Launch of Capital Health Network

Yesterday I spoke at the launch of the Capital Health Network. The entity was officially launched by Simon Corbell MLA, Minister for Health and Deputy Chief Minister.

The Chair of the Network, Dr Martin Liedvogal, shared the Blue Print with attendees. This document sets out the roadmap for the Network.

My speech is posted here for people to read. As usual, I strayed from the script a little bit...


Health Care Consumers Association is very pleased to work with the Capital Health Network. We are the peak consumer organisation in the ACT and represent the interests of consumers in our very complicated health system.

Consumers and carers need to have a strong voice not only at the Board level but across the operational areas of the Network. We supported a small group of experienced consumer representatives and advocates to provide important perspectives in the development of the blueprint for the Capital Health Network. We worked closely with the staff to develop the foundation documents.

We need to build our understanding of the needs of the community so that services can be developed and supported to meet those needs. The population health planning function of the Network presents us with an opportunity to refine our health system to keep our community as well as possible.

Primary healthcare is essential to a healthy community. There is a new round of reform being led by the Federal Government and this is driven by the desire to control costs in the health system.  But we need to remember that it should not only be about reducing costs in the short term but how we can improve the health of our communities in the long term. The focus of the reform has to be on spending health dollars on what works the best.

There is also reform in workforce. We are at an interesting point where there are many players stepping into the primary care space. General practice-based primary health care is still key but we are seeing the potential for more services delivered by other health practitioners like health coaches, peer workers in mental health and – dare I say it - pharmacists. And we know that private health insurers in this country are also very interested in how they can offer products to support consumers in primary care.

We are also seeing an increased focus on self care and self-management by people with chronic conditions. Health literacy is the key.

Affordability of healthcare is one of the biggest issues for consumers. Out of pocket costs of primary health care are significant. The MBS rebate has not kept pace with the increasing costs and so many consumers face very real decisions about what services to access or which prescription to fill. Cost to see GPs, medical imaging, pathology, prescription and over the counter medications, physiotherapists, and then there's the cost for dental care.

We need to make primary health care more affordable so people can access the care that will benefit us. The stronger our primary health care the less demand for acute services.

There is much work to do but the Capital Health Network does not have to do this alone. There are roles for the ACT Government, the professional bodies, community services, consumer organisations and of course the Network’s membership.

So in closing I would like to congratulate the staff and Board of the Capital Health Network. I would also like to acknowledge the work of the former CEO Leanne Wells, former Board Chair Rashmi Sharma, and also the role that Vlad Alexandric and Angelene True have played in the transition.

Community based solutions can only be developed in partnership. Clearly the Capital Health Network understands this and we look forward to continuing to work with them to meet the challenges the primary health care system faces and improve the health of our communities.

Darlene Cox
Executive Director

CORPORATISED MEDICINE – A BLESSING OR A BURDEN FOR CONSUMERS?

The Sydney Morning Herald has been running a few articles about corporatised medicine this week.  HCCA has had concerns about this development as it has applied in the ACT, especially after the closure of corporate practices in Wanniassa and North Canberra a couple of years ago, and the forced re-location of their doctors to corporate medical centres in the town centres.

Corporatisation of General Practice is becoming increasingly commonplace in Australia.  In 2006-7, only 8.2% of general practitioners were working solo, while 56.1% worked in practices with five or more doctors, although not all of these could be classed as fully corporate practices in the way this is generally understood.  The attraction of corporate medical clinics, such as those run by Primary Health Care, Sonic Health and Healthscope, seems obvious if you are a GP.  Joining a corporate clinic means that the administrative costs and procedures are dealt with by the company and not the doctor, alleviating an area of concern for many general practitioners.  In addition, generous “sign-on” fees are often offered to entice GPs into selling practices.  However, GPs who “sign-on” with a corporate clinic agree to work a certain number of hours and to sacrifice as much as a half of their billings to the corporation.

As a result of this system, insiders claim that GPs working in corporate clinics are pressured into cramming more patients into consultation hours, reducing time spent with each patient and increasing profits.  The “all-in-one” service approach of many corporate clinics has drawn criticism as well.  Many clinics house various diagnostic services such as pathology and x-ray, meaning that it is financially desirable to have patients take advantage of such services “in-house”. 

