SSWAHS + SWSLHD + SLHD and the Medicare Locals - 70

In a remarkable bit of spin by the CEO of the Southern Highlands Division of General Practice comes this short piece from the Wednesday publication of the Southern Highland News.

While there is nothing new about this news it does give a remarkable impression of "the tail wagging the dog". Does anyone really believe that the Southern Highlands Division of General Practice somehow pulled off this coup without the major contribution of the other partner?

At least, finally, the local community who are supposed to "find it easier to navigate the health system" are being told about it! Well done, Dr Ruscoe.

Enhanced health services for Southern Highlands
9th November 2011
By: Southern Highland News

The Southern Highlands Division of General Practice, in partnership with our neighbouring Division in Macarthur, has been successful in its bid to establish the new South Western Sydney Medicare Local.

This will become operational on July 1, 2012, and will eventually cover primary care services from Bankstown in the north to Wingecarribee in the south, mirroring the boundaries of our Local Health District.

It is one of thirty-eight organisations selected to become the next Medicare Locals that will drive access to better primary health care across Australia, announced by Minister for Health and Ageing Nicola Roxon on Friday.

"Importantly, Medicare Locals will maintain and build on the excellent work already done by the local Divisions of General Practice, with GPs and general practice being at the centre of a strong, integrated primary health care system," the Minister said.

The new Medicare Local will be responsible for population health planning, identifying and filling gaps in primary care services and will have greater involvement in co-ordination and integration of services at the local level.

"The Federal Government’s Medicare Local concept is designed to make it easier for patients to navigate the health system", CEO of the Southern Highlands Division of General Practice, Dr Warwick Ruscoe, said.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 67

TO anticipate what is expected to be delivered by the Sydney South West Medicare Local the only information we health consumers have are these comments by Mr Rene Pennock on the website of the SSW GP Link, the umbrella organisation which includes the Southern Highlands Division of General Practice.

 

Concerned health practitioners and other health service providers may take comfort from the final dot point in the Division's commentary:  

"They will be accountable to local communities to make sure the services are effective and of high quality."

 

 It will become our responsibility to ensure that this accountability is enshrined in this Medicare Local. To do that the health consumers and health care providers need to be proportionately represented on the Board of this Medicare Local. 

Already, the GPs on the Boards of the current two Divisions of General Practice (Macarthur and Southern Highlands) are moving to exclude non-GPs on the SSW Medicare Local by suggesting that only GPs have the organisational expertise to manage effectively a Medicare Local. 

Well, that's news to me and to other people who have effectively managed health service organisations of even greater magnitude.

  

What are Medicare Locals?

Medicare Locals will be primary health care organisations established to coordinate primary health care delivery and tackle local health care needs and service gaps.

They will drive improvements in primary health care and ensure that services are better tailored to meet the needs of local communities.

Medicare Locals will have a number of key roles in improving primary health care services for local communities.

• They will make it easier for patients to access the services they need, by linking local GPs, nursing and other health professionals, hospitals and aged care, Aboriginal and Torres Strait Islander health organisations, and maintaining up to date local service directories.
• They will work closely with Local Hospital Networks to make sure that primary health care services and hospitals work well together for their patients.
• They will plan and support local after hours face-to-face GP services.
• They will identify where local communities are missing out on services they might need and coordinate services to address those gaps.
• They will support local primary care providers, such as GPs, practice nurses and allied health providers, to adopt and meet quality standards.
• They will be accountable to local communities to make sure the services are effective and of high quality.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 66

THE following message is from the CEO of the SSW-GP-Link and posted on their website

http://www.macdivgp.com.au/site/index.cfm?display=288436

In this statement the CEO says:
"Our start date will be 1st July 2012 which leaves us just over 7 months to implement our plans and listen to the members and community we serve." 

One is driven to ask the obvious question - "Why didn't you do this before making the collective public of the South West Sydney captive to your plans, Mr Pennock! Now the public must listen to your plans as hatched by your Division and that of the Southern Highlands Division of General Practice!"

What can be suggested is, perhaps, the dis-enfranchised mass of health consumers, private and public healthcare providers, and the managers of the non-government health service sector should take up Mr Pennock's offer and use the  Contact Us  link to make your voice heard; ask the hard question; or ask the question what are you planning to provide to us in the Wollondilly and Wingecarribee Shires?

Perhaps you would like to start by looking at the scope of the SSW Medicare Local through the Department of Health and Ageing website: www.yourhealth.gov.au

 

Medicare Local Information

"Sydney South West GP Link in partnership with our colleagues Southern Highlands Division of General Practice, is very proud to confirm that on the 4th November 2011 the Hon Nicola Roxon MP, Minister for Health and Ageing, announced that we were successful in our application to form the South Western Sydney Medicare Local (SWSML). We will be one of 62 new Medicare Locals across the Nation implementing the new Primary Health Care Reform.

"Our start date will be 1st July 2012 which leaves us just over 7 months to implement our plans and listen to the members and community we serve. We are also extremely fortunate that South Western Sydney will have one Medicare Local and one Local Health District. This alone is a significant step towards improving integration between primary health care and the hospital system.

"As this link becomes more populated over the next few months please click on Contact Us for any questions or issues you wish to raise. I strongly encourage anyone to provide us with any feedback as we move towards our start date on 1st July 2012."

