SSWAHS = SWSLHD + SLHD and the Medicare Locals - 69

If ever we needed to see what the agenda of the College of GPs (and some of the existing Board members of the Divisions of General Practice) has been in their submissions for ownership of the Medicare Locals, this Media Release spells it out emphatically - "We intend to maintain control because none other than a medical practitioner can do the job of running the Medicare Local".

Local allied health practitioners and community members with health and/or business acumen should be champing at the bit to ensure that they can rein in the entrepreneurial plans of this Juggernaut.  

The only way to provide the diverse, effective and efficient community based health services to the Southern Highlands is for the community members delivering and receiving those services to have equality in the decision making of their Medicare Local. Only then will the Vision of the Bankstown Health Coalition be able to be replicated in the Southern Highlands.

7 November 2011
 
Medicare Locals – GPs must retain a strong leadership role

To avoid fragmentation of patient healthcare, the Royal Australian College of General Practitioners (RACGP) urges the Government to consult closely with the medical profession as it progresses the establishment of Medicare Locals.

On Friday, the Minister for Health and Ageing released a list of 38 organisations that have been selected to become the next Medicare Locals.

RACGP President Professor Claire Jackson said that Medicare Locals will have a broader focus than their predecessor Divisions of General Practice, and whilst this should provide a greater opportunity for integrated team based care, it is essential that GPs retain strong leadership roles, and that the general practice is seen as the patient's community healthcare home.

“Quality general practice is the foundation of primary care and must be the basis of Medicare Locals. Our focus needs to remain on enhancement of services to the patient and the community taking care to avoid fragmentation,” she said.

The College is pleased that Minister Roxon acknowledged the importance of ‘GPs and general practice being at the centre of a strong, integrated primary healthcare system’ and the need to ‘build on the excellent work already done by the local Divisions of General Practice’.

“The RACGP believes it is important we remain included in the discussions around the development of each of these organisations and we urge members to remain involved so that general practice continues to be the cornerstone of reform.

“It is likely that the governance of a Medicare Local will be through a skills based board rather than representative based board. GPs with such skills are encouraged to apply and have a voice,” Professor Jackson concluded.
– ends

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 68

There is no doubt that the South West Sydney Health Coalition (SWSHC) and the Bankstown GP Division have been diligent in their attempt to pursue the formation of a collaborative Medicare Local for the region, and magnanimous in defeat!


Not only has the SWSHC outclassed their bigger competitor but they have, in an exlemporary fashion followed the criterion set out for all bidders by the Federal Department of Health and Ageing. They have put to shame their rivals in the Macarthur-Southern Highlands consortium who have failed the critical test of consultation prior to submitting their relevant bids.


One can only hope, as residents and health consumers of the Southern Highlands, that the Vision and ethical approach of the SWSHC is maintained by an appropriate representation from the SWSHC on the Board of the proposed SWS Medicare Local due to commence by 1 July 2012.


Socrates, for one, will find no credibility in a SWSML Board which does not espouse the same SWSHC Vision of : "democratic decision making, transparent governance, and equitable distribution of resources, to benefit all families across the region."

Welcome to SWSHC
 
 

The South West Sydney Health Coalition (SWSHC) formed in 2010, to secure democratic decision making, transparent governance, and equitable distribution of resources across all parts of the future South West Sydney Medicare Local.

Since 2010, thirty five organisations signed MOUs to work together, to transform this vision of a Medicare Local into reality.

The SWSHC has, from its origins, been driven by a shared vision, of how family doctors, health and community organisations should work together to improve the health of people living between Bankstown and Bowral.


In July 2011, the SWSHC lodged a bid to become the South West Sydney Medicare Local.

On 4 November 2011, we learned that we were not the successful bidder. As a consequence, the SWSHC will negotiate with the Macarthur-Southern Highlands bid consortium to form the South West Sydney Medicare Local.

Importantly, today’s decision means that the SWSHC has not yet secured its original vision – to ensure the South West Sydney Medicare Local foundations rest on democratic decision making, transparent governance, and equitable distribution of resources, to benefit all families across the region.

Looking towards 2012 and beyond,  the SWSHC is now well positioned to represent the interest of family doctors, health organisations, and local communities, to secure our vision for the South West Sydney Medicare Local, through a formal mediation process with the Macarthur and Southern Highlands bid consortium.

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.

