SWSLHD and Bowral's Health - 45

Rebate cuts jeopardise GP role in child mental health

26th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

CHILDREN’S mental health visits to GPs have risen dramatically under the Better Access program and cutting the rebates would leave the profession’s role in child mental health care in doubt, new research suggests.

An analysis of Bettering the Evaluation and Care of Health (BEACH) data by the research project’s own authors also suggests GP involvement in child psychology has become less prescription-focused under Better Access as the family doctor plays a more active ongoing role in the mental health care of young Australians.

The study, published in the latest Australian and New Zealand Journal of Psychiatry, claims to be the first dedicated snapshot on GP treatment of child mental health issues over four decades.

Better Access, which offers rebates for GP mental health plans, was introduced in 2006 but is being scaled back – with some rebates cut by almost half – to save $400 million from next week.

The BEACH paper indicates:

·     The proportion of GP mental health visits by patients younger than 15 jumped from 1.4% in 2000–01 to 2.6% in 2008–09

·     16.8% of child mental health visits to GPs claimed Better Access rebates, compared to 7% of GP mental health visits from patients of all ages in 2006–08

·     The rate of GPs prescribing medication to children in mental health visits fell from 28.8 per 1000 in 2000–01 to 18.3 in 2008–09

·     Child mental health visits to GPs for enuresis, insomnia and “behavioural problems” have fallen dramatically since 1971, while child GP visits for ADHD, anxiety, depression and autism rose.

BEACH director and report co-author Associate Professor Helena Britt said the study confirmed Better Access had led to a massive increase in children being treated by their GPs for mental health issues and predicted the rebate cuts would have an impact.

“With the decreased payments to GPs and the decreased number of [psychologist] visits being covered by the program, I’m sure there will be an effect on the extent to which GPs are involved in children’s psychological problems, as with adults,” she told MO.

Dr Emil Djakic, chair of AGPN – a member of United General Practice Australia (UGPA), which is fighting the rebate cuts – said changes to funding child mental health treatment “need to be done with some caution”.

He said the cuts would fund programs targeting children with more complex psychological problems but lamented “the fact that that’s been done, rather than by building on funding for primary healthcare, by a relative change of funding for the general practice side of the equation”.

Australian and New Zealand Journal of Psychiatry 2011; online 22 October, DOI:10.3109/00048674.2011.610743

 
Related:

Tags: Children, Mental Health, Better Access, BEACH, AGPN

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 58

Uncertain future for AGPN and SBOs

• By Michael Woodhead on  15 September 2011

AGPN board members are to become the founder members of a new Medicare Local National Body, but a question mark remains over the future role  - if any - of the AGPN and GP division state-based organisations (SBOs).

A communiqué (link) from the AGPN board says health minister Nicola Roxon has made it clear that SBOs will not continue in their current form when the Medicare Local National Body is formed.

The Federal government will stop funding the SBOs after December 2012, but the AGPN says the new national Medicare Local National Body should have a strong state and territory presence.

 “While the MLNB is expected to take on a state-based function, it is not expected that this will mirror the current roles of the SBOs,” it says.

Instead, the AGPN board says it will work with SBOs “to determine the relevant state functions and how best to deliver these.”

In its communiqué the AGPN board says its members will form the transitional governance team for the new Medicare Local National Body until more permanent  members are appointed and a permanent board is set up.
However, this raises the question of who will represent the remaining GP divisions and SBOs during the transition to Medicare Locals.

AGPN will lose its funding from July 2012, but the board says no action has been made to wind up the AGPN as yet. It is conducting a survey of AGPN members to assess views of the future direction of the network.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 57

Medicare Locals show their new DNA

• By Michael Woodhead on  25 August 2011

The new branding for Medicare Locals has been unveiled at a meeting of some of their leaders with the Prime Minister and health minister Nicola Roxon in Canberra today.

“Australia’s network of Medicare Locals will be easily identifiable as a cohesive national network with its new ‘ribbon helix’ branding,” said AGPN chair Dr Emil Djakic at a Medicare Local Forum held at Parliament House.

