carbon tax, mining super tax etc), the Health Reform has to give way and let alone mental health. In his concluding remark, Prof Hickie pointed out the obvious - if the Government is smart enough to fix the long overdue mental health problems, many of the physical health issues will become more manageable and not vice-versa!

To download WHO's report, go to the following link:
http://www.who.int/mental_health/policy/Integratingmhintoprimarycare2008_lastversion.pdf

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 16

Now it’s time for the real health reform

22nd Feb 2011

Robert Wells all articles by this author

The Government is to be congratulated on reaching agreement this week with the states and territories to break the impasse that arose following the previous ‘agreement’ in April 2010.

The new agreement provides for a phased growth in Common­wealth funding for hospitals to reach 50% by about 2014 (from its current level of around 40%) and to remain at that level, including for growth.

Commonwealth and state/terri­tory contributions will be paid into pooled accounts and funds will be distributed from those accounts by an independent agency based on ‘efficient’ price for services in larger hospitals and block funds for smaller institutions.

The price, too, will be set independently. The agreement includes targets of a maximum waiting time of four hours for service in emergency depart­ments and 95% of elective surgery being undertaken within the clinically indicated times.

The MyHospital website will continue and report data on individual hospital performance.

The agreement is in principle only at this stage, with more detail to be discussed by officials on technical implementation issues.

There is some concern that the detail will be the Achilles heel that will ultimately bring the whole edifice down but presumable a spirit of cooperation and the national interest will prevail.

Is the agreement a good outcome?

The agreement achieves a key objective of getting hospital funding arrangements between governments on to a clear footing for the next decade.

The move to casemix as the basis of funding and the Commonwealth’s commitment to match 50% of costs, including growth, should remove some of the traditional argy-bargy, although the ‘blame game’ will continue.

The transparency of the funding arrangements is a strong point, although likely to provide many ‘sticking points’ for assiduous bureaucrats. The targets for ED and elective surgery will no doubt result in gaming and distortions, but what’s new? Improved performance can be expected over time with the public reporting of hospital level data.

Overall, it is a good outcome from that limited set of perspectives.

Does the agreement constitute a landmark health reform? Are there any gaps still left? The strength of the agree­ment is that it clears the decks for a few years around vexed questions of hospital funding.

However, it does not provide a long-term answer to the question of how we cope with rising hospital costs; at best it buys us time to work through that issue in a more considered way.

Inevitably the states’ and territories’ capacities to cover half hospital operating costs plus invest in new capacity will be all-consuming. We need to start planning for that now and asking ourselves how we will tackle that problem.

While the agreement includes some initiatives in relation to primary health care, that area needs much more attention and that is where more comprehensive health reform is needed.

The agreement takes a step back from the previous commitment that the Commonwealth would become the sole funder of primary health care and so the current fragmented system will continue. Reform now needs to focus on how the fragmentation can be overcome within the multiple-funder environments.

The sharp end of this reform now seems to be with the Medi­care Locals, which have been given a boost through the new agreement, with a bringing forward of their establishment and a plan to have more of them.

Fortunately, the agreement spells out in more detail than has previously been available just what the Medicare Locals will be expected to do. Key elements of their role will be to:

• Identify local service gaps with the funding flexibility to do something to address them;

• A specific focus on improving access to after-hours care;

• Clear reporting and accountability against a national performance framework; and

• Improve coordination of primary healthcare across various providers.

So the challenge for us all now is to get the primary health reform process happening within this framework.

Robert Wells

Director, Menzies Centre for Health Policy

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 15

Building the future of healthcare

28th Mar 2011

The good, the bad and the ugly of Medicare Locals. Pamela Wilson reports.
Pamela Wilson all articles by this author

2 comments

LAST month, the medical profession finally got its first real glimpse of the Commonwealth’s vision for its new health reform tool, Medicare Locals.

The Commonwealth’s 21-page document, Guidelines for the Establishment and Initial Operation of Medicare Locals, gave a broad outline of what these primary healthcare organisations will be expected to do, how they will do it and who will govern them. It also formally invited interested parties to step up to the challenge.

So far, many health commentators agree the aspirations in the guidelines – although they are mere statements at this stage rather than policy – are promising.

Robert Wells, director of the Menzies Centre for Health Policy at the Australian National University, feels there is potential for Medicare Locals to better tailor services to communities. Given they will be tasked with identifying gaps in local services, there is a real opportunity for the new bodies to focus on disadvantaged populations, such as Indigenous or refugee patients.

“The guidelines seems to give Medicare Locals a much better role in working with the Local Hospital Networks in their area and state/territory government community health… and there is a greater capacity [to develop] a more localised approach to healthcare,” says Mr Wells.

Although pointing out the new bodies are not an end point in themselves, AGPN chair Dr Emil Djakic agrees Medicare Locals are the tool through which the Commonwealth’s national primary healthcare strategy can be delivered.

