Audit calls for PHN transparency overhaul

Greater transparency, reporting, oversight, and accountability is needed to ensure the nation’s Primary Health Networks (PHNs) are delivering a return on billions of dollars in funding, according to a new investigation.
 
On Tuesday, the Australian National Audit Office (ANAO) handed down a suite of recommendations, aimed at improving the performance management framework of PHNs.
 
The audit follows the release of a scathing RACGP submission last year, which called for PHNs to be held accountable for how they are spending government money.
 
‘Such inefficiency is unacceptable when general practice is experiencing some of the most significant challenges in its history and struggling to remain financially sustainable,’ it said.
 
The ANAO found the Department of Health and Aged Care (DoHAC) has been ‘partly effective in its performance management of PHNs’, and ‘established largely fit-for-purpose compliance and assurance arrangements’.
 
However, it went on to raise concerns around a lack of evaluation, compliance with grant requirements, and timely performance reporting.
 
‘Health has not demonstrated that the PHN delivery model is achieving its objectives,’ the audit found.
 
‘Health’s PHN performance reporting is not timely, complete or consistently useful.’
 
RACGP President Dr Nicole Higgins said the audit demonstrates the need for national consistency and transparency for PHNs.
 
‘This report reflects GP and member concerns around how taxpayer money is being spent at a time when general practice has been starved of funds,’ she told newsGP.
 
‘General practice is so regulated and legislated, and we have to deal with so much red tape, so it’s confronting and disappointing to see that the PHNs have been able to operate without the same expectation of accountability.
 
‘As the funding and bureaucracy has evolved, there’s been less accountability and less respect for the role of GPs in primary care.’
 
Since 2015, $11.6 billion in grant commitments have been allocated to fund the nation’s 31 PHNs.
 
However, the auditor found for $10 billion of these grants, the DoHAC ‘has not complied’ with Commonwealth Grant Rules and Guidelines requirements.
 
‘Public performance reporting is not timely or informative about overall PHN delivery model performance, and does not include information about individual PHN performance,’ it said.
 
‘Health had no evaluation plans for the PHN delivery model after 2018.
 
‘A lack of baseline and relevant performance data impedes understanding of whether the delivery model has met its objectives.’
 
Dr Higgins has grave concerns regarding the billions of dollars being awarded to PHNs without adequate monitoring or evaluation, particularly in the context of chronic underfunding for general practice.
 
‘Imagine if we had that kind of money in general practice at the coalface and how that would improve patient care,’ she said.
 
‘If the Government is going to use PHNs as a vehicle to deliver its funds, it needs to know how the money is being spent, what the money is being spent on, and the outcomes that are being achieved.
 
‘This is money that could be spent in general practice, but it’s being spent often in ways that we have no oversight about.’
 
The ANAO’s report went on to make eight recommendations for change, with the DoHAC already agreeing to seven, and one in principle.
 
Its top recommendation is for DoHAC to ensure PHNs fully comply with transparency and accountability requirements established in grant agreements.
 
It is also calling for the establishment of performance measures, for the department to publish individual PHN’s performance data and analysis in annual reports, as well as the development of an evaluation plan for the PHN’s delivery model to determine whether it is achieving its objectives.
 
Dr Higgins said it is essential these recommendations are acted upon.
 
‘We had the Kruk Report which recommends general practice cut the red tape, and I expected PHNs will have to do the same to deliver better outcomes,’ she said.
 
‘With the Government spending billions of taxpayer dollars, we expect transparency and accountability, and they should be working with general practice to achieve the best community outcomes.’
 
In response, the DoHAC welcomed the audit’s findings and said it is committed to implementing its recommendations.
 
‘The department is committed to demonstrating the performance of the PHN Program and will evaluate the PHN delivery model,’ it said.
 
‘The department appreciates the report’s recognition that the department is continuously engaging and consulting with its partners and key stakeholders to improve the effectiveness and operation of the PHN Program and will continue this approach in developing and implementing our response.’
 
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