SSWAHS = SWSLHD + SLHD and the Medicare Locals - 68

There is no doubt that the South West Sydney Health Coalition (SWSHC) and the Bankstown GP Division have been diligent in their attempt to pursue the formation of a collaborative Medicare Local for the region, and magnanimous in defeat!


Not only has the SWSHC outclassed their bigger competitor but they have, in an exlemporary fashion followed the criterion set out for all bidders by the Federal Department of Health and Ageing. They have put to shame their rivals in the Macarthur-Southern Highlands consortium who have failed the critical test of consultation prior to submitting their relevant bids.


One can only hope, as residents and health consumers of the Southern Highlands, that the Vision and ethical approach of the SWSHC is maintained by an appropriate representation from the SWSHC on the Board of the proposed SWS Medicare Local due to commence by 1 July 2012.


Socrates, for one, will find no credibility in a SWSML Board which does not espouse the same SWSHC Vision of : "democratic decision making, transparent governance, and equitable distribution of resources, to benefit all families across the region."

Welcome to SWSHC
 
 

The South West Sydney Health Coalition (SWSHC) formed in 2010, to secure democratic decision making, transparent governance, and equitable distribution of resources across all parts of the future South West Sydney Medicare Local.

Since 2010, thirty five organisations signed MOUs to work together, to transform this vision of a Medicare Local into reality.

The SWSHC has, from its origins, been driven by a shared vision, of how family doctors, health and community organisations should work together to improve the health of people living between Bankstown and Bowral.


In July 2011, the SWSHC lodged a bid to become the South West Sydney Medicare Local.

On 4 November 2011, we learned that we were not the successful bidder. As a consequence, the SWSHC will negotiate with the Macarthur-Southern Highlands bid consortium to form the South West Sydney Medicare Local.

Importantly, today’s decision means that the SWSHC has not yet secured its original vision – to ensure the South West Sydney Medicare Local foundations rest on democratic decision making, transparent governance, and equitable distribution of resources, to benefit all families across the region.

Looking towards 2012 and beyond,  the SWSHC is now well positioned to represent the interest of family doctors, health organisations, and local communities, to secure our vision for the South West Sydney Medicare Local, through a formal mediation process with the Macarthur and Southern Highlands bid consortium.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 60

Mediation failure forces divisions to quit ML merger

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

DOUBTS about the federal government’s Medicare Local (ML) boundaries have re-emerged after mediation between two Sydney division-led bodies, aimed at forcing them into a single ML, collapsed.

Souring relations between a Bankstown division-led consortium and a group led by Macarthur and Southern Highlands divisions prior to the first ML deadline had previously prompted the AGPN to appoint a mediator so the parties could form an ML by next year.

But mediation has since failed, with Macarthur-Southern Highlands having now lodged its own bid, which could see it handed responsibility for the 35 practices it is locked in a feud with.

A Macarthur spokesperson told MO the group would not agree to further mediation until the fate of the ML had been decided.

Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.

“It’s such an enormous area with so many complex needs and organisations,” she said.

Dr Brian Morton, chair of the AMA Council of General Practice, warned divisions to settle their differences or risk having general practice “locked out” of MLs. A department spokesperson said the awarding of tenders took into account the applicants’ “ability to engage with key stakeholders”.


Well, it seems the fickle finger of fate has written on the wall of the Southern Highlands Division of General Practice! Christmas is beginning to look gloomy for the CEO and Board of the local Division. 

The final paragraph of the statement above is pretty clear about what causes a Division like the Macarthur - Southern Highlands consortium being "locked out" of Medicare Locals because they can't settle their differences. Certainly the Department of Health and Aging representative suggesting the criteria of the applicant's "ability to engage with key stakeholders" does not apply to the SHDGP's involvement with local people, public and private health practitioners and NGOs. Telling key stakeholders after the event what the SHDGP has done to apply for Medicare Local funding is hardly consulting or engaging, with them.

The other bit of mis-information the Chair of the SHDGP published in his lengthy column in the Division's last newsletter was that the mediation between the Macarthur-Southern Highlands consortium ended because the Bankstown GP Division put in their own application. However, the report published above suggests that it was the Macarthur-Southern Highlands consortium who withdrew from the mediation to lodge their own submission first. Further, the Macarthur spokesperson stated that they would not engage in any further mediation until after the outcome of the second series of Medicare Local allocations had been resolved. It seems they are hoping to get in and only then use their improved position to hammer away at the Bankstown GP Division.

"Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.
“It’s such an enormous area with so many complex needs and organisations,” she said."  

This suggestion by Dr Harnett is Solomon-like in its simplicity. The Medicare Local could be split in two. However, in order for the Bankstown GP Division to achieve the numerical population quota set by DoHA, required for MLs it is likely that they may have to extract from Macarthur-Southern Highlands some of the territory that they acquired prior to the implementation of the Medicare Locals. 

Can I see these empire-building expansionists willing to hand over territory? Not likely!

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 59

Southern Highlands Division of GPs - Is this its last Hurrah?

A strange thing happened on the way to the Forum a few weeks ago! Sighted coming out of Springett's Arcade into the Oxley Mall carpark was a very distracted CEO of the Southern Highlands Division of General Practice, Dr Warwick Ruscoe. No doubt he was trying to work out if he will have a job (or a Division) after July 1st, 2012.


It has been interesting to follow the fall and fall of the SHDGP and its diehard Chair and CEO. I notice that even the Sydney South West GP Link (formerly the Macarthur Division of General Practice) is being very peripheral in its reference to any possible association with the Southern Highlands Division. Like an afterthought, the reference is tacked on the end of their latest news on their website. Possibly much like their expectation of what they think they can bring to the Southern Highlands.

In his September 2011 SHDGP Newsletter column the CEO says: "Successful applicants to establish Medicare Locals in rounds 2 and 3 are expected to be notified in October or November, for implementation in either January or July 2012." Hope springs eternal in his breast, it seems. Fortunately, the CEO has kept it a very brief comment this time round. Perhaps Dr Ruscoe has seen the fickle finger of fate writing on the wall of his office.


However, the Chair (Dr Vince Roche) of the SHDGP Board was a bit more forthright in the same September Newsletter - well perhaps a lot more forthright in his comments! He says: "In my last piece in May, I wrote that “the pace of threatened Primary Care reform quickens!” I would qualify this now with the further words “for some”!" This was possibly a reference to their failed attempt at convincing that the combined Macarthur-Southern Highlands Medicare Local submission should have been one of the Round One successes. Is this sour grapes? 

Dr Roche states in the Newsletter: "A great deal of time and energy has been invested by Warwick, Sally and myself in getting our Medicare Local (ML) proposal – in conjunction with the Macarthur Division of General Practice (now known as SSW GP Link) – ready for the second application deadline in July. Huge efforts were made to have Bankstown GP Division join Southern Highlands Division and GP Link in this proposal, as Bankstown lies in the ML footprint determined by the Federal Government. However, at the last moment, negotiations fell through and Bankstown again lodged an independent proposal."

What is not stated is that the Bankstown GP Division rejected the advances of the Macarthur-Southern Highlands consortium because they felt that itwas not in the best interests of their consumers. They knew this because they had frequent and extensive community forums with consumers, NGOs and public and private health providers. They also felt that the Macarthur-Southern Highlands proposal did not understand the social demography of their population, nor did it respect the GP and other healthcare providers in the Bankstown area.


Says Dr Roche: "The first 19 MLs were announced in June – and four in NSW. Why four? A cynical observer might postulate that one went to an urban ML (Western Sydney ML), one regional (Hunter Urban ML), one rural (Murrumbidgee ML) and one to an Independent MP's seat (New England ML)." Perhaps the only cynical observer is Dr Roche. Perhaps those four NSW Medicare Locals simply put in the best submissions by complying with all the criteria that the Commonwealth had required. Something which the SHDGP did not.

"The federal Government will announce the successful bidders in October or November, and these MLs will become operational from January or July 2012", says Dr Roche. Alarmingly, Dr Roche is suggesting a: real need to bring GPs from the Divisions into cooperation and participation as leaders in the new MLs, and that experience serving in Divisions over the previous 18 years had created skills in governance, service delivery and population health that few other potential ML Board members drawn from other branches of healthcare would have in the short term." This is the sort of self-promotion which seems to have been the cause of the failure of the Macarthur-Southern Highlands sortie into the Bankstown GP Division's jurisdiction.

Perhaps, the people of the Southern Highlands can do without the entrepreurship and empire building of the Macarthur (SSW GP Link)-Southern Highlands consortium. Let's just depend upon the GP Practices to continue to deliver all the services we need.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 34

At last, there is something more substantial in the way of the every-growing backlash against the Federal government's Super Clinics and Medicare Locals. Socrates notes that this survey of GPs is of just a small sample, but it does seem to confirm the anecdotal view that there is mass confusion amongst the general practitioners of just what will be the business of the Medicare Locals and of the Super Clinics and how either will in any way change the delivery of health services in the Australian community.