“But it’s the changes Medicare Locals will bring to local health care services for both health care professionals and consumers that will make the difference over time,” Dr Djakic said.

Leaders for the first 19 of the planned 62 Medicare Locals met in Canberra and heard the Prime Minister say that they would be “front and centre in the push to “ shift the centre of gravity from hospitals towards primary health care”.

She said Medicare Locals would play a key role in helping to improve access to after-hours care, chronic disease prevention and management programs and mental health initiatives.

“Medicare Locals will deliver home-grown solutions to local health problems and make it easier for Australians to see and contact a health professional,” a statement said.

However, a critic (link)  this week blogged that the creation of Medicare Locals was the Federal government’s way of exerting control over previously independent bodies. He claimed that the Federal health department would have the final say over staff appointments, programs, membership structure, and would have to sign off on any contacts contracts over $22,000.

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 = SWSLHN + SLHN and the Medicare Locals - 46

AGPN seeks accelerated Medicare Local timeline

24th May 2011

A CALL by the AGPN to launch more than 15 Medicare Locals in July has met with fierce resistance from the GP fraternity.

With the Government yet to announce which Medicare Locals will be the first to be established, the AGPN said there were more than 15 that could feasibly be launched now.
 It urged the Government to bring forward their launch, and not wait six months to announce the next tranche as planned.

AGPN chair Dr Emil Djakic said there would be no financial disadvantages in launching an additional 10 Medicare Locals from 1 July.

“The work and commitment is there... Why wait another six months?” Dr Djakic told MO.

“If there are other proposals that came to that original invitation to apply that meet the eligibility criteria and really look like being able to get on and do the job, then we should be allowed to roll our sleeves up and get on with it.”

AMA president-elect Dr Steve Hambleton, however, said too much remained unknown about the organisations, and he reiterated his concern that GP autonomy would be reduced.

“Accelerating the process means there’s going to be more risk, not less,” he said.

RDAA president Dr Paul Mara also urged “slowing down” the rollout, saying GPs had been “hoodwinked” because Medicare Locals were set to take fund-holding from GPs.

Federal Health Minister Nicola Roxon’s office had not responded to MO’s queries at the time of press.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 36

First Tranche Applications Exceed Expectations

The Australian General Practice Network (AGPN) has stated that the process for application was both “thorough and exhaustive”, whilst at the same time calling on the Federal Government to commence as many Medicare Locals as possible in the first round (see http://www.ergpa.com.au/news/development-of-medicare-locals-on-track-just-waiting-for-the-tick/).

The Australian Medical Association (AMA) is continuing to call for further consultation with the medical profession, and push for deferred establishment, with expanded timelines (see position statement @ http://ama.com.au/node/6500).

The Victorian Healthcare Association (VHA) (see http://www.vha.org.au/positionstatements2010.html) and Statewide Primary Care Partnerships have continue to exercise caution in their approach.

Meanwhile, consumer groups and allied health professionals are starting to knock on the doors and ask some valid questions about their role and position in this change.

As somewhat of a pragmatist I tend to believe this is all an important part of people working out where they stand in relation to the changes afoot, and what the likely impact will be on their patients, their business or service and the overall landscape of health care in Australia. None of which is a bad thing, it all challenges all of us in how we plan for, deliver and receive services, which is ultimately the point of system reform in the first place.

What I think is the real issue right now is how we keep our health care services focussed on the outcomes, rather than the process of change. It’s very easy to be distracted by the minutia of the funding cycles and the many, many reporting requirements, the boundary cut offs, and who gets what from which level of government. It’s easy to forget that ultimately we are there to assist people in need of care and good health. Our job is about finding the best way to do that, in this case under a Medicare Local banner, but still with the same concern for how our communities get the best from their health care system.

So at the end of the day, does it matter what they’re called, or how many start in July and how many start 6 months later? What do you think?