Rene Pennock
Chief Executive Officer

The boundaries of each Medicare Local can be viewed at www.yourhealth.gov.au

Medicare Locals to Commence from July 2012

Medicare Local	Applicant	State/Territory
Central Coast NSW	Central Coast Division of General Practice	NSW
Eastern Sydney	South Eastern Sydney Division of General Practice	NSW
Far West NSW	NSW Outback Division of General Practice	NSW
Inner West Sydney	Central Sydney GP Network	NSW
South Eastern Sydney	Sutherland Division of General Practice	NSW
Southern NSW	Southern GP Network	NSW
South Western Sydney	Sydney South West GP Link and Southern Highlands Division of General Practice	NSW
Eastern Melbourne	Eastern Ranges GP Association	Victoria
Gippsland	East Gippsland Primary Health Alliance, Central West Gippsland Division of General Practice, and General Practice Alliance South Gippsland	Victoria
Goulburn Valley	Goulburn Valley Division of General Practice	Victoria
Grampians	West Vic Division of General Practice	Victoria
Hume	Albury-Wodonga Regional GP Network	Victoria
Central Queensland	CQ Medicare Local	Queensland
Far North Queensland	Far North Queensland Rural Division of General Practice	Queensland
Sunshine Coast	Sunshine Coast Division of General Practice	Queensland
Wide Bay	GP Links Wide Bay	Queensland
Country South SA	Murray Mallee General Practice Network	South Australia
Bentley-Armadale	Canning Division of General Practice	Western Australia
Perth Central and East Metro	Perth Primary Care Network	Western Australia
Northern Territory	General Practice Network NT, Aboriginal Medical Services Alliance NT and NT Government Department of Health	Northern Territory

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 - 27

With the close of the submission phase for the funding of the Medicare Locals perhaps it is timely for us to "go back to the future" and ask the bleeding obvious. Given that we have not had any discussion with, or debate from, the Macarthur-Southern Highlands Divisions of General Practice, is it pointless to expect that a Medicare Local, managed by the corporatised Macarthur-Southern Highlands Divisions of General Practice, will ever improve the health services the residents of both jurisdictions, seek. Sadly, Socrates, says "Yes, it is pointless".

What could have been a great step forward for health providers in the private and public sector, and the health consumers, to provide and access a cohesive, diverse and well funded point of contact and coordination, a future Medicare Local is unlikely to enhance any of the existing, or future, health and welfare services in the Southern Highlands. Just in the same way that the current Division of General Practice is failing to deliver the support and services expected, and required, by the general practitioners in the Southern Highlands.

What will we learn from the Medicare Locals tender documents?
Melissa Sweet

The tender documents for the first of the new primary health care organisations known as Medicare Locals are expected to be released any day now. Presumably, this is the place to keep an eye for them.

Dr Harry Hemley, president of the Australian Medical Association Victoria, has some questions about how they will work, as per his piece below.

Croakey has plenty of other questions too – including what will be their impact on the inverse care law, and population health more broadly? And will they entrench or address some of the problems associated with fee-for-service health care?

Are there better alternatives to Medicare Locals?

Dr Harry Hemley writes:

Prime Minister Gillard’s revised health proposal is an improvement on Kevin Rudd’s complicated hospital financing plan, with promises to deliver increased funds, more beds, transparency, greater clinical input and less red tape.

But the PM’s proposed expansion of Rudd’s Medicare Locals could prove a costly exercise without improving access to GPs and allied health providers in the community. So far Medicare Locals are mysterious bodies that promise to increase bureaucracy and reduce patient choice – not a wise investment if we’re striving to keep patients out of hospitals.

And given the current boundaries span hundreds of kilometres, they may not even be local.

Since the Commonwealth Government first announced Medicare Locals in April last year, health workers, consumers and even state government representatives have puzzled over their role and how they will work. And if these health care providers and bureaucrats are puzzled just imagine the need to provide clarity to the people who will be dependent upon the Medical Locals - the health consumers.

The health sector is awaiting the release of the tender documents from the Commonwealth that should make it clear what these new Medicare Locals will actually do. So far we have just been told that Medicare Locals will make things better, but not how.

We know they will provide (or maybe coordinate) after-hours care to communities and coordinate access to specialists and allied health professionals but we don’t know who will run them, whether they will offer health services, and whether they will be an improvement on current services. Socrates notes that none of these questions have been discussed with, let alone, described to, the local communities and service providers of the Southern Highlands and the Macarthur area by the respective Boards of the Divisions of General Practice.

With an initial price tag of almost half a billion dollars, this was an enormous cost for such vague objectives. We have been asked to take on Medicare Locals as an act of faith.

To justify such a cost, the Commonwealth needs to show how patient care will be improved with Medicare Locals. I’m yet to be convinced.

One of the biggest frustrations in primary care is patients’ difficulty getting an appointment to see a GP. There are no quick fixes to increase the supply of GPs – it takes around ten years for a GP to finish their training – and Medicare Locals are certainly not going to produce more GPs. In actual fact, given the primary care gatekeeper role that Medicare Locals will provide, it is conceivably possible that only those general practitioners and the Division of General Practice's "preferred" clinical practitioners will be receiving the referrals of patients from the Medicare Local.