“Medicare Locals are going to be the organisational infrastructure that builds on what has already been happening in the division network to try and deal with some of these things which our existing system had not been addressing,” he says, referring to access, inequity, prevention, better management of chronic conditions and accountability.

But not everyone has been won over. The AMA recently took a strong stance against the formation of the new bodies, claiming none of the details released by the government about Medicare Locals explains exactly how they will benefit patients or communities.

AMA president Dr Andrew Pesce has in fact called for the roll-out of Medicare Locals – set to begin from 1 July – to be shelved until greater consultation with clinicians has taken place.

There are still too many unanswered questions, he argues, particularly on the issue of fund-holding and GP involvement.

The consensus among health commentators seems to be that while the initial framework looks promising, the true test of success will be in the program’s implementation.

They argue this will require the Commonwealth not only to ensure adequate and flexible funding for the new bodies, but also to ensure that Medicare Local executive bodies have an understanding of the integral role that general practice must play in their functioning, and in overall primary healthcare reform.

It is this last point – how involved general practice, and general practitioners, will be in Medicare Locals – that is weighing on everyone’s minds.

The Medicare Locals boards will be skills-based and not representative, meaning there are no mandated seats for GPs or other practitioners.

However it is widely hoped that clinicians with governance skills will put up their hands to be involved.

“Unless GPs are significantly represented on those boards, I think the concept will not work well,” says Dr Pesce.

RACGP president Dr Claire Jackson says the main query from the college’s GP members is the amount of support they can expect from Medicare Locals, given that they will succeed divisions of general practice.

“GP groups are obviously very keen to see Medicare Locals embrace a broader health professional network but not to lose sight of the fact… there needs to be a heavy emphasis on general practice as the central pivot for primary care service delivery in the community,” she says.

Eastern Ranges GP Association CEO Kristin Michaels, who hopes her Victorian division will be among the first successful 15 tenders, says that among her colleagues there is strong recognition that general practice must be highly engaged in this process.

“It’s about those skills you bring to the table, but ideally you want a couple of GPs with [governance] skills,” she says.

As confident as Ms Michaels is in the success of her division’s bid, she is not as optimistic about the Commonwealth’s claim in the guidelines that “over time, Medicare Locals will be given the capacity to use Commonwealth program funding flexibly”.

“We’ve not really seen the Commonwealth able to achieve that [flexibility in control of funding] completely in the past. It’s difficult for governments to let go of things,” she says.

Dr Djakic believes it won’t be clear how much control Medicare Locals will truly have until the Healthy Communities Report for each area is produced by the National Performance Authority.

“How much funding and flexibility will depend on what questions or accountability a Medicare Local has to have against the Healthy Communities Report,” he says.

There are also questions about the funding mechanisms of the new bodies, after Prime Minister Julia Gillard stated they would become fund-holding organisations in the future.

United General Practice Australia released a statement last month urging the Commonwealth not to introduce fund-holding arrangements for MBS and PBS.

Dr Pesce also told MO he was concerned that a lack of consultation with the profession on this issue by the Commonwealth meant fund-holding was being considered.

“There have been references to Medicare Locals as fund-holding. We were previously given reassurances that funding for medical services would be for primary care and not through primary healthcare organisations,” he says.

“We’ve tried to get clarification on that [from the government], we haven’t been able to.”

Another funding concern relates to the distribution of money for the after-hours reform with which Medicare Locals are being tasked.

Dr Djakic is urging the Commonwealth not to strip funding from those after-hours services that are working well and instead have a critical look at what it genuinely takes to sustain them.

Dr Pesce agreed that the Commonwealth shouldn’t try to fix programs that aren’t broken.

“We all recognise that after-hours care can be done better… [but] we have to be careful that where something is working, the change doesn’t harm that.”

Already, in every way, it seems Medicare Locals will not lock into a one-size-fits-all model.

Ms Michaels points out that among her colleagues in other divisions there is already a strong difference in opinion on things such as the organisational structure Medicare Locals should take, and whether divisions themselves will transition into Medicare Locals or contract as service providers.

No matter what model each division decides upon, one thing is clear: this is the end of divisions of general practice as they have been known for the past 19 years.

On 30 June 2012, funding to divisions – including the AGPN – will be transferred to Medicare Locals.

But it is expected that the new model won’t simply be the divisions program by another name.

“Medicare Locals have the capacity to do something bigger and better than divisions have been able to do… with a little bit more funding and more formalised relationship expectations,” says Ms Michaels.

The reality is that the true shape of Medicare Locals won’t be known until July this year when the first 15 are up and running.

Medicare Locals

What are they?

- There are 42 agreed boundaries (with the exception of Victoria and Western Australia). However, the final number may exceed the planned 57.

- $477 million over four years will be used to establish the Medicare Local network.

- Annual core funding for each will be about $171 million.

- They will be expected to have some common membership of governance structures with Local Health Networks (LHNs).

- Boards will comprise seven to nine members.

- Although not mandatory, an organisational membership – with community groups and local health services – is preferred over an individual membership model.

