Primary Health Care Reform and PHCOs

1. Primary Health Care Reform and PHCOs

2. 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

3. Why reform? Australia’s health challenge 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

4. Reform Recommendations 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.

5. Reform Announcements 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.

6. Mental Health? • Primary Mental health services which target mild to moderate mental illness will be 100% Commonwealth Funded • Prison Health stays a State function • Specialist community mental health services for those with severe mental illness will be included in a further dialogue by COAG in 2011 • Initially many Commonwealth fund held mental health programs will be transferred to the PHCOs • ATAPs will be boosted to undertake more care for disadvantaged groups (ATAPS Tier 2) • ATAPs will get $58m to support flexible packages for acute mental health patients residing in the community ( ATAPS Tier 3)

7. What role for a PHCO? 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: • improving the delivery of and access to GP and primary health care services at the local level to ensure there are fewer gaps in services, particularly for patients with chronic conditions and special needs; • working with local health care professionals, and engaging with the community, to ensure services work with each other so that patients will find it easier to navigate the local health system to find services they need; and • working with LHNs to assist with patients’ transitions out of hospital, and where relevant into aged care, to ensure smoother transitions between service providers and greater coordination of services.

8. What role for a PHCO? • PHCOs will be responsible for a range of functions aimed at making it easier for patients to navigate the local health care system and to provide more integrated care (COAG B26.).They will: • work with local health care professionals to ensure services cooperate and collaborate with each other so that patients can easily and conveniently access the full range of services they need; • facilitate allied health care and other support for people with chronic conditions, as identified in personalised care plans prepared by GPs (Budget states this is the core function and mental health is considered chronic care) ; • identify groups of people missing out on GP and primary health care, or services that a local area needs, and better target services to respond to these gaps, for example, targeting gaps in GP services for aged care recipients;

9. What role for a PHCO? • work with Local Hospital Networks to identify the best pathways between services, and to assist with patients’ transitions out of hospital, and where relevant into aged care; • deliver health promotion and preventive health programs targeted to risk factors in communities, in cooperation with the National Preventive Health Agency, once it is established; and • as needed in the execution of other functions, undertake population level planning and potential fund-holding roles in areas of market failure and where patient needs are not being met. And ( Budget May 2010) • Fill gaps in after hours GP care • Facilitate linkages with aged care settings

10. Why divisions to be the starting point for a PHCO? 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

11. PHCO Membership 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

12. Governance 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

13. Accountability • PHCOs will have dual accountability: to members and to funders. The primary funder being the Commonwealth Government under an agreed and negotiated national performance and improvement framework. • PHCOs should operate under a set of organisational standards and nationally agreed performance and improvement indicators • PHCOs will report quarterly against a range of population health indicators on the local region they serve

14. Boundaries • These criteria include geography, predicted future growth corridors, communities of interest and relationship to other service infrastructure, and capacity for local community and stakeholder engagement, and of course politics • Based on these factors and the population criteria identified in the Final Report of the NHHRC, this would result in 50-60 PHCOs and around 120-140 LHNs • Cross border community of interests is a topical issue, and the logical mapping suggests the capital region could cross the border into NSW • However ACT is likely to have an ACT only LHN

15. Form KPMG have suggested several structural options- • Incorporating a new company limited by guarantee • Existing Division transforms into PHCOs • Divisions and/or other partner entities merge to form a PHCO • National Commission/Entity with branch regional entities • Joint venture established by two or more entities At this stage we don’t think they will be statutory authorities

16. A Voice for Primary Care 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.