Secondly, it confirms what seems to have been evident in this blog, and elsewhere, that there has been very little information provided to local communities about how the Medicare Locals will operate to improve their local health services. The big exception has been the Bankstown GP Division and their SWS Health Coalition.

Let's hope that the Federal Government budget focusses on what works and what does not when it comes to making cuts in health spending.

GPs: Axe Medicare locals to free up health funding

19th Apr 2011

Byron Kaye all articles by this author

JUST weeks out from what is predicted to be a tight Budget, GPs have pointed the way for the Gillard Government to reach its all-important surplus: freeze the rollout of super clinics and scrap Medicare Locals altogether.

Winding back incentive payments for pharmacists to dispense generic drugs also rated a high mention in MO’s latest national poll of 150 GPs.

Asked where health spending should be cut in the May Budget, 77% of GPs nominated the super clinics program – now $630.4 million deep in promised Commonwealth funding.

Nearly 40% recommended Medicare Locals for the chopping block, freeing up at least some of the $416 million that has so far been committed to their rollout, which begins on 1 July.

“If you took the super clinics money from Canberra, the leverage that you would get would train five times as many students and doctors,” AMA vice-president Dr Steve Hambleton said.

“Nobody can understand anything about whether super clinics are any benefit to the health system at all.”

Health economist Professor Gavin Mooney said the super clinics program was too advanced to be stopped, but “what could be possible and a good thing would be if Medicare Locals were delayed”.

The survey, conducted by Cegedim Strategic Data, also found 45% of GPs wanted to see a reduction in the $1.50 payment that pharmacists receive each time they substitute branded medicines with generic ones.

One area where some GPs and the Government appear to agree is the chronic disease dental scheme, which the Gillard Government claims is costing close to $63 million a month.

Nearly a quarter of those surveyed would be happy to see the scheme axed.

The poll comes as medical researchers held a series of rallies protesting widely tipped budget cuts to the sector of $400 million.

GPs were not short of ideas for where to spend the savings. Two-thirds nominated indexing MBS rebates to inflation as a priority.

Dr Hambleton said the rebates had been “systematically underdone” for years, making out-of-pocket expenses harder for patients to meet.

A quarter of GPs wanted MBS rebates for point-of-care testing (PoCT).

Robert Wells, director of the Menzies Centre for Health Policy at the ANU, said Government support for PoCT was inevitable, but a rebate now could undermine the new funding deal with pathologists. But given PoCT was both safe and convenient, he said, rebates for this should be supported.

This poll was conducted for Medical Observer by Cegedim Strategic Data research company.

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SWS Health Coalition in action - this how it can (should) be done!

Meet Your Neighbour - Bankstown GP Division

The Mental Health Coordinating Council’s initiative to encourage organisations to meet, learn more about each other and find ways to work better together. Come and learn more about Bankstown GP Division and how NGOs and GP Divisions can work together.

When:

Monday, 18 April 2011

Duration:

2.00pm to 4.30pm

Where:

Bankstown GP Division, Bankstown Civic Tower, Level 7, 66-72 Rickard Rd, Bankstown

Contact:

For more information Rod West 02 9555 8388 ext 110 rod@mhcc.org.au

RSVP for catering purposes: Carrie Stone 02 9555 8388 ext 0 meetyourneighbour@mhcc.org.au

More about the Meet Your Neighbour - Bankstown GP Division

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 31

It seems that there have been almost as many leaks from Canberra about our pending May 2011 Federal Budget, as there have been with a cup of water in a sieve! Most attention has been on the scientific Research and Development grants which are expected to be chopped by the Federal government.

Most recent news has been the means testing for family allowances and child care, and health and education projects.

Let's make the suggestion now that, if health cuts are required, the Federal Government should, first of all as a matter of priority, consider stopping the roll out of the Medicare Locals ($500,000,000 savings) and the funding for the Local Health/Hospital Networks (LHNs) which are incorporated in the Federal-State governments funding agreement.

In NSW, which is the only State that may have implemented the LHNs since 1st January this year, it appears to have rolled them out on the promise of the funding. However, all the previous NSW government seems to have done is add another bureaucratic layer to an already over-corporatised health system.

As reported in this blog previously it would seem that the Federal government has already told the previous NSW state government to get rid of the LHNs that they have rushed to implement.