They will be required to:

- form strong working relationships with LHNs and Lead Clinician Groups to deliver coordinated healthcare;

- undertake certain responsibilities such as fast-tracking after-hours reform, driving telehealth services and supporting the development of e-health and GP super clinics;

- undertake analyses of gaps in health services in their area and provide evidence-based strategies to improve patient outcomes;

- participate in the performance and accountability framework, including the Healthy Communities Reports prepared by the National Performance Authority.

Comments:

Dr Manda
29th Mar 2011
8:28am

Does the $477m include what was spent on Divisons etc or is it on top of? How many more bureaucrats or other health professionals are going to be paid from this money to ensure MLs run as per primary care "changes" (not reforms till proven please!? Dollars given usually contain political spin.
Dr Manda, Sydney

Dr Manda
29th Mar 2011
9:08am

The ALP rants eternally about "equality of access". It uses this as a pretext for nationalising medical care. This benefits middle class lefties only, not the poor. But even the cockatoo who sits on my back porch every morning can see that Medicare Locals are Stage 2 of the socialisation of medicine. The public hospitals have been impoverished by Medicare. General practice is next. What brand of socalism we end up with depends only on who owns the facilities and employs the doctors. if it is the state, we become International socialists( i e Communists), or if the Medicare Local facilities are left in corporate hands, we are "only" National Socialists (that is, Nazis).
Some choice.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 14

Just to emphasise the problems we Southern Highlands health consumers may face in the near future if the Macarthur-Southern Highlands marriage takes place with two entrepreneurs jockying for the presidency!

Bitter split emerges in race towards Medicare Locals

17th Mar 2011

Byron Kaye all articles by this author

3 comments

GP networks vying to become Medicare Locals (MLs) have been urged to cooperate after a joint bid by three divisions to become Australia’s biggest primary care hub collapsed into a bitter split.

With the 4 April deadline for the first round of ML tenders looming, the Sydney-based General Practice Network Northside (GPNN) unexpectedly broke from neighbouring Northern Sydney General Practice Network (NSGPN) and Manly Warringah Division of General Practice (MWDGP) to prepare a solo bid.

In his division’s newsletter, due to be sent to members this week, NSGPN chair Dr Harry Nespolon suggested he had been “double crossed” and questioned whether GPs could “trust or support such an organisation”.

“It’s pretty hard to see how a GP in Palm Beach is going to feel warm and cuddly about [being serviced by a Medicare Local] which is basically the Hornsby division,” he told MO.

The remaining two networks would continue to work on their own joint bid, he added.

GPNN chair Dr Jennie Kendrick said governance, membership and function were the key issues that led to the decision to pursue the solo bid, but she hoped all parties would be able to work together regardless of the outcome.

“It’s a practical decision,” Dr Kendrick told MO.

“We don’t have any problems working with them.”

AGPN CEO David Butt urged cooperation among divisions bidding for MLs.

Tags: medicare locals, divisions, tender

Comments:

ed
17th Mar 2011
5:36pm
These networks only provide a cushy paid job to GPs who have no skills in looking after patients. Some of the GPs involved would not be able to treat a diabetic seizure or a serious complaint. They can all write care plans but not see anything wrong in a child that has difficulty reading and hearing. As one who told me at a clinical meeting, "I like my red wine and earn money via Medicare so that my children can go to a private school". He was...(sorry, I am a coward)

ondocfarm
17th Mar 2011
6:25pm
Oh..so power and glory cannot be shared.....? Well each should go it alone! Our area has seen three different divisions merge into one that has a ?? degree of usefulness, but keeps the combined egos of those involved ensconced and well paid (many are NOT GPs) even if the bulk of the GPs covered find it hard to define what benefit occurs.

MLs just a bigger mess and also of undefined usefulness?

Solidarity
17th Mar 2011
11:27pm
The whole concept is flawed; leave traditional GP structures alone and stop twiddling knobs to prop up a Federal government in meltdown. ML already smells like BER and insulation and every other scheme that has gone wrong. Toxicity rising from it already.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 13

Socrates is pleased to announce that, for the very first time, the CEO of the Southern Highlands Division of General Practice - Dr Warwick Ruscoe, has uttered some words about his plans (or lack of them) for a "local" Medicare Local.

More divisions split over Medicare Locals

29th Mar 2011

Byron Kaye all articles by this author

BIDDING for Medicare Locals (MLs) has led to another bitter rift between GP divisions, with accusations that some are spreading false information now tainting the contest to become the hub for Sydney’s south-west.

With the deadline for the initial round of ML submissions next week, an AGPN-appointed mediator has been called in to instigate talks between Bankstown-based South West Sydney Health Coalition (SWSHC) and rival joint bidders the Macarthur Division of General Practice and the Southern Highlands Division of General Practice.

The talks came after Bankstown GP Division CEO Andrey Zheluk, whose division is spearheading the SWSHC bid, accused his rivals of claiming to be the “official bid” for the area’s ML.

He said in a statement that his rivals “do not enjoy any exclusive right” and the claims “adversely reflect… on the future formation of a Medicare Local”.

