Mark Harris, Centre for Primary Healthcare and Equity, UNSW - Primary Care Organisations: Promise...
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Transcript of Mark Harris, Centre for Primary Healthcare and Equity, UNSW - Primary Care Organisations: Promise...
Primary Care Organisations:
promise and performance
Mark Harris, Centre for Primary Health Care and Equity
Note: The author is a Director of Inner West Sydney Medicare Local.
The Centre for Primary Health Care and Equity has contributed to a recent
Evaluation of Medicare Locals. This talk contains no material from or
reference to this evaluation which is confidential. It is based on publicly
available information.
Centre for Primary Health Care and Equity
Outline
• Historical and international context
• Objectives of Medicare Locals
• Perceived performance
Aim: To review the objectives & performance
of primary care organisations
Centre for Primary Health Care and Equity
Divisions of General Practice
• The purpose of the Divisions Program was to provide
services and support to general practice at the local level to
achieve better health outcomes for the community
• Divisions conducted a wide range of activities, such as
providing support for practice accreditation, practice nurses
and introduction of electronic medical records which helped
to transform the organisation and infrastructure of general
practice .
• However despite some success in diabetes shared care,
Divisions demonstrated less impact on clinical performance
in key areas of prevention and management of chronic
disease.
–Scott A, Coote W. Health Econ. 2010 Jun;19(6):716-29.
Centre for Primary Health Care and Equity
National Health and Hospital
Reform Commission 2009
Enhance service coordination and population health planning priorities
at the local level through the establishment of Primary Health Care
Organisations, evolving from or replacing the existing Divisions of
General Practice. These organisations will need to
• have appropriate governance to reflect the diversity of clinicians and
services forming comprehensive primary health care;
• be of an appropriate size to provide efficient and effective
coordination (say approximately 250 000 to 500 000 population
depending on health need, geography and natural catchment); and
• meet required criteria and goals to receive ongoing Commonwealth
funding support.
Centre for Primary Health Care and Equity
PHC Strategy 2010
Building blocks:
• Regional Integration through
establishment of Medicare Locals
• Integrated information systems
(including PCeHR)
• Developing a skilled workforce
• Infrastructure including superclinics
• Financing and System performance
Objectives:
• Improving access, reducing inequity
• Better chronic condition management
• Increased focus on prevention
• Improving quality, safety, performance
and accountability
Centre for Primary Health Care and Equity
PHC Strategic Framework (approved by health
ministers 2013) • Medicare Locals, as partners of Local Hospital Networks, assist in
supporting and enabling better integrated and responsive local
primary health care services.
• As independent bodies, they will be working across boundaries in
primary health care and creating interfaces with the acute and aged
care sectors.
• Medicare Locals also have responsibility for:
• population health planning and needs assessment for their
regions,
• identifying gaps in primary health care services,
• and developing and implementing strategies,
in collaboration with communities, population groups and service
providers that address these service gaps.
Centre for Primary Health Care and Equity
International experience
• Primary care organisations have been established
(and disestablished) in the United Kingdom, New
Zealand and some provinces of Canada.
• Functions vary but they include improving access to
and quality of primary care and integration between
primary, hospital and social care (eg aged care).
• Evaluations have demonstrated some improvements
in access and quality but less evidence of integration
of care and continuing variation in performance
between primary care organisations.
Centre for Primary Health Care and Equity
New Zealand
Centre for Primary Health Care and Equity
Objectives of Medicare Locals
1. To improve the patient journey through developing
integrated and coordinated services
2. To provide support to clinicians and service providers to
improve patient care
3. To identify the health needs of local areas and develop
locally focused and responsive services
4. To facilitate the implementation of primary health care
initiatives and programs (including ATAPS, After-hours
access and Closing the gap in indigenous health)
5. To be efficient and accountable with strong governance
and effective management
Centre for Primary Health Care and Equity
Evolution
– 61 Medicare Locals evolving from the previous
Divisions network
– First wave of 19 Medicare Locals established
July 2011; 18 in January 2012 and 24 in July
2012.
– allocated flexible federal funding of more than
$1.8 billion over five years as well as additional
funding for specific programs such as Closing
the Gap, Access To Allied Psychological
Services (ATAPS) and After-hours care.
Centre for Primary Health Care and Equity
Role of Medicare Locals in planning and co-
ordinating primary care and community health
services
• undertake population health needs assessment and planning
(including joint planning with Local Health Networks and other
organisations),
• participate in the national performance and accountability
framework,
• analyse PHC service gaps including for disadvantaged or under-
serviced population groups
• identify strategies to improve health outcomes and quality of local
service delivery
• facilitate reduction in inappropriate service use and avoidable
hospitalisation.
Centre for Primary Health Care and Equity
Responsive programs and services to address
local community needs (AMLA)
• 2,600 community / consumer events, in planning and designing
services in response to local need;
• Over a million occasions of service provided by Medicare Locals
through a mix of direct delivery and commissioned services, often to
vulnerable and disadvantaged populations
• 445,000 mental health occasions of service including Access to
Allied Psychological Services (ATAPS), the Mental Health Nurse
Incentive Program, headspace and rural psychological services.