Obviously, if the Federal-State health budgets are going to be impacted by the soon to be announced Federal Budget cuts, then the funding for the not wanted LHNs will be top of the list.

If these obvious cuts are, in fact, brought into reality it would be up to the new coalition NSW State government to decide whether their State Budget can maintain the additional funds needed to support the LHNs and the state's Medicare Locals. Socrates's hope is that they recognise that the NSW population can do without the additional mis-management that such poorly run and poorly considered projects can introduce.

It would be hoped that both the Federal and NSW governments will see that some of the current applications for Medicare Locals from NSW are very short on the necessary community consultation and colloboration with other public and private healthcare providers. The latter is best exampled by the recent application by the Macarthur-Southern Highlands Division of General Practice consortium. The contrast has been the very extensive consultation and collaboration done by the Bankstown GP Division and their SWS Health Coalition.

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 - 25

This news item from the ABC News demonstrates the difference in the process of developing a Medicare Local application by Divisions of General Practice. In this case the ACT Division has done what the Bankstown GP Division has done and gone to the local community and health service providers to get a broad-based consensus on how the Medicare Local would improve the access by the community to their local health services.

Contrasted with these two Divisions is the appalling neglect by the Macarthur and Southern Highlands Divisions in bringing together a collaborative partnership with local health and welfare service providers, along with the local community to produce a constructive Medicare Local which does not just simply massage the egos of a pair of CEOs.

ACT doctors apply for Medicare Locals

Updated Wed Apr 6, 2011 3:56pm AEST

Canberra-based doctors and health organisations have made a joint application for Medical Locals funding from the Federal Government.

ACT Doctors have applied to establish a Medicare Locals (ML) group under the Federal Government's health reform program.

The ACT Division of General Practice submitted the paperwork on 5 April 2011, the closing date for applications.

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

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

The ACT's division President Dr Rashmi Sharma says Canberra-based organisations such as pharmacists, chronic disease support groups and the ANU Medical School have backed the application.

"The concept behind Medicare Local is basically that we work at a more local level," Dr Sharma said.

"All of the groups that are listed are people who provide care within the primary healthcare space, before you get to the hospital. So looking at the preventative side of things."

Dr Sharma says the idea is to boost preventative care messages and reduce the number of people needing to go to hospital.

"What Medicare Locals aim to do is actually to bring in the rest of the workforce within Primary Healthcare. So basically we are talking about your pharmacists, podiatrists, physiotherapists, nursing staff, consumer groups and mental health and actually packaging it all together. So we avoid these silos of care, which we all know about and we have all experienced."

Tags: doctors-and-medical-professionals, health-policy, health-administration, act, canberra-2600

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 - 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

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 7

It would seem that the long arm of the Southern Highlands Division of General Practice has reached up to the Bankstown GP Division's Twitter page. Ah well! I guess it had to be expected that the self-protectionist executive and Board of the Southern Highland Division would seek to, like King Lear, hold back the tide of growing criticism from its members and others in the community.

What is there of which to be critical, one might ask? Well let's examine what the role and function is of any Medicare Local as defined by the Federal Government and reported by Grant McArthur in last weekend's Herald-Sun:

"Medicare Locals are intended to be primary care networks in charge of planning and delivering health services in their area, with GPs, allied health, nurses and pharmacists possibly sitting on their boards.

"The Federal Government is yet to outline whether it will manage day-to-day services and doctor rosters, or if it will take a more administrative or advisory role."

And this was the reported comment of the Victorian Government's Health Minister in the same article:

"We think it is unfortunate that the Commonwealth has not been very precise about the role of Medicare Locals," state Health Minister David Davis said. "They have said they want to do more after-hours GP work, but exactly how they implement that has not been laid out.

Even blind Freddy can see that this does require community and health provider consultations at best and, at least, to be involved in informing the community as to what the "semi-autonomous" Southern Highlands/Wollondilly Medicare Local will look like, and what services, if any, it will provide.

Again, a search of the local press, the Division's own website, and that of the Macarthur Division reveals nothing forthcoming from the CEO and Board of the Southern Highlands Division of General Practice. If information has been merely trickled from top down to the local GPs who are members of the Division then that process hardly constitutes being a "primary care network(s) in charge of planning and delivering health services in their area".

This then begs the question: "When will Dr Ruscoe and the Board of the Southern Highlands Division of General Practice become open and transparent about their plans for the delivery of health services in the Southern Highlands and the Wollondilly communities?"

