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 Executive can't keep a good team down!

Bowral Hospital is up to speed - SHN - MORGAN DOWNS 13 Sep, 2010 10:34 AM

Bowral and District Hospital is performing well, according to the latest report of the Bureau of Health Information.

The Bureau’s first edition of Hospital Quarterly (April-June 2010) shows that Bowral and District Hospital’s waiting times for elective surgery are better than the state average, as are the times within which patient treatment should begin in the Emergency Department.

Bowral & District Hospital General Manager, Denis Thomas, said the results reflected the “hard work and dedication of staff”.

“We are pleased that 86 per cent of patients rated their experience in the Emergency Department as good, very good or excellent,” Mr Thomas said.

“From April to June this year the Emergency Department saw more than 4200 patients – 668 of whom were admitted to the Hospital.

“Staff saw all patients – across all categories - within the recommended NSW benchmark timeframes.”

Mr Thomas said Bowral and District Hospital achieved other improvements, including:

• 100 per cent of triage one patients (immediately life threatening) were seen immediately or within two minutes;

• 82 per cent of triage two patients (imminently life threatening) were seen within 10 minutes, two per cent higher than the benchmark;

• 78 per cent of triage three patients (potentially life threatening) were seen within 30 minutes, three per cent more than the benchmark;

• 85 per cent of triage four patients (potentially serious) were seen within one hour, 15 per cent more than the benchmark;

• 98 per cent of triage five (less urgent), were seen within two hours, 28 per cent more than the benchmark.

“I’d like to congratulate all staff, whose tireless efforts help our department continually improve and achieve positive results for our patients,” Mr Thomas said.

Socrates says: "This is the work of the local service and the staff of Bowral Health. My comment to the SSWAHS Executive is - Give Bowral Hospital and their General Manager and his staff the credit for these good results. They did achieve the better than benchmark results because they live locally, believe locally and are more concerned about the health needs of their community than anyone in Liverpool."

SSWAHS Executive bites the hand that tries to help it. Please explain!

Bowral Hospital renal unit going to waste - SHN - TRAVIS HOLLAND - 02 Apr, 2010 11:17 AM

GOULBURN MP Pru Goward and local renal patients have labelled Bowral Hospital’s Renal Unit a waste.

“The hard fought for renal dialysis service at Bowral Hospital is a patient-free area, sitting idly in the Short Stay Ward,” Ms Goward said.

“What a shocking waste of expensive equipment, not to mention the hard work that went into raising $500,000 to provide this service,” she said.

Highlands resident Michael Richardson, who is in need of renal dialysis three times a week, said he had been “barred” from using the facility.

Mr Richardson was self-dialysing at Bowral until recently, when he developed complications and needed medical supervision.

Since then, the problems had been resolved and Mr Richardson had hoped to return to the local hospital.

But he was upset he had to travel to Campbelltown because he was “not wanted” at Bowral.

Ms Goward said Mr Richardson was the only local patient who had ever been able to use the facilities, despite the unit operating for two years.

In Februrary, the News reported the case of Barbara Clarke, who was forced to travel to Concord Hospital for treatment.

Southern Highlands Renal Appeal chairman Bob Barrett said the community raised $650,000 in the past eight years to establish the renal unit at Bowral Hospital.

He said the Sydney South West Area Health Service (SSWAHS) had asked for only $105,000 of the funds.

“We are rather anxious for them to take the rest,” he said.

Mr Barrett wanted only to see - the funds put to use, paying for equipment that would be used.

“They are turning patients away and saying ‘do it at home’,” he said.

Ms Goward questioned why the Health Service could not provide a renal nurse to staff the unit.

“The Health Minister needs to explain why she will not sanction training for nurses to enable them to assist dialysis patients at Bowral Hospital”, she said.

“There is clearly a need yet, for some reason, the Minister would rather allow expensive equipment to go to waste while patients drive three times a week to Campbelltown for dialysis.”

Mr Richardson’s mother, Margaret, said renal patients such as her son needed medical support from a nurse even if they were able to self-dialyse.

“If an alarm goes off, she’s got to know what that alarm is and what to do,” Mrs Richardson said.

Mr Richardson said patients also needed support to recover blood sugars and liquids during and after the procedure.

Mrs Richardson said lives were being put at risk by the need to travel to Liverpool in emergencies.

