SSWAHS = SWSLHN + SLHN and the Medicare Locals - 29

It would appear that Socrates is not alone in beginning to see that the concept of Divisions of General Practice should NOT be the fundholders to provide, purchase or even determine how the Medicare Local should direct how local health practitioners - private as well as public - should provide the health services to the residents in their jurisdictions.

The majority of general practitioners have indicated as much in this recent AMA survey of NSW members.

The question now could be asked: "If budget savings have to be made federally this year, should the government be putting $500,000,000 into a project that appears to have little support from the people who are meant to run the Medicare Locals. In fact, should the government be funding even those current Divisions of General Practice which are not even reflecting the beliefs of their members?"

You be the judge: Dump the yet to be accepted Medicare Locals project, or dump the scientific research programs that are known to deliver positive health outcomes for our country's, and the world's, population.

Results from first quarterly GP e-mail survey

There was an excellent response to our first single-issue email survey of GP members, with over 150 responses in 5 days. The full report can be found below.

The message seems clear – GPs are opposed to Medicare Locals as they are currently proposed.

Should they be established (as seems likely), Divisions should get involved in the tendering process but the roles of Medicare Locals should be limited to the types of things that Divisions currently do. GPs are strongly opposed to roles that include the provision or purchasing of health services.

Demographic Information

Question: Are you male or female? Number who answered: 159
Male	103	65%
Female	56	35%

Question: Where is your practice located? Number who answered: 159
Gosford, Newcastle, Sydney or Wollongong	97	61%
Rural / Regional	62	39%

Question: What age group are you in? Number who answered: 159
Younger than 40	9	6%
40 to 49	29	18%
50 to 65	97	61%
Older than 65	24	15%

Question: What sort of practice do you work in? Number who answered: 159
Solo GP	22	14%
Group practice	114	72%
Corporate	12	8%
Other answers	11	7%

Support for the AMA position and GP Divisions

Question: Do you support the AMA position on Medicare Locals? Number who answered: 143
Yes	No
123	20
86%	14%

Question: Do you support the concept of the replacement of GP Divisions with primary health care organisations? Number who answered: 139
Yes	No
40	99
29%	71%

Question: Do you support the continuation of Divisions? Number who answered: 99
Yes	No
75	24
76%	24%

Roles and management of Medicare Locals

Question: What roles should primary health care organisations undertake? Number who answered: 134
Activities currently undertaken by Divisions	84	63%
Training for practice nurses and allied health practitioners	63	47%
Improving integration between primary care and hospital services	97	72%
Development of local primary health care policy	70	52%
Identification of gaps in local primary health care services	92	69%
Employment of nurses and allied health practitioners	35	26%
Provision of primary health care services	27	20%
Purchasing health services from GPs and other primary health practitioners	26	19%
Managing Commonwealth and/or State primary health care funding	27	20%
Other answers	15	11%

Question: Do you support Divisions tendering for the right to run Medicare Locals? Number who answered: 134
Yes	No
83	51
62%	38%

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 and mental health in the Southern Highlands - 3

It is important to note the comments of Professor Ian Hickie in regards to the inequitable access of people from the low socio-economic levels within the Australian society. Equally, one must consider the capacity of people from culturally and linguistically diverse backgrounds having an even more limited access to the Federal Government's "Better Access" program. Not only may there be a financial disincentive but the numbers of therapists with other language skills is also limited.

Socrates adds another caveat to the "Better Access" program additional to the concerns raised by Professor Hickie. That concern is whether the newly formed "Medicare Locals" will have the capacity to restrict the businesses of those private practitioners who operate within the jurisdiction of the Medicare Local.

It would seem that even the current Divisions of General Practice, through their control over member general practitioners, have the ability to determine who they will promote and who they will not, within their current jurisdictions. It is not unknown that some CEOs of current Divisions will promote their own staff to general practitioners over any other private practitioner so as to, as one CEO put it: "I will promote my staff member to provide the medicare funded services because if they didn't get the work I would not be able to pay them." Perhaps, the staff member should have been expected, like every other private practitioner to promote themselves, in a competitive market. Such competition, obviously, might lead to bulk-billing and therefore improved access for persons with a low socio-economic status.

Mental health access program failing the needy

15th Mar 2011

Andrew Bracey all articles by this author

1 comment

A SENIOR Government adviser and mental health expert has warned that the contentious Better Access to Mental Health Care program has failed to meet its aims despite its ballooning costs.

Professor Ian Hickie, a member of the Government's National Advisory Council on Mental Health and executive director of the University of Sydney's Brain & Mind Research Institute, has called on the Government to urgently overhaul the program.

His comments, made on the ABC's AM program this morning, come as Mental Health Minister Mark Butler was set to release a long-awaited review of the program today.

Professor Hickie told the ABC patients in greatest need were getting the least services through the program, labelling its results a "travesty".

"The probability is that those in higher-income areas who have a capacity to pay are also getting the most money back from the Government for common mental health services," he said of the program, which was initially allocated $500 million over four years.

"It's now cost over $1.5 billion and it costs over $500 million a year and over the next five years it's likely to grow to being almost $1 billion per year. We won't have any money left for other essential mental health programs unless we restructure this particular program."

Professor Hickie also suggested the Medicare fee-for-service-based system had "allowed the professionals to set up lots of small businesses in the well-off suburbs of our major cities and to charge higher rates for their services".

"So that they can get both the co-payment... plus the Medicare rebate. And that's what the Government's essentially encouraged them to do."

"Nicola Roxon said in opposition that she would change this. A different payment system would see those same professionals providing services in other suburbs - in the outer suburban areas and the regional areas where they're desperately needed."

In response, Minister Butler conceded that there were "some limits to this program in terms of its capacity to apply equitably across the population and to reach the harder-to-reach groups".

"There's no question that it demonstrates the need to balance the fee-for-service arrangement that you see in the better access program that we've just evaluated with targeted programs that deliberately go out to reach the harder-to-reach population [such as] younger people, people who live in rural and regional Australia and people living on our urban fringes in lower socio-economic areas," he told the ABC.

Read the Better Access evaluation

Comments:

Cheung

15th Mar 2011
5:30pm

Try finding a public mental health service without long waiting lists even for those clients considered to be in urgent need. Rarely can you find a Psychiatrist who accepts medicare only and many families can not afford gap payments even if they have health insurance. It is just as difficult to access psychology services and then those with vacancies have only a couple of years experience which is fine for run-of-the-mill problems but not for those clients who are seriously in crisis.
On a positive note, the program has raised interest, awareness and acceptance of mental health issues. It is something we do not want to lose however with some refining and tweaking such as means tested access and taking the services to the people this program could truly be sensational.