I'm told that at one meeting, late last year, of Mental Health Professionals in the Southern Highlands a suggestion was made that Dr Ruscoe be invited, to a subsequent meeting, to discuss the evolution of the Medicare Locals in the Southern Highlands. The response from the GPs present at the meeting was that there are other people of more interest than Dr Ruscoe who could be invited to speak at subsequent meetings. One could consider from this comment that even members of the Division believe that Dr Ruscoe is more of a legend in his own mind than in the minds of others.

Certainly the absence, already, of any public comment about the local version of the proposed Medicare Local could mean that Dr Ruscoe may have been a speechless invited speaker! So, who is this man who seems to wield such power and influence? Perhaps Socrates's next posting should bring some clarity to this question.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 6

On the Bankstown GP Division Twitter a question was raised about the scope and scale of the Southern Discomfort felt in Bowral about the state of health services and, I guess, about the comments I made about the Southern Highlands Division of General Practice.

My purpose was to draw attention to the extreme variance between the actions taken by the Bankstown Division and the lack of action taken by their counterparts in the Southern Highlands, in respect of the advocacy for a more appropriate Medicare Local. In the case of Bankstown the Division there took an active role in developing a coalition of organisations and other health providers to agitate and advocate for the maintenance of a family focused medical practice. Their community was being supported by the Division and was being invited to participate in the process.

In the Southern Highlands the Division of General Practice has not made any public comment, has not issued any press releases, and has not even published any information about the proposed changes on their website. The whole process of change appears to have become the Southern Highlands Division of General Practice "secret business".

To my knowledge no NGO or community group with a stake in the way in which health services are meant to be delivered has been advised about, or invited to, anything to do with the development of a Medicare Local as a "Branch" or "semi-autonomous rural network". One of my informants has recently advised me that the nearest that any such explanation has been forthcoming is a promise from the CEO of the Division to address some of the local psychologists about what impact the changes may have on their private practices. It also seems that the meeting has only come about because the CEO is a neighbour of the psychologist arranging the meeting.

The question needs to be asked: "Why has there not been the same level of discussion, activity and collaboration with consumers, health care providers and NGOs in the Southern Highlands as there has been in the Bankstown and similar areas?"

Possibly, the Southern Highlands Division of General Practice CEO and Board may feel that they are on top of the issues related to the implementation of the "semi-autonomous rural network" but it seems that the GPs, who the Division purportedly represents, have been left in the dark as much as has been the local community. To my knowledge there has been no dialogue with the GPs, and there certainly has been nothing in the local press. Nor has there been a public meeting for community members, health care providers and health care organisations who will obviously be affected by any implementation of a local Medicare Local.

To the Bankstown GP who asked the question about the scope and scale of the Southern Discomfort I ask "How would you feel if you had no input or feedback as to what was about to (perhaps) radically change the way in which health services would be delivered to you, as a consumer, or by you as a medical practitioner?" My belief is that most people would want to know about the change or, hopefully, want to take an active role in any proposed change. Unfortunately, in the Southern Highlands, no one other than the Division of General Practice CEO and the Board knows of the change, nor has any organisation appeared to have an active collaboration within the process.

Yes, the Southern Discomfort is extensive in scope and scale - and just wont go away.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 5

Socrates is putting in a bid to see if the Southern Highlands community can attract Dr Susan Harnett to become the CEO of the moribund Southern Highlands Division of General Practice. What a dynamic individual she is! Articulate, expressive, and someone who has the committment and desire to bring about the best possible outcome for the patients in her area of the South West Sydney Medicare Local.

Her coalition of general practitioners and health care workers had a breakfast meeting at Bankstown this morning. Not only is she effectively knitting together a strong coalition of health services she and her committee are effective in informing the community and health care providers about what the future direction is for their local health services.

In fact, if Socrates wants to know what is happening in the Southern Highlands he only has to go to the Bankstown GP Division's website or Twitter to get the good oil! In contrast, the silence from the Southern Highlands Division of General Practice is deafening! Not one word about their plans for the Medicare Local in the local press. Not one public meeting of health care providers reported as being planned by the Division. Obviously the autocratic machine in the Division is working on something but the community and other health providers will be left like mushrooms - in the dark!

Here, in part, is what Dr Susan Harnett was able to say to their large roll-up of interested people.

“This business breakfast was part of our response to recent federal government changes to how family medicine works across Australia,” said Dr. Harnett.

“On February 22 2010, the Prime Minister announced the federal government will form new family health organisations, Medicare Locals, across Australia,” said Dr. Harnett. “Over coming months, these Medicare Locals will make sure community and health organisations work ever more closely with local hospitals and family doctors.”