For consumers, there are both benefits and disadvantages to this arrangement.  For example, most corporate clinics bulk-bill patients as in a large practice this is financially viable.  In house diagnostic services are also a positive, when they are employed appropriately.  However, these gains may come at the loss of continuity of care for patients, as in a corporate clinic patients do not usually have a regular doctor, but see whichever GP is available at the time.  Also, there has been a disturbing recent trend in some corporate clinics to demand an upfront payment from those presenting for services at a clinic, and this is not refunded even if a disgruntled consumer leaves to seek treatment elsewhere because of long wait times.

The unfair treatment of GPs in this environment where profit is the biggest motivator has garnered media attention in NSW in recent days.  Primary Health Care has been accused of demanding that doctors complete more hours on the end of their contracted time in order to make up their quota.  GPs claim they have been threatened with litigation by the health care giant. 

HCCA stands against this type of corporatised medicine which does little to embrace the new paradigm of patient-centred care being promoted by the Australian Commission on Safety and Quality in Health Care.  In 2008, HCCA supported a rally to try to keep the GP clinic at Wanniassa open, and later appeared at a Legislative Assembly inquiry into GP shortages, noting that centralisation of GP resources into town centre locations did little to make access to GPs any easier.

Details of past HCCA positions on GP clinics and more information about people centred care can be obtained from the HCCA office.   Remember, GPs are people too.  Please let HCCA know if you have had any recent positive or negative experiences with corporatised medicine in Canberra or NSW, and we will feed this back to the Commission in response to its consultation paper on patient-centred care.  There are other potential solutions to the problems that have led to the development of corporate GP clinics.  Better public primary healthcare services through enhanced community health centres incorporating nurse practitioner led walk-in clinics and collective practices such as Super Clinics supported by Commonwealth Government funded infrastructure are two new models we would support in Canberra.  Let’s hope the current reforms in health policy settings will give more support to these options.

Russell McGowan

Consumer experiences of self managing chronic conditions

In August HCCA facilitated a workshop of around 50 consumers on behalf of the ACT Division of General Practice (ACTDGP). This workshop is part of Interprofessional Learning Project currently underway involving ANU and the ACTDGP.

Consumers were asked specifically about what helps them to self management their chronic conditions and what barriers they encounter in their self management. Participants worked in table groups to share their experiences and document their ideas.










A number of speakers also gave presentations to participants.

Russell McGowan (Pictured) talked about the national level reform in chronic conditions and also talked about his involvement with the Consumers Health Forum project on developing resources to support people to self manage their chronic conditions

Judy Stone, told the participants about the Interprofessional Learning programs currently underway in ACT Health

Other speakers included Susan Abbott (ANU), Amanda Plowright (SHOUT), Ann Thomson (RSI and Overuse Injury Association) and Jo Stewart, a peer leader for the Living a Healthy Life with Chronic Conditions workshops.

Enablers

Knowledge of the system and their condition were identified as important enablers for consumers. Working with a doctor who is knowledgeable about the condition, treatment options and available supports was also important. Research, particularly using the internet, was mentioned as were self help courses as a way of gaining knowledge.

Some existing services were identified as significant enablers for managing chronic conditions: Job Access, psychology services, hydro pools and other services sere identified as desirable. Good medical services particularly GP services were also identified as enablers.

Participants identified the need for appropriate design for people with chronic conditions.

Participants repeatedly identified support from others, groups, families, friends, as important enablers for management of chronic conditions.

When communication channels are respectful, informed, inclusive and personable they were seen as enabling the management of chronic conditions. Effective communication between health providers facilitated by good record keeping was also identified.

Participants identified good treatment and plans to treat as important in enabling them to manage a chronic condition. This plan could include lifestyle factors. A multi pronged or holistic approach was mentioned.

Having plenty of money was identified as an enabler to self managing a chronic condition.

Participants identified that a positive attitude and determination are useful enablers.

Barriers

Participants were very vocal about the need for health professionals to interact with them as people first. They want respectful, honest, considered and comprehensive communication about their situation.

Lack of Medical Profession Knowledge about chronic conditions was seen as a barrier to the management of those conditions and the variation between doctors knowledge was raised by participants.

