‘The bar has been set too low’: RACGP criticises oversight of PHNs

Insufficient oversight. Potentially inefficient spending of taxpayer funds. Systemic governance issues and poorly managed conflicts of interest.
 
These are the among the highly critical observations included in a recent RACGP submission to the Australian National Audit Office (ANAO) about the oversight of the country’s 31 Primary Health Networks (PHNs), the organisations tasked with improving primary care.
 
The ANAO auditors are inviting contributions on whether the Department of Health and Aged Care (DoH) manages the performance of PHNs in a way that is fit for purpose; whether compliance has been well monitored; and if the PHN program meets its objectives.
 
In the 12-page document, the RACGP outlines significant member concerns on all three fronts, and queries how taxpayer funds are being spent.
 
‘Such inefficiency is unacceptable when general practice is experiencing some of the most significant challenges in its history and struggling to remain financially sustainable,’ the submission states.
 
The college suggests that assessing PHN performance should shift towards being judged on the delivery of outcomes rather than the provision of services.
 
‘The community and primary care stakeholders of PHNs need to be involved in determining these indicators to ensure outcomes are meaningful,’ the RACGP states.
 
The submission contains 14 recommendations for improving PHN oversight and performance, including a requirement for the organisations to show support to general practices within their area.
 
‘PHNs must be able to demonstrate how their support to general practice is based on the needs of local GP practices,’ it states.
 
The role of PHNs in hospital discharges is also placed under scrutiny, with the college suggesting a new indicator should be introduced to measure the rate of hospital discharge summaries made available to GPs within 48 hours.
 
The RACGP submission advocates for a new way to assess PHN measures designed to ‘improve the interface between primary and secondary healthcare’ and help reduce preventable hospitalisations.
 
Additionally, it puts forward potential improvements to the way PHNs work with Aboriginal Community Controlled Health Organisations (ACCHOs).
 
‘PNHs have been found by ACCHOs to insufficiently consult and collaborate with them and have failed to provide them with adequate resourcing to serve their Aboriginal and Torres Strait Islander populations,’ the college states.
 
‘The Government must move beyond optional guidelines on how PHNs and ACCHOs work together and create mandatory standards for Aboriginal consultation and equitable involvement in commissioning.’
 
Another recommendation suggests mandatory governance processes and organisational structures to ensure PHNs take a consistent approach, including towards conflicts of interests.
 
Last year, North Queensland PHN was the focus of some controversy, when two GPs resigned from the board over conflict-of-interest concerns, including Dr Nicole Higgins before she became RACGP President.
 
While the DoH conducted an audit into the PHN, the full findings were not made public.
 
The RACGP submission also highlights controversy surrounding a decision by Gippsland PHN to contract after-hours health services to the bushfire-affected town of Mallacoota to a Sydney-based company offering telehealth-only services.
 
‘Those providing tenders to PHN commissioning processes receive insufficient information about why tenders are rejected and why successful tenders are rewarded,’ the submission states.
 
‘This is contributing to a culture of mistrust between GPs and PHNs who struggle to reconcile the role of PHNs in supporting GPs while continually finding their tenders rejected in favour of non-GP services.
 
‘This mistrust has also grown because of a lack of accountability around the tendering process.’
 
However, the RACGP makes clear that the criticisms are not directed at all PHNs and acknowledges ‘a diversity of performance’.
 
‘While some PHNs have come under scrutiny and remain the subject of criticism, there are also PHNs who perform exceptionally well and drive quality and efficiency improvements in primary health,’ the submission states.
 
‘The RACGP also acknowledges the limitations faced by PHNs where state governments and other stakeholders may be reluctant to engage with PHNs or primary care more broadly.’
 
PHNs became part of the health system in 2015 to improve patient care and make healthcare more efficient and effective.
 
According to the RACGP submission, the amount of time that has now elapsed means the organisations should ‘have moved beyond the stage where initiating and implementing programs is challenging’.
 
‘While PHNs remain young institutions, the indicators they are currently required to meet set the bar too low and do not sufficiently drive or measure outcomes,’ it said.
 
‘PHNs should now be sufficiently mature that they can be expected to initiate and implement complex programs without being driven by performance management.’
 
Earlier this year, newsGP sought to establish how many general practices had opened and closed in the previous 12 months in each PHN area.
 
Just over half of the PHNs contributed information, with others stating that either the information was unavailable, or they were unable to provide it.
 
The ANAO is accepting contributions for the audit until 6 December, with a report currently scheduled for tabling in March 2024.
 
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