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 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.