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

Jolyon Attwooll

29/11/2023 4:19:50 PM

Federal Government scrutiny of the country’s 31 Primary Health Networks is falling well short, according to the college.

Concept image about an audit
The RACGP has put forward a series of recommendations for tracking the performance 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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A.Prof Christopher David Hogan   30/11/2023 8:44:23 AM

Divisions of General Practice- an initiative of RACGP & AMA we’re introduced by a conservative government to integrate General Practice into the state health systems to overcome the fragmentation of health service provision.
They were funded by money that would otherwise have increased Medicare rebates .
Many worked extremely well.
Then began the death of GP by a thousand cuts with the substitution of Medicare Locals ( a poor name as they were neither) & then the PHNs supposedly introduced to “integrate government policies “ rather than serve the needs of General Practitioners & their communities.
It is a very good idea to investigate these organisations

Dr GP   30/11/2023 10:44:02 AM

PHNs might be different everywhere but within our local PHN has very little GP involvement, little understanding of what happens in day to day general practice, and a reluctance for GP input/leadership in the organisation. Lots of other health professionals within the organisation in leadership positions - except GPs.

I get it that primary health care is much more than general practice but the lack of GP input is quite astounding given the role they're suppose to play.

Dr Lisa Gwenyth Beecham   30/11/2023 2:20:49 PM

At GCPHN we have always had active GP involvement with 1/2 the Board made up of GPs. We have always been mindful of the important role GP- Primary care play in the health ecosystem and during the pandemic we were the first PHN in the country to source PPE and fit tests for primary care. Our Directors met weekly with the local GCHHS to facilitate pandemic collaborative approach. We have always strived to do detailed Needs analysis informed by data and source commissioned services to fill the gaps in the Primary Care setting. Our data tool Primary Sense has been rolled out Nationally to assist with ongoing point of care GP prompts to enable translation of best evidence into practice and streamline care in General Practice. We have consistently and tirelessly worked towards better clinical handover between all healthcare professionals and have had commitment from our local HHS to deliver on this over the next 12 months. Join PHN committees to effect change !

Dr Petronella Barbara Slootmans   30/11/2023 7:01:37 PM

Finally there may be some scrutiny of PHN's. I am a rural GP and have found them completely ineffective when it comes to supporting General Practice.
They have taken over some tasks of other health organisations such as our local one and then did not deliver that service. An example is a list which 360 Health and Community did for GP's every month of GP's practising in the region, allied health professionals names and contact numbers, Psychologists names and numbers as well as a list of visiting specialists and numbers; Public health departments eg Mental health; Paediatric mental health and Drugs and alcohol and finally also contact numbers for the Metropolitan hospitals. This was an invaluable tool which could be given to every new GP or Registrar who arrived.
The reason for termination of that task was "no time and not enough funding".
Practice support is also now non-existant and face to face visits by PHN representatives was stopped in Covid and has never been resumed.

Dr William James Hare   30/11/2023 9:28:33 PM

Primary Health Care Networks formerly Medicare Locals former Divisions of General Practice were originally established by a Labor Government to be fund holders, to try and pay GPs from government and not through private billing and Medicare rebates. They have always been a dismal failure and a total waste of government money with nothing to do with general practitioners and general practice

Dr R   2/12/2023 11:30:00 AM

Another level of unnecessary bureaucracy and waste of public money that is better spent elsewhere.
PHN have very little benefit/input in GP practices in my region.

Dr Richard Mark Smith   2/12/2023 1:07:52 PM

The Divisions of General Practice and the PHNs have wasted billion$$ on a pathetic political bureaucracy masquerading as a "primary health service".
It has diverted healthcare funding from Medicare.
Hence is has impoverished patients and GPs, and undermined General Practice.
It does not represent GPs needs and does not improve the quality of care for patients attending general practice. This is my experience over 20years of rural and 20years in metropolitan practice.
General Practice has been dying a death of 1000 cuts
Do the PHNs care ?
I have spoken at meetings and been patronised and ignored !
I have questioned the rationale and relevance of programs and any dissent or discussion is closed down.
They do not support my practice or my patients one iota.

Dr C   4/12/2023 7:16:31 PM