Government should “reinforce general practice as the cornerstone of integrated primary health care, to ensure patient care is optimal” – Review of Medicare Locals
It took just a 16-page report and a stroke of the Federal Treasurer’s pen to end the life of the 61 Medicare Locals that were established in 2011-2012 to improve the coordination and integration of primary health care in Australian communities.
At the time it was said they would “make it easier for patients to navigate their local health care system”. How well this worked might be judged from the finding that the ‘Medicare Local’ name was so confusing that many people still came to ML offices seeking Medicare refunds.
In his report to the Minister for Health, Professor John Horvath AO noted, “I observed signs on the doors of Medicare Locals advising they were not a claims office.”
Unlike the proposed $7.00 GP co-payment, the decision on the Medicare Locals was one of the better-kept secrets in Budget 2014, although this may not be saying much.
However, it came as little surprise, and no great disappointment to many observers, even if some of the MLs were considered good performers, with the NSW North Coast’s local entity believed to be one of them.
The Medicare Local scheme, which will no longer be funded after June 2015, was a centrepiece of the former Labor government’s health reform agenda. Now it is to be unpicked: the name (“confusing and without contextual meaning”) will be scrapped, and its national umbrella body, the Australian Medicare Local Alliance, will be abolished (“it appears to have struggled to understand its role and fulfil its mandate”).
The AMLA chair Dr Arn Sprogis described the government’s decision as “shocking”, asserting that it will affect frontline health services and the health and wellbeing of Australians around the country. He said replacing Medicare Locals with Primary Health was 'reinventing the wheel' and a waste of taxpayers' money.
Conversely, the NSW North Coast Medicare Local (NCML) welcomed the release of Professor Horvath’s report, with CEO Vahid Saberi saying it “validated the work being done by the Board and staff across the NSW North Coast.”
Mr Saberi added that over the past two years NCML staff had been “buoyed by the community’s receptivity and recognition of the work they are doing to connect health services, fill existing gaps and ensure everyone in the community has access to quality health care when and where they need it.”
Because “most people who use hospital services also see a GP, specialists and other allied health services, we have created partnerships and put systems in place to make the patient journey through the health system easier to navigate,” Mr Saberi said.
Importantly, GPs will be returned to a central role in the regional healthcare process as key advisers to new ‘patient centred’ Primary Health Organisations (the name is a recommendation only).
“It is essential GPs have a significant presence within the corporate structures of PHOs,” Prof Horvath said.
“Broader and deeper GP involvement can be achieved through establishing local Clinical Councils. I see these Councils as influencing inter-sector collaboration, developing and monitoring integrated care pathways, and identifying solutions for service gaps.
“GPs need to buy-in to PHOs and see benefits from their involvement.”
Further addressing GP involvement, he added, “General practice is critical for a high performing, cost effective, primary health care system to orientate health care away from expensive hospital services.
“It is paramount that relationships with general practice are rebuilt and GPs are appropriately engaged. There needs to be GP buy-in at both the governance and operational levels and for them to be able to see benefit of their involvement.”
He felt the PHOs should be “boundary aligned” with existing Local Hospital Networks (known as Local Health Districts, LHDs, in NSW), a goal that may be a challenge to achieve, as he advocated fewer planning entities, not more. Yet most MLs, and certainly the NSW North Coast’s, span a footprint larger than a single LHD. In our case, the ML covers Northern NSW and Mid North Coast LHDs.
Other recommendations included that,
• Government should review the current Medicare Locals’ after hours programme to determine how it can be effectively administered. The government should also consider how PHOs, once they are fully established, would be best able to administer a range of additional Commonwealth funded programmes.
• PHOs should only provide services where there is demonstrable market failure, significant economies of scale or absence of services.
• PHO performance indicators should reflect outcomes that are aligned with national priorities and contribute to a broader primary health care data strategy.
“PHOs will build on the strengths of Medicare Locals, but by avoiding unnecessary corporate bureaucracy and duplication a greater proportion of funding should be targeted to frontline services,” Prof Horvath said.
“General practice will have a key role in PHOs and, through Clinical Councils, a greater say in the governance and strategic direction of their local primary health care systems and development of integrated care pathways.
“Similarly, local communities, through Community Advisory Committees, will have greater engagement to shape health services.”
He ended on an upbeat note: “The future for primary health care is bright.”