“When the PM launched Medicare Locals, she described them as an invisible engine, joining up health services. The PM said that our patients may never see or hear the Medicare Local engine working behind the scenes. But if the engine works well, then patients will simply get the best care.”

“Here, in south west Sydney, the Medicare Local will cover a huge area. The Medicare Local will centre on Bankstown, Fairfield and Liverpool, and take in the urban edge of the Macarthur region. Meanwhile, a separate, semi-autonomous rural health network will extend south of Camden, through Wollondilly, to Bowral in the Southern Highlands,” she said.

“Across this huge Medicare Local, the real challenge for each health and community organisation will be to think through what this means for them locally. While the federal government has described the many benefits of joined up health services, the reality is that our many family doctors, non-government organisations and other health providers need to have a good reason to take time out of their day to meet, and to actively collaborate on improving patient care in their local area,” said Dr. Harnett.

“Even though the Medicare Local hasn’t yet been finalised, we’ve already found that a really broad range of organisations across south west Sydney really want to work more closely with local family doctors, and to work collaboratively towards improving the health of our many diverse communities,” she said.

“Today, through the SWSHC, we’ve brought together many health organisations that have never even spoken with each other before. And in so doing, we’ve also opened up new ways for these organisations to do business locally,” Said Dr. Harnett.

”Joining up local health services just makes business sense. This is the missing ingredient that will really make the South West Sydney Medicare Local work. By building new bridges, we’ll make sure everyone has a real stake in improving the way health works across this part of Sydney,” she said.

“Through this SWSHC breakfast, we’ve taken the first steps to family doctors working in new ways with disability and community organisations, with local pharmacists, physios, with mental health, ageing and other health providers,” said Dr. Susan Harnett.“

“This is our once in a lifetime chance to improve how local health works. This business breakfast was just the the first step to a healthy future for families across south west Sydney.”

Note the words she uses when Dr Harnett describes the scope of their Medicare Local. This is the first confirmation that the Southern Highlands Division of General Practice may be extending its grip into the Wollondilly Shire.

"Meanwhile, a separate, semi-autonomous rural health network will extend south of Camden, through Wollondilly, to Bowral in the Southern Highlands,” she said.

The use of the word "semi-autonomous" opens up some hope that someone else other than the current CEO and Board of the Southern Highlands Division of General Practice will ever be able to demonstrate that it is capable of meeting the requisite strategic objectives as set out by the Australian Government for Medicare Locals.

In the meantime, Bankstown GP Division and its Health Coalition, can we borrow Dr Susan Harnett!? Please!

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 3

Ouch! While I have to say that the Bankstown GP Coalition Network have achieved their best outcome in that they have a smaller urban Medicare Local which enables them to provide the type of family practice health services it has come at a cost to the people of the Southern Highlands. The Bankstown GP Coalition Network is now connected with the Liverpool-Fairfield and Macarthur Divisions of General Practice. This limits the whole northern Medicare Local to the urban areas within the southern boundary of the Macarthur area.

This change to the Northern Coalition of GP Divisions then changes the configuration of any possible Medicare Local which takes in the Wollondilly and Southern Highlands Shires. So what might happen? Well, as has been reported previously in this blog the, Southern Highlands Division of General Practice has gone remarkably mute on the subject. Their website is devoid of any information available to the community. In fact they have not had an updated newsletter to their member GPs since July 2010. Quite a difference to the Bankstown and Macarthur Divisions websites.

Now here is the dilemma facing us in the Southern Highlands! It may be that our local entrepreneurial CEO of the Southern Highlands Division of General Practice is looking northwards to draw in the Wollondilly general practices to the current Southern Highlands Division. While that might increase the size of the population of their catchment it gives no promise of anything changing to benefit the people's health needs. To date, there has been no communication from the local Division about their plans for the community. How unlike the work done by the Bankstown Division who engaged their community in the fight for their health services.

What will be alarming is if the current CEO and Board of the Southern Highlands Division of General Practice will become the controlling organisation of an enlarged area. One could hope that the GPs of the Wollondilly Shire will insist that there is a spill of the current Board and that the position of CEO is made vacant. I would be confident in saying that most of the GPs in the Southern Highlands would like to have the opportunity to have a purge of the current operators of their Division.

It would be refreshing (but notably unlikely) if Dr Warwick Ruscoe stepped aside. His history of being a medical administrator has not been without question and conflict. Perhaps in the saga of the Medicare Locals history is beginning to repeat itself.