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Medicare Locals - Criteria for applicants

Given the apparent failure (again) of the Macarthur - Southern Highlands consortium to gain selection in the second tranche of the successful Medicare Locals announced this week, it is perhaps timely to reproduce here the DoHA selection criteria which the consortium needs to consider for the third tranche to be notified. I suggest to the Boards of the SWSGP Link and the SHDGP that they should consider in particular Criterion 2; and Criterion 4 - 6. 

At present, there are clearly significant gaps in the consultation process with key stakeholders and groups that the consortium has been required to have in the development phase of their application. Perhaps they should take a serious look at the way in which the Bankstown GP Division progressed their community consultation process

The relevant consortium Boards need to beat their collective breasts and admit their failure and then, start again!

2.4 Selection Criteria

There are six (6) selection criteria against which applications for Medicare Local funding will be assessed. These criteria are outlined below:

Criterion 1:

Demonstrated expertise and capacity to address the five Strategic Objectives for Medicare Locals specified above, for the selected catchment area including outlining:

i. Activities currently undertaken and previous achievements which relate to each of the five strategic objectives;

ii. How these activities can be extended and expanded to meet the needs of a modern primary health care system;

iii. Demonstrated knowledge of the population base, health service architecture and infrastructure, utilisation and other demographic characteristics and health priorities in the proposed catchment area (this should indicate the evidence from which this knowledge is drawn);

iv. A strategy for development of a population and health service plan to address need;

v. Infrastructure already in place;

vi. Capacity to collect and manage data as appropriate;

vii. Strategies for ensuring appropriate accountability and transparency to the community; and

viii. Indicative personnel and other resources to be allocated to deliver these activities.

AND

Criterion 2:

Proposed governance and operational arrangements, including:

i. Details of the proposed legal/corporate and organisational structures;

ii. Experience and skills expertise of the proposed Executive;

iii. A structure that recognises the diversity of clinicians, services and health care recipients within the modern primary health care sector;

iv. Structures that encourage and maintain local engagement and responsiveness;

v. A transition plan, including estimates of costs associated with transition activities;

vi. Strategy for ensuring appropriate clinical governance;

vii. Strategy, skills and expertise to manage flexible funding to target services to the local community’s specific needs;

viii. Strategy for establishing effective linkages with other sectors and organisations, including Local Hospital Networks; and

ix. Strategy for ensuring community engagement and accountability.

The assessment panel will have regard for the desired governance attributes, including broad community and health professional representation, as well as business management expertise; and strong clinical leadership.

AND

Criterion 3:

The financial viability of the Medicare Local including:

i. Demonstrated record in efficient and effective use of funds of each organisation covered by the proposal;

ii. The experience and expertise of the organisation’s proposed executive team to manage substantial public funds appropriately; and

iii. Current contractual arrangements.

AND

Criterion 4:

Demonstrated evidence of ability to engage with and form productive relationships with key stakeholders, providing supporting evidence of any current partnerships and operational arrangements, and strategies to improve engagement with:

i. Community Organisations;

ii. Aboriginal and Torres Strait Islander Health Organisations;

iii. Workforce Organisations;

iv. General practice;

v. The broader primary health care sector; and

vi. Research Organisations.

AND

Criterion 5:

Strategies and ability to respond to local needs and emerging priorities, including Commonwealth priorities in Aboriginal and Torres Strait Islander health, eHealth and telehealth, mental primary health care, aged care, population health and after hours primary health care.

AND

Criterion 6:

Evidence of ability to build upon a sustained track record of high performance as a Division/s of General Practice or primary health care related organisation, including:

i. Driving improved outcomes and system change in general practice and primary health care through effective practice support;

ii. Improving eHealth and information management infrastructure, including the use of data to improve preventive health and chronic disease management in clinical practice, to measure the effectiveness of health program delivery, and to inform population–based services planning and evaluation;

iii. Effective governance and corporate management;

iv. Demonstrating effective collaborative relationships with other agencies and health service providers to achieved improved referral pathways, health service provision and/ or outcomes, including a demonstrated culture of inclusion across the spectrum of primary health care service provision and local community engagement;

v. Demonstrating compliance with contractual obligations;

vi. Delivering sustained achievement and improvement against national performance indicators for Divisions of General Practice (where relevant) and associated programs; and

vii. Actively sharing expertise and resources with others to promote quality improvement and knowledge transfer across the primary health care sector.

The selection panel will develop a relative merit list from the applications assessed, based on the selection criteria above, and provide recommendations of preferred applicants to the Minister for Health and Ageing.