My fear is that Medicare Locals could actually reduce patients’ ability to choose their health care provider. If a new central bureaucracy is in charge of rationing care and linking patients with providers, what is to stop them attempting to contain costs by referring the patient to the least expensive provider? Or only those practitioners who are in favor with the Division's "Medicare Local"

GPs currently coordinate the care of patients with chronic diseases such as diabetes, cancer and heart disease and the conditions that lead to these diseases like obesity. For a diabetic patient, for instance, their GP would oversee their care and coordinate the services of a diabetes nurse, a dietician, a podiatrist, and an endocrinologist. So what will change with a Medicare Local run by the Macarthur-Southern Highlands Divisions of General Practice?

There are flaws to this system but these would be fixed with minor adjustments, such as an increase in patient rebates to see their doctor, nurse or allied health practitioner, and better rebates for longer consultations. It’s not a system that requires a complete overhaul, especially when the alternative is care coordination on a bureaucratic scale. So, do we really need a Medicare Local - or would us having access (as we now do) to our preferred General Practitioner simply suffice? After all, not even the current Divisions of General Practice have the veracity and collegiate governance to inspire all general practitioners to want to join them! Will a Medicare Local be any better for the residents of the Southern Highlands? Do we even need a local Division of General Practice?

With extra funding for general practice clinics to take on additional nurses or expand their premises to accommodate extra psychologists, dieticians, other allied health providers (and even specialist doctors), patients with chronic diseases would see vast improvements.

Another cheaper and more effective way to improve the care coordination of a patient with complex medical needs is to fund care coordinators within primary care settings. This would ensure patients connected with all of the services they needed – meals on wheels, home help, their pharmacist and home nursing care – and allow their clinic-based doctors, nurses and allied health practitioners to spend more time seeing patients rather than organising services.

The PM has promised that access to after-hours medical care would improve with Medicare Locals. The plan is to establish an after-hours national call centre which can refer to a nearby after-hours clinic. This makes for a great announcement but it fails to address the problem: GPs are reluctant to open after hours because patient rebates barely cover the cost of opening, paying reception staff, hiring security guards and attracting practice nurses.

Again, some improvements to the current system would achieve better access for patients. With fair funding for general practice clinics to remain open after hours, patients would be able to visit the clinic of their choice at a time convenient to them.

Prime Minister Gillard has given herself and the states until the middle of the year (2011) to work out the details of the health deal. No level of tweaking can fix the problems with Medicare Locals. The whole concept – spending half a billion dollars to employ bureaucrats to coordinate the care of patients they’ve never seen – is flawed. The Prime Minister should consider simpler and more streamlined alternatives. It could even save millions of dollars. Given the current discussion about the severity of the proposed Budget cuts for existing programs to enable the Federal government to bring the Budget back into surplus, perhaps this is one program where the "less rather than more" principle can apply to the proposed Medicare Locals, especially here in the Southern Highlands and the Macarthur areas. Socrates would be happy to have no such Medicare Local, or even a Division of General Practice if it meant that other more worthwhile programs could continue to be funded.

• Dr Harry Hemley is president of the Australian Medical Association Victoria

SWSLHN + SLHN = SSWAHS - 1

On the 12 October last year, Socrates wrote in response to an article by Ben McClellan appearing in the SHN of 11 October 2010. The article was to let us know that a businessman who wished to establish a retail complex in Moss Vale, which would have included a super clinic with allied health as well as medical services, had indicated that it was not going to proceed.

The following is an extract from that blog posting of mine. In it I suggested that there had been some evidence of skullduggery by the CEO of the Southern Highlands Division of General Practice in the loss of the project to Moss Vale and to the people of the Southern Highlands. Given its location there would have been a few GPs in Moss Vale who would have been challenged by the development, including the Chair of the Division of General Practice.

Recently, I've been advised that another person in the Southern Highlands who has his own blog, which he uses to badmouth others, has taken umbrage at Socrates's revelations about the entreprenurial carryings on by the CEOs and Boards of both the Southern Highlands and the Macarthur Divisions of General Practice in respect of their application to create a mega- Medicare Local without any consultation with the community or other health service providers in the public and private sectors.

Well, for the record, there is some evidence of what was stated in October 2010. This is an extract from the article by Ben McClellan, with my commentary at the end.

"Is the hand that stirred the pot for Mr Ibrahim the hand of the SSWAHS Executive or the hand of the Southern Highlands Division of General Practice?

"........The super clinic plan included 13 different services ranging from a 24-hour medical centre to physiotherapy and cosmetic surgery.

"Mr Ibrahim lashed out at Wingecarribee Council’s planning department over a failed retail shopping centre at the Mazda car yard in Mittagong.

"He said the council had “mucked him around” and the project was no longer commercially viable.

"He said developers could be 100 per cent compliant with the council’s stipulations and still have projects turned down.

"Mr Ibrahim also denied Theo Onisforou’s Intersection project in Station Street, Bowral, which could have a medical centre, would clash with the Gillian Centre.

"He said the clinics would “complement each other” and the specialists at his centre would benefit from Mr Onisforou’s GP clinic.

“Bring it on,” he said."

"Socrates says: Again, sometimes the things that go on behind the scenes are as cut throat in the Wingecarribee as they are in the big end of town when competitors make life difficult for those who oppose their respective developments. Was the Southern Highlands Division of General Practice a bit more than a little miffed by the success of Mr Ibrahim and the St Henri Group in securing their site in Moss Vale while the Division did not?"

