Medicare Locals up for discussion

The Gillard Government is getting on with the job of reforming our health and hospital system and has taken the important next step in establishing a network of primary health care organisations – Medicare Locals – by releasing a discussion paper on their planned roles, functions and governance.

The discussion paper outlines what activities Medicare Locals will undertake, how they will be structured, and how they will engage with patients and health providers.

The paper outlines five key objectives for Medicare Locals:

• Identification of the health needs of local areas and development of locally focused and responsive services including a stronger focus on prevention and early intervention;
• Improving the patient journey through developing integrated and coordinated services;
• Providing support to clinicians and service providers to improve patient care, particularly the better prevention and management of chronic disease;
• Facilitating the implementation and successful performance of primary healthcare initiatives and programs; and
• Being efficient and accountable with strong governance and effective management.

The paper expects that Medicare Locals will be independent legal entities with formal linkages to Local Hospital Networks and will build upon the existing role of Divisions of General Practice.

Medicare Locals will have strong links to local communities, health professionals – including GPs, practice nurses and allied health professionals – and service providers enabling them to respond more effectively to the needs of local communities.

They will provide more co-ordinated care, improve access to services and drive integration between GPs, hospitals, allied health, mental health and aged care.

Minister for Health and Ageing, Nicola Roxon, said that one of the first important tasks of Medicare Locals will be to help coordinate 24 hour GP after hours access, which will take pressure off our hospitals.

GP Super Clinics are a key element of the Australian Government’s strategy to build a stronger primary health care system, having already provided over 250,000 services across Australia.

A total 26 GP Super Clinics are currently either operational, offering early services or under construction.

The first Medicare Locals are expected to commence operations in mid-2011 with the remainder commencing in mid-2012.

The Government’s discussion paper and information on how to respond to the discussion paper is available at http://www.yourhealth.gov.au. Submissions must be received by 15 November 2010.

The National Rural Health Alliance (NRHA) has provided Minister Roxon, with a Rural Issues Paper on Medicare Locals. NRHA chair, Dr Jenny May, says that for Medicare Locals to be effective in rural and remote areas a number of critical characteristics must apply and there are traps to avoid.

“Last week’s announcement by Health Minister of some of the proposed details went only so far in settling the nerves of those who fear that a major opportunity may be lost,” said Dr May.

The Alliance believes key issues for Medicare Locals in rural and remote areas must include:

• close engagement with the local community and clinicians;
• their boundaries being based on communities of interest – meaning that in some areas they must traverse state/territory borders;
• the flexibility to select the focus of their first activity;
• having a close working relationship with hospitals and other health institutions in their own
• area and in the regional centre and capital city; and
• funding and other support measures commensurate with their work.

“In rural areas the location and size of Medicare Locals should be determined by the benefits of ‘localisation’ rather than by considerations of economies of size. They must be small enough in area for meaningful relationships to be maintained among individual clinicians, and between them and local hospitals, other service providers and the community. Their boundaries should be fixed in part by community of interest – including current flows of people to retail and other services,” said Dr May.

The Alliance believes populations of 50,000 are sufficient for the effective undertaking of the tasks envisaged for Medicare Locals: assessing local health needs, planning to meet those needs, and supporting programs and personnel once they are in place.

“Medicare Locals will not work well if they span huge geographic distances and ignore natural communities of interest. In less populous areas where it is the same clinicians who staff primary, acute and aged care facilities, the Medicare Local and the Local Hospital Network should operate as a single entity,” she continued.

“Only this will result in the sort of integration necessary to support the interdependence of primary, hospital and aged care that already exists in more remote areas. The new Medicare Locals should be allowed to select the key local priorities for the first focus of their work and be given sufficient resources to succeed.

“There will be unavoidable competition between them for the scarce services of epidemiologists, population health experts and health service planners – and rural health workforce shortages will be brought into even sharper focus,” she said.

Failure now carries the risk of ‘reform aversion’ for years to come. In rural and remote areas progress will be determined by the extent to which inequities in access to health services and in health status are reduced.