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