“There is no emergency plan for renal patients in the Southern Highlands,” she said.

She questioned why a nurse could not travel from Campbelltown on set days in a trial for local patients.

“They say it is too far for a nurse to travel,” she said. “If it’s too far for a nurse, it’s too far for a patient.”

A SSWAHS spokesman said patients were better off travelling because of the care available at other hospitals.

“Bowral and District Hospital is networked with larger hospitals like Campbelltown, where patients can receive their dialysis in a dedicated unit staffed by renal physicians and specialist nurses.”

Socrates says: "I wonder if the SSWAHS spokesman has ever travelled between their Liverpool SSWAHS base and Bowral. Great reality check for SSWAHS that comment by Mrs Richardson in her final quote above."

SSWAHS and its neglect of Bowral Health - the Local State Member's view

SOUTHERN HIGHLANDS HEALTH SERVICES: Pru Goward - Member's question about the Bowral health services. NSW Parliament - 1st June 2009

Ms PRU GOWARD (Goulburn) [5.18 p.m.]: I draw the attention of the House to health services in the Southern Highlands. A fortnight ago the shadow Minister for Health, Jillian Skinner, spent a day in my electorate. She had heard much from me about Bowral hospital and its position at the end of the food chain as far as Sydney South West Area Health Service is concerned, so she was keen to visit and meet local residents and medical personnel to get some firsthand input. In the morning we met with a number of people concerned about the deterioration in service standards at the hospital and, following the application of the member for North Shore to the health Minister we were granted a tour of Bowral hospital with the general manager, Denis Thomas. In the afternoon we attended a public meeting I had called to meet constituents and listen to their concerns. We met a number of staff during our tour and there is no doubt our hospital is blessed by having extremely competent, hardworking and committed people working there.

Bowral Hospital has a very loyal consultative support group made up of community members who act more or less as liaison between the community and the hospital. This is a very good idea, in theory at least, but in practice, the group is bound by confidentiality and, as such, is as much controlled by the New South Wales Government as is the hospital`s general manager. The public meeting was a forum for people to not only voice their concerns but also to put forward suggestions for improving local health services. The meeting was unanimous in its support for, and faith in, the expertise and dedication of the medical staff.

Despite the flagging morale of the career medical officers, whose working conditions were changed without consultation, not a single person at the meeting-and more than 100 people were there-complained about the medical treatment they had received. What they did complain about was the appalling access to services, including the lack of psychiatric beds and the many occasions on which they were turned away and sent elsewhere. Today we heard in this House the shocking story of Gregor Gniewosz, who underwent an amputation as a result of picking up an infection in Liverpool Hospital. He also emerged from the public meeting. I refer also to the hospital`s children`s ward. The Minister for Health circulated a media release in which he stated, correctly I understand, that the new children`s ward at Bowral Hospital was on track for completion later this year. He said:

This is a tremendous result for the local community, which has been so supportive in ensuring children and their families have access to a facility that reflects today`s needs. The community has been more than supportive.

That would have to be the understatement of the year. The community forced this refurbishment. The BDCU Children`s Foundation began lobbying for this ward some five years ago. The area health service pontificated, promised, prevaricated and postponed but the foundation continued to raise money in the hope that the Minister for Health and the Sydney South West Area Health Service could eventually be dragged kicking and screaming to a point that it would provide a children`s ward with facilities that would actually contribute to the recovery of ill children. The foundation, which to date has raised $330,000, and everyone in the community who has supported and driven the concept of the new children`s ward have been a great deal more than just supportive. In the same media release, the Minister for Health said:

Local services are very important to the New South Wales community and they are the door to the excellence of the entire health system.

Again, I could not agree more. Why then has there been a determination made by New South Wales Health to direct complicated orthopaedic procedures away from Bowral Hospital? Does the Minister feel that local orthopaedic specialists are not expert enough to deal with complicated procedures or, as is most likely the case, is there a financial reason of some sort for this decision? In a notice circulated by the Ambulance Service, ambulance officers have been informed that Bowral Hospital will no longer deal with orthopaedic assessment for serious fracture injuries such as pelvis, long bones and neck of femur fractures. Ambulance officers will now have to take those patients out of the local area, probably to Liverpool. I understand that neck of femur fractures are most common in the elderly, and with a growing population of elderly residents in the Southern Highlands it beggars belief that they should be shipped out of the area, away from their support network, to a hospital located more than an hour away by car. I will not go into how long it would take to reach Liverpool Hospital by train. That is a subject for another private member`s statement.

