SSWAHS = SWSLHD + SLHD and the Medicare Locals - 52

First Medicare Locals urged to retain GPs’ central role

10th Jun 2011 - Medical Observer

Byron Kaye   all articles by this author

THE AMA has written to the first 15 Medicare Locals urging them to keep doctors central to governance, rule out holding funds and commit to working closely with GPs at every stage of setting up the new primary health hubs.

The AMA has strongly opposed the $416 million Medicare Locals program, arguing the Federal Government has failed to explain how it will improve GP services and is rushing through the reform with just weeks before the supposed 1 July start date.

Four of the first 19 Medicare Locals – all in Victoria – have not been publicly announced with the Government citing a need to redraw the boundaries as the final stumbling block.
The are expected to be named next week.

Yesterday, AMA president Dr Steve Hambleton wrote to the 15 publicly announced successful tenderers – all currently divisions of general practice – asking them to address concerns that the Medicare Locals structure will dilute the governance input of GPs and weaken patient care.
“We are concerned that the Government is rolling out its Medicare Local policy with desperate haste, despite a lack of detail and genuine consultation with the broader medical profession,” Dr Hambleton wrote in the letter.
“Integrating and coordinating the range of organisations and service providers operating within primary healthcare, and better linking primary healthcare and other sectors, is something that can deliver benefit if it is done well.
“However, there is a significant potential for Medicare Locals to get this wrong if they fail to listen to the views of the medical profession.”

The AMA has asked the Medicare Locals to confirm that local doctors would be represented at all levels and have “strong majority representation” on boards and rule out any fund-holding arrangement for GP and other specialist medical services.

Several divisions chosen among the first 19 Medicare Locals, contacted by MO this week, indicated that they would change their board structures to reflect the broader range of primary health professionals expected to be represented by the new bodies.

Tags: Medicare Locals; AMA; Hambleton; governance

Comments: 

Detracter
10th Jun 2011
3:34pm

This is essentially a Labor governments attempt to centralise power and influence over what used to be a non-government operational area. Labor, and particularly Gillard, are doing this in the industrial relations area and the wider economy with the Carbon tax, Mining tax and Flood tax.
If she wins the next election, I could well anticipate a push for universal bulk-billing across the profession to reflect her central control agenda, dating from thirty years ago.
The AMA move to increase GP representation on these Medicare Locals seems to reflect my thinking on this matter.

Pav
10th Jun 2011
3:46pm

I don't really give a s#%t.

Just so long as the ML's take full responsibility and are accountable for their own actions when they stuff up - not just turf them back to the GP for patching up their mistakes.

ed
10th Jun 2011
4:39pm

Pav' arguement assumes that GPs who work in the Locals are not responsible and have inferior knowledge and skills. The same arguement was put across when the Corporates had commenced business. Errors are made by any type of a GP. What we have to worry is under GILLARD-ROXON AXIS OF SOCIALISED MEDICINE, SOON WITCH DOCTORS Will be employed . Then there will be trouble.And in the famous word of the bard' there was movement at the station'.

John Wellness
10th Jun 2011
5:01pm

A medical dominance of divisions of general practice has led to a fragmentation of primary health care and probably poorer health outcomes, especially for patients with complex chronic illnesses. We need practices that have multidisciplinary teams with each occupation contributing its own strengths. We also need a more preventative approach embracing behavioural as well as medical perspectives. The Medical Locals need governance systems that will allow us to become a health system - not a bunch of independent doctors and allied health practitioners. Doctors have a leading role to play in clinical governance but a lesser role in business governance.