• 135,000 services through the Coordinated Care and Supplementary
Services Program to Aboriginal and Torres Strait Islander people
with chronic disease
• 350 new after-hours services to improve access to urgent after-
hours care, including contracting general practice, medical
deputising services, after-hours clinics and pharmacy
Centre for Primary Health Care and Equity
Actions to improve equity of access to health services
Effective strategies in increasing equity of access to PHC:
• Making primary health care more available
• Reducing cost to consumers (co-payers)
• Establishing systems to increase availability (appointments/afterhours)
• Involving non-medical staff in service delivery
• Developing culturally appropriate services and providers
• Increasing continuity of care, and providing reminders for follow up care
• Involving local communities, and responding to their needs
• Providing education to develop patient skills and health literacy
• Providing outreach services
• Offering support through telephone, or home visits
• Monitoring accessibility through audit and patient feedback
Shi L, Starfield B, Kennedy B, Kawachi, I. Income Inequality, Primary Care, and
Health Indicators. J of Family Practice, 1999; 48(4): 275-284
Centre for Primary Health Care and Equity
Actions by MLs to improve equity of access to health
services
Effective strategies in increasing equity of access to PHC:
• Making primary health care more available (workforce)
• Reducing cost to consumers (ATAPS)
• Establishing systems to increase availability (afterhours)
• Involving non-medical staff in service delivery (allied health)
• Developing culturally appropriate services and providers (refugee health)
• Increasing continuity of care, and providing reminders for follow up care
(hospital pathways)
• Involving local communities, and responding to their needs (community
consultation and engagement)
• Providing education to develop patient skills and health literacy (patient
education)
• Providing outreach services (Closing the gap)
• Offering support through telephone, or home visits
• Monitoring accessibility through audit and patient feedback (Practice
support)
Centre for Primary Health Care and Equity
Consumers Health Forum
• The Medicare Local Program has
already demonstrated its potential
to engage consumers as active
participants in their own healthcare
• While the performance of
Medicare Locals has been
variable, several have already
made significant progress in
identifying and assessing the
healthcare needs and gaps within
their communities.
• Medicare Locals have succeeded
in establishing and administering
existing programs including after-
hours care programs.
Australian Medical Association Web Survey of 1212 GPs
• 68.8% indicated that their Medicare Local
had failed to engage and listen to them about
the design of local health services.
• 60.8% believed that their Medicare Local
does not value or recognise the inputs of
local GPs.
• 61.9% indicated that their Medicare Local did
not have effective programs to provide
patients in aged care facilities with access to
allied health services in a timely fashion.
• 73.0% indicated that their Medicare Local
had not improved local access to care for
patients in comparison to the former Division
• 71.6% believed that their Medicare Local had
not improved the delivery of primary care
overall and should not be retained.
Diverse views on the performance of Medicare
Locals
Centre for Primary Health Care and Equity
Access to general practice
• The percentage of patients who had
seen a GP in the preceding 12
months, and who felt they waited
longer than acceptable to get a GP
appointment, ranged from 28% to
8% across Medicare Locals
• The number of after-hours GP visits
per person varied from 0.71 visits per
person to 0.03 in 2010–11, and from
0.79 visits to 0.05 in 2011–12. The
number ranged from 0.71 visits per
person to 0.14 visits across metro
Medicare Local populations
nationally in 2010–11 and from 0.79
visits to 0.15 visits in 2011–12.
Percentages of children aged 1 year fully immunised, by
Medicare Local catchment, 2011–12
The percentage of children aged
1 year fully immunised ranged
from:
Highest 94% – Great South
Coast (Vic), Hume (Vic),
Barwon (Vic), Murrumbidgee
(NSW), Grampians (Vic),
Goulburn Valley (Vic),
Australian Capital Territory
Lowest 85% – Far West NSW
The percentage of Aboriginal
and Torres Strait Islander
children aged 1 fully immunised
ranged from:
• Highest 94% – Gold Coast
(Qld)
• Lowest 69% – Bentley-
Armadale (WA)
Centre for Primary Health Care and Equity
What next: Medicare Locals review
Led by Prof John Horvath AO is examining
• the role of Medicare Locals and their performance against stated
objectives
• the performance of Medicare Locals in administering existing
programs, including after-hours GP services
• recognising general practice as the cornerstone of primary care in
the Medicare Locals functions and governance structures
• ensuring Commonwealth funding supports clinical services, rather
than administration
• processes for ensuring that existing clinical services are not
disrupted or discouraged by Medicare Local programs
• interaction between Medicare Locals and Local Hospital Networks
and other health services, including boundaries
• tendering and contracting arrangements other related matters
Centre for Primary Health Care and Equity
Questions? / Discussion
www.cphce.unsw.edu.au