SSWAHS = SWSLHN + SLHN: 3

It was with some delight that I found that the organisational problems we are experiencing in the Southern Highlands have resonated with the GPs in the Bankstown Division of General Practice, a Division which I mentioned as being more progressive and demonstrating advocacy for health consumers than is evident in their silent counterparts in the Southern Highlands Division of General Practice.

In my previous posts I remarked on the different stance the Bankstown coalition of GPs and Divisions has presented to NSW Health (and to the Federal Government) for more manageable sized Medicare Locals which can adopt and provide health resources and programs for the health consumers within their target areas. This was in marked contrast to our own Division which seems to want to hold on to their autonomy as a "branch" of the Macarthur Division of General Practice. Does this mean that the Southern Highlands "Branch" retains the inept Board that we currently have? If so, it seems that there have to be questions asked as to how the current Chief Executive of the Southern Highlands Division can be retained when he lacks the confidence of many of the GP members of the current Division.

Yes, the Tweeter on Twitter who captioned my last blogs as "Southern Dis-Comfort" got it perfectly correct: the current structure of the Southern Highlands Division of General Practice is giving us health consumers very little comfort. Looking at the strategies which have been driven by Dr Warwick Ruscoe and the Board they seem remarkably self-serving and for the purpose of self-aggrandisement, rather than for the benefit of the local community.

When push came to shove in the promotion of improved surgical theatre lists, and in the improvement for local treatment of renal disease, and the refurbishment of the Children's Ward at Bowral Hospital - the Board of the Division has been stoic in their silence and always absent in their presence. When the SSWAHS barricades needed to be charged it was left to the community's aged and the infirm and just one or two specialist medicos to lead the way. A Medicare Local that does not need to worry about biting the hand that feeds it would be of benefit to any community, none more so than the community in the Southern Highlands.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 2

The difference between the advocacy of the Chair of the Bankstown Division of General Practice and the deathly silence of her counterpart in the Southern Highlands Division of General Practice is extraordinary. For one, Dr Susan Harnett made a submission to the NSW Health in respect of the Carla Cranny and Associates Report about the Medicare Locals boundaries. The Southern Highlands Division's report was notable for its absence in the process.

Secondly, Dr Harnett wrote eloquently about the diversity and cultural mix of the communities their GPs served and expressed the general feeling that they could be effective advocates for their patients with the local hospitals, ancillary services and allied health providers. Whereas, the silence of the Southern Highlands Division of General Practice would suggest that their own interests are more paramount than the interests of their patients.

Here is the full text of the submission made by Dr Susan Harnett. It gives a clear explanation of the plans for the Medicare Locals and provides a sensible alternative to the mega Medicare Local with which we now appear to have been given.

Submission by Dr. Susan Harnett (Chair, Bankstown GP Division Inc.)

Principles for determining boundaries or catchment areas for Medicare Locals, including potential differences between metropolitan, rural and remote areas (eg size of catchment populations, natural catchment areas)

"We believe that three distinct Primary Health Care Organisations in south west Sydney will provide the optimal configuration for state and federal primary health care policy implementation over the next 10 years to 2020 and potentially beyond.

"As outlined in the NSW Health and Commonwealth discussion papers, the three PHCOs will be based on Local Government Area (LGA) and Sydney South West Area Health Service borders, current patient flows, transport corridors, demographic congruence, and projected population growth. Based on these characteristics the evidence indicates that the three PHCOS should be:

i. A Central Sydney PHCO based on the existing Central Sydney Division of General Practice.

"This PHCO will cover the relatively affluent areas extending from the CBD across the inner west. This includes the border suburbs of Lakemba and Canterbury and similar where local tailoring of services for specific areas of need can be appropriately managed by this PHCO, without creating a massive challenge for efficient administration or governance, which would result from a larger area.

ii. A South Western Sydney PHCO based on the amalgamation of the existing Bankstown and Fairfield- Liverpool Divisions of General Practice.

"This PHCO will focus on providing services to the well established urban communities in the Bankstown- Fairfield- Liverpool corridor which have a very high proportion of CALD residents and specific areas of health disadvantage due to their relatively low-SES and related factors.

iii. A Macarthur-Southern Highlands PHCO based on the current Campbelltown - Bowral area LGA’s as defined by the Divisions for future PHCO boundaries.

This Campbelltown-based PHCO will focus on establishment and provision of primary health services in a growing region of Sydney, including part of the South West Growth Centre, Campbelltown, Camden, and adjoining suburbs with outreach to the border limits of the current Southern Highlands Division.