khanGP
10th Jun 2011
6:19pm

When the concept of ' Super Clinics ' was being mooted, a lot of the GPs were stating - but where will the Govt. get the GPs from to work in these Clinics. At that point in time, I told my Colleagues, that the Govt. has a Master Plan in place - they will not need GPs to run these ' Super Clinics ' - they will run them without GPs - they will have their ' Nurse Practitioners ' running them. What with these NPs being given Prescribing Rights / Radiology & Pathology requesting Rights / Rights to refer these Patients ( sorry, ' Clients ' ! ) to Specialists & to Emergency Depts., GPs will be made redundant.
I was then, told that I am being ' Paranoid '.
My GP Colleagues felt then, that we, GPs would be elevated to a ' Consultant ' Role. Why would a NP refer a Patient to a GP, when he / she could refer to a Specialist or an ED ?? Our Local Divisions still feel that we, GPs would have a Lead Role in these ' Medicare Locals ' !! When there is a Collection of ' Primary Care ' Practitioners, each one of these Groups would want an EQUAL Voice in the Board of such an Organisation. So, the Board of these Medicare Locals, will have a Representative from each of the Groups - i.e. one each of a GP/ NP / Pharmacist / Chiropractor / Herbalist / Physiotherapist / Iridologist / Naturopath , etc.etc. The Voice of the GP would be only a ' Whisper in a crowded room '.
Wake up my dear GP Colleagues.
DR. AHAD KHAN, GP Glenbrook NSW

jadugar dar
11th Jun 2011
1:28pm

Ahad has summarised it beautifully!!!! I have said the same for a long time. Nicola has always regarded that GP's are unnecesary.We have one of two alternatives available to us now. 1. Register as a NP with our Medical Degrees and 2. Qualify and elevate to a Specialist level & register accordingly. And of course the 3rd is quit because GPs will not unite and take Industrial Action. Any alterations in the status of the AWU members would by now resulted in Libya-like turmoil. Good luck to those GPs who are retiring, dying or quitting.

Green Demon
11th Jun 2011
3:33pm

so....The 2010 Intergenerational Report, Australia to 2050: future challenges found that total government spending on health will rise from 4% of GDP in 2009/10 to 7.1% in 2049/50 and the bulk of the increase will be on MBS, hospital services and the Pharmaceutical Benefits Scheme.
Aged care expenditure is also projected to rise significantly from 0.8% of GDP in 2009/10 to 1.8% by 2049/50 with residential aged care recording the highest growth.

It's ok to moan; be chicken little with sky falling in but what will happen we can't afford to pay for health? Having a greater emphasis via MLs on population; prevnetaive health has to be a no brainer! or do we head down a teared system like the US who will be facing 20% of GDP spending for the same period? Some words of actual wisdom may be helpful

Amateur Observer
12th Jun 2011
11:52am

Why does General Practice seem to be the only specialty group singled out for special attention by the Federal Health department in their recurrent trial-and-error attempts at health reform? I'm sensing a bit of gutlessness amongst the Feds when it comes to foisting experimental programs onto other medical specialties.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 51

Medicare Locals must manage expectations

20th Jun 2011 - Medical Observer

Dr Emil Djakic   all articles by this author

A NEW era in primary healthcare reform is about to get under way as the first tranche of Medicare Locals shifts into implementation mode as of next week.

The announcement of the successful first-round applicants is testament to the high performance of the General Practice Network and to all the hard work that went into preparing applications – a process that has been testing at the best of times.

For many, though, it has been a bittersweet announcement. For those divisions that did not meet the criteria in the first round, further work will need to be done, and the feedback provided by the assessors will be eagerly awaited.

For some, the Government has made it clear that forming partnerships to submit joint bids will assist in meeting the criteria for the next round, and the Government has encouraged a number of competing applicants to do so.

This advice is a reflection of the emphasis on partnerships, collaboration and increased stakeholder engagement that Medicare Locals are required to demonstrate.

For the first tranche of Medicare Locals, though, managing expectations will now be part and parcel of this implementation phase. This new model of care through these new primary healthcare organisations will be created over time, and in due course consumers, carers and healthcare professionals will start to appreciate the subtle but effective changes that Medicare Locals will be able to deliver in making the primary healthcare sector easier to navigate.

Contributing substantially to a smoother, consumer-friendly system will be the role Medicare Locals play in the promotion and support of e-health solutions across the primary care setting.

They will be fundamental in driving the change, adoption and support strategy of the Government’s Personally Controlled Electronic Health Record (PCEHR) system – due to begin rolling out nationally from July next year. The PCEHR promises to deliver better health outcomes for consumers by providing consistent, accurate and timely information to healthcare providers, assisting them in making better decisions around diagnosis and treatment, and minimising the risks associated with allergies and medication mismanagement.