Top-of-the-range orthopaedic specialists work at Bowral Hospital. The decision to direct complicated orthopaedic procedures away from Bowral Hospital is offensive to the local service and is an erosion of the specialist facilities we have in Bowral. The community has formed a group that is not beholden to the State Government. It will not be bound by confidentiality. It will include members of the public, medical personnel, allied health personnel and ancillary staff to help lobby the Government. It will be a force to be reckoned with. I congratulate Di Hurdwell, a local resident who stood up at the public meeting and offered to form this pressure group on what I am sure will be a great initiative.

Does the Southern Highlands Division of General Practice deliver the "optimal service" to the people of the Southern Highlands?

Does the Southern Highlands Division of General Practice deliver the "optimal service" to the people of the Southern Highlands as it states on its website? Or is it merely a subservient tool for the Imperial SSWAHS? The local Division seems to be more intent on acquisitions rather than delivering a service to their GPs.

For example, the SH Division employs staff to provide services that are already delivered by private allied health service providers in the community. Yet, because of its influence over the general practitioners it is meant to support, it exercises a monopoly. That is, it recommends GPs to preferentially refer their patients to the member of staff employed by the Division rather than to the private practitioners in the community. Where is the right to choose their practitioner for the patient?

Socrates is aware from personal experience that the general practitioners he has had to see over his long years (treatment for hemlock poisoning, etc), that the majority of GPs do have a mind to treat their patients with respect and provide them with options. This dialogue of mine today is not about the GPs in the Southern Highlands but about their Division and its Chief Executive. Their Chief Executive has openly stated that he will fight to market the Divisional staff to the area's GPs simply to be able to continue to employ them. Who has employed them - well the Chief Executive. But what processes does he follow in employing the staff, and what qualities and skills do they bring to ensure the provision of "optimal care" is delivered by them?

And can the staff employed by the Chief Executive deliver all the programs that he says (in the website) the Division can deliver to the people of the Southern Highlands. There is no doubt that the Aged Care and the Diabetes Coordinators are well experienced in their clinical fields and the services they deliver are well used. But what about the other services that the Division touts on the website? Mental health services delivered to the aged care facilities in the Highlands, the non-directive pregnancy support counselling, the better outcomes in mental health program, the better access mental health program, the mental health nurse incentive program - who delivers these?

These programs are all funded by the federal government through Department of Health and Aging or Medicare Australia. The qualifications of the practitioners used for these programs are dictated by the Medicare Australia and/or the relevant professional college or association. The Division, however uses its own set of hoops to select who it should anoint to do the work. I wonder what Medicare Australia or the Department of Health and Aging would think about the Southern Highlands Division of General Practice? In particular its Chief Executive and its Board.

Socrates is already aware from his reading of the scroll called "The Highlands Doctor" that, for example, GPs are being encouraged to refer their patients to a person for the "Better Access" program when they could be doing some of the "Better Outcomes" program which is funded by the federal government and the Division is the fundholder. Why use a Medicare funded program to keep their staff member employed? Perhaps it has something to do with running out of the funds for "Better Outcomes" because the funds were used for something better - like employing staff rather than providing a service to the patients referred to it.

The other program that seems to have disappeared off the scroll appears to be the Mental Health Nurse Incentive program - another of the Medicare funded programs. From the more ancient scrolls on the Division's website it would appear that the Chief Executive was employing someone who was hoping to be a Credentialed Mental Health Nurse, the only people (besides GPs and psychiatrists) who Medicare allows to participate in the program's delivery. It appears to be a good program (perhaps even a great one) which allows vulnerable people with a severe mental illness to have care coordination by a credentialed mental health nurse so that they might remain out of hospital and be cared for in their own community.

It would seem that the person employed by the Division was not successful in obtaining the credentialed mental health nurse qualification so the Division could no longer use them. From the official website of the Australian College of Mental Health Nurses the list of Credentialed Mental Health Nurses shows that there are three qualified and approved CMHNs in the Southern Highlands, which is not bad considering there are only about 800 nation-wide. However, the Division, for reasons unknown, is not supportive of the existing CMHNs and appears to have gone secretive as to their reasons why. The information about the MHNIP is no longer public on the website having been placed in the log-in "doctor's secret business" section on their website.

