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PHNs give many Medicare Locals new lease of life

Medicare Locals are involved in more than half the organisations selected by the Federal Government to succeed them, details of successful Primary Health Network applicants show.

The 28 preferred Primary Health Network operators announced by Health Minister Sussan Ley include at least 18 in which Medicare Locals are a dominant or major partner, including for PHNs in Northern and South Western Sydney, North West Melbourne, Gippsland, South Brisbane, Adelaide, Perth (both North and South), Tasmania, the Northern Territory and the ACT.

The Government has committed $900 million to create 31 PHNs to replace Labor’s Medicare Locals scheme, which is being shutdown following the results of the Horvath Review that found many were top-heavy, expensive and failed in their primary goal of supporting seamless patient care.

Ms Ley said that, by being much more closely aligned with the boundaries of state Local Hospital Networks and having a clearer focus on outcomes, the PHNs would ensure far better integration between primary and acute care services.

The Minister said the PHNs would work directly with GPs, hospitals, other health professionals and the community to ensure better care, including by reducing the merry-go-round of treatment experienced by many patients with chronic and complex conditions.

“Primary Health Networks will reshape the delivery of primary health care across the nation,” Ms Ley said. “The key difference between Primary Health Networks and Medicare Locals is that PHNs will focus on improving access to frontline services, not backroom bureaucracy.”

But, ironically, Medicare Locals appear to be the backbone of many of the consortiums that have successfully tendered to operate PHNs – a fact acknowledged by the Minister.

Many of the successful PHNs were harnessing skills and knowledge from a range of sources, including allied health providers, universities, private health insurers and “some of the more successful former Medicare Locals”.

“There’s no doubting that, individually, there were some high-quality Medicare Locals across the country,” Ms Ley said. “However, there were also plenty that haven’t lived up to Labor’s promise.”

The AMA was a leading critic of Labor’s Medicare Local scheme because it had limited the involvement of local GPs.

At the time the Horvath Review was released, AMA President Associate Professor Brian Owler said that while some individual Medicare Locals had performed well in improving access to care, “the overall Medicare Local experiment has clearly failed, largely due to deliberate policy decisions to marginalise the involvement of GPs”.

Concerns have also been expressed that private health funds might try to use PHNs to interfere in the provision of primary care, and insurers Bupa and HCF have been involved in supporting tenders for four PHN consortia, including the Partners 4 Health consortium in Brisbane North, and the WA Primary Health Alliance covering the three Western Australian PHNs (Perth North, Perth South and Country WA).

But, according to an investigation by Medical Observer, the insurers will have no operational role and were involved strictly as support players.

Partners 4 Health is the trading name of Metro North Brisbane Medicare Local, and Chief Executive Abbe Anderson told Medical Observer HCF and Bupa were just two of many groups that had backed the successful application from her organisation.

“While MNBML has the support of a wide range of key participants – including those listed – I think we had over 30 organisations that provided us with letters of support and endorsement in our application,” Ms Anderson said. “But the PHN itself will be governed and managed by the same organisation that has been running the ML since its inception.”

Adrian Rollins