Participants recognized that they needed to be well informed about their chronic conditions, however they were struggling to gather reliable information which would help them to successfully manage their chronic conditions. They were also concerned about the level of general knowledge in the community about chronic conditions.

The shortage of doctors in Canberra both GP’s and specialists was seen as a barrier to managing chronic conditions. This was reflected in many comments about waiting times to see doctors.

Participants identified specific areas of service deficit as a barrier to managing chronic conditions. These included, interpreter services, hydro therapy, rehab gyms, well resourced support groups, advice advocacy services, and service closures.

Carers were recognized by participants as central to their ability to self manage their chronic conditions and when carers were not available self management was threatened.

Participants were acutely aware of the need to provide well designed, accessible public spaces and transport and that when this did not exist it was a barrier to managing chronic conditions.

Poor dental services were identified as a barrier to self management of chronic conditions.

Isolation from community was a concern for participants.

Participants repeatedly highlighted the added costs associated with managing a chronic condition: home help, medication, therapy, tests and medical visits. Loss on income was also mentioned. Several participant also mentioned their concerns around transparency in decision making around the cost of ordering tests and intervention.

Participants were frank about their concerns about their experiences where they perceived a power imbalance in their interactions with the medical profession in managing their chronic conditions.

A report is currently being finalised for ACTDGP and will be available on the HCCA website soon.

GP Task Force Final Report

On 15 September 2009, the ACT Minister for Health, tabled the final report of the GP Taskforce in the ACT Legislative Assembly. The report is entitled General Practice and Sustainable Primary Health Care: The Way Forward and is available online (454kb Pdf)

The report presents the outcome of the ACT GP Taskforce’s debate and deliberation following consultation with a broad range of people and organisations

The final report provides the ACT Government with a range of recommendations that supports the provision of general practice and contribute to building a system of sustainable primary
health care for Canberra.

The Report covers issues including

• Workforce Challenges such as workforce supply and better support for General Practice
• Development of the non-medical workforce
• Short and long term sustainability
• Evolving service models
• Access to primary care for Residential Aged Care Facilities
• linking with Government's sustainable transport plan
• Health Literacy and e-Health
• Develop easy to read guidelines for the community and the profession on how to access health records
  

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Consumer Experiences and Expectations of General Practice in the ACT: A Snapshot 2009

The Health Care Consumers' Association (HCCA) is the peak consumer voice on health care in the ACT. Currently our organisation is supporting a consumer member of the ACT Government’s GP Task Force.

We want to know about your experiences and expectations of general practice in the ACT.

We have developed an on line survey so that we can get a better understanding of the consumer experiences and expectations of general practice in the ACT. We will use the results to advocate for consumers in the ACT. We will make the results of this survey publicly available and also share the results with the GP Task Force.

It will take about 10 minutes to complete the survey. Your responses are anonymous.

The GP Task Force was set up in April 2009 by the ACT Minister for Health, Katy Gallagher after several suburban general practices suddenly closed their doors. The ACT is suffering form a persistent shortage of general practitioners; we would need to recruit 60 full time GPs to satisfy demand. It is clear that we are not going to find 60 GPs overnight. The GP Task Force is investigating options and innovations for improving access to primary health care (ie, non hospital health care) in the ACT and will report back to the ACT Legislative Assembly in September.

If you wish to provide any documents which relate to the questions in this survey or which you consider may be of interest to HCCA, please send by either email (GPSnapshot@gmail.com), fax (02 6290 1662) or by mail to:

GP Snapshot
Health Care Consumers' Association
PO Box 717
MAWSON ACT 2607

Take the survey now

GP Task Force Consultation

HCCA are conducting an online survey get a snapshot of GP usage in the ACT and a snapshot of how health consumers would like things to be. The survey is almost finalised and includes questions that the Task Force is asking all GP clinics in the ACT.

The GP Task Force was set up in April 2009 after several suburban general practices suddenly closed their doors. The ACT is suffering form a persistent shortage of general practitioners; we would need to recruit 60 full time GPs to satisfy demand. It is clear that we are not going to find 60 GPs overnight. The health minister wants the GP Task Force to investigate GP workforce issues in Canberra.