In the meantime, patients who could or should be referred to this program are not able to be referred because the only two CMHN in the Highland currently being used by GPs are unable to take on any more patients, and the other although credentialed since August 2009 has never received any referrals at all possibly due to misinformation provided by the Division to the local general practitioners.

Hmmm! Socrates has to then wonder at the Division's claim:

"Southern Highlands Division of General Practice (SHDGP) is a federally funded not for profit organisation which assists general practitioners and the Health Service to deliver health services to people in the Southern Highlands.

The Division acknowledges the support of the Commonwealth Department of Health and Ageing in respect of funding the Division's activities."

And:

"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."

Does it really, Chief Executive, or is the Division just as money grabbing as the so-called "for profit" organisations? Perhaps it is now time for the merger with the Macarthur Division of General Practice where they don't seem to run out of funds for their funded programs, and they employ people but they still seem to manage to work collaboratively with their general practitioners and with the private sector, especially the allied health and mental health nurses, without having to prostitute themselves to the empire of SSWAHS.

SSWAHS and the local Division of General Practice.

Welcome to the Southern Highlands Division of General Practice

"Southern Highlands Division of General Practice (SHDGP) is a federally funded not for profit organisation which assists general practitioners and the (SSWAHS) Health Service to deliver health services to people in the Southern Highlands."

In its most recent "Highlands Doctor" newsletter their Chair makes the following comments about the proposed changes in health services generally, and especially community and primary health care. He writes of the "Primary Health Care Organisations" proposed by the federal government.

"What are PHCOs?

The Government has determined that these are best formed from the Divisions – or GP Networks, as they are often now known.

Over the past dozen years, the Divisions have shown that they can unite GPs into public health co-ordination and delivery roles, and gradually change the health culture from a hospital bed based one to one more focused on primary care.

They have successfully been fundholders – for example, in Better Outcomes in Mental Health (BOMH) and More Allied Health Services (MAHS - which has funded our Diabetes program).

The Divisions were the natural contenders to run the PHCOs – though there are a number of other organisations (eg health funds and other “for profit” health companies) which are keen to do the job if GP Divisions are not.

It seems to me that Divisions are best suited for these expanded roles.

However, the Government does not wish to deal with a cumbersome number of small PHCOs – there are 110+ Divisions across Australia currently – so it has indicated that it wishes Divisions to seek partners and amalgamate to form PHCOs to serve a population of about 600,000 people.

This means that our Division, serving just 45,000 to 50,000 people, would not be big enough to form a PHCO in our own right. We will now be talking to our neighbouring Divisions to find the partner that has the most commonality in purpose, philosophies, service delivery etc.

All this has to also be examined in the light of the changes in boundaries to the area health services (Sydney South West Area Heath Service is likely to be divided into two or three smaller areas under the Federal proposals).

As we find out more details of the roles that we will be expected to play in the remodelled heath system, we need to identify all the best features of our Division and make sure we maintain these benefits to our doctors, our practices and our patients as we move into these new reforms.

It is heartening to see that the Government has recognised the pressing need for infrastructure funding for general practices - though most GPs feel that 20+ more “super clinics” (what a dismal name – almost as bad as “Medicare Local”?) and 400+ general practice infrastructure grants is just scratching the surface.

If we are going to be working with more practice nurses, allied health workers and co-located with other primary health services (eg Primary Health Nurses), we need more rooms.

And we have a growing number of registrars (20% increase in the number of registrars in our local City Coast Country Training (CCCT) organisation for 2011, for example), medical students, PGPPP junior doctors – as well as practice nurse and general nursing trainees seeking experience within GP walls. Again, all need room and/or rooms!

Our Division will keep you posted as we work our way through these new reforms. We enjoy a reputation already among Federal and State heath administrators as an innovative, “can do” Division, and I am confident that our experience as Division over the past 16 years will stand us in good stead to take a lead role as we transition into a PHCO.

It is a great opportunity to work out how we can do things better, and with the anticipated funding, make this actually happen.

Vince Roche

His comments are followed by those of the Division's Executive Officer. Noticeably in his text there is a sense of contrast to the opening statement of the Southern Highlands Division being a "federally funded not-for-profit organisation which assists general practitioners and the (SSWAHS) Health Service to deliver health services to people in the Southern Highlands."

