Medicare Locals

AMA Victoria will be holding a forum on Medicare Locals on Tuesday 13 July 2010. See details here. We encourage all GPs to attend.

Dr Harry Hemley wrote an article on Medicare Locals for Australian Doctor on 8 June 2010. Read the article here.

“The Government is putting in place new Medicare Local organisations that will decide what services the sickest people in our community need. We think the doctor and the patient should make patient care decisions, not some faceless bureaucrat.”

Look for the July edition of vicdoc for more on Medicare Locals, including this article from Dr Leon Massage.

Budget update: The Commonwealth has committed $460 million for Primary Health Care Organisations, to be called Medicare Locals.

• Divisions of General Practices will be progressively wound up as their contracts end.

• The Medicare Locals first task will be to coordinate after hours care, using nurse call centres, and referring to an ‘on duty’ doctor.

• Over time, Medicare Locals will also support community health promotion and prevention programs, and take a greater role in community-based mental health service provision.

• There’s an additional $460 million for Medicare Locals, but few details. Click here to read the Commonwealth Government's Medicare Locals facts sheet.

Dr Pesce said, “For the new primary health care organisations, or Medicare Locals, to be fully effective in meeting patient and community needs, they must complement and support the work of GPs, not replace them.

“As the Government has promised, GPs will remain responsible for the overall management of a patient’s care.

“Medicare Locals must provide GPs with more options to help their patients access allied health services - particularly in areas of unmet need.

“Medicare Locals must be about improving patients’ access to allied health care, and not adding new layers of bureaucracy and red tape.”

NHHRC recommendation 21: “Service coordination and population health planning priorities should be enhanced at the local level through the establishment of Primary Health Care Organisations, evolving from or replacing the existing Divisions of General Practice. These organisations will need to:

have appropriate governance to reflect the diversity of clinicians and services forming comprehensive primary health care;
be of an appropriate size to provide efficient and effective coordination (say, approximately 250,000 to 500,000 population depending on health need, geography and natural catchment); and
meet required criteria and goals to receive ongoing Commonwealth funding support.”

The report recommends that the government utilise the existing funding for divisions and provide an additional $150 million per annum (NHHRC, p. 252). Divisions had 3000 staff and $178 million in funding in 2007-08 (Data from PHCRIS 2009).

The Draft National Primary Care Strategy does not contain clear recommendations, but does consider Primary Health Care Organisations. The Australian General Practice Network (AGPN) is quoted as supporting Primary Health Care Organisations, and the draft strategy states, "Interestingly, there are differing views between the Divisions and AGPN on this issue. Almost half the individual Divisions made submissions ... and they were evenly split for and against the concept" (element 7, p. 105). The draft strategy also notes that the role of divisions or other regional organisations role in prevention could be strengthened (element 3) .

AMA Vice President Steve Hambleton said, "We know that GP-led primary health maximises health care benefits to our patients – and that is what we need to protect. If the proposed Primary Health Care Organisations are a mechanism to impose outside control, impose funds rationing and interfere in the doctor/patient relationship, they are to be resisted. If they are GP-led and are a mechanism to reduce the Federal-State bureaucratic divide and to focus scarce resources on unmet need, then they could be supported" (Australian Medicine, 14 December 2009).

The Prime Minister's final health reform plan will see Primary Health Care Organisations come from existing divisions networks. For more information, click here.