What evidence did I have, you might ask, for me to imply such a thing, viz., that Dr Warwick Ruscoe was opposed to Mr Ibrahim and the St Henri Group establishing a Super Clinic for the benefit of the residents of the Southern Highlands in general, and for the residents of Moss Vale in particular?

Well, let's go to the Wingecarribee Council Minutes for Wednesday 10 December 2008 and on page 9 we find "v-EP3 Demolition of Existing Dwelling & Erect Strata Commercial Medical Suites and Chemist, Lot A DP377731, 166 Argyle Street, Moss Vale". This is the Moss Vale retail development proposed by the St Henri Group for its Super Clinic. It was supported in Council by Mr Ibrahim speaking in support of it, as one might expect. The Minutes also indicate that there were some objectors and the person nominated to speak on behalf of the objectors was named.

"Reporting on LUA 08/1047 which has been received to demolish an existing dwelling and
erect a 2 storey building containing strata commercial medical suites and chemist with
basement parking for 188 cars at Lot A DP 377731, 166 Argyle St Moss Vale. The applicant
and a representative of the objectors have been invited to address Council.

Mr Sam Ibrahim, the Applicant, addressed Council on this matter.
Mr Warwick Rusco addressed Council on behalf of the objectors."

Yes, it does say Mr (not Dr) and there is a missing letter at the end or the surname, but it does look suspiciously like Dr Warwick Ruscoe was the spokesman on behalf of the "objectors". Just to make sure a white pages search in the Southern Highlands telephone directory shows only one person with a listing anything like the Warwick Rusco in the Council Minutes of December 2008.

One can be entitled to say: "Why is it that the CEO of the Southern Highlands Division of General Practice could be objecting to the development of a super clinic in Moss Vale? A 24-hour facility which would clearly be of benefit to health consumers in the Southern Highlands, and particularly, those in the southern towns and villages, and also reduce the patient flow to the Emergency Department of Bowral Hospital." The super clinic would also be a bulk billing practice and be a "one-stop-shop" medical centre, including a pharmacy.

Perhaps, ever the cynic, Socrates can identify the following reasons:

1. Dr Warwick Ruscoe has always been an opponant to bulk-billing medical practices, stating that: such practices encourages patients to seek opportunities to easily gain sick certificates to avoid going to work;
2. Dr Warwick Ruscoe had his own Divisional aspirations of opening a super clinic in Moss Vale, to be built over the council car park adjacent to the GP practice of the (then) Chair of the Board of the Southern Highlands Division of General Practice - Dr Vince Roche. The Division's application for that DA was subsequently lodged with Council - and rejected because of its use of the Council car park.
   
3. Dr Roche's family had/has an interest in the Moss Vale Pharmacy - opposite the Roche GP practice - which would be in competition of the pharmacy involved in the proposed retail development of Mr Sam Ibrahim.

For the record, Council approved the St Henri DA proposal unanimously.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 15

Building the future of healthcare

28th Mar 2011

The good, the bad and the ugly of Medicare Locals. Pamela Wilson reports.
Pamela Wilson all articles by this author

2 comments

LAST month, the medical profession finally got its first real glimpse of the Commonwealth’s vision for its new health reform tool, Medicare Locals.

The Commonwealth’s 21-page document, Guidelines for the Establishment and Initial Operation of Medicare Locals, gave a broad outline of what these primary healthcare organisations will be expected to do, how they will do it and who will govern them. It also formally invited interested parties to step up to the challenge.

So far, many health commentators agree the aspirations in the guidelines – although they are mere statements at this stage rather than policy – are promising.

Robert Wells, director of the Menzies Centre for Health Policy at the Australian National University, feels there is potential for Medicare Locals to better tailor services to communities. Given they will be tasked with identifying gaps in local services, there is a real opportunity for the new bodies to focus on disadvantaged populations, such as Indigenous or refugee patients.

“The guidelines seems to give Medicare Locals a much better role in working with the Local Hospital Networks in their area and state/territory government community health… and there is a greater capacity [to develop] a more localised approach to healthcare,” says Mr Wells.

Although pointing out the new bodies are not an end point in themselves, AGPN chair Dr Emil Djakic agrees Medicare Locals are the tool through which the Commonwealth’s national primary healthcare strategy can be delivered.

“Medicare Locals are going to be the organisational infrastructure that builds on what has already been happening in the division network to try and deal with some of these things which our existing system had not been addressing,” he says, referring to access, inequity, prevention, better management of chronic conditions and accountability.

But not everyone has been won over. The AMA recently took a strong stance against the formation of the new bodies, claiming none of the details released by the government about Medicare Locals explains exactly how they will benefit patients or communities.

AMA president Dr Andrew Pesce has in fact called for the roll-out of Medicare Locals – set to begin from 1 July – to be shelved until greater consultation with clinicians has taken place.

There are still too many unanswered questions, he argues, particularly on the issue of fund-holding and GP involvement.

The consensus among health commentators seems to be that while the initial framework looks promising, the true test of success will be in the program’s implementation.

They argue this will require the Commonwealth not only to ensure adequate and flexible funding for the new bodies, but also to ensure that Medicare Local executive bodies have an understanding of the integral role that general practice must play in their functioning, and in overall primary healthcare reform.

It is this last point – how involved general practice, and general practitioners, will be in Medicare Locals – that is weighing on everyone’s minds.

The Medicare Locals boards will be skills-based and not representative, meaning there are no mandated seats for GPs or other practitioners.

