 Building health communities through partnerships
Australian General Practice Network Forum
25-28 November 2006, Gold Coast
Attended by Libby Kalucy, PHC RIS
The combination of formal sessions and informal conversations at this very large Forum stimulated many ideas as well as providing a great opportunity to catch up with people.
Philip Davies, Deputy Secretary of the Department of Health and Ageing considered small stand alone practices will not be fit for purpose as Primary Care becomes more complex and challenging. New organisations including the Divisions network and corporates are emerging to help practices respond to the changed situation. Divisions' role is in moving to an organised system with smooth interfaces between primary health professionals and others. Davies mused about paying Divisions to achieve rather than to exist, by rewarding them to improve population health.
Speakers from UK, NZ and Australia discussed blended payment systems for general practice, such as a mixed remuneration model with fee for service, lump sum capitation for chronic conditions and performance based payment aligned with defined health outcomes as an incentive for quality improvement. Integral to capitation is registration of patients, putting general practice at the interface between bio-clinical and broader social health according to David Colm-Thome from UK.
The power and energy generated by the National Primary Care Collaboratives was obvious. Among lessons so far, Dale Ford identified NPCC would not have achieved system change and clinical practice management systems without Divisions of general practice. Jon Goodman outlined ways the Gold Coast Division was extending the initial experience for their practices, eg through local collaboratives. The general practice data in the NPCC had been a fantastic change management tool to move general practice to a population health framework in NT.
The findings of two APHCRI Stream 4 projects were well received. John Wakerman spoke about models of primary health care in rural and remote areas, and Claire Jackson about integrated health care governance. These and other reports are available at www.anu.edu.au/aphcri/Spokes_Research_Program/index.php
Strengthening the primary health care approach
National Primary and Community Health Network Chronic Disease Management Forum
8 November 2006, Brisbane
Attended by Libby Kalucy &
Ann-Louise Hordacre, PHC RIS
There is a compelling case for action with the new paradigm of chronic disease management encompassing survivors of previously terminal diseases, as well as conditions requiring lasting management and ongoing care.
In order to move forward, Andrew Wilson from Queensland Health suggested the following are needed both nationally and locally to reorient the system: effective partnerships, investment in appropriate and directed initiatives, integration and coordination in the service model, real community engagement, and a paradigm shift - from acute to proactive.
Following a presentation on current Federal initiatives, Hal Swerissen drolly stated that with so many chronic disease programs it was like watching Fox channel! The challenge was how to bring them together. With chronic disease consuming a large proportion of health resources, funding can be a lever to drive change, but competing commonwealth and state aims lead to contradictory payment incentives and sanctions, along with piecemeal and fragmented design. He suggested a number of revolutionary payment design principles that focused on the person, care pathways, outcomes, prevention and early intervention, system redevelopment and capacity building. Recognising that evolutionary methods were more likely, he proffered blended payments and program reforms based on existing arrangements as the most likely way forward.
Despite different contexts, a panel of speakers representing the states and Northern Territory identified many similar initiatives: partnerships, clinical networks, hospital avoidance, involvement with Divisions of General Practice, quality improvement at the system level, and a move towards integrated services. They discussed workforce issues including recruitment and retention along with the development of proactive planned coordinated care engaging the patient as partner in self management. Evaluation issues were abundant, as well as issues of aligning different initiatives within and between levels of government.
Participants to this comprehensive one day workshop were left with the challenging question from Claire Jackson - What will you do differently Monday…?
Presentations and speeches from this meeting are available on the website:
Web: www.latrobe.edu.au/aipc/cdih/pchnetwork/national_conf_nov06/index.htm
Unravelling the patient maze
 Australian Healthcare Association conference
9-10 November 2006, Brisbane
Attended by Libby Kalucy &
Ann-Louise Hordacre, PHC RIS
The painting of a health care maze produced during the opening reception of this conference served as a continual reminder of the conference theme. The lack of system thinking in an industry dominated by individual professionals addressing the perceived needs of individual patients was a key topic.
A whole of system approach and lean thinking were prominent on the agenda, which focused principally on the hospital sector. Mapping links and the whole patient journey is very revealing to eliminate waste and allow predictive work. However, solving the problem of ‘patient flow' in one section of a hospital in isolation invariably runs up against bed blockage in another. Extending this idea – solving the internal flow problems in one hospital will run into blockages in other areas of the acute, primary and community health care sectors in a city.
Many speakers suggested the health system is structured around funding issues related to the needