Current Issues

1. Current Issues Bill Newton CEO Network 20 March 2009

2. Current Issues • Reform agenda • Funding formula, rurality and other changes • Network performance

3. Reform agenda Inputs • AGPN’s PHC Position Statement • Commissioned papers • Harris, Kidd & Snowden • Jackson & O’Halloran • Swerissen • Dwyer & Eagar • Other papers & reports • Centre for Policy Development • Expert Ref Group, Primary Health Strategy Interim Report

4. AGPN Position Statement (p 35) New regional enterprises will • Receive pooled funds; allocate regional budgets for services • Plan population health, primary health care activities, workforce. • Increase community engagement and intersectoral linkages • Contract providers to deliver services • data management; evaluation; quality monitoring. Div Network: national infrastructure supporting primary health care delivery in Australia ...will play fundamental part in regionalisation • Divs expand roles to a wider membership base; take on greater responsibilities for the health and wellbeing of the population Options for divisions • Become the regional enterprise • Be one of several members of regional enterprise • Service providers competing for funds from regional enterprises

5. Commissioned papers Harris, Kidd & Snowden (RACGP) • Divisions of General Practice become Divs of Primary Health Care, representative of all involved in Primary Health Care (cp UK & NZ). Jackson & O’Halloran • Regional Health Councils, (500,000 to 1 mil), to fund and be accountable for all heath care. Members from • Area / District Health • Division • public hospital • private sector • indigenous community • community health sector • Local community

6. Swerissen New governance and organisational arrangements to • plan and fund primary and community care • Register and accredit providers for access to funding • Monitor and manage provider performance and care outcomes • Report to government, consumers and the community on primary and community care performance Must be • Big enough to complement and integrate with hospital and specialist services and to have the organisational capacity to develop and manage the service system • at arms’ length from service providers • primarily focused on governance, development of system capacity, management and accountability rather than service provision

7. Dwyer & Eagar Regional Health Funding Authorities (HFAs) • whole states (Tas, NT, ACT, SA) or across state boundaries (eg FNQ, the North NT, North WA) • plan, commission, fund and regulate health care providers in their region • Commission, but not deliver, all services from prevention to palliation to the regional population • funds networks or other collaborations among the region’s health service providers

8. Centre for Policy Development Regional Healthcare Organisation (RHO) • 200,000-400,000 people (=50 to 100 RHOs ) • identify regional health needs, service utilisation patterns, and health spending • Fund services to meet needs • Board: local government, divisions, area health services or equivalent, CHCs, ACCHS, plus citizens/consumers to prevent domination by interests

9. External Reference Group, Primary Health Care Strategy(green discussion paper) Regional organisation to • Plan & co-ordinate services • Deliver programs • Allocate funding to local services

10. NHHRC Interim Report • Regional structures to enhance service coordination and population health planning; big enough to have a critical mass of clients and to provide efficient and effective coordination • Divisions of Primary Health Care, evolving from or replacing Divisions of General Practice. These will need to be of an appropriate size and take into account • alignment with state and territory health region boundaries • natural regions across state borders • their capacity to deliver on their core role and • their ability to facilitate networks

11. Implications for the Network • Some form of regional organisation likely • Purchaser provider split • Divisions must • Be of sufficient size and capacity • Align with other (health) boundaries • Consider natural regions across state borders • Develop and facilitate networks

12. Divisions Network Funding Formula • Predicted to be introduced from 1 July 09 • Will use 2006 ABS population data • Winners and losers; no additional funding • Extent of change will depend on SEIFA, rurality, loadings, etc • Phased introduction? • Ministerial announcement expected in March, but timing said in February not to be certain

13. Rurality, RRMA and ARIA • RRMA will change to ARIA+ • Likely disadvantage for Victorian • Divisions • Practices • GPs • Only relates to the geographical factors • No information about • loadings for disadvantage, health needs, etc • Phased introduction? • Awaiting minister’s decision

14. Implications for the Network • The only certainty is that changes are coming • Speculation based on previous work since the RIC (2004-05) suggests divisions in Victoria, Tasmania and SA will lose funding overall • Uncertainty about planning for 2009-10 • Anxiety among staff, possible loss of skilled staff • Increased pressure and uncertainty for rural GPs

15. Network Performance • Minister Roxon: performance not consistent • Phillip Davies: failure to tackle network weaknesses; some divisions struggle to demonstrate value; strong as weakest link, etc • David Butt’s paper (20/11/09) • government is prepared to give divisions greater roles and responsibilities but the network needs to demonstrate its ability to deliver high quality services consistently and cost effectively across the country • key risk to the future role of the Network is poor performance in a few divisions having potentially profound consequences for the entire network.

16. Network performance (2) • Stronger response from DoHA to perceived inadequacies and failures to deliver on contract • More specific performance indicators in contracts • Terry Findlay’s project • Not new issues; many raised by the Philips Review and the Review Implementation Committee (2004-05) So, what would a high-performing division look like?

17. What a good division would look like(Vic/Tas CEOs 2006) • Accredited Governance features • Contested elections • Board members trained in governance • Members judge division as well governed • Regular turnover of board membership • Including non GPs on Board • Strategic plan independent of contracts • Forward financial plan • Benchmarks governance structures and processes

18. What a good division would look like(Vic/Tas CEOs 2006) Management features • A CEO virtually full-time • Qualified CEO • A comprehensive monitored communication system with the members • A database that monitors practices, including • Location • Accreditation status • PIP status • IM systems • Immunisation levels etc • GPs • Practice nurses • Practice managers • other staff • Division contact with all people in all practices

19. What a good division would look like(Vic/Tas CEOs 2006) Management features • An integrated multi-disciplinary CPD program • Provision of a Practice Nurse network • Provision of a Practice Manager network • All program staff understand and use the research evidence for practice capacity (see UNSW CGPIS research, Wagner and Grol-the theoretical basis for division work) • Benchmarks programs and services • Capacity to meet contractual requirements demonstrated • Diverse funding sources

20. What a good division would look like(Vic/Tas CEOs 2006) Stakeholder relations • Involved in joint collaborative projects with key stakeholders • Division recognised by stakeholders as key point of contact re GP • Engagement with communities

21. Next steps for Victorian divisions? • Discuss with boards • Strengthen member engagement • Consider criteria for • Joint work, formal and informal linkages with neighbouring divisions • Linkages with other services • Boundary re-alignment • Extension of membership