The Health Reform Agenda

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

2. The Health Reform Agenda What is it? What are we up to? What does it mean for us? Helen Moore May 2010

3. Health Care Environment • Many challenges to overcome and opportunities to be seized • Government needs to deliver on two years of reviews • Government health plan accepted by COAG • Agenda being pushed by PM

4. Why change? • Health system is complex, fragmented, too institutionally focused • Tertiary care too expensive - can’t continue to do tomorrow what we are doing today • Importance of primary health care building globally

5. Globally from the WHO …..the experience of industrialised countries has shown that a disproportionate focus on specialist, tertiary care, provides poor value for money. And …… Hospital-centrism carries a considerable cost in terms of unnecessary medicalisation and iatrogenesis, and compromises the human and social dimensions of health.

6. Many studies done within countries both industrial and developing, show that areas with better primary care have better health outcomes, including total mortality rates, heart disease mortality rates and infant mortality and earlier detection of cancers…. The opposite is the case for higher specialist supply, which is associated with worse outcomes. Starfield B. M.D.

7. Key reform directions from COAG • Major reform of: Health and hospitals Economy Commonwealth/State relations • National Health and Hospitals Reform provides platform for reform of governance and financing on which other reforms can be built.

8. Key reforms for health ….. • One national health system • national leadership, • local delivery • One major government funder for health • 1 July 2011 Commonwealth covers 60% of efficient in-hospital costs • 1 July 2012 established Local Hospital Networks across the country

9. Other Announcements to date • Increase in GP, specialists and allied health training places • Post graduate support • After hours and rural locums • CDM package • Commonwealth - 100% responsibility for aged care • Mental health initiatives • Tobacco

10. The Budget….. • PHCOs called Medicare Locals in Budget papers • $290 million over 4 years to establish Medicare Locals • PHCOs will have similar but extended roles to divisions • $390.3 million over 4 years for 4600 full time GP nurses • $25,000 per full time GP for registered nurse, $12,500 for an enrolled nurse for eligible accredited general practices – to max $125,000 • $34.1 million for rural locum programs to support 3000 nurses and 400 allied health professionals for leave to attend CPD

11. COAG outcomes • definite focus on hospitals with significantly more money for public hospitals, • establishment and operation of Local Hospital Networks to be role of states/territories • Funding will be from Commonwealth, pooled at state level and distributed to LHN • Commonwealth more input to hospital policy, funding and performance

12. Primary Health Care Organisations • Commonwealth to take full funding and policy responsibility for all GP and PHC services • By 1 July 2011 first wave of PHCOs established • By 1 July 2012 remaining PHCOs to be established • PHCOs to be independent legal entities with strong links to communities, health professionals and service providers

13. What is a PHCO? • PHCOs will be built on GPNs • PHCO will be big enough to be robust and have capabilities and competencies to do job • PHCO will not be responsible for management of general practice and PHC services within boundaries • The number and boundaries of PHCOs determined by the Commonwealth

14. PHCO roles • Develop regional health plans and models of care for their communities • Support the health workforce (including practice support) and develop PHCO leaders and managers • Deliver programs that promote health • Allocate funding and ensure delivery of services • Direct health service provision to communities • Community and provider engagement

15. Transferred services – initial group • Community health centres services • Primary mental health care services • Primary and secondary prevention programs • Immunisation • Screening programs • Hospital avoidance programs

16. Transferred services – later • Community health promotion • Population health • Prevention programs • Drug and alcohol programs • Child and maternal health services • Community palliative care • Specialist community mental health services

17. Commonwealth’s aim … • Better integrate “the current patchwork of GP and primary health care services” • Reduce cost shifting and blame shifting • Drive efficiency • Encourage integrated care

18. Clear central message • PHC reform to be 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/Divisions

19. What does it mean for general practice? • General practice key to primary health care • PHCOs to support general practice by • facilitating integrated services, • enhancing capacity of practice to manage chronic conditions • ensuring greater access to services • assisting patients with hospital to home transition • providing preventive care programs

20. Our general practice network is ….. • Unique, valuable part of Australia’s health system • Only national, state and regional / local infrastructure of its type • Covers entire country, delivers local health solutions through general practice, with national and state based capacity to lead, support and guide the system • Has scope, agility and position to respond quickly and effectively in roll-out of national and local primary health care programs

21. Change is coming whether we want it or not It’s better to be there at the beginning and have some input!