Mr Zheluk told MO mediation was progressing “slowly” but could result in a joint bid.

Southern Highlands Division CEO Dr Warwick Ruscoe denied claiming exclusive rights.

“We don’t consider ourselves the official bid,” he said. “If someone else wants to make a bid, that’s fine.”

The latest rift follows a recent stoush between divisions in the city’s northern suburbs, after a joint bid between three divisions broke down.

It also came as the AMA presented its own vision for MLs. Last week the association called for the rollout of the new bodies to be put on hold pending further consultation with the profession.

It its position statement, the AMA reaffirmed its staunch opposition to any fundholding arrangements for GP and specialist services or the PBS.

It also stated that local doctors must hold leadership roles on the new bodies.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 12

What can we learn from the national rural health conference?

Gordon Gregory writes:

Proceedings at the 11^th National Rural Health Conference in Perth last week demonstrated that, despite how busy health professionals are in rural and remote areas, they have a firm grasp of the risks and opportunities associated with the health reform agenda.

In her speech to the closing session, Nicola Roxon reminded her listeners of the substantial investments the Rudd and Gillard Governments have made in rural and remote health. Not for the first time, the Minister was at pains to emphasise that these rural commitments were in place before the hung parliament added another reason for a regional focus.

The majority of those at the conference were people engaged at the coalface in the real work of managing rural and remote health services. For them the bigger picture is a thing of great importance but of considerable mystery.

Quite how the establishment of Medicare Locals and Local Hospital Networks over the next 18 months will impact on them and their work cannot possibly be clear: if it’s not plain and obvious to the painters of big pictures, it certainly won’t be obvious to the Director of Nursing at Nyngan.

What is certain is that most of the hopes generated through the health reform process of the last three years are now hanging on Medicare Locals. If they succeed (and everyone accepts that it will take some time), there is the prospect of a more integrated primary care system and a better patient journey.

The more ambitious people – and those with even greater patience – even have hopes that Medicare Locals will be effective on the broad primary health care front, by helping at the local and regional level to integrate the contributions that education, food and water policies, housing and public transport etc make to health status. (Handy hint: if the paragraph you’re reading or writing doesn’t encompass primary or secondary education, or food policy, or employment status or community development, it is not about primary health care.)

The health reform process might be described as ‘stuttering’ due to the recent decision of Western Australia to join in and continued uncertainties hanging over the situation in Victoria and New South Wales. Nevertheless people at the conference were optimistic that there is light at the end of the tunnel – and that it is not coming from the construction team extending its length.

For many people, therefore, the future and the success of Medicare Locals is a matter of trust. In rural and remote areas (we argue) surely we can have better access to integrated care from the right person at the right time – and surely a good way to achieve this (we believe) is through us (consumers and providers) having greater local control over our health services. This belief certainly reflects the number one word that was on people’s lips at the Perth conference: empowerment.

So the immediate challenge is to make sure that everyone who ought to be involved in a Medicare Local application is involved.

Some people are calling for a delay in the first tranche so there can be better understanding, more consultation. Others want, at this very late stage, to unpack the whole proposal and re-shape it yet again.

Let’s get on with it I say: how much longer do we all need, how much more patience have we all got!

The Alliance has an agreed set of principles for Medicare Locals – particularly those in rural and remote areas – and the challenge now is to move from theoretical constructs, to getting all the right people involved and committed to acting on those principles.

Seize the Day!

One Comment

1. Duggy the DC3
   Posted March 25, 2011 at 6:31 pm

   The people who truly understand the needs of Rural and remote health are too busy trying to deliver what they can with the limited resources they have, in an underfunded and undermanned sector. The people who have the time, inclination and Corporate Knowledge to understand such a broad brush approach to reform simply must acknowledge that consultation is the key or the whole thing becomes another Disaster of administrative incompetence.

SSWAHS = SWSLHN + SLHN and the NSW State Election - 2

What has the NSW Coalition promised for health?

March 27, 2011 – 2:31 pm, by Melissa Sweet - Croakey on Crikey

"What will the change of Government mean for health in NSW?

"These are the headlines of what has been promised, according to the incoming Health Minister Jillian Skinner’s website.

• An extra 1,390 beds and 2,475 more nurses for the NSW health system. This includes 550 more beds and 275 more nurses over-and-above those currently promised by Labor at an additional cost of $340 million

• Increased funding for chronic disease management by $57 million to improve sufferers’ quality of life and drive down unnecessary hospital admissions.

• Establishment of a NSW Mental Health Commission, based on best practice models around the world, including the Western Australian Mental Health Commission. It will also provide quarantined and accountable funding for mental health expenditure; and establish three specialist units within the Mental Health Commission to better manage the experience of mental health patients and carers, divert mental health patients away from the prison system, and help ensure a smooth operation of the Mental Health Review Tribunal.

• Development of a state-wide NSW Pain Management Plan to ease the burden of suffers of chronic pain, improve their quality of life and help them re-enter the workforce. They will also maintain existing pain management and research programs across NSW.

• Establishment of an Office of Preventative Health. Located in South West Sydney, the office will have a state-wide focus and be established in partnership with the University of Western Sydney.

• A NSW Liberals & Nationals Government will fix hospitals (a promise that will no doubt come back to bite!) by investing over $3 billion in health infrastructure over the next term of government. The $3 billion investment includes an injection of an additional $885 million to fast track hospital upgrades, redevelopments and other health infrastructure priorities over the next four years, as well as the existing health infrastructure projects in the State Budget.

• A NSW Liberals & Nationals Government will appoint Peter Wills AC to help develop a 10-Year Medical Research Strategic Plan for NSW. They will also boost medical research in NSW by $20 million to drive innovation aimed at providing better patient care.

• A NSW Liberals & Nationals Government will commit $10 million to provide local health checks and improved management of chronic diseases is expected to dramatically improve the health of those at risk of, or who suffer from conditions such as diabetes, asthma, obesity and cardiovascular disease.

• A new Telehealth Technology Centre – devised and driven by doctors and their patients will be set up at Nepean Hospital under a Libnerals & Nationals Government in NSW.

• The NSW Liberals & Nationals have announced plans to increase funding for drug and alchol treatment – the first new money for respected bodies successfully treating addictions since the 1999 drug summit.

• The NSW Liberals & Nationals have released a policy outlining its intention to increase funding for the IPTAAS scheme by 50% – an extra $28million over four years.

• NSW Liberals & Nationals will deliver change to close the gap, an article Jillian wrote for the AMA’s medical journal. It was published in NSW Doctor in May 2010.

• A speech Jillian gave to the Australian Industry Information Association in April on e-health

• The Coalition’s plans to reform the management of the public health system are outlined in a document called ‘Making it Work’ released in March 2009.

***

"Meanwhile, we shall wait to see the implications for national health reform. No doubt some senior health bureaucrats are also wondering about their jobs…"

These promises seem very promising but, as far as the Southern Highlands community is concerned, they are short on detail as how these promises will result in improved health services and provide a more substantial, new and enhanced public hospital to meet the needs of our expanding and ageing population. Unfortunately, we may have to wait another four years to find out.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 11

In my previous posting I noted the negative response from the general practitioners in the Blue Mountains in regard to their non-representation on the Board of the Nepean-Blue Mountains Local Health Network. Here is an abbreviated part of what they had to say:

Katoomba out in cold on hospital board: specialist

BY SHANE DESIATNIK
Blue Mountains Gazette
23 Mar, 2011 09:55 AM

"Australian Medical Association (AMA) Blue Mountains district representative Dr John England has raised questions over the makeup of the Nepean/Blue Mountains Local Hospital Network board (LHN) established in January, claiming it is virtually a Nepean Hospital establishment.

“The consensus at the meeting was that we don’t know anyone [on the Nepean/Blue Mountains LHN board] except Dr James Bramley, who is based at Nepean Hospital but does relief and occasional weekend work at Katoomba Hospital,” Dr England said.

“Nobody really represents Blue Mountains hospitals [on the board] — that is the truth. “You know the saying, the big dog eats all the food.

“We hope that in the future there will be actually people who work full-time at Katoomba Hospital appointed to the board.

“But what I really think is needed is that doctors appointed to Nepean Hospital should have to work at least one day per fortnight at Katoomba Hospital as part of their contracts.”

These statements made me interested to find out something about the SWSLHN Board members and just what they had in the way of qualification to be able to manage the delivery of health services from Fairfield to Bowral.

Here is the published list for the SWSLHN: Professor Phillip Harris AM (Chair); Mr Timothy Bryan; Ms Carolyn Burlew; Ms Christine Carriage; Professor Brad Frankum; Dr Kathryn Gibson; Mr Mark Johnson; Professor Margot Kearns; Dr Jens Kilian; Ms Debbie Roberts; and Professor Jeremy Wilson.

With the magic of Google it is simply amazing what one can find out about people!

Professor Phillip Harris is, among other appointments, Head of Cardiology at the Royal Prince Alfred Hospital (not in the SWSLHN);

Mr Timothy Bryan is a bit of a mystery as it appears he hasn't done much in his life, yet - though there was a convict with the same name who was given his ticket-of-leave in the Colony of NSW at Mudgee on 30th of April 1850!

Ms Carolyn Burlew is the Vice President of the Institute of Public Administration Australia (NSW Division) and has an impressive pedigree of working for the NSW Government and its various Departments. Ms Burlew currently has another 7 positions on various Boards and other ventures in addition to her place on the SWSLHN Board;

Ms Christine Carriage is an Indigenous Project Officer and has a career in helping to improve the health of Aboriginal communities through the "Close the Gap" program;

Professor Brad Frankum is Professor of Clinical Education at the University of Western Sydney's Medical School and also is a specialist in the field of immunology. He has been used in the Macarthur area to inspire school students to consider a career in medicine and he is sufficiently a realist to state: that there is a real battle approaching with the access to, and distribution of, health care. At the Macarthur Anglican School he noted: "Western Sydney gets ripped off with health services". Well, I just hope that Brad Frankum can set his sights upon the more rural parts of the SWSLHN when he begins to argue for more health resources.

