Behind the smoke and mirrors: Medicare Locals
‘Medicare Local’ is the latest buzz-term in the Rudd Government’s ever growing arsenal of words. What are they, who will be in charge, and most importantly, will they be of any use in real health care terms? Dr Leon Massage sifts through the spin to find out.
There has been so much spin about Medicare Locals and their previous incarnation, Primary Health Care Organisations, that most people, even well-informed doctors, are confused about what they really are, what they will do, and who will run them.
If the aim of the Commonwealth Government was to confuse and obfuscate, it has done a great job and should congratulate itself. In this brief article, I will try to get past the smoke and mirrors, and the spin, and explain the truth behind the moves.
What are Medicare Locals?
Medicare Locals is Kevin Rudd’s preferred name for the concept that had previously been known as Primary Health Care Organisations (PHCOs).
One of the 123 recommendations of the National Health and Hospitals Reform Commission (NHHRC) was that Divisions of General Practice should morph into, or be replaced by, PHCOs. Most Divisions were perceived as being too small, and these new entities would need to serve larger populations of between 250,000 and 500,000.
It was specifically stated that the boards of these new organisations would not be made up of General Practitioners. In order to “reflect the diversity of Primary Health Care” these boards would have to include different health professionals; and they would also require board members with a diversity of skills such as legal and financial.
The end of Divisions as we know them
The spin:
The official line is that the Divisions will evolve into Medicare Locals (PHCOs).
The truth:
Divisions of General Practice, as we know them, are finished; gone; kaput.
Funding for the Divisions of General Practice will cease from June 30 2012. They will disappear.
Medicare Locals will be established as new companies. They will definitely not be Divisions of General Practice, and they will not be run for GPs or by GPs.
Their target audience will be the larger community; they will no longer be general practice-oriented. They will be totally new organisations that are not membership-based.
What will Medicare Locals do?
The spin:
There is a lot of talk about the TTThe Government says these organisations will do everything. They will improve health, work with GPs and forge closer ties with communities. They will also solve the problems of chronic disease, service inadequacy and doctor shortage, and lots more.
The truth:
The structure and function and composition of Medicare Locals is still undeclared and unknown. There is no question that the change to Medicare Locals is
more about politics than it is about health care.
What are Medicare Locals likely to do? They will look after the primary healthcare needs of a region. They will possibly take on service coordination for patients, especially those with chronic and complex problems. And they are also likely to be responsible for population planning and for meeting specific Commonwealth-initiated targets.
What will Medicare Locals not do? They will definitely not be looking after the needs of GPs or general practice.
Do you remember the beginning of the Divisions movement?
Those of you who have excellent memories will remember that Divisions were created to improve health delivery to the community by focusing on GPs. They were founded to up-skill GPs, remove them from isolation, improve knowledge and uptake of IT and implement change.
Divisions achieved all this, and much more.
Most importantly, the money that was used for the creation of Divisions was taken from the Medicare rebates for general practice. In other words, GPs paid for them.
I am not arguing for the continuation of Divisions of General Practice. It is quite possible that Divisions of General Practice have had their day and it is time for them to be disbanded.
Saving the Divisions of General Practice is not the issue. The big losers in this new equation are GPs. The question that must be answered is: who is going to continue to support our GPs with IT, continuing medical education, accreditation, and all the other benefits that they have been getting from their Divisions? It certainly will not be the Medicare Locals!
The only thing local about Medicare Locals is their name. They will just be large, cumbersome, bureaucratic organisations that will purport to represent every allied health entity.
Rather than being local, they will be far more distant from the community and from primary care providers - especially general practitioners. The relationships that many Divisions of General Practice have cultivated and established with their GPs over 15 years will disappear overnight.