However it is widely hoped that clinicians with governance skills will put up their hands to be involved.

“Unless GPs are significantly represented on those boards, I think the concept will not work well,” says Dr Pesce.

RACGP president Dr Claire Jackson says the main query from the college’s GP members is the amount of support they can expect from Medicare Locals, given that they will succeed divisions of general practice.

“GP groups are obviously very keen to see Medicare Locals embrace a broader health professional network but not to lose sight of the fact… there needs to be a heavy emphasis on general practice as the central pivot for primary care service delivery in the community,” she says.

Eastern Ranges GP Association CEO Kristin Michaels, who hopes her Victorian division will be among the first successful 15 tenders, says that among her colleagues there is strong recognition that general practice must be highly engaged in this process.

“It’s about those skills you bring to the table, but ideally you want a couple of GPs with [governance] skills,” she says.

As confident as Ms Michaels is in the success of her division’s bid, she is not as optimistic about the Commonwealth’s claim in the guidelines that “over time, Medicare Locals will be given the capacity to use Commonwealth program funding flexibly”.

“We’ve not really seen the Commonwealth able to achieve that [flexibility in control of funding] completely in the past. It’s difficult for governments to let go of things,” she says.

Dr Djakic believes it won’t be clear how much control Medicare Locals will truly have until the Healthy Communities Report for each area is produced by the National Performance Authority.

“How much funding and flexibility will depend on what questions or accountability a Medicare Local has to have against the Healthy Communities Report,” he says.

There are also questions about the funding mechanisms of the new bodies, after Prime Minister Julia Gillard stated they would become fund-holding organisations in the future.

United General Practice Australia released a statement last month urging the Commonwealth not to introduce fund-holding arrangements for MBS and PBS.

Dr Pesce also told MO he was concerned that a lack of consultation with the profession on this issue by the Commonwealth meant fund-holding was being considered.

“There have been references to Medicare Locals as fund-holding. We were previously given reassurances that funding for medical services would be for primary care and not through primary healthcare organisations,” he says.

“We’ve tried to get clarification on that [from the government], we haven’t been able to.”

Another funding concern relates to the distribution of money for the after-hours reform with which Medicare Locals are being tasked.

Dr Djakic is urging the Commonwealth not to strip funding from those after-hours services that are working well and instead have a critical look at what it genuinely takes to sustain them.

Dr Pesce agreed that the Commonwealth shouldn’t try to fix programs that aren’t broken.

“We all recognise that after-hours care can be done better… [but] we have to be careful that where something is working, the change doesn’t harm that.”

Already, in every way, it seems Medicare Locals will not lock into a one-size-fits-all model.

Ms Michaels points out that among her colleagues in other divisions there is already a strong difference in opinion on things such as the organisational structure Medicare Locals should take, and whether divisions themselves will transition into Medicare Locals or contract as service providers.

No matter what model each division decides upon, one thing is clear: this is the end of divisions of general practice as they have been known for the past 19 years.

On 30 June 2012, funding to divisions – including the AGPN – will be transferred to Medicare Locals.

But it is expected that the new model won’t simply be the divisions program by another name.

“Medicare Locals have the capacity to do something bigger and better than divisions have been able to do… with a little bit more funding and more formalised relationship expectations,” says Ms Michaels.

The reality is that the true shape of Medicare Locals won’t be known until July this year when the first 15 are up and running.

Medicare Locals

What are they?

- There are 42 agreed boundaries (with the exception of Victoria and Western Australia). However, the final number may exceed the planned 57.

- $477 million over four years will be used to establish the Medicare Local network.

- Annual core funding for each will be about $171 million.

- They will be expected to have some common membership of governance structures with Local Health Networks (LHNs).

- Boards will comprise seven to nine members.

- Although not mandatory, an organisational membership – with community groups and local health services – is preferred over an individual membership model.

They will be required to:

- form strong working relationships with LHNs and Lead Clinician Groups to deliver coordinated healthcare;

- undertake certain responsibilities such as fast-tracking after-hours reform, driving telehealth services and supporting the development of e-health and GP super clinics;

- undertake analyses of gaps in health services in their area and provide evidence-based strategies to improve patient outcomes;

- participate in the performance and accountability framework, including the Healthy Communities Reports prepared by the National Performance Authority.

Comments:

Dr Manda
29th Mar 2011
8:28am

Does the $477m include what was spent on Divisons etc or is it on top of? How many more bureaucrats or other health professionals are going to be paid from this money to ensure MLs run as per primary care "changes" (not reforms till proven please!? Dollars given usually contain political spin.
Dr Manda, Sydney

Dr Manda
29th Mar 2011
9:08am

The ALP rants eternally about "equality of access". It uses this as a pretext for nationalising medical care. This benefits middle class lefties only, not the poor. But even the cockatoo who sits on my back porch every morning can see that Medicare Locals are Stage 2 of the socialisation of medicine. The public hospitals have been impoverished by Medicare. General practice is next. What brand of socalism we end up with depends only on who owns the facilities and employs the doctors. if it is the state, we become International socialists( i e Communists), or if the Medicare Local facilities are left in corporate hands, we are "only" National Socialists (that is, Nazis).
Some choice.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 14

Just to emphasise the problems we Southern Highlands health consumers may face in the near future if the Macarthur-Southern Highlands marriage takes place with two entrepreneurs jockying for the presidency!