Dr Kathryn Gibson (not to be confused with Dr Katherine Gibson of the UWS) is the Head of the Rheumatology/Immunology Unit of the Liverpool Hospital as well as being an Associate Professor in the Medical School.

Mr Mark Johnson could be the same Mark Johnson (AO) who, until July 2008 was the Deputy Chairman of the Maquarie Infrastructure Group (MIG), which in 2007 made a loss of $1.7 billion. Nevertheless, he does have some powerful credentials in his pedigree with a law degree (Melb) and an MBA from Harvard. It has been stated that he is one of the most widely respected, accomplished, and experienced corporate advisers in Australia. Gee! I hope I got the right guy here! If I have, then I imagine that Mr Mark Johnson AO will be distracted by being on the Board of Westfield and the 3 other Advisory Boards for the Australian Government.

Professor Margot Kearns is Pro Vice Chancellor and Executive Dean of Nursing at the University of Notre Dame in Sydney which had its first graduating class in December 2008. The photos of her seem to indicate a maternal and caring person. Hopefully, Professor Kearns will be cognizant of the needs of the nursing staff in the more remote and rural areas of the SWSLHN.

Dr Jens Guenter Kilian is the Director of Cardiology at Bankstown Hospital and also Conjoint Senior Lecturer in Medicine at the University of Sydney. He studied medicine at the University of Melbourne and has qualifications from there in medicine and surgery. Dr Kilian obtained his degrees in 1998 and has been working as a staff specialist in cardiology since October 2006.

Ms Debbie Roberts is the CEO of Youth Solutions, a Macarthur-based NGO which, obviously enough, seeks to improve the health and well-being of young people in the Macarthur area. However, I do know that Youth Solutions has also taken an interest in what happens to the youth of the Southern Highlands.

Professor Jeremy Wilson graduated in medicine from the University of Sydney in 1974. He specialised in Gastroenterology at Concord and Prince of Wales hospitals. At the latter he tinkered a little with drug and alcohol services and it was here that he aspired to create the first of his Very Big Buildings to celebrate his work. Unfortunately, he didn't get his way and so he took off to America with his bat and ball, to undertake research as a Visiting Fellow at the Mount Sinai School of Medicine. Upon his return to Sydney he was appointed as a Conjoint Senior Lecturer of School of Community Medicine at the UNSW and became Associate Professor of Medicine in 1997. Following a surge of appointments to Bankstown-Lidcombe Hospitals and the newly established SWS Clinical School he became Professor and Director of Medicine at Liverpool Hospital. While Professor Wilson is a renowned pancreatologist, he is more renowned in the old SSWAHS as the lead developer of "The Way Forward" document in which the SSWAHS divided itself into divisions of clinical streams. He was renowned for being one of the most senior SSWAHS to completely forget about Bowral Hospital and the community health services in the Southern Highlands. At least, out of that debacle he did manage to wrangle another of his Very Big Buildings at Liverpool Hospital.

So what does this little expose tell us? Well we appear to be no better off in the SWSLHN than our friends up in the Blue Mountains.

No representation by the significant health care providers in the community - the general practitioners. No real health consumers representing the mainstream community members. No real opportunity to engage in public discussion or consultation, with the bulk of the Board consisting of academics and senior clinicians who have mixed roles. Those who are not clinicians or academics are equally tasked with multiple positions in multiple organisations.

Somehow this whole exercise of appointing a Board to govern the activities of a Local Health Network seems to be a cynical exercise in developing a framework structure for a hollow organisation. Maybe returning to the autonomy of a Board for a local hospital will be the only way local health services will get the resources and funding they need. Is the current trend just another way for the senior specialists getting the machines that go "ping" at the expense of the basic clinical and health needs of the communities the health service is meant to serve?

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 10

Another rural-based hospital appears to be having the same concerns as Bowral Hospital, and the Southern Highlands community, about the SWSLHN understanding and recognizing the unique issues faced by a rural District hospital and their community's health needs.

The following article is from the Blue Mountains Gazette and reflects a much more responsive Division of General Practice than the Southern Highlands Division of General Practice under the control of its CEO. At least the Katoomba and Blue Mountains Division used their AMA representative to introduce a forum for their Division's GPs to hear what each of the 2011 election contenders had to say about their health policies. Secondly, they were in a position to advise the candidates what they, the GPs,considered to be the election issues for health.

In the Southern Highlands there has only been stony silence and, as seen in the previous post, absolute refusal on the part of the Division to comment about Medicare Locals and the SWSLHN, generally. As far as Socrates is aware there has been no meeting attended by the general practitioners of the Southern Highlands at which they could be informed of the planned marriage of their Division with that of the Macarthur area. Certainly, the only announced meeting to which the CEO agreed to attend was with a handful of the local psychologists in private practice - and that was done only as a favour to his neighbour!