There are two things in his text which stand out for old Socrates: one is the vision that he has of this being a great opportunity for his Division and others to grab a large part of the pot of taxpayers money to satisfy his vision of an Empire in the south. The second stand-out feature is the total absence of how the Divisional Executive in general, and its Executive Officer in particular sees how this windfall is going to be helpful to the "people in the Southern Highlands".

Call old Socrates a bit of a windbag - but can anyone else see the words - "patients" or "people" in the writings of either of these other windbags? All Socrates can see is a couple of old cronies backslapping each other for managing to extract a lot on money out of current and previous governments for their own plans, staff and programs.

Primary Health Care Organisations (PHCOs):

These are now being called ‘Medicare Locals’ by the Government – apparently reflecting a move away from ‘Primary’ given the pending legal action surrounding that title.

This new name is being resisted by AGPN and the Divisions and, in company with many others, we are continuing to use the term PHCO.

Boundaries for the sixty or so PHCOs, to which the existing 111 GP Divisions will be reduced, are to be agreed between the Commonwealth and the States by December 2010. This will have regard to the boundaries of the new Hospital Networks.

In the case of the SSWAHS Hospitals, it is possible that we will know the network boundaries as soon as late this year. However the current betting seems to be favouring a two way split, with our network including Liverpool Hospital.

Key strategies for PHCOs will move away from predominantly individual clinician based membership, with activity and governance to be more reflective of wider community based health care providers.

GPs are to remain the cornerstone in the overarching governance structure. Amongst other things, PHCOs will have responsibility for after hours services; strategic planning and development; workforce issues; and population health.

We understand that PHCOs are to cover populations of up to 600,000 people and therefore one thing is certain in our case. That is, we are too small to be able to constitute a PHCO. Indeed, the AGPN has just released the Cranny Report into the suggested PHCO boundaries which has us amalgamated with Macarthur Division.

To this end, we have commenced negotiations with Macarthur Division to, amongst other things, ensure that we retain our rural status and activities and our local management. However, there are still hurdles to cross, including that, while the Government acknowledges the Cranny Report, at the end of the day, PHCOs have to relate to the future Hospital Networks as agreed with the States.

This is to be agreed by December of this year under the COAG agreement. According to the Government’s handouts, the first round of 14 or 15 PHCOs are to be in place by July 2011 with the remainder by July 2012.

We are collaborating with Macarthur Division to go all out to be in the first round, since waiting until the later date will carry the danger of a longer period of instability. There will be dedicated transition funding over and above the normal Division funding which will provide for our existing Division services in the meantime and during the transition period.

Other measures flowing from the Commonwealth Budget which are worth repeating include a national EHealth System to be in place over the next two years; more GPs; 23 new Super Clinics and work on 425 existing practice premises to allow team based care; the Practice Nurse Program; paid training for PNs; better support for RACF nurses; more mental health nurses; more mental health programs; and the new Diabetes program.

It is noteworthy that PHCOs in various forms now exist in New Zealand, Canada, the UK and the US. It is expected that there will be a Canberra-based central PHCO as well as State branches. Some in the network are favouring the retaining of existing Divisions, with the Division becoming a part of the PHCO. However this seems unlikely.

Lastly, any Division that doesn’t move into the PHCO model will not be funded beyond 2012. Perhaps most importantly of all for GPs, the PHCOs will not control individual GP practice matters.

Warwick Ruscoe

Now call Socrates a bit of a simpleton but I seem to recall that this last author was most outraged that he was overlooked in a pre-selection ballot for a nice safe Liberal seat. A second rebuff was his failed attempt to have the Wingecarribee Council approve his grand plan to build a "super clinic" (funded by the federal government, of course) over the public car park in Moss Vale which, only coincidentally (of course), happens to be right next to the Moss Vale GP practice owned by the Chairman of the Division.

Even more alarming is the unholy alliance with SSWAHS looks as though it is going to be the preferred option for the Southern Highlands Division if the prediction from the Executive Officer is correct about the links with Liverpool Hospital, the Imperial home of the SSWAHS Executive.

Perhaps the Southern Highlanders should be asked by the State and Federal Health Ministers whether we want more of the same treatment that has been dished out to us by Liverpool and SSWAHS.