Bitter split emerges in race towards Medicare Locals

17th Mar 2011

Byron Kaye all articles by this author

3 comments

GP networks vying to become Medicare Locals (MLs) have been urged to cooperate after a joint bid by three divisions to become Australia’s biggest primary care hub collapsed into a bitter split.

With the 4 April deadline for the first round of ML tenders looming, the Sydney-based General Practice Network Northside (GPNN) unexpectedly broke from neighbouring Northern Sydney General Practice Network (NSGPN) and Manly Warringah Division of General Practice (MWDGP) to prepare a solo bid.

In his division’s newsletter, due to be sent to members this week, NSGPN chair Dr Harry Nespolon suggested he had been “double crossed” and questioned whether GPs could “trust or support such an organisation”.

“It’s pretty hard to see how a GP in Palm Beach is going to feel warm and cuddly about [being serviced by a Medicare Local] which is basically the Hornsby division,” he told MO.

The remaining two networks would continue to work on their own joint bid, he added.

GPNN chair Dr Jennie Kendrick said governance, membership and function were the key issues that led to the decision to pursue the solo bid, but she hoped all parties would be able to work together regardless of the outcome.

“It’s a practical decision,” Dr Kendrick told MO.

“We don’t have any problems working with them.”

AGPN CEO David Butt urged cooperation among divisions bidding for MLs.

Tags: medicare locals, divisions, tender

Comments:

ed
17th Mar 2011
5:36pm
These networks only provide a cushy paid job to GPs who have no skills in looking after patients. Some of the GPs involved would not be able to treat a diabetic seizure or a serious complaint. They can all write care plans but not see anything wrong in a child that has difficulty reading and hearing. As one who told me at a clinical meeting, "I like my red wine and earn money via Medicare so that my children can go to a private school". He was...(sorry, I am a coward)

ondocfarm
17th Mar 2011
6:25pm
Oh..so power and glory cannot be shared.....? Well each should go it alone! Our area has seen three different divisions merge into one that has a ?? degree of usefulness, but keeps the combined egos of those involved ensconced and well paid (many are NOT GPs) even if the bulk of the GPs covered find it hard to define what benefit occurs.

MLs just a bigger mess and also of undefined usefulness?

Solidarity
17th Mar 2011
11:27pm
The whole concept is flawed; leave traditional GP structures alone and stop twiddling knobs to prop up a Federal government in meltdown. ML already smells like BER and insulation and every other scheme that has gone wrong. Toxicity rising from it already.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 13

Socrates is pleased to announce that, for the very first time, the CEO of the Southern Highlands Division of General Practice - Dr Warwick Ruscoe, has uttered some words about his plans (or lack of them) for a "local" Medicare Local.

More divisions split over Medicare Locals

29th Mar 2011

Byron Kaye all articles by this author

BIDDING for Medicare Locals (MLs) has led to another bitter rift between GP divisions, with accusations that some are spreading false information now tainting the contest to become the hub for Sydney’s south-west.

With the deadline for the initial round of ML submissions next week, an AGPN-appointed mediator has been called in to instigate talks between Bankstown-based South West Sydney Health Coalition (SWSHC) and rival joint bidders the Macarthur Division of General Practice and the Southern Highlands Division of General Practice.

The talks came after Bankstown GP Division CEO Andrey Zheluk, whose division is spearheading the SWSHC bid, accused his rivals of claiming to be the “official bid” for the area’s ML.

He said in a statement that his rivals “do not enjoy any exclusive right” and the claims “adversely reflect… on the future formation of a Medicare Local”.

Mr Zheluk told MO mediation was progressing “slowly” but could result in a joint bid.

Southern Highlands Division CEO Dr Warwick Ruscoe denied claiming exclusive rights.

“We don’t consider ourselves the official bid,” he said. “If someone else wants to make a bid, that’s fine.”

The latest rift follows a recent stoush between divisions in the city’s northern suburbs, after a joint bid between three divisions broke down.

It also came as the AMA presented its own vision for MLs. Last week the association called for the rollout of the new bodies to be put on hold pending further consultation with the profession.

It its position statement, the AMA reaffirmed its staunch opposition to any fundholding arrangements for GP and specialist services or the PBS.

It also stated that local doctors must hold leadership roles on the new bodies.

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

Dr Warwick Ruscoe - SSWAHS = SWSLHN + SLHN

It seems that not only was Dr Ruscoe involved as a Managing Director of HCC and subsequently a consultant to the HCC (and as a major shareholder - to James Hardie Industries) about the development of the Taj Mahal-type private hospitals on the North Shore, but it does seem that he spent some time administering the Greenoaks Private Hospital (Greenacre, NSW) as the following legal matter seems to suggest.

"MEDICAL TRIBUNAL OF NEW SOUTH WALES
DEPUTY CHAIRMAN: HIS HONOUR JUDGE WALL, Q.C.
MEMBERS: DR. B. AMOS DR. B. POLLARD and MS. L. ADAMSON
FRIDAY 20TH MAY, 1988
RE: COMPLAINT AGAINST DR. PETER JAMES DAWSON DECISION

"A complaint was lodged by the Secretary of the Health Department of NSW on 13th October, 1987, alleging that Dr. Dawson has been guilty of professional misconduct in respect of the treatment of Mrs. Carole Lesley Tatham at Greenoaks Private Hospital, Greenacre on 18th August, 1985, the particulars of which were:

"The Tribunal received submissions in the form Dr. Dawson, A/Prof. Torda, Dr. O.F. James, Dr R.L. Millard, Dr. Dr. M.S. Jun and Dr. W.J. Ruscoe which had all been prepared for submission to the Investigation Committee which had considered the matter on 10^th August, 1987.

