GPV is a QIC accredited organisation

Current Issues

Bill Newton

CEO Network

20 March 2009

Current Issues

• Reform agenda

• Funding formula, rurality and other changes

• Network performance

Reform agendaInputs• AGPN’s PHC Position Statement• Commissioned papers

– Harris, Kidd & Snowden– Jackson & O’Halloran– Swerissen– Dwyer & Eagar

• Other papers & reports– Centre for Policy Development– Expert Ref Group, Primary Health Strategy

Interim Report

AGPN Position Statement (p 35)

New regional enterprises will– Receive pooled funds; allocate regional budgets for services– Plan population health, primary health care activities, workforce.– Increase community engagement and intersectoral linkages– Contract providers to deliver services – data management; evaluation; quality monitoring.

Div Network: national infrastructure supporting primary health care delivery in Australia ...will play fundamental part in regionalisation

– Divs expand roles to a wider membership base; take on greater responsibilities for the health and wellbeing of the population

Options for divisions1. Become the regional enterprise 2. Be one of several members of regional enterprise 3. Service providers competing for funds from regional

enterprises

Commissioned papers

Harris, Kidd & Snowden (RACGP)• Divisions of General Practice become Divs of Primary

Health Care, representative of all involved in Primary Health Care (cp UK & NZ).

Jackson & O’Halloran• Regional Health Councils, (500,000 to 1 mil), to fund

and be accountable for all heath care. Members from– Area / District Health – Division– public hospital– private sector – indigenous community– community health sector – Local community

Swerissen

New governance and organisational arrangements to • plan and fund primary and community care • Register and accredit providers for access to funding• Monitor and manage provider performance and care outcomes • Report to government, consumers and the community on primary

and community care performance

Must be• Big enough to complement and integrate with hospital and

specialist services and to have the organisational capacity to develop and manage the service system

• at arms’ length from service providers • primarily focused on governance, development of system capacity,

management and accountability rather than service provision

Dwyer & Eagar

Regional Health Funding Authorities (HFAs)• whole states (Tas, NT, ACT, SA) or across state

boundaries (eg FNQ, the North NT, North WA)• plan, commission, fund and regulate health care

providers in their region • Commission, but not deliver, all services from

prevention to palliation to the regional population • funds networks or other collaborations among the

region’s health service providers

Centre for Policy Development

Regional Healthcare Organisation (RHO) • 200,000-400,000 people (=50 to 100 RHOs )• identify regional health needs, service utilisation

patterns, and health spending • Fund services to meet needs• Board: local government, divisions, area health

services or equivalent, CHCs, ACCHS, plus citizens/consumers to prevent domination by interests

External Reference Group, Primary Health Care Strategy(green discussion paper)

Regional organisation to • Plan & co-ordinate services• Deliver programs• Allocate funding to local services

NHHRC Interim Report• Regional structures to enhance service coordination

and population health planning; big enough to have a critical mass of clients and to provide efficient and effective coordination

• Divisions of Primary Health Care, evolving from or replacing Divisions of General Practice. These will need to be of an appropriate size and take into account

– alignment with state and territory health region boundaries

– natural regions across state borders

– their capacity to deliver on their core role and – their ability to facilitate networks

Implications for the Network

• Some form of regional organisation likely• Purchaser provider split• Divisions must

– Be of sufficient size and capacity – Align with other (health) boundaries– Consider natural regions across state borders – Develop and facilitate networks

Divisions Network Funding Formula

• Predicted to be introduced from 1 July 09• Will use 2006 ABS population data• Winners and losers; no additional funding• Extent of change will depend on SEIFA, rurality,

loadings, etc• Phased introduction?• Ministerial announcement expected in March, but timing

said in February not to be certain

Rurality, RRMA and ARIA

• RRMA will change to ARIA+• Likely disadvantage for Victorian

– Divisions– Practices– GPs

• Only relates to the geographical factors• No information about

– loadings for disadvantage, health needs, etc– Phased introduction?

• Awaiting minister’s decision

Implications for the Network

• The only certainty is that changes are coming• Speculation based on previous work since the

RIC (2004-05) suggests divisions in Victoria, Tasmania and SA will lose funding overall

• Uncertainty about planning for 2009-10• Anxiety among staff, possible loss of skilled

staff• Increased pressure and uncertainty for rural

GPs

Network Performance

• Minister Roxon: performance not consistent • Phillip Davies: failure to tackle network

weaknesses; some divisions struggle to demonstrate value; strong as weakest link, etc

• David Butt’s paper (20/11/09)– government is prepared to give divisions greater

roles and responsibilities but the network needs to demonstrate its ability to deliver high quality services consistently and cost effectively across the country

– key risk to the future role of the Network is poor performance in a few divisions having potentially profound consequences for the entire network.

Network performance (2)

• Stronger response from DoHA to perceived inadequacies and failures to deliver on contract

• More specific performance indicators in contracts

• Terry Findlay’s project• Not new issues; many raised by the Philips

Review and the Review Implementation Committee (2004-05)

So, what would a high-performing division look like?

Accredited

Governance features Contested elections Board members trained in governance Members judge division as well governed Regular turnover of board membership Including non GPs on Board Strategic plan independent of contracts Forward financial plan Benchmarks governance structures and processes

What a good division would look like(Vic/Tas CEOs 2006)

A CEO virtually full-time Qualified CEO A comprehensive monitored communication system

with the members A database that monitors practices, including

– Location– Accreditation status– PIP status– IM systems– Immunisation levels etc– GPs– Practice nurses– Practice managers– other staff– Division contact with all people in all practices

Management features

What a good division would look like(Vic/Tas CEOs 2006)

An integrated multi-disciplinary CPD program Provision of a Practice Nurse network Provision of a Practice Manager network All program staff understand and use the research

evidence for practice capacity (see UNSW CGPIS research, Wagner and Grol-the theoretical basis for division work)

Benchmarks programs and services Capacity to meet contractual requirements

demonstrated Diverse funding sources

Management features

What a good division would look like(Vic/Tas CEOs 2006)

Involved in joint collaborative projects with key stakeholders

Division recognised by stakeholders as key point of contact re GP

Engagement with communities

Stakeholder relations

What a good division would look like(Vic/Tas CEOs 2006)

Next steps for Victorian divisions?

• Discuss with boards• Strengthen member engagement• Consider criteria for

– Joint work, formal and informal linkages with neighbouring divisions

– Linkages with other services– Boundary re-alignment– Extension of membership