"The National Health and Hospitals Reform Commission’s Final Report, A Healthier Future for All Australians recommended that PHCOs “be of an appropriate size to provide efficient and effective coordination (approximately 250,000 to 500,000 population) depending on health need, geography and natural catchment”.

"In this context, the proposed South West Sydney PHCO (Bankstown-Fairfield-Liverpool) would have approximately 300 practices (~560 GPs) serving a population of approximately half-a-million residents (570,000 calc)

Suggestions about the optimum number of Medicare Locals in a particular state, territory or region, including potential boundaries in each area

"The report commissioned by AGPN (Carla Cranny 2010) provided options for PHCO sizes and configurations which were focussed on massive population numbers and assumptions of scale that were not evidence-based beyond aggregating numbers for LGAs, Divisions and PHCOs as massive regions.

"Whether the number in NSW is 15, 16 or more or a total of 49 Primary Health Care Organisations (PHCOs) across Australia is not the question, since the number should be determined as a consequence of enagement of local populations to meet local needs. As quoted by AGPN CEO David Butt who said the final number of PHCOs would be the product of careful consultation with divisions on regional need.

“There is no right answer as to what the number should be,” Mr Butt said. “There are obviously different options... taking into account different criteria.”

http://www.medicalobserver.com.au/news/agpn-maps-future-of-49-divisions

"Such PHCO combinations as “Inner Western Sydney & Canterbury Bankstown” covering huge areas of Sydney with massive populations (Ashfield, Bankstown, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Strathfield and part Sydney with a project population by 2021 of 763,164 people) are expected to be unmanageable, and doomed to repeat the current ‘downsizing’ exercise from NSW Health re: super-sized Area Health Services being regionalised so they can respond more effectively to local needs.

Specific comments on the Carla Canny & Associates report (where relevant)

"Amongst government announcements in the lead up to the election, there have been two public discussion papers that have proposed options for redrawing health care boundaries in the Bankstown and Fairfield –Liverpool areas:

1. Permanent dissolution of the Bankstown, Fairfield, and Liverpool Divisions into a Campbelltown-based Macarthur -Southern Highlands PHCO. This option was outlined in the document titled “Discussion Paper on Implementing the National Health Reform in NSW” (NSW Health August 2010). Under this option, Bankstown GP Division would be forced into amalgamation with Fairfield-Liverpool under an expansion of the current Macarthur -Southern Highlands Divisions, to which there is considerable local GP resistance.

2. Permanent dissolution of Bankstown into a Central Sydney PHCO, based on the current Central Sydney Division. This option was outlined in the document titled “Framework for development of Primary Health Care Organisations in Australia” (Carla Cranny and Associates May 2010). Also under this option, Fairfield-Liverpool would become the northern margin of a giant Macarthur -Southern Highlands PHCO, to which there is considerable local GP resistance.

"These two documents made different recommendations, and have created significant confusion in south west Sydney.

"Further, under both scenarios 1 and 2 there is a significant risk that the local influence on primary health care decisions will be lost across much of south west Sydney. Health professionals in Bankstown, Fairfield and Liverpool may be inappropriately (& permanently) relegated to the periphery of decisions made in central Sydney or Campbelltown, under options proposed by Carla Cranny and Associates, and NSW Health. That is, health professionals and communities in some of the most complex and disadvantaged urban LGAs in Australia, will effectively be silenced, and permanently disengaged unless the Bankstown-Fairfield-Liverpool alliance is allowed to develop.

Comments on Local Hospital Networks

"NSW Health has determined it will be using the term “Local Health Networks” (not Local Hospital Networks), apparently as it has a large stake in community health services which may not be part of the Commonwealth health reform process. This is potentially a disaster for PHCOs in NSW unless service-provider agreements are created between the LHN and the PHCO. The Commonwealth should determine through COAG the process for developing policy that binds Commonwealth & States/Territories to the health reform agenda, so that every jurisdiction is able to progress with these National reforms.

"An example of such PHCO-LHN collaboration policy would be the requirement to have at least 1 (but not more than 2 for example) cross-Board memberships of these two entities. Currently it is unclear what the LHN/PHCO clinical and administrative governance practices will be and to whom such issues as complaints will be referred."

Does not this submission make one wish that Dr Susan Harnett was the Chair of the Southern Highlands Division of General Practice? At least she had something to say before the shotgun marriage took place. Our Division seems to have lost its voice!