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Put family doctors at centre of primary care networks: AMA

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The organisations being set up by the Federal Government to replace Medicare Locals should be led by family doctors and focus on supporting general practice and plugging gaps in care, the AMA has said.

AMA President Associate Professor Brian Owler said the Horvath Review had identified significant problems in the conception and operation of Medicare Locals, and their replacement by Primary Health Networks (PHNs) was an important opportunity to get things right.

“While some Medicare Locals have clearly done a good job 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,” Associate Professor Owler said. “We can’t afford to get it wrong a second time.”

But the AMA has expressed concern about the possible involvement of private for-profit organisations, such as health insurers, in operating PHNs.

Late last month, A/Professor Owler sounded the alarm on an apparent concerted push by health funds to assume a greater role in primary health care, warning that experiments such as Medibank Private’s contribution to the running costs of some Queensland GP clinics in return for privileged access for its members could pave the way for US-style managed care.

In his review, released by the Government in May, former Chief Medical Officer Professor John Horvath found that the performance of Medicare Locals had been highly variable and inconsistent.

Professor Horvath reported that Medicare Locals had, by and large, fallen short of meeting the “genuine need” for organisations that brought together health professionals and hospitals to fill gaps in services and provide patients with seamless care.

“While there are a few high performing Medicare Locals, a great many are not fulfilling their intended role,” he said. “I found lack of clarity in what many Medicare Locals are trying to achieve, with considerable variability in both the scope and delivery of activities. This has resulted in inconsistent outcomes…dispirited stakeholder engagement, poor network cohesion, and reduced sector influence.”

A/Professor Owler said GPs needed to be given a central role in the PHNs to ensure such mistakes were not repeated.

“The AMA wants PHNs to be better targeted and more driven by family doctors at the local level,” he said.

The AMA President said international experience, including from New Zealand, showed that GP leadership was vital if PHNs were to make a difference and improve patient care and outcomes.

“GPs are generally the first point of call in the health system, and they can provide high quality clinical input as well as first-hand knowledge of where improvements in the health system need to be made,” he said.

In its submission to the Horvath Review late last year, the AMA recommended that Medicare Locals be replaced by a network of primary health controlled organisations that were led by, and responsive to, GPs; that focused on supporting GPs in caring for patients, working collaboratively with other health care professionals; and were not overburdened by excessive paperwork and policy prescription.

The AMA has developed a plan for PHNs that calls for a focus on three broad areas:

·        identifying local health needs and addressing gaps in services;

·        improving general practice capacity through IT, e-health and training support, and facilitating multidisciplinary team care; and

·        engaging with Local Hospital Networks to coordinate care for high risk patients, such as those with multiple chronic conditions.

Under the Government’s plans, PHNs will come into operation from 1 July next year.

Adrian Rollins