The Southern Highland News has been scoured for any sort of story or letter relating to the SWS Local Hospital Network (SWSLHN), or the marriage proposed to the Macarthur Division of General Practice for the Medicare Local. Contrast that with the transparency of the Bankstown and the Blue Mountains Divisions of General Practice who have held community and GP membership forums throughout the past eight months to the present time.

Even the Macarthur Division's website has been devoid of the information which could be of interest to its members. It might be deduced from this veil of secrecy that all business associated with their proposed bid for the Medicare Local has been secret Board business at which the interests and contributions of others (including their members) is considered to be without value.

From Socrates own perspective, the proposed union between the Southern Highlands Division and the Macarthur Division of General Practice is doomed to fail. Why is this so, you may ask! Well looking at the two personalities involved, one can't help but note that both are in the business of building empires. Both have notable expansionist aims and both are actively seeking to access the available funding from Canberra to achieve their ambitions.

One only has to look at the website for the Macarthur Division of General Practice to recognise that this so-called not-for-profit organisation designed to support and meet the needs of general practitioners is really a substantial corporation. Look through the list of staffing and their titles at the Division and you will see how corporatist it has become!

On the other hand, our local Division has less such positions but the CEO still runs the business of the Southern Highlands Division of General Practice as if it is his own corporation. The Board, in the meantime, is a tokenistic group who acquiesce to every suggestion made by their CEO. Perhaps the Southern Highlands Division should seriously consider its relationship and true status in the planned nuptials with the Macarthur Division. There will be only one winner to emerge from the marriage - and there won't be much connubial bliss in it for the Southern Highlands Division of General Practice!

Socrates suggests that, before the Marriage Celebrant joins the two in this marriage of inconvenience, and asks if anyone is aware why the two should not be joined in marriage, there is a resounding shout of "yes" from the local the communities of the Southern Highlands and the Macarthur area. Let us join together to put a stop to this obscenity.


"Katoomba out in cold on hospital board: specialist"

BY SHANE DESIATNIK
Blue Mountains Gazette

23 Mar, 2011 09:55 AM

"Australian Medical Association (AMA) Blue Mountains district representative Dr John England has raised questions over the makeup of the Nepean/Blue Mountains Local Hospital Network board (LHN) established in January, claiming it is virtually a Nepean Hospital establishment.

"Dr England, a Katoomba Hospital-based specialist with decades of experience, made the comment to the Gazette after attending a closed meet the candidates session in Katoomba on March 16 hosted by the AMA.

“The consensus at the meeting was that we don’t know anyone [on the Nepean/Blue Mountains LHN board] except Dr James Bramley, who is based at Nepean Hospital but does relief and occasional weekend work at Katoomba Hospital,” Dr England said.

“Nobody really represents Blue Mountains hospitals [on the board] — that is the truth. “You know the saying, the big dog eats all the food.

“We hope that in the future there will be actually people who work full-time at Katoomba Hospital appointed to the board.

“Certainly the make-up of the LHN board and the topic of transport and access to hospital services in the region were the issues mostly talked about at the meeting.”

“But what I really think is needed is that doctors appointed to Nepean Hospital should have to work at least one day per fortnight at Katoomba Hospital as part of their contracts.”

NSW AMA president Dr Andrew Steiner said last Wednesday’s candidate’s forum was the first of its kind held by the AMA in the Blue Mountains prior to a state election.

"I’m impressed by the attendance by local doctors and Blue Mountains GP Network members,” Dr Steiner said.

“The AMA has a 10-point priority plan for the election but the three main components are the need to address access block in major teaching hospitals, create enough positions for interns and doctors in training and involve clinicians in decision-making.”

Dr Warwick Ruscoe - SSWAHS = SWSLHN + SLHN and the Medicare Locals - 9

Mediator steps in over Medicare Local rivalry

• By Gemma Collins on 23 March 2011

"An independent mediator has been called in to resolve disputes between rival divisions of general practice bidding to form a Medicare Local in outer Sydney.

Tensions are rising between two consortiums, the South West Sydney Health Coalition (SWSHC) and the Macarthur and Southern Highlands Divisions who have both submitted bids to form a Medicare Local covering the city’s south west region and beyond.

The Federal government’s controversial planned boundaries for the new primary health care organisations means it will be one of the biggest Medicare Locals in the country.

The SWSHC, which includes the Bankstown GP Division, released a statement claiming the Macarthur and Southern Highlands Divisions had been making “certain assertions” over who is going to win the bid.

And CEO of the Bankstown GP Division, Andrey Zheluk, told 6minutes they had been in discussions with the independent mediator on how to resolve the tensions.

“This is what happens when you try and bring together independent organisations,” he said.

“It is not unique to south west Sydney as there are similar problems going on across Australia. But we have been brought together by a government policy and we have to make the best of it.”

