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 - 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!