SSWAHS = SWSLHN + SLHN and the Medicare Locals - 17

Are we getting the right primary care policies?

7th Mar 2011

Dr Steve Hambleton all articles by this author

2 comments

JUST about everybody wants to see practical achievable reform in primary healthcare. Things can and should be done better. With the right policies and proper support for GPs, it is achievable.

But are we getting the right policies? Judging by the reaction from health professionals – not only GPs – the Government does not seem to be getting much bang for its primary care reform buck.

In the same way that GP super clinics have failed to spark the imagination of health professionals or patients, it looks like Medicare Locals are getting similarly poor reviews. And I think the criticism for the most part is justified – and not just for the lack of detail or clarity of the proposals.

The Government seems convinced that Medicare Locals will somehow take the pressure off emergency departments (EDs). Wrong. This simply will not happen. The ED problems are there because of bed block, not Category 4 or Category 5 patients. Besides, many of these patients should not be seen by a GP in any case. They are appropriately seen in the ED and often need admission.

The ability of Medicare Locals to help ‘join up’ the health system has been severely compromised by the change in the balance of healthcare funding back to almost the status quo.

There should be a single funder. The previous reform arrangements were not perfect either, but at least the Commonwealth was taking more responsibility.

The fact is that there is no momentum any longer for any parts of our health system to come together because the funding keeps going to separate silos. There is the hospital money silo. There is the community services silo. There is the GP and related primary care silo. The aged care silo. The Indigenous care silo. And so on.

We do not have a health system. We have health systems – totally disconnected. We will know that we have real health reform when they have all been re-connected.

At its most recent meeting, the AMA Council of General Practice agreed that there are gaps in Australia’s population health coverage that need to be identified and targeted, but I don’t see that the proposed structure under the COAG Agreement will make it any easier. It is frustrating.

The collection of data by Medicare Locals is also problematic. The ‘monitor and provide feedback’ approach to the performance of primary healthcare providers is also problematic. It does not reflect the reality of private general practice.

Blindly putting your faith into GP Super Clinics being the saviours of primary care cannot be supported either, especially as they are so badly located and so lacking in planning and consultation.

They have the capacity to backfire badly on the Government.

Providing infrastructure grants and supporting the GPs who are already committed to their communities would be a much smarter investment – economically and politically.

Governments seem wedded to Medicare Locals and they are already in the process of being established, but these are not the primary healthcare organisations that were envisaged by the National Health and Hospitals Reform Commission.

Given this political reality, it is up to us – the AMA and the medical profession – to do all we can to shape and influence this policy so it actually delivers tangible benefits to patients and communities and supports hardworking GPs.

The AMA is pushing heavily for medical practitioner involvement in the governance of Medicare Locals to avoid repeating the bureaucratisation of primary care that we saw in public hospital care.

The priority for general practice is to build on the chronic disease management gains that have been made and to promote teaching in general practice to support the next generation of doctors.

The current system is not completely broken. We are getting some of the best health outcomes in the world, but we do need further support and it has to be the right support.

The Government is not helping its cause by using terms such as fund-holding and managed care or by continuing to allow the hint of role substitution to linger in the primary care reform debate.

The Government must heed the profession’s warnings, or Medicare Locals could soon be a distant memory.

Comments:

John Wellness
7th Mar 2011
4:29pm

I agree with many of Dr Hambleton's diagnoses. The original GP Superclinic Policy put out by Kevin Rudd and Nicola Roxon in June 2007 had so much promise. Admittedly reducing ED visits was always unlikely to happen and interestingly no-one seems to understand that good proactive primary health care could reduce the number of Category 1-3 patients (strokes, heart attacks and diabetes for starters) but the preventative angle looked promising. Sadly the bureaucrats failed to bring preventative care into the decision-making process and the superclinics presenting at two national conferences barely mention it. This is simply because existing "illness" funding will not allow multidisciplinary preventative care. The location of the Superclinics too has been inept. At a time when there are lots of areas needing services to help meet population growth needs putting them in established areas was simply woeful. Putting them on hospital grounds will work directly against keeping patients out of hospitals.

