Dr Paresh Dawda
The Budget brings Medicare Locals short life to an end in June 2015. Their function as a primary health care organisation will be replaced by Primary Health Networks (PHNs). Successful PHNs will be announced next year, following an open contestable process; the details of which are expected in Spring. The ACT Medicare Local (ACTML) will tender to be the ACT’s PHN. For the ACTML this is a natural progression in a unique jurisdiction and the reforms offer a springboard to the next level.
The ‘Horvarth’ Rert has been endorsed by the Federal Government and provides a window on the specification for PHNs. The expectations include a paramount role for general practice as well as other primary care providers. A key function will be to integrate care across the whole health system leading to improved patient outcomes. Where services gaps exist, they will commission those services rather than provide them (unless there are exceptional circumstances).
The starting point for this journey of integrating care and improving outcomes is to understand the current state. The ACTML’s comprehensive needs analysis provides that understanding and has been launched by the ACT’s Chief Minister and supported by the ACT Government. It has been produced following a systematic process and articulates the current and future needs. It will evolve to include more detailed snapshots of health status and needs at sub-regional levels, in natural catchments such as Belconnen and Tuggeranong.
As Canberra’s population grows older and experiences an increasing prevalence of chronic conditions and multi-morbidity, some of these needs are not surprising. They include:
- improving access to care, particularly for vulnerable groups like the elderly and homelessness;
- a need to prevent chronic diseases where possible;
- support patients to manage those chronic conditions well if they do develop;
- for those patients with more complex needs to improve the coordination of care;
- and the accurate and timely transfer of clinical information.
Services need to be more integrated and seamless from a consumer perspective. The health reform affords the opportunity to operate under one common strategic framework, together with the ACT Government, so all our efforts are aligned to tackling the same common shared goals as one system. To bring together the different organisations that make up the system will require strong relationship based frameworks. Where gaps in the population needs require additional services, a joint commissioning approach will be actively explored with an intent to underpin those strong relationships and common goals with innovative contracting arrangements that could, over time, pool resources, share risk and provide joint governance.
PHNs are primary health organisations, which operate at a meso level of the health system. Many countries including New Zealand, UK, Canada and US have such organisations. In some countries those organisations have evolved from primary care provider needs. In other countries, as in Australia, governments have introduced them. Irrespective of their origin, their critical success factor is simple: to engage and support its clinical community in delivering effective and high quality services for their patients.
As simple as it sounds, achieving this in meaningful way is challenging but certainly possible. The ambition is a bottom-up approach supporting clinicians every step of the way, with enabling processes that make their jobs easier to perform and allow them to focus on the clinical care for their patients. Specific projects like HealthPathwayswill be a great enabler, but alone will not be sufficient. In some cases new tools or infrastructure will help. In other cases, new services will be needed; in others existing services will need to redesigned or improved and to achieve this will require a new set of skills. Supporting practitioners to develop these new skills will be a priority. These new services, such as a health coach for patients with heart disease, may be housed in the medical centres where consumers usually receive most of their care, or where a wider team is required, in the ‘medical neighbourhood’.
ACTML has taken an engaging approach in thinking about the future direction. It has listened to its members, the community, clinical leaders, consumers, and other stakeholders. It has heard that it has strong foundations, but the complexity of health is changing, and hence it will build on those foundations. There are opportunities galore to improve the health of our citizens. Working together and collaboratively across the broad spectrum of public and private, government and non-government stakeholders we can seize those opportunities as a PHN.