Primary Health Care Reform and PHCOs Giving voice during a period of change The one thing we know is reform will occur in the health sector and primary health is the soft target Why reform? Australia’s health challenge
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The one thing we know is reform will occur in the health sector and primary health is the soft target
The Government has embraced the challenge of health reform and the Prime Minister has described seven guiding principles for reform.
Key principles include patient-centred care, the need to improve connected, comprehensive primary or front line care, and to improve the health and wellbeing of communities
Given the number of major reviews commissioned by the Government the government has made election announcements on reform
The Final Report of the National Health and Hospitals Reform Commission (NHHRC), A healthier future for all Australians, included a number of significant and far reaching recommendations.
Of particular relevance were the recommendations that, at the national level:
The Commonwealth should take responsibility for all policy and funding for Primary Health Care. That includes all of community care, primary care, mental health and aged care, and outpatient department funding.
That the Commonwealth take over 60% of hospital funding based on outcome indicators but not the direct with hospitals formed into Local Hospital Networks. Over time 100% of outpatients will be Commonwealth funded.
At the local level, service coordination and population health planning priorities should be enhanced through the establishment of regional Primary Health Care Organisations (PHCOs), “evolving from or replacing existing divisions of general practice”. The Government calls these Medicare Locals.
The creation of PHCOs will improve the delivery of GP and primary health care services at the local level and ensure local GP and primary care is better integrated and more responsive to the needs and priorities of patients and communities. (COAG B2.) PHCOs will aim to do this by:
And ( Budget May 2010)
PHCOs would build on the existing national footprint, expertise, capacity, government investment, and clinician and community engagement of Divisions.
Divisions are only funded to June 2012 and provide the budget base for a Commonwealth funded transition to PHCOs – 10-15 first wave PHCOs will be established from 1 July 2011.
Divisions will be given the opportunity to submit a proposal to establish PHCOs (an ‘internal tender’). A transition support fund will assist evolution by providing resources to support the development of new constitutions, strategic plans, performance frameworks and organisational standards
Must include general practice and must also be broad based and reflective of the local service delivery environment, namely primary health care providers or support services to primary health care professionals and the consumers they serve.
It is not clear if Members will be expanded membership based organisations such as Divisions or have organisations as Members.
It is more likely that PHCOs will be new organisation with skills based boards and primary health organisations as members
A skills-based Board with Directors reflecting the diversity of clinicians and services forming comprehensive primary health care
A proportion of appointed and elected Directors to ensure optimum skill mix
Advisory and consultative structures to garner clinical, community and health stakeholder input and engagement and to lead clinical governance
KPMG have suggested several structural options-
At this stage we don’t think they will be statutory authorities
Regardless of what happens in the reform process we can choose to be takers of the outcomes proposed by Commonwealth and State governments, or we as the major primary care stakeholders can seek to establish a collective voice to articulate the needs of the regions non-government providers and the community we serve.