Medicare Locals will also be responsible for managing, coordinating and communicating a significant increase in after-hours GP services as they begin rolling out from 1 July this year.

Contributing to the unsustainable burden on the hospital system – especially emergency departments – is the fact that after-hours GP services are patchy and inconsistent, and where they do exist, many people are unaware of where they are, or have misconceptions about what a GP is able to treat, resulting in unnecessary trips to the hospital.

These early initiatives are only a small number in what will be a comprehensive suite that Medicare Locals will develop and deliver over time.

But the success of even these early programs, and the confidence in the system that comes with them, will be completely reliant on the sufficient resourcing and support of these organisations from the beginning, and on the ability of Medicare Locals and the Government to manage early expectations.

 

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 50

Divisions may lose Medicare Local slot

20th Jun 2011 - Medical Observer

Byron Kaye   all articles by this author

THE AGPN has warned GP divisions that failing to present a tender in the next round of bids for Medicare Locals could see contracts go to an outside entity.

While the Federal Government kept the first round of ML applications exclusive to divisions, it has said it will consider non-division entities in the next two rounds.

With some divisions yet to form unified consortium bids, and others refusing because they oppose MLs, AGPN chair Dr Emil Djakic warned that those taking a “no-compromise position” did so “at their own peril”.
“If another organisation that can create an argument for eligibility for the criteria in that patch chooses to, with or without the participants of those [divisions], then the [Health] Department has clearly said it will fund them,” he told MO.

With the first 19 of the confirmed 62 MLs chosen, the countdown is on for the next round of tendering, which closes at year’s end.

The move to an open contest has fuelled speculation that entities such as private health insurer Medibank Private, which recently won the tender for the after-hours GP telephone service, would bid. However, Medibank told MO in a statement that it had no plans to tender for an ML “at this point in time”.
AMA president Dr Steve Hambleton said division or not, any outfit that applied must be focused on general practice.
“It’s hard to say who may apply,” he said.
“[However] any entity that was looking in this area should have a majority of GPs to provide the clinical input that is required.”

Dr Djakic’s warning may have been heeded by two neighbouring divisions, previously contesting to be the South West Sydney ML. Bankstown GP Division chair Dr Susan Harnett, whose division is one of three involved in the disputed ML, told MO last week that while a “difference in ideologies” remained, a unified bid was being negotiated.

The long-term future of the AGPN, meanwhile, remains unclear.
Dr Djakic last week conceded that greater consultation and dialogue with divisions and the state-based organisations (SBOs) was needed over the issue of whether the AGPN should eventually become a go-between for Government and MLs as it is for divisions.

A pivotal vote on the issue at a national meeting of all 111 divisions last week was postponed until November due to flight disruptions from the Chilean ash cloud.

The motion, which required 75% of division support to pass, faces serious opposition. The largest SBO, GP NSW, wrote to all 33 NSW divisions recommending they oppose the change until the AGPN provided further evidence of its worth.

General Practice SA, with 14 divisions, did not take a formal position but told MO there was “not unilateral support”.

General Practice Victoria was the only SBO to publicly back the change.

Meanwhile, the Federal Government has finally named the first four winning Victorian ML bids, which had been kept under wraps while the geographic boundaries for the state’s MLs were redrawn.
They are in Inner East Melbourne, Barwon (near Geelong), Inner North West Melbourne and Northern Melbourne.

The Government also confirmed the number of Victorian MLs will be 17, making a total of 62 nationwide.
Health Minister Nicola Roxon said the new Victorian boundaries were chosen because of “a number of factors, including the views of state governments, how MLs would align with Local Hospital Networks, local population numbers, existing local health services and patient referral patterns”.

Tags: Medicare Locals; AGPN; Medibank; AMA

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 49

Socrates says that it would appear that someone in Nicola Roxon's office has gotten the message that in the Southern Highlands there was sufficient "Southern Dis-Comfort" about the way in which the Southern Highlands Division of General Practice has approached the whole concept of Medicare Locals.

