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RACGP calls for PHN overhaul
The college says evaluation of long-term goals, and reform to better integrate general practice with the wider health system, are needed.
A recent newsGP poll found more than half of respondents rate the value provided by their local PHN as ‘poor’ or ‘very poor’.
The RACGP has called for GP-driven structural improvements to boost trust and engagement with their local Primary Health Networks (PHNs).
In a new submission, the college said it recognises that PHNs have a vital role in filling gaps between local needs and funded Federal Government priorities, but changes are needed.
Responding to the Review of Primary Health Network Business Model and Mental Health Flexible Funding Model, the RACGP makes 22 recommendations to improve the governance and focus of PHNs to improve nationally consistent operations, while ensuring regional needs are met.
The Department of Health and Aged Care review is aiming to ‘improve PHNs’ efficiency and effectiveness of health services’, as the program’s policy settings have not changed significantly since being established in 2015.
In its submission, the RACGP acknowledges that GPs have ‘variable experiences’ with their local PHNs, ranging from positive engagement to frustration at a lack of support and consultation.
A January newsGP poll of more than 1200 respondents revealed just 10% rate their PHN as ‘very good’, while 21% rate as ‘poor’, and the majority (36%) rate their PHN as ‘very poor’.
PHNs need a ‘re-examination of underpinning goals and long-term intent’, the college submission states, and general practice must be at the heart of decision-making.
They also need to ‘actively engage’ with stakeholder organisations representing primary care and priority populations, such as the RACGP and Aboriginal Community Controlled Health Organisations (ACCHOs) to bring national expertise to local issues.
Sydney GP Dr Tim Senior is a medical advisor for RACGP Aboriginal and Torres Strait Islander Health and was involved in the development of the college submission.
He told newsGP while there is potential in PHNs to be able to coordinate local agencies and services based on the needs of local communities, this is ‘very variable’ across the country.
‘Realising this potential requires clarity about what PHNs do and real accountability in how this is done … the RACGP recommendations are designed to achieve this across the board,’ he said.
‘For PHNs to enhance GPs’ ability to provide this care – by ensuring adequate workforce, accessibility of local referral services and health professionals as well as local action on social determinants of health – GPs need to be involved in the advice and governance of PHNs and need to be able to trust PHNs.'
National consistency and transparency
The RACGP also recommends for PHNs to operate with accountability for their communities, with mandatory governance and performance standards, independent auditing and transparency.
‘PHNs must aspire to be accurate and trusted representatives of specialist GPs and other primary care services within their regions,’ the submission states.
The latest submission comes off the back of college advocacy from a recent PHN audit, which demonstrated the need for national consistency and transparency.
The college is now calling for improvements to PHNs’ governance and the focus of its nationally consistent operations.
Dr Senior says this is important because PHNs are the only agency to have a remit to measure and meet community needs beyond those patients attending a single general practice.
‘This means PHNs have the opportunity to tailor healthcare coordination locally, responsive to local need,’ he said.
‘Strengthening the clarity of purpose and accountability mechanisms are the only way of ensuring this happens across all PHNs.’
Mental Health Flexible Funding
Greater flexibility of funding arrangements outside the Mental Health Flexible Funding model to enable innovative funding models is also on the RACGP’s agenda.
Mental health programs commissioned by PHNs should be well integrated and as simple to refer to as existing mental health services, the submission highlights. PHNs must also act as facilitators to engage a patient after a hospitalisation and support them to initiate treatment with their GP, and support the GP to take over the patient’s care.
Collaboration with Aboriginal and Torres Strait Islander health stakeholders
PHNs should be required to regularly collaborate with other regionally based organisations and key stakeholders that reflect their population, including ACCHOs, primary care providers, aged care facilities and other PHNs. The RACGP says this will support collaboration and the scaling up of successful programs.
‘There has been a longstanding concern that PHN funding for Aboriginal and Torres Strait Islander health diverts funding away from ACCHOs, which goes against what we know works for Aboriginal and Torres Strait Islander people, and against the Closing the Gap commitments,’ Dr Senior said.
He said PHNs can only make a real difference in Aboriginal and Torres Strait Islander health by ensuring:
- local Aboriginal and Torres Strait Islander people and services are embedded in PHN governance and involved in design delivery and evaluation of services
- there are principles of Aboriginal and Torres Strait Islander data sovereignty
- Aboriginal and Torres Strait Islander inclusion is considered in PHNs’ own employment, commissioning, tendering and purchasing decisions.
Government funding models
The RACGP recommends the future of PHNs to flexibly fund programs with short, medium and long-term funding arrangements, with these funding decisions driven by the requirements of the programs, rather than government funding cycles.
It also expresses concern around the Government increasingly using PHNs to implement national policies which distract from their intended role as local organisations.
‘There is a tension for PHNs attempting to measure and meet local needs, but being funded to implement Government health policy irrespective of local need,’ Dr Senior said.
‘At the moment these contrasting, and sometimes conflicting, aims are ambiguous. The health of local communities would be better off with health services and social care agencies responsive to local need.
‘Even if it was clear that PHNs were the local arms of the Department of Health, that may not improve community health, but we’d all be clear on what they were there to do.’
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Aboriginal and Torres Strait Islander health mental health funding PHNs Primary Health Networks RACGP submission
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