The GP Task Force has been charged with the responsibility of investigating options and innovations for improving access to primary health care (non hospital health care) in the ACT. The Task Force will report back to the ACT Legislative Assembly in September.

The Health Care Consumers' Association is supporting a consumer member of the ACT Government’s GP Task Force. This has been Janne Graham. In Janne’s absence Ann Wentworth has taken on this role.

The results will form a strong component of our response to the GP Task Force discussion paper, soon to be released.

Consumers, General Practice and General PRactitioners

The GP Task Force is interested in identifying consumer needs and expectations about general practice and general practitioners. Janne Graham is member of the GP Task Force and has written this post based on her considerable experience as a consumer representative and work completed by the Consumers Health Forum.

The organized health consumer movement has consulted widely with consumers on their experiences and perceptions of general practice, and their engagement with practitioners.

Generally research on consumer satisfaction highlights differences between the criteria applied by doctors and by consumers to a consultation in general practice.

What people want from their general practices includes:

Structural Issues

• Bulk billing/ affordable access
• Physical access, both locality and building design
• Out-of hours access
• Gender choice
• Good appointment systems – emergency and routine.

Consumers use different medical services for different needs. For conditions perceived to require extended care consumers prefer “traditional” general practices.

Process Issues

• Holistic approach, including knowledge of and referral to other health and community resources
• Improved preventive approach.

Outcome Issues
Providing explanations, diagnosis, outlining expectations of interventions and treatment
GPs as managers/team leaders seen as valuable when done well but not always necessary
Gatekeeper role acknowledged relating to access to health services but problematic (particularly for people with disabilities) when relating to other social resources (e.g. pensions)

“Some consumers place greater emphasis on accessibility of the practice, some on the attributes and qualities of the practitioners and some on the quality of care available. These differences might vary for different consumers, or groups of consumers, including those with special needs.” Review of Standards of General Practice p2

References

Consumer Perspectives on General Practice Restructuring, Consumers Health Forum of Australia, undated (1991?)

Building Links with Consumers: The Key to Quality General Practice, Consumers Health Forum of Australia, 1993.

Consumers Expectations of General Practice in Australia, Consumers Health Forum of Australia April 1999

Putting Consumers in the Picture – Consumer Perspectives on Better Integration of General Practice and Other Primary Health Care and Related Services, Consumers Health Forum of Australia, June 1999

Review of Standards of General Practice, Consumers Health Forum of Australia, March 2004

Wade T Engaging Consumers with General Practice in Primary Care Development in The Australian Health Consumer, No 2 2003-4, pp27-8

GP Task Force

The GP Taskforce has been charged with the responsibility of investigating options and innovations for improving access to primary health care in the ACT and reporting back to the ACT Legislative Assembly in September 2009 with its recommendations.

The Taskforce is jointly chaired by Ross O'Donoughue, Executive Director, Policy Division, ACT Health and Dr Clare Willington, GP Advisor to ACT Health. Ms Janne Graham is the consumer representative on the Task Force and is being supported by HCCA. Further details of membership is available online.

The Terms of Reference include the review and consolidation of work already undertaken by the ACT and Commonwealth governments on access to primary care services in the ACT and the exploration and recommendation on legislative options to protect the rights of patients and the health workforce. It also includes consideration and recommendations on provisions to improve access to primary care services for vulnerable populations, including the aged, people with mental illness and the isolated.

The GP Taskforce has had reasonable coverage in the Canberra Times, Sydney Morning Herald and the ABC.

Open disclosure is about open communication

Last year I participated on a working group that developed education materials for general practitioners and registrars on open disclosure. This work was completed with the Royal Australian College of General Practice.

I have just received a final copy of the open disclosure education module and the companion workbook. It was a particularly long process (with a 10 month hiatus) but finally the module was launched at the RACGP Annual Scientific Convention on Saturday 4 October by Dr Chris Mitchell, and GP consultant to this reference group, Dr Genevieve Hopkins.

The module and it's companion workbook is available from RACGP publications or can be downloaded from http://www.racgp.org.au/safety.

A copy of the module will be sent to every registrar in Australia.

The RACGP is confident that the module is comprehensive and meets the needs of registrars and new entrants to general practice, who may be new to the complexities of open disclosure.