Perhaps now, the Board and CEO of the Southern Highlands Division of General Practice will undertake the basic principle of the Medicare Locals funding parameters and commence to speak with the public and private healthcare providers in the area, and the NGOs, to develop a collaborative model of health care in the Southern Highlands. Then, and only then, will they comply with the basic requirements for funding. The clock is ticking... and by July 1st 2012, the SH Division of General Practice will cease to exist.

Strangely enough, someone seems to have objected to the re-publication of the information of this publicly available information from the Medical Observer in which their author reports the content of a media release of the successful tenderers for the first of the Medicare Locals.

One can only speculate about who that might be. Socrates has yet to be given the answer to that question, and to the other as to how a publicly issued media release and publication can allegedly infringe copyright......!?

Roxon unveils first Medicare Locals

6th Jun 2011 - Medical Observer

Byron Kaye   all articles by this author

THE first 15 Medicare Locals have been unveiled by Health Minister Nicola Roxon, however Victoria has been left off the list as the Baillieu Government holds out on wider health reform.

The first tranche of MLs are split between the states, with four successful tenders named in NSW and five in Queensland.

Victoria’s absence has led the AGPN to call on the Victorian divisions to put pressure the Baillieu Government to sign up to the reform as soon as possible.

Four MLs have been earmarked by the Federal Government for Victoria, however the Baillieu Government requested extra time to consider the ML boundaries in its state. It is expected the four will be officially announced next week.

The situation has led AGPN CEO David Butt to issue an email to all divisions – which MO has obtained – to explain the situation, which he describes as “disruptive and farcical”.

“While this means that these four will definitely go ahead as planned, it now leaves a level of uncertainty about potential boundary changes for other Victorian MLs,” Mr Butt wrote.

“By the end of last week, the Federal Government’s plan was to proceed with two additional MLs in Victoria. Unfortunately, we now no longer have that certainty.

“If any of you from Victoria can bring any pressure to bear on the Victorian Government to stop the delays and allow the primary healthcare reforms to get going, then please do so.”

Announcing the MLs, Health Minister Nicola Roxon said the first round of successful applicants were chosen for their established records in improving primary healthcare for their local community and strong plans to improve local primary care services into the future.

The successful applicants are as follows:

Comments:

SMS
6th Jun 2011
4:38pm

Nothing good will come out of this for the average gp .
I am going to retire .

Rob the Physician
6th Jun 2011
4:45pm

MORE political interference in OUR health systems !!! e

Gerard Matthew
6th Jun 2011
5:12pm

The public don't seem to get it. If you tax the people and give it back as "benefits" there is a huge cost of bureaucracy to administer it with another layer to monitor the adminstration with the result that much less really helps the people targeted for the "benefits". Too much money goes to bureaucracitic empires rather than to the people who really need it.

khanGP
6th Jun 2011
5:43pm

The Divisions of General purport to represent the Voice of its Members. In reality, they do not. They do not seek the Individual GP Members' points of View on Important Developments, by way of conducting regular FAX / E-MAIL Surveys. Surveys with simple Questions - eg. Tick a ' Yes ' or a ' No ' to the Question - ' Do you wish your Division to be involved with the formation of 'Medicare Locals ' ?
I challenge each Division to pose such a Question to its Members & find out for themselves, the TRUTH - i.e. The majority of GPs do not want their Division to be involved in the formation of ' Medicare Locals '.
GPs are inundated at work & do not have time to attend Meetings - a Quick FAX / E-MAIL Survey is the way to go.
I believe the Divisions & the AGPN have betrayed their GP Members.
DR. AHAD KHAN
G.P. GLENBROOK NSW

Biggles
6th Jun 2011
6:24pm

who knows whats a medicare local?

Ive been living 3 minutes from my surgery, usually know the names of most of the school captains and prefercts and the primary school etc etc, and have been into probably 1 in 4 houses in the district over the last 20 years - medicare could NEVER be that local... dream on.........

Dr T
6th Jun 2011
7:05pm

"You're not having any dessert unless you finish your greens!"

How typical of the federal government to wave a big at over Victoria. No, it's not a carrot. And David Butt is wrong. The states have the right to determine what happens with their state health dept funding. We still have state governments David. Until they do away with them the federal government is just the paymaster. The federal government would be acting inappropriately if it withheld primary care funding on the basis of state health decision making. Everyone knows that. Come on.