The CEO of Southern Highlands Division, Dr Warwick Ruscoe, was contacted by 6minutes but he refused to comment." http://www.6minutes.com.au/

This article is the compelling reason why there needs to be a community response to the inaction and obfuscation of the CEO of the Southern Highlands Division of General Practice - a refusal to comment! When it comes down to the wire the only benefit that the health consumers of the Southern Highlands will obtain is when they agitate, advocate and become activists, for themselves and on behalf of their community.

Take note of what the South West Sydney Health Coalition (SWSHC) and the Bankstown GP Division have been able to achieve while the CEO of the Southern Highlands Division of General Practice has been colluding with his counterpart in the Macarthur Division of General Practice to see how much of the Federally-funded financial pie they can each consume.

In my study of the history of the Age of Enlightenment the above scenario reminds me of the time when the world was divided into two - with what the King of Spain and the King of Portugal each considered to be part of their kingdoms - the Divisions of the Southern Highlands and Macarthur should take a lesson in history and take note of what a relatively small kingdom can do to the expansionist plans of others. The rise of England as a significant power saw the demise of both Spain and Portugal and led to the maps of the world being changed for centuries to come.

So also can it be that a people revolt in the Southern Highlands and the SWS Health Coalition's area of interest can sink the ambitions of the entrepreneurs in both the Southern Highlands and Macarthur Divisions of General Practice!

Write letters of support for the application bid for the SWS Health Coalition to enable them to manage the Medicare Local that will incorporate the Southern Highlands community.

Central DoH&A Office postal address:

Department of Health & Ageing
(Medicare Locals)
GPO Box 9848,
Canberra ACT 2601, Australia

SSWAHS = SWSLHN + SLHN - and the Medicare Locals - 8

To Socrates, the truth about the medical entrepreneurs seem to have a life of its own! Our friendly community and family-focused general practitioners and community organisations in the Bankstown area appear to have had enough of the "spin" from the southern brotherhood of the Macarthur-Southern Highlands Divisions. In their latest media release the SWS Health Coalition have made it very clear that they will not be rolled by the Juggernaut from the south, and that the proposed Medicare Local to be operated by the Macarthur-Southern Highlands Divisions is not a done deal.

All power to the SWS Health Coalition! However, let's take note that we, as community members and consumers of health services, need to support this northern movement for self-determination. Community members are being asked (and expected) to take some control of the planning of health services in their local area: health services that are inclusive of health and welfare organisations, general practitioners, allied health practitioners and public health services.

Rather than wait to have something unhelpful being imposed upon us by the Macarthur-Southern Highlands Divisional consortium in the the roll-out of the Medicare Locals, let us be proactive enough to demand what we know will be of benefit to our local communities rather than passively accepting something being of benefit only to the Macarthur-Southern Highlands Divisions of General Practice.


"Medicare Locals? An open letter to communities, elected officials and families across south west Sydney.

"Medicare Locals are new federally funded organisations that will build stronger links between family doctors, hospitals and other health and community services.

"The South West Sydney Health Coalition has recently been made aware of certain assertions made by the Macarthur and Southern Highlands Divisions of General Practice concerning the formation of a Medicare Local in south west Sydney.

"The purpose of this letter is to inform you that the South West Sydney Health Coalition denies each of these assertions categorically as being completely without basis in fact.

"The Macarthur-Southern Highlands Divisions do not represent the “official bid” for the South West Sydney Medicare Local. The Macarthur-Southern Highlands Divisions do not enjoy any exclusive right to lodge a bid for a Medicare Local covering the Bankstown, Fairfield, Liverpool, Campbelltown, Camden, Wollondilly, and Wingecarribee local government areas.

"We believe these assertions by the Macarthur- Southern Highlands consortium adversely reflect upon the actions and integrity of the South West Sydney Health Coalition, and on the future formation of a Medicare Local that will serve all local families equally across south west Sydney.

"The South West Sydney Health Coalition is made up of over 20 organisations. The South West Sydney Health Coalition represents health, community and aged care organisations from across south west Sydney, and is now the largest and most geographically diverse collaboration lodging a bid for the Medicare Local in south west Sydney. The South West Sydney Health Coalition is lodging a competitive bid for the entire South West Sydney Medicare Local, ranging from The Southern Highlands to Bankstown.

"Whatever the outcome of the competitive Medicare Local application process, the members of the South West Sydney Health Coalition remain committed to working collaboratively and harmoniously with all family doctors, community and health organisations across the region now and into the future.

"Furthermore, we sincerely hope that individuals’ personal views in this manner will not undermine the genuine efforts of the health, community and aged care organisations in the south west Sydney area to establish a Medicare Local that will ensure a healthy future for local families."

MEDIA
Andrey Zheluk 0425 278 398
Website: www.swshc.org.au

Socrates suggests that we all write to the Canberra office of the Department of Health and Ageing with our letters of support for the Bankstown application to operate the Medicare Local in our area.

Central DoH&A Office postal address

Department of Health & Ageing
(Medicare Locals)
GPO Box 9848,
Canberra ACT 2601, Australia