From my perspective, as the consumer representative on the working group I appreciated the recognition of the importance of open communication between consumers and doctors and I think the materials reflect that. In the ACT the Health department is in the process of implementing open disclosure. While the examples on the modules are specific to general practice the issues around communication are generic enough to prove useful for registrars in hospitals also.

Darlene

Inquiry into the closure of the Wanniassa Medical Centre

We have prepared a submission to the ACT Legislative Assembly Standing Committee on Health and Disability.

We have sought views from our members and drawn on that input in preparing our submission. Many people contacted us to share their perspective on this issue and we thank you for your support.

Our submission is available on our website (90kb Pdf) and available for you to read. We are interested to hear your feedback on this.

The Terms of Reference for the Inquiry are online. In summary the Committee will consider:

• the circumstances of the closure;
• the impact on the residents of the Tuggeranong Valley;
• the nature of the ACT Government's relationship with privately owned general practice in the ACT; and
• possible options for the future delivery of GP services in the ACT.

The Canberra Times contributes to publish letters to the Editor on this issue.

Rally to protest the closure of the Wanniassa Medical Centre

Around 300 people participated in this morning's rally to protest against the closure of the Wanniassa Medical Centre. The rally was organised by Annette Ellis MP. Ms Ellis addressed the crowd outlining the concerns she had heard from the local community.





Russell McGowan addressed the crowd and highlighted the concern of the HCCA that this decision was made based on what was best for the shareholders of Primary Healthcare rather than the best interests of the local community and the consumers who attended the surgery.



I took the opportunity to mix with people this morning and had a number of conversations. The themes were very clear

• profit comes before the welfare of the patient
• parking at the Phillip Clinic is poor and access for elderly is difficult, the access via bus was mentioned many times and is a source of considerable concern.
• the closure of the clinic erodes the community. People expressed concern at the effect of the closure on other businesses in the Centre, including the chemist, supermarket and newsagent.
• One woman commented that if she had to wait for hours to see a "random GP" at the Phillip Clinic she may as well go to the Emergency Department where she will see a random doctor at no direct cost to her.

There has been strong media coverage in this story. Members of the public have posted comments to the Canberra Times website in response to Natasha Rudra's story last Friday.

There is a petition circulating. This will be forwarded to Primary Healthcare on Thursday night so that it arrives on 8 August. Contact the office of Annette Ellis at 205 Anketell Street
Tuggeranong or by calling 62931344

Closure of Wanniassa Medical Centre

The closure of the Wanniassa Medical Centre and consequent relocation of the services and GPs to Phillip is a matter of great concern to residents in the Wanniassa area and is an all too familiar story to Canberra.

We have been contacted by members expressing their concern over the closure of the Wanniassa Medical Clinic. Their views are shared by many others, as you can see with the media coverage.

The issue of continuity of care, especially with people with chronic conditions, is a significant concern.

One of our members commented:

I cannot see that moving a medical centre which caters for a wide range of people in a local area, with nearby shops and with reasonably good public transport to a location in a busy centre without adequate public transport and parking problems on many days is at all 'patient centered'.

Annette Ellis MP for Canberra has issued a press release saying that she considers this to be unacceptable. She also says:

“The Wanniassa Medical Centre has been there for 20 years, it has regular patients who have connections and relationships with their own GPs. The Colbee Court facility is walk-in, no appointments – so if you want a particular doctor you’ll have to turn up and hope. For those who can make the commute to Phillip, their medical relationships with their doctors are not guaranteed because of this move."

The Government’s walk-in clinic offers one solution to this intractable problem but we would also encourage serious consideration of expanding the clinical roles of health care professionals, including the increased use of nurse practitioners and other allied health workers.

The GP clinic is an entry point to our heath system and at the same time operates as a business. Many GPs are in the unenviable position of balancing consumer access to primary health care with meeting their business costs. Inevitably this leads to conflicting priorities. In this case, it appears that many of the consumers using the Wanniassa Medical Centre are the losers.

We need to find a more effective way of ensuring consumers receive safe and appropriate care in primary health care setting.

The HCCA media release is available on our website (34kb Pdf).

We want to hear your views on this issue