"The transcript of these proceedings before the Investigating Committee was also admitted before the Tribunal. The relevant hospital records, including operation and anaesthetic records and post-mortem examinations reports were also admitted into evidence before the Tribunal."

The nature of this hearing was that Dr Dawson employed as an anaesthetist in Dr Ruscoe's hospital failed to identify a respiratory problem during the surgery of the patient who subsequently died. The reports flowing from the investigation do suggest that there was a great deal of confusion and misinformation which seemed to be present in the discussions between Dr Dawson and the surgeon.

Some of the discussion related to whether or not a crucial piece of equipment used by the anaesthetist during the procedure was actually operating as it should. It does seem that Dr Dawson may have been correct about the failure of the equipment which would have alerted the surgeon and Dr Dawson that things had gone awry. In fact His Honour did make the point that there may very well have been an equipment failure. Nevertheless His Honour did find that Dr Dawson did fail in his duty and subsequently ordered that he be deregistered.

This does lead to a peripheral question. Should Dr Dawson have been appointed to the position of anaesthetist at The Greenoaks Private Hospital? Certainly, during the Tribunal Hearing even Dr Dawson admitted that his use-by-date had pretty much expired. So should the buck stop on the Chief Executive's desk given that Dr Ruscoe most likely had the say as to who was appointed.

Secondly, given that even His Honour noted that the critical piece of equipment had failed to alert Dr Dawson and the surgeon to the fact that the patient was in respiratory arrest during the surgery. So who should be responsible for the maintenance of the surgical equipment. Does the buck also stop with the Chief Executive of the Hospital? In my view, and hopefully in the view of others, Dr Ruscoe should have been held more accountable for the patient's death than appears to have been the case.

What do you, the reader of this blog, think? Is this the man we really want to organise the health care needs of the community in the Southern Highlands?

"Wenkart's built an elephant and made the residents look at its arse." - Peter Barley

This posting, which is primarily a re-posting of an article, accessible in the public domain, was first printed in the Sydney Morning Herald on 16 October 1992. As such, the article is retained for the valuable lesson it gives about how medical entreprenuers can over-reach themselves when trying to explore the "bigger is better" model of health care.

As we are now entering a new phase where the Federal Government is encouraging Divisions of General Practice and a new breed of medical entrepreneurs to develop Medicare Locals and Super Clinics it is perhaps timely to remind those tempted by the new money to consider the perils of those past experiences.

A personal commentary made here by Socrates about the local situation in the Southern Highlands was deemed "offensive and defamatory" by one person named in this 1992 SMH article. Given that the informant insists on sending their letters to a third party it has taken some time for this message to get through to Socrates. However, now I know!

As a consequence, any personal comment previously made by me, on the content of this article and including the persons named in it, has been deleted.

On 16 October 1992, Valerie Lawson (Sydney Morning Herald) wrote:

"WHO CAN ever forget the medical superstar of 1985 - Dr Geoffrey Edelsten? He was the very model of a modern medico-entrepreneur with his blow-wave, his Porsche with the SEXY number plates, his pink helicopter and his trophy wife, Leanne.

The liquid flowing through the Edelsten medical empire was not blood, but money. It was fuelled by the profits from pathology and property, but while the empire grew the Taxation Office watched. Edelsten's practice of tax minimisation helped service his debt for a while, but finally the tax man pounced and Edelsten was bankrupt.

If Edelsten had not gone belly-up in 1988, he might well have swung into the next big phase of entrepreneurial medicine, the development of the high-tech private hospital and medical centre alongside Sydney's over-burdened and financially troubled public hospitals.

As it was, his former partner, Dr Tom Wenkart, and two other medical entrepreneurs, Dr Warwick Ruscoe and Dr Carl Bryant, seized the moment in 1988. Just as Professor John Dwyer of Prince of Wales Hospital has recently revived his plan to create a hospital-resort at Prince Henry Hospital, Doctors Wenkart, Ruscoe and Bryant contemplated planeloads of overseas tourists on a health pilgrimage to their luxury hospital resorts. The vision was state-of-the-art Taj Mahals offering high-tech medicine, all funded by private health insurance."

"What went wrong for the locals (Wenkart, Ruscoe and Bryant)? For one thing, timing. The Sydney hospital palaces - like so many of the city's new hotels - were conceived in the bicentennial year of optimism. That year, an overheated private hospital market saw bed licences trading at "astronomical sums", according to Dr Campbell. Then came the property slump, the recession, the rise in interest rates and a fall in private health insurance.

One investment banker sniffs: "These private hospitals were designed as Taj Mahals. The men behind them are salesmen with a vision. These things are designed as monuments to them. They are over-engineered and over-capitalised. You can buy private hospital beds now for under $100,000, but these new ones were costing $200,000 to $300,000 a bed to build."

The company which wants to build Northern Private alongside Royal North Shore was also given a financial infusion last year when James Hardie lent HCC$34 million. James Hardie is the biggest shareholder in HCC with 50 per cent; other major shareholders are Medibank Private and Leighton Holdings. HCC won the Northern Area tender for the hospital with a payment of $5 million.