Comments (1)

Bel
18 April 2011

Great blog Kristin,

Not taking away from the importance of being informed and asking questions, as health professionals and consumer groups have every right to seek understanding and further have a voice but I think it’s really important that in light of “reform uncertainty” people are reminded that regardless of what is happening, what could happen or even what should happen, that our focus remains with the patient and our ability to assist them with the best possible health outcome.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 30

AGPN calls for more Medicare Locals to start in July

• By Gemma Collins on 15 April 2011

The AGPN is urging the Federal government to fast-track its plans for Medicare Locals after the first round was inundated with applications.

AGPN Chair Dr Emil Djakic is calling for more than the planned 15 Medicare Locals to be implemented in July after 58 bids were submitted from across the Divisions of General Practice.

Dr Djakic said that the high response rate proved the network was “willing to transform primary health care services”, although five Medicare Local areas did not attract any applications.

“The AGPN is urging the Federal government to support the commencement of as many as possible in this first round if more than 15 applications meet the eligibility requirements,” he said.

“The sooner these organisations can be established in communities across the country, the sooner the benefits to the local health system will flow to those communities.”

As reported in 6minutes, the application process has triggered disputes among some of the divisions who have been unhappy with the government’s planned boundaries for the Medicare Locals.

An independent mediator had to be called in to help resolve a row between the Sydney consortiums - the South West Health Coalition (SWSHC) and the Macarthur and Southern Highlands Divisions - who both submitted bids for a Medicare Local in the south west."

Socrates wishes good luck to the SWS Health Coalition in achieving the outcome they seek. Their preparation and community consultation places them poles apart from the secretive "Boards only" process adopted by their competitors. I hope that if the SWS Health Coalition is the successful applicant for the SWS Medicare Local, they will aim to expand their network to include the Wollondilly and Wingecarribee LGAs.

If the SWS Health Coalition can't extend their reach to the Southern Highlands area then perhaps they can give some good advice to the Macarthur and Southern Highlands Division about how they can improve their game. That is, of course, if those Divisions of General Practice retain their current funding. After all, the Medicare Locals are meant to replace the Divisions, are they not? And in the context of the proposed Budget constraints and cuts, perhaps a cut to the funding for Divisions of General Practice would be helpful.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 26

More is less for Medicare Locals

18th Feb 2011

Caroline Brettingham-Moore all articles by this author

THE Gillard Government’s decision to increase the number of Medicare Locals (MLs) has received a mixed reaction from the divisions of general practice, with some claiming it will stymie and delay health reform.

As part of the revamped COAG deal, Prime Minister Julia Gillard raised the number of MLs beyond the planned 57 to ensure the organisations were more responsive to community needs.

But AGPN chair Dr Emil Djakic said the decision would result in weaker, less effective organisations.

“Creating a larger number of what will be less capable organisations with a dilution of funding and capacity will stymie [the] reform agenda,” Dr Djakic said.

He added that any changes to ML boundaries would delay invitations to apply, which could see the government miss the scheduled implementation date for the roll-out of the ML program. The first MLs are scheduled to be up and running by 1 July.

“We want to get operational by 1 July and every day that ticks by is going to really impair the current Government’s ability to get things up and going,” Dr Djakic said.

A spokesperson for the Department of Health and Ageing said it was not known how many more Medicare Locals would be established but confirmed that some boundaries would be re-mapped in certain areas according to population size.

Chair of the Dandenong Casey GP Association in Victoria, Dr Nicholas Demediuk, said the constant changes from the Government were taking a toll on the divisions.

“You start losing your enthusiasm to put too much effort into planning because the goal posts could be changed next week,” Dr Demediuk said.

But in NSW, Bankstown GP division CEO Andrey Zheluk, welcomed the changes.

“It is interesting that the government is talking about the importance of engaging with local communities – the importance of smaller MLs is something we strongly advocated. We have a multicultural population and it is important to respond to local needs,” he said.

Tags: Medicare Local, AGPN, COAG

Comments:

John Wellness
19th Feb 2011
2:17am

It's always a balance between the economies of scale and the more personal relationships that can occur with smaller organisations. Personally I feel that smaller organisations are more attuned to their communities and there is significant loss of function when primary health care gets too big. Lets go for the largest practical number we can. Some of the proposed MLs are simply too big.