The Medicare Locals don't look like being very different. Giving the inside track to divisions of general practice is unlikely to generate new ideas and new ways of delivering care. When nearly 1/3 of the total burden of care is preventable by lifestyle improvement that there is so little attention given to looking at new ways of preventing chronic disease is scandalous. The primary health sector could make a huge difference if its funding system could lead to new forms of practice and program delivery. Just don't hold your breath waiting for proper reform.
John Wellness

Detracter
7th Mar 2011
5:56pm

We have a Health Care System built around Disease Management rather than Disease Prevention so you can get funding and administration set ups for diabetics but nothing for the obese person they were for the last twenty years.
Western medicine is falling apart financially as we keep diseased people alive and dependent upon us for ever increasing decades. Politicians have by nature a three year thinking cycle ,so every bureaucratic strategy they come up with in their Health Care tent, such as Superclinics in marginal seats, is aimed at getting themselves out of that boggy tent onto drier more publicly recognised land such as the environment or climate change.
We doctors are in an elite group of highly intelligent articulate people who are trained primarily to think differently to the rest of the population, and secondarily with technical and practical skills unreachable by the rest of the community.
We have a responsibility to actively change the health agenda away from the money for disease formula, to a health prevention formula. The health agenda is quickly moving away from and diluting our clinical skills, and a doctors hand on the abdomen in the middle of the night in former years is now being replaced by a nurse with a MRI scan request.
Our society is not training enough doctors of our standards as it is easier and cheaper to import them, so we as a group need to actively get into the health care debate and challenge and re-educate the politicians, media and general public. We need to stop being seen as a group always whinging about money and repaint ourselves as the caring intelligent professionals our patients see us as.
We need to take control of the Health Care debate away from the politicians and run it ourselves.
Detracter

SSWAHS and the Southern Highlands Division of General Practice - An unholy alliance?

SSWAHS has a way of ingratiating itself with subservient organisations by throwing a bit of money their way. This notion of buying friendship is not unknown in political circles. Ancient Athenian and Roman society was notorious for it, and little has changed in the intervening years.

What SSWAHS gets in return are organisations willing to do the work that SSWAHS should be doing for the health and wellbeing of the residents of its empire, and generally, the work is done for a pittance. The other thing SSWAHS obtains is the silence of the organisations it funds. Organisations that might normally be advocates, activists or, the gods forbid, agitators on behalf of the marginalised and vulnerable in the SSWAHS empire bite their lips and remember the cheque is in the mail.

A classic example in SSWAHS is the Southern Highlands Division of General Practice. This Division is supposedly the representative organisation of most of the general practitioners in the Southern Highlands. Their website trumpets more about their links with governments - both state and federal - but mostly about their unusual relationship with SSWAHS from whom they seek both money and glory. This is what they say about SSWAHS:

"External Relations

A sound relationship has been established with the Sydney South West Area Health Service (SSWAHS) which reaches from Camperdown to Wingello covering seven Division areas. These Divisions have a close working relationship with SSWAHS.

Southern Highlands Division has a long established and close working relationship with the Wingecarribee section of the Area Health Service.

This relationship includes:

• a fully integrated diabetes service which is based on the CARDIAB data base
• an integrated program for secondary prevention in ischaemic heart disease to also be based on the CARDIAB data base
• the supply of medical services to the local CAPAC (Community Acute Post Acute Care) and the Palliative Care Program operated by the Area Health Service
• the Division's After Hours Service being designed to reduce the GP patient load on the Bowral Hospital Emergency Department as well as meeting GP and community needs
• regular Liaison Committee Meetings with the Area Health Service representative
• the Division is located in the grounds of Bowral Hospital
• close working relations between GPs and the Community Health Service and the Mental Health Service.

Being a rural area, Division members provide VMO services to the local hospital at Bowral (BDH). This includes 7 GPs providing one admitting officer at all times; four GPs providing low risk obstetric care; one GP surgeon. A number of members act as Medical Officers in the hospital Emergency Department. Members also serve on Area Health Service Committees including standing committees such as Quality Assurance and Clinical Council and various ad hoc committees."

In reading this one would think that this is an organisation that has the interest of all its patients and residents at heart. With such an involvement with SSWAHS and with such a "long established and close working relationship" with SSWAHS, one could be excused for thinking that with all those Highlands general practitioners, and especially those acting as emergency department doctors, Visiting Medical Officers, members of Standing Committees, and working in the Maternity Ward, they would have been advocates for their patients at the "save our hospital and health services" rally a couple of months ago. Apart from an orthopaedic surgeon, already known for his advocacy, there was no obvious representation from local general practitioners and none from their Division, which is situated on the grounds of Bowral Hospital courtesy of SSWAHS. There has been no public outrage from the Southern Highlands Division of General Practice and nor should we expect to see any for they tread the safe path.

Perhaps their Executive Officer and their Board should take the time to review their Division's Mission Statement and decide on whether they truly assist their members to provide the "optimum care to health consumers in the Southern Highlands area." It may be time that the Division and its Board recognize that they also have a responsibility to the residents of the Highlands to advocate more strongly to SSWAHS for the rights of those health consumers to have the treatments they need here - in the Southern Highlands! Perhaps now is the time for the Division to bite the hand that feeds it.

"Mission Statement

The mission of the Southern Highlands Division of General Practice is to assist local general practitioners in providing optimum care to health consumers in the Southern Highlands area."

Is it really so, Executive Director and Board members of the Southern Highlands Division of General Practice?