The selection panel will also have regard to the desirability of achieving a reasonable spread of Medicare Locals across the country and geographic classifications for the first tranche of Medicare Locals.

All applicants should note that, where the assessment process does not identify a preferred applicant within a Medicare Local region, the Department reserves the right to broker an arrangement between funding applicants and/or other interested parties.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 63

Second wave of Medicare Locals announced

• By Michael Woodhead on  4 November 2011 - 6Minutes

An additional 38 Medicare Locals have been announced by Health Minister Nicola Roxon today.

However, only 18 of the new Medicare Locals will be established from 1 January 2012, while the remaining 20 will be part of a third wave of 25 Medicare Locals to commence from 1 July 2012.

In total there will be 62 Medicare Locals, including the 19 that have already been announced and which are in the process of being established from “high performing”divisions of general practice.

The Medicare Locals to start in January are:

NSW: Illawarra-Shoalhaven, Nepean-Blue Mountains, North Coast NSW, Northern Sydney and Western NSW;

Victoria: Bayside, Frankston-Mornington Peninsula, Loddon-Mallee-Murray, Lower Murray    Macedon Ranges and North Western Melbourne, South Eastern Melbourne;

Queensland: Central and North West Queensland, Darling Downs- South West Queensland;

South Australia: Northern Adelaide, Southern Adelaide-Fleurieu;    

WA: Fremantle, Goldfields-Midwest, Rockingham-Kwinana-Peel.

Health minister Nicola Roxon said further work was needed for Medicare Locals for North Eastern Sydney and Hunter Rural in NSW, Great South Coast and South Western Melbourne in Victoria and Kimberley-Pilbara in Western Australia.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 60

Mediation failure forces divisions to quit ML merger

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

DOUBTS about the federal government’s Medicare Local (ML) boundaries have re-emerged after mediation between two Sydney division-led bodies, aimed at forcing them into a single ML, collapsed.

Souring relations between a Bankstown division-led consortium and a group led by Macarthur and Southern Highlands divisions prior to the first ML deadline had previously prompted the AGPN to appoint a mediator so the parties could form an ML by next year.

But mediation has since failed, with Macarthur-Southern Highlands having now lodged its own bid, which could see it handed responsibility for the 35 practices it is locked in a feud with.

A Macarthur spokesperson told MO the group would not agree to further mediation until the fate of the ML had been decided.

Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.

“It’s such an enormous area with so many complex needs and organisations,” she said.

Dr Brian Morton, chair of the AMA Council of General Practice, warned divisions to settle their differences or risk having general practice “locked out” of MLs. A department spokesperson said the awarding of tenders took into account the applicants’ “ability to engage with key stakeholders”.


Well, it seems the fickle finger of fate has written on the wall of the Southern Highlands Division of General Practice! Christmas is beginning to look gloomy for the CEO and Board of the local Division. 

The final paragraph of the statement above is pretty clear about what causes a Division like the Macarthur - Southern Highlands consortium being "locked out" of Medicare Locals because they can't settle their differences. Certainly the Department of Health and Aging representative suggesting the criteria of the applicant's "ability to engage with key stakeholders" does not apply to the SHDGP's involvement with local people, public and private health practitioners and NGOs. Telling key stakeholders after the event what the SHDGP has done to apply for Medicare Local funding is hardly consulting or engaging, with them.

The other bit of mis-information the Chair of the SHDGP published in his lengthy column in the Division's last newsletter was that the mediation between the Macarthur-Southern Highlands consortium ended because the Bankstown GP Division put in their own application. However, the report published above suggests that it was the Macarthur-Southern Highlands consortium who withdrew from the mediation to lodge their own submission first. Further, the Macarthur spokesperson stated that they would not engage in any further mediation until after the outcome of the second series of Medicare Local allocations had been resolved. It seems they are hoping to get in and only then use their improved position to hammer away at the Bankstown GP Division.

"Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.
“It’s such an enormous area with so many complex needs and organisations,” she said."  

This suggestion by Dr Harnett is Solomon-like in its simplicity. The Medicare Local could be split in two. However, in order for the Bankstown GP Division to achieve the numerical population quota set by DoHA, required for MLs it is likely that they may have to extract from Macarthur-Southern Highlands some of the territory that they acquired prior to the implementation of the Medicare Locals. 

Can I see these empire-building expansionists willing to hand over territory? Not likely!

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.