Solidarity

19th Feb 2011
5:03am

"Engaging with local communities"-I can't think of a more worn cliche. There is nothing that keeps a local community running better than a thriving General Practice free of political interference in the form of superclinics. Glib badges and new dollar dazzlers, the marks of this Federal Government to date, are no substitute for leaving General Practices intact and strengthening it by concentrating on training more and more GPs without any Marxist social engineering.

Stratmatonman
19th Feb 2011
4:07pm

17 years and $2Billion to prove the network is utterly indispensable to the daily working life of a GP - it hasn't happened HAS IT!. As an inaugural director of my own division in 1993, 1 of the 5 founder subscribers of AGPN (then ADGP) and a WA Founder SBO member, I lost the faith last Nov and finally left my local board.

The DHA has progressively strangled the Divisions with paternalistic, top down micro-management, loss of innovation opportunities and over-rigid one size fits all programs - the gulf between what could have been (why I got involved) and what became of it all, makes me weep. And I care too much........

Dr Harry Hemley, President AMA Victoria
21st Feb 2011
12:01pm

I am especially concerned that Medicare Locals will control access to allied health care for patients with diabetes, and patients needing after hours care — cutting across existing services and in many cases leading to reduction of access to patients of services already available. For instance in many localities — particularly rural — the family doctor is available on the phone, after hours and throughout the night. These services which are very effective are threatened to be lost to an inefficient and faceless triage.

Sterling
25th Feb 2011
2:22pm

In response to Solidarity: 19 Feb 2011

Well, personally, I can't think of a more worn cliche than the entrepreneurial GP running a thriving practice based on free market principles, with a copy of Ayn Rand's Fountainhead under one elbow.

Wakey wakey - you get most of your income from the government. Let's see how far you get straying away from the government teat you so despise.

At the end of the day, GPs are but an instrument of government policy, and the government will exercise its right to purchase the most cost effective and efficient services it desires.

I would strongly counsel you to read some recent health services literature about public attitudes towards GPs effectiveness vs nurse effectiveness, as well as literature related to health outcomes by various health professions.

The picture for GPs in the medium term is not great. It is reasonable for any government to control uncontrolled costs in any policy domain by all policy instruments at its disposal.This means substitution of overpriced medical services for equally effective allied health and nursing services.

There, at last, is the free market.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 24

100 days to become a Medicare Local

• By Gemma Collins on 6 April 2011
• 6Minutes
  

"It will take 100 days for Divisions of General Practice to transform into “high performing” Medicare Locals, according to business experts who are offering their help with the transition.

The consultancy firm Ernst and Young has come up with a “transition framework” to help individual organisations competing to become part of the government’s $417 million plan for Medicare Locals.

And it will only take 100 days for the Divisions of General Practice to become Medicare Locals, according to their advert on the AGPN website.

The company may be too late in helping organisations submit their bids for the first round of 15 Medicare Locals, due to start in June.

But there is still time for the second round due to start next year, with the deadline on July 19.

And Ernst and Young which says it has done work for the UK’s Department of Health, insists the transition can be covered over four phases.

The phases range from developing a bid and a 100 day plan to assessing the health needs of the population, creating a workforce and finally “executing” the plan.

“You have a unique opportunity to transform the delivery of primary healthcare as part of the overall reform program and transition to a system of high performing Medicare Local organisations that are capable of realising the benefits envisaged,” the company says."

It would seem to Socrates that even Blind Freddy can see where a large chunk of the Federal Government's funding will go if the so-called "not-for-profit" corporate organisations such as the Macarthur-Southern Highlands Divisions consortium gets the nod for setting up a Medicare Local up in Macarthur.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 23

Waiting game begins for first Medicare Locals

5th Apr 2011
Medical Observer

THE countdown to the announcement of the first 15 Medicare Locals to begin operation is now on, despite continued opposition from the AMA.

While the Health Department has not released a date for the announcement of successful applications, or the number received, an AGPN spokesperson said the network expected more than 50 tenders to have been submitted by the 5 April deadline.

The first 15 Medicare Locals are due to begin operations from 1 July. The tendering period and process have been marred by public feuds and stoushes between competing GP divisions.

