For example, the SH Division employs staff to provide services that are already delivered by private allied health service providers in the community. Yet, because of its influence over the general practitioners it is meant to support, it exercises a monopoly. That is, it recommends GPs to preferentially refer their patients to the member of staff employed by the Division rather than to the private practitioners in the community. Where is the right to choose their practitioner for the patient?
Socrates is aware from personal experience that the general practitioners he has had to see over his long years (treatment for hemlock poisoning, etc), that the majority of GPs do have a mind to treat their patients with respect and provide them with options. This dialogue of mine today is not about the GPs in the Southern Highlands but about their Division and its Chief Executive. Their Chief Executive has openly stated that he will fight to market the Divisional staff to the area's GPs simply to be able to continue to employ them. Who has employed them - well the Chief Executive. But what processes does he follow in employing the staff, and what qualities and skills do they bring to ensure the provision of "optimal care" is delivered by them?
And can the staff employed by the Chief Executive deliver all the programs that he says (in the website) the Division can deliver to the people of the Southern Highlands. There is no doubt that the Aged Care and the Diabetes Coordinators are well experienced in their clinical fields and the services they deliver are well used. But what about the other services that the Division touts on the website? Mental health services delivered to the aged care facilities in the Highlands, the non-directive pregnancy support counselling, the better outcomes in mental health program, the better access mental health program, the mental health nurse incentive program - who delivers these?
These programs are all funded by the federal government through Department of Health and Aging or Medicare Australia. The qualifications of the practitioners used for these programs are dictated by the Medicare Australia and/or the relevant professional college or association. The Division, however uses its own set of hoops to select who it should anoint to do the work. I wonder what Medicare Australia or the Department of Health and Aging would think about the Southern Highlands Division of General Practice? In particular its Chief Executive and its Board.
Socrates is already aware from his reading of the scroll called "The Highlands Doctor" that, for example, GPs are being encouraged to refer their patients to a person for the "Better Access" program when they could be doing some of the "Better Outcomes" program which is funded by the federal government and the Division is the fundholder. Why use a Medicare funded program to keep their staff member employed? Perhaps it has something to do with running out of the funds for "Better Outcomes" because the funds were used for something better - like employing staff rather than providing a service to the patients referred to it.
The other program that seems to have disappeared off the scroll appears to be the Mental Health Nurse Incentive program - another of the Medicare funded programs. From the more ancient scrolls on the Division's website it would appear that the Chief Executive was employing someone who was hoping to be a Credentialed Mental Health Nurse, the only people (besides GPs and psychiatrists) who Medicare allows to participate in the program's delivery. It appears to be a good program (perhaps even a great one) which allows vulnerable people with a severe mental illness to have care coordination by a credentialed mental health nurse so that they might remain out of hospital and be cared for in their own community.
It would seem that the person employed by the Division was not successful in obtaining the credentialed mental health nurse qualification so the Division could no longer use them. From the official website of the Australian College of Mental Health Nurses the list of Credentialed Mental Health Nurses shows that there are three qualified and approved CMHNs in the Southern Highlands, which is not bad considering there are only about 800 nation-wide. However, the Division, for reasons unknown, is not supportive of the existing CMHNs and appears to have gone secretive as to their reasons why. The information about the MHNIP is no longer public on the website having been placed in the log-in "doctor's secret business" section on their website.
In the meantime, patients who could or should be referred to this program are not able to be referred because the only two CMHN in the Highland currently being used by GPs are unable to take on any more patients, and the other although credentialed since August 2009 has never received any referrals at all possibly due to misinformation provided by the Division to the local general practitioners.
Hmmm! Socrates has to then wonder at the Division's claim:
"Southern Highlands Division of General Practice (SHDGP) is a federally funded not for profit organisation which assists general practitioners and the Health Service to deliver health services to people in the Southern Highlands.
The Division acknowledges the support of the Commonwealth Department of Health and Ageing in respect of funding the Division's activities."
And:
"The mission of the Southern Highlands Division of General Practice is to assist local general practitioners in providing optimum care to health consumers in the Southern Highlands area."Does it really, Chief Executive, or is the Division just as money grabbing as the so-called "for profit" organisations? Perhaps it is now time for the merger with the Macarthur Division of General Practice where they don't seem to run out of funds for their funded programs, and they employ people but they still seem to manage to work collaboratively with their general practitioners and with the private sector, especially the allied health and mental health nurses, without having to prostitute themselves to the empire of SSWAHS.
