Overview of Primary Health Care Organisations
  The National Health and Hospital Reform Commission released a report which recommended sweeping changes to what we loosely call our health system. However, it is one of the more boring recommendations which nonetheless seems to have captured the imagination of many GPs; the Primary Health Care Organisation (PHCO). IntroductionPHCOs are not to be confused with “Comprehensive Primary Health Care Centres” which have been described as super superclinics. At this stage there is no relationship between the two.   The PHCO is poorly described in the NHHRC report but much has been read into that description that doesn’t exist in reality. In fact, the role to be performed by PHCOs is described as follows: “Primary Health Care Organisations (evolving from or replacing Divisions of General Practice) should provide future service co-ordination and population health planning within local communities.”  Defining the differences with Divisions of General Practice; the difference between PHCOs as described in the NHHRC Report and Divisions of General Practice may be summarised as follows:
  1. Size
PHCOs are going to be bigger geographically. Recommendation 21 says that PHCOs should “be of an appropriate size to provide efficient and effective coordination (say, approximately250,000 to 500,000 population depending on health need, geography and natural catchment)”. They’re also going to be broader in membership in that primary care clinicians of all types would need to be engaged to some extent to enable any sense of meaningful service co-ordination. How this would be achieved is not described.
  1. Governance
The Minister has stated that PHCOs will not be Statutory Authorities (AGPN Forum, 2009). Given that, PHCOs are most likely to be companies limited by guarantee as is the Division currently. However, the governance structure will be required to “reflect the diversity of clinicians and services forming comprehensive primary health care” (recommendation 21).
  1. Population health planning
This is new. Population health has hitherto, in NSW at least, been the responsibility of Area Health Services. It will require significant data collection and management capacity.
  1. Service co-ordination
Many Divisions have little experience in this area. IDGP has been engaged in the Illawarra Co-ordinated Care Trial, Illawarra leg Ulcer Clinic (ILUC) , headspace and the Clinical Psychology Service (CPS) so would seem to have some advantage in this area. Keeping what’s worked, if IDGP members choose to move IDGP on into a PHCO, it would be expected that we would insist that existing GP services were transferred. These would include:

  1. OTIiS

  2. Practice support staff

  3. Home Medication Review

  4. National Prescribing Service support

  5. CPS

  6. ILUC (Illawarra leg Ulcer Clinic)

 

In summary, the NHHRC Report is light on detail but they recommend PHCOs should be bigger than Divisions of General Practice but similar in function apart from a population health capacity. The most demanding challenge on a PHCO would be making services “joined up” (K Rudd, July 2009), ie making the patient journey through multiple providers easier.

 AGPN view

AGPN has released their own “Blueprint” for PHCOs. That’s a different picture. They start by emphasising the centrality of general practice to the success of PHCOs. They suggest that PHCOs should commence in June 2012 when the main contract for Divisions of General Practice expires. The important additional recommendations to those of the NHHRC include:

  1. Services to general practices

  2. Services to the community for disadvantaged people

  3. Health promotion

  4. Workforce support (at present other agencies are funded for this task)

  5. That PHCOs are specifically tasked to facilitate interdisciplinary education and research in primary care.

Bit more dramatic than the NHHRC but, at this stage, no great changes for Illawarra GPs.

 Funding as recommended by AGPN

The NHHRC Report does not make any recommendations on funding for PHCOs but the AGPN Blueprint does. Funding sources suggested by AGPN include:

  1. Existing Divisions’ funding (which would be relatively greater due to reducing the number of boards, CEOs, Finance and HR managers, etc)

  2. Community Health funding. This is a major recommendation as Community Health has (or used to have in the Illawarra) large staff numbers. However, the recommendation is logical in that they are the experts in health promotion. This recommendation is particularly important in NSW which has seen Community Health used as a vehicle for supporting early discharge of elderly patients from hospitals – an entirely inappropriate role for Community Health staff.

  3. Other (unspecified) Commonwealth funding that currently goes to NGOs. This could be quite a controversial recommendation.

  4. MBS and PBS are specifically excluded from the funding model.

 Governance as recommended by AGPN

The Blueprint refers to two options for Divisions; viz amalgamation or the formation of a new organisation. The Board of each PHCO would be “skills based”. This means that there would be a mix of GPs (and other clinicians) with people with particular skills relating specifically to governance.

Membership would be either individual or by representative group. This is an important distinction. A large PHCO would not only have perhaps 500 – 700 GPs as members (if they chose to join) but many other allied health professionals as well. This is the major risk to GPs but a risk which can be mitigated by appropriate Articles of Association.

 Summary

The NHHRC Report is light on detail about PHCOs. AGPN has entered the debate with wider ranging recommendations but which still lacks detail. There is no suggestion that PHCOs take over the funding of general practice but there is a recommendation that they do take over Community Health funding.

There is no suggestion that GPs will have to belong to a PHCO as indeed a small number are not members of Divisions of General Practice  If PHCOs work, they will have achieved two outcomes. They will have made the patient journey easier for patients and for GPs and they will have improved access to health care by the population in general and by the marginalised in particular. Both are considerable challenges.  Unmentioned in either document is the important outcome to make general practice an attractive career option for young medical graduates. It must succeed on that basis or anything else is just shuffling the deck chairs.

  
 
site designed and developed by e-motion design
Illawarra Division of General Practice