Applicants planning to bid for the next round of Medicare Locals, scheduled to begin operating in January and July next year, have until 19 July to lodge proposals.

The AMA has meanwhile maintained its opposition to the establishment of Medicare Locals, pending further government consultation with the profession.

Comments:

ed
6th Apr 2011
5:03am

The health Minister's divide and conquor rule is seen in everything she does. Not satisfied in reducing us doctors to just filling driving medicals she now wants witch doctors from the jungles of Cameroon to look after Australians. Ask her who does she go to when sick. Doctors in Canberra should boycott her and let her visit a herbalist in Melbourne.

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 and the local Division of General Practice.

Welcome to the Southern Highlands Division of General Practice

"Southern Highlands Division of General Practice (SHDGP) is a federally funded not for profit organisation which assists general practitioners and the (SSWAHS) Health Service to deliver health services to people in the Southern Highlands."

In its most recent "Highlands Doctor" newsletter their Chair makes the following comments about the proposed changes in health services generally, and especially community and primary health care. He writes of the "Primary Health Care Organisations" proposed by the federal government.

"What are PHCOs?

The Government has determined that these are best formed from the Divisions – or GP Networks, as they are often now known.

Over the past dozen years, the Divisions have shown that they can unite GPs into public health co-ordination and delivery roles, and gradually change the health culture from a hospital bed based one to one more focused on primary care.

They have successfully been fundholders – for example, in Better Outcomes in Mental Health (BOMH) and More Allied Health Services (MAHS - which has funded our Diabetes program).

The Divisions were the natural contenders to run the PHCOs – though there are a number of other organisations (eg health funds and other “for profit” health companies) which are keen to do the job if GP Divisions are not.

It seems to me that Divisions are best suited for these expanded roles.

However, the Government does not wish to deal with a cumbersome number of small PHCOs – there are 110+ Divisions across Australia currently – so it has indicated that it wishes Divisions to seek partners and amalgamate to form PHCOs to serve a population of about 600,000 people.

This means that our Division, serving just 45,000 to 50,000 people, would not be big enough to form a PHCO in our own right. We will now be talking to our neighbouring Divisions to find the partner that has the most commonality in purpose, philosophies, service delivery etc.

All this has to also be examined in the light of the changes in boundaries to the area health services (Sydney South West Area Heath Service is likely to be divided into two or three smaller areas under the Federal proposals).

As we find out more details of the roles that we will be expected to play in the remodelled heath system, we need to identify all the best features of our Division and make sure we maintain these benefits to our doctors, our practices and our patients as we move into these new reforms.

It is heartening to see that the Government has recognised the pressing need for infrastructure funding for general practices - though most GPs feel that 20+ more “super clinics” (what a dismal name – almost as bad as “Medicare Local”?) and 400+ general practice infrastructure grants is just scratching the surface.

If we are going to be working with more practice nurses, allied health workers and co-located with other primary health services (eg Primary Health Nurses), we need more rooms.

And we have a growing number of registrars (20% increase in the number of registrars in our local City Coast Country Training (CCCT) organisation for 2011, for example), medical students, PGPPP junior doctors – as well as practice nurse and general nursing trainees seeking experience within GP walls. Again, all need room and/or rooms!

Our Division will keep you posted as we work our way through these new reforms. We enjoy a reputation already among Federal and State heath administrators as an innovative, “can do” Division, and I am confident that our experience as Division over the past 16 years will stand us in good stead to take a lead role as we transition into a PHCO.

It is a great opportunity to work out how we can do things better, and with the anticipated funding, make this actually happen.

Vince Roche

His comments are followed by those of the Division's Executive Officer. Noticeably in his text there is a sense of contrast to the opening statement of the Southern Highlands Division being a "federally funded not-for-profit organisation which assists general practitioners and the (SSWAHS) Health Service to deliver health services to people in the Southern Highlands."