Since then, the original plan for a 210-bed hospital has been scaled back to a 150-bed hospital costing $60 million. "Shareholders are looking at financing it themselves," said Dr Warwick Ruscoe, a consultant to HCC and its former managing director. However, James Hardie's group planning manager, Mr David Luke, said the company was also "talking to potential investors outside the company. It's difficult at the moment. A lot of investors seem uncertain".

The market is suspicious about James Hardie's commitment to HCC, believing it may offload its stake completely, as foreshadowed by company executives last year.

HCC also has the right to develop a private hospital on land it has owned for four years adjacent to Westmead Hospital, but this project has been put on hold indefinitely, Dr Ruscoe says.

In April this year, the council received an application from Macquarie for a 300-bed private hospital with a 150-room hotel attached, a medical centre and 80 medical suites, plus associated retail stores including a fast-food style of restaurant and parking for 1,266 cars. (The number of beds in the private hospital has since blossomed to 500.)

On July 2, the council called a public meeting at which residents objected to the look of the building, its height and overshadowing effect and the traffic impact of the complex, in operation 24 hours a day.

Members of the Camperdown Residents Action Group who attended included Jenny Thompson and her law student husband, Peter Barley, who live directly opposite the planned service entrance of the private hospital in Church Street. Peter Barley remarked: "Wenkart's built an elephant and made the residents look at its arse."

Another objector at the meeting was Dr Harry Haber, a local GP and past president of the Central Sydney General Practitioners Association. Said Dr Haber: "The GPs think Macquarie should stick to its pathology. They want to open a large general practice business in the new hospital. If they do that, why should we not boycott Macquarie Pathology Services? They would also hope to capture all the private pathology work at the private hospital."

Dr Wenkart replied: "The local GPs feel endangered, but the days of the solo GP are numbered anyway."

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 - 4

What is expected of the Medicare Locals? In summary the following principles are the key points required of any organisation that holds itself up as an appropriate organisation to receive the Federal funding to manage a Medicare Local.

"The overarching objective of MLs is to ‘coordinate primary health care delivery to address local needs and service gaps’. The guidelines set out the functions of MLs, including the expectations of the Government, according to the following ‘strategic objectives’:

• Improve the patient journey through developing integrated and coordinated services
• Provide support to clinicians and service providers to improve patient care
• Identification of the health needs of local areas and development of locally focused and responsive services
• Facilitation on the implementation and successful performance of primary health care initiatives and programs
• Be efficient and accountable with strong governance and effective management"

Has the Southern Highlands Division of General Practice ever been able to offer "integrated and coordinated services"? What support has it ever offered clinicians and service providers to improve patient care? How has the Division's CEO and Board gone about identifying local health needs and the development of locally focused and responsive health services? Has the CEO or the Board ever participated in any public community forum or meeting to gain any impression of the local needs? Apart from the government funded programs and initiatives what primary health care has the Division ever promoted outside the organisational structure of the Division? Where is the proof that the Southern Highlands Division of General Practice has been efficient and accountable of the Federal and State funding with which it has been provided in past years? If it is an honorable and honest Board and CEO perhaps they can explain why the government funded mental health programs have been limited because the money provided has been diverted towards the Division employing its own staff. Does this suggest good governance and financial management? The only answer for any of these questions and for any response attributable to the "strategic directions" enumerated by the Federal government for Medicare Locals is a universal "No!"

and

"MLs are expected to ‘provide more integrated care’ and ‘ensure more responsive local GP and primary health care services’. These examples point to the importance of the interface between MLs and the Commonwealth and MLs and the States if they are to achieve their objectives. Integration at the local level is also likely to be critical. The goodwill of external organisations and individuals, over which the ML has little or no control, and the availability of incentives to encourage organisations to participate in the MLs will be important.

Although the first group of MLs are likely to be drawn from ‘high functioning’ Divisions of General Practice, many of which have had experience in negotiating some of these issues, as MLs their role is much broader.

To fulfil the Government’s long term objective for MLs to provide a ‘coordinated package of care’ and act as fund holders for primary care, an agreed definition of what constitutes primary health care and sufficient empowerment of MLs would seem to be necessary pre-requisites."

One has to ask whether the historical record of the Southern Highlands Division of General Practice meets even the basic requirements for these "strategic directions" and "expectations" enumerated in these foregoing quotes from Canberra.

Has the Southern Highlands Division of General Practice been a "high functioning" Division? Has it been able to work with other health and welfare based organisations in the Southern Highlands? Has it ever been able to "provide a coordinated package of care" to meet the whole of life health needs of the local community? Has the Southern Highlands Division of General Practice ever held consultations with any NGO or representative community group about the health need requirements of the local community? How integrated have they been with their local community and the other health service providers? The truth is that the the CEO and the Board of the Southern Highlands Division of General Practice would have a resounding "No" or "None" marked against each of these questions on the Division's report card.

Yet, by default and for no other reason, the Federal and State governments could be sending about $2 million dollars per year of taxpayers money to the Southern Highlands Division of General Practice to spend in providing boutique services and programs through the Division's organisational structure in an attempt to enhance its own status, while local GP practices attempt to maintain the health and well-being of the Southern Highlands community.

God help us all if the Southern Highlands Division of General Practice remains controlled by that failure of a medical administrator. This area will either get no funding, or will not be able to retain any funding provided by the Federal and/or State governments.

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.