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AGPN acknowledges the financial support of the Australian Government Department of Health and Ageing. The reform framework Where are we at?. David Butt 21 May 2010. Policy work. Has been extensive Position Statement Blueprint

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The reform framework where are we at

AGPN acknowledges the financial support of the Australian Government Department of Health and Ageing


The reform framework where are we at

The reform frameworkWhere are we at?

David Butt

21 May 2010


Policy work

Policy work

  • Has been extensive

    • Position Statement

    • Blueprint

    • Policy on a wide range of issues arising from the above, plus for and from Federal Government reforms eg.

      • eHealth,

      • Infrastructure

      • mental health

      • practice nursing etc


Government announcements endorse clear central message

Government announcements endorse clear central message

  • PHC reform built around general practice

  • Aim to create an integrated and comprehensive platform of services, bringing together privately funded GP services with State-funded community health services

  • Potential significant benefits to community, patients and GPN members

  • Challenges and opportunities for GPNs


Where to from here

Where to from here........

  • Moving from claiming the space to implementation phase

  • Many unanswered questions

  • Our role to try to influence the answers and outcomes

    • Aim to not have too much imposed

    • And don’t lose or bargain away what we have achieved


Commissioned reports

Commissioned reports

  • KPMG transition plan

  • Carla Cranny & Associates boundary modelling

  • DLA Phillips Fox – membership and governance

  • Eugenia Cronin – leadership and organisational development


Transition plan

Transition plan

  • Both a strategy and a plan

    • Based on recent announcements and reasonable assumptions

  • Goes through:

    • Strategic intent: what we are trying to achieve

    • Overview of transition

    • Detailed transition planning


Transition plan 2

Transition plan 2

  • Ultimate output a toolkit for transitioning

  • Aim for draft to be released next week

  • Looks complex electronically

    • Will later be issued as manual in a binder with discrete sections

    • Aim to continue to build on it

    • New work and updates to be sent out and slotted in

    • May include State-specific sections

    • Expect will include GPN/PHCO specific sections over time


Transition plan 3

Transition plan 3

  • What is the network transitioning to?

  • Main areas of change:

    • Scope and scale of PHCO operations

    • Additional levels of accountability

    • Boundaries and configuration

    • Governance and membership

    • Level of authority of PHCOs


Transition plan 4 strategy on

Transition plan 4: strategy on....

  • Program objectives, scope and scale of operation

  • Configuration, regional ‘positioning’ and branding

  • Role and function of national organisation

  • Boundaries, size and number

  • Legal structure

  • Membership

  • Governance

  • Partnerships and stakeholder engagement

  • Performance, improvement and quality systems

  • Funding, authority and accountability


Transition plan 5

Transition plan 5

  • Due diligence

    • Regardless of pathway chosen, change is coming

    • Need to determine what you want to do

    • What do you want to become, and do you have the capacity, competence and stamina to do it?


Transition plan 6

Transition plan 6

  • Five pathways examined

    • NewCo

    • Transition of existing company

    • Merger

    • Branch office

    • Joint venture


Transition plan 7

Transition plan 7

  • Staged implementation

    • Transition plan envisages 10 year timeframe to become fully operational

    • Includes pre-transition tasks, establishment phase, consolidation, ongoing transfer of roles and responsibilities to PHCOs, to full operation


Transition plan 8 transition streams

Transition plan 8: Transition streams

  • Governance and corporate structure

  • Stakeholder engagement and partnerships

  • Funding

  • Membership

  • Organisational performance & CQI

  • Accountabilities

  • Business processes

  • Change management


Transition plan 9 operating model

Transition plan 9: Operating model

  • Strategic planning and development

  • Health service development, delivery and integration elements

  • Population health & community development elements

  • Workforce planning


Next steps

Next steps

  • Depend on funding, gov decisions, process, etc

  • Includes development of due-diligence pre-assessment check-list

  • Transition tools and templates (do it once)

  • Project management team

    • Resource clearing house

    • Change management & organisational development support

    • Marketing ad branding


Next steps 2

Next steps 2

  • Don’t be put off by transition plan detail

  • Intended as a guide/tool kit/check list – not to be prescriptive

  • Release will be backed up by navigation guide, webinar, ongoing communications, etc

  • Draft for feedback


Governance and membership

Governance and membership

  • DLA Phillips Fox: independent legal advice

  • Based on government announcement, blueprint

  • Independent non-government entities

  • Companies limited by guarantee


Governance and membership 2

Governance and membership 2

  • Preferred membership base GP & PHC organisations

    • GPNs or alternative GP entities

    • Community health services

    • Mental heath services

    • ACCHS

    • LHNs

    • Local Government

    • Education providers


Governance and membership 3

Governance and membership 3

  • Skills-based Board – some elected and some appointed

  • Strong highly visible clinical leadership

  • Effective clinical governance

  • Consumer and community engagement mechanisms and structures


Governance and membership 4

Governance and membership 4

  • Develop as NewCos unless there are compelling local reasons to choose alternative pathways

  • GPN Boards to remain highly mindful of legal responsibilities to existing company during transition process


Governance and membership 5

Governance and membership 5

  • Feedback sought from network on governance and membership by 30 May

  • Also on national organisation, recognising transitioning of AGPN & SBOs

  • Vital role in supporting PHCO transition

  • Need to ensure important skills/IP and functions retained & built upon


Boundary modelling

Boundary modelling

  • Carla Cranny engaged to develop objective assessment of boundaries for PHCOs following NHHRC report and AGPN Blueprint

  • Nationally consistent criteria relevant to proposed roles and functions of PHCOs

  • Modelling based on population health planning principles and service development models for primary health care environments


Core demographic health status and workforce characteristics

Core demographic, health status and workforce characteristics

  • Catchment population size based on June 2008 and projected population growth to 2021

  • Age structure - % 0-4 and % 65 plus and % 85 plus

  • Indigenous and CALD population %

  • Socioeconomic status as proxy for high health need – Index of Relative Socioeconomic Disadvantage for PHCO and major variations in proposed catchment

  • Workforce data - limited to GP profile from Division annual returns including patient to GP ratio as need indicator


Design criteria

Design criteria

  • Align with LGAs, state boundaries, future LHN boundaries, service delivery environment

  • Size and scale varies considerably

  • Recognises need for branch offices, also role as service providers

  • Preferred Victorian option:

    • 8 metro

    • 7 rural


Federal government view

Federal Government view

  • Half as many PHCOs as LHNs

  • Good to have boundary alignment where possible

  • Open to cross border models

  • Victorian LHNs – likely to be structured very differently to other States


Current possible lhn scenario

Current possible LHN scenario

  • Vic44

  • NSW20

  • Qld20

  • SA 4

  • WA 4

  • NT 1

  • ACT 1

  • Tas 1

  • Total 95


Organisational leadership development

Organisational & leadership development

  • Work modelled on UK transition from PCGs to PCTs

  • Focus on leadership, skills development, capacity building, systems design

  • Culture to drive development of high performing PHCOs which maximise skills of workforce and are a truly great place to work

  • Major role for GPNs/PHCOs supported by AGPN & SBOs


The reform framework where are we at

  • Transformational change requires transformational leadership

  • So let’s do it


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