There are two things in his text which stand out for old Socrates: one is the vision that he has of this being a great opportunity for his Division and others to grab a large part of the pot of taxpayers money to satisfy his vision of an Empire in the south. The second stand-out feature is the total absence of how the Divisional Executive in general, and its Executive Officer in particular sees how this windfall is going to be helpful to the "people in the Southern Highlands".

Call old Socrates a bit of a windbag - but can anyone else see the words - "patients" or "people" in the writings of either of these other windbags? All Socrates can see is a couple of old cronies backslapping each other for managing to extract a lot on money out of current and previous governments for their own plans, staff and programs.

Primary Health Care Organisations (PHCOs):

These are now being called ‘Medicare Locals’ by the Government – apparently reflecting a move away from ‘Primary’ given the pending legal action surrounding that title.

This new name is being resisted by AGPN and the Divisions and, in company with many others, we are continuing to use the term PHCO.

Boundaries for the sixty or so PHCOs, to which the existing 111 GP Divisions will be reduced, are to be agreed between the Commonwealth and the States by December 2010. This will have regard to the boundaries of the new Hospital Networks.

In the case of the SSWAHS Hospitals, it is possible that we will know the network boundaries as soon as late this year. However the current betting seems to be favouring a two way split, with our network including Liverpool Hospital.

Key strategies for PHCOs will move away from predominantly individual clinician based membership, with activity and governance to be more reflective of wider community based health care providers.

GPs are to remain the cornerstone in the overarching governance structure. Amongst other things, PHCOs will have responsibility for after hours services; strategic planning and development; workforce issues; and population health.

We understand that PHCOs are to cover populations of up to 600,000 people and therefore one thing is certain in our case. That is, we are too small to be able to constitute a PHCO. Indeed, the AGPN has just released the Cranny Report into the suggested PHCO boundaries which has us amalgamated with Macarthur Division.

To this end, we have commenced negotiations with Macarthur Division to, amongst other things, ensure that we retain our rural status and activities and our local management. However, there are still hurdles to cross, including that, while the Government acknowledges the Cranny Report, at the end of the day, PHCOs have to relate to the future Hospital Networks as agreed with the States.

This is to be agreed by December of this year under the COAG agreement. According to the Government’s handouts, the first round of 14 or 15 PHCOs are to be in place by July 2011 with the remainder by July 2012.

We are collaborating with Macarthur Division to go all out to be in the first round, since waiting until the later date will carry the danger of a longer period of instability. There will be dedicated transition funding over and above the normal Division funding which will provide for our existing Division services in the meantime and during the transition period.

Other measures flowing from the Commonwealth Budget which are worth repeating include a national EHealth System to be in place over the next two years; more GPs; 23 new Super Clinics and work on 425 existing practice premises to allow team based care; the Practice Nurse Program; paid training for PNs; better support for RACF nurses; more mental health nurses; more mental health programs; and the new Diabetes program.

It is noteworthy that PHCOs in various forms now exist in New Zealand, Canada, the UK and the US. It is expected that there will be a Canberra-based central PHCO as well as State branches. Some in the network are favouring the retaining of existing Divisions, with the Division becoming a part of the PHCO. However this seems unlikely.

Lastly, any Division that doesn’t move into the PHCO model will not be funded beyond 2012. Perhaps most importantly of all for GPs, the PHCOs will not control individual GP practice matters.

Warwick Ruscoe

Now call Socrates a bit of a simpleton but I seem to recall that this last author was most outraged that he was overlooked in a pre-selection ballot for a nice safe Liberal seat. A second rebuff was his failed attempt to have the Wingecarribee Council approve his grand plan to build a "super clinic" (funded by the federal government, of course) over the public car park in Moss Vale which, only coincidentally (of course), happens to be right next to the Moss Vale GP practice owned by the Chairman of the Division.

Even more alarming is the unholy alliance with SSWAHS looks as though it is going to be the preferred option for the Southern Highlands Division if the prediction from the Executive Officer is correct about the links with Liverpool Hospital, the Imperial home of the SSWAHS Executive.

Perhaps the Southern Highlanders should be asked by the State and Federal Health Ministers whether we want more of the same treatment that has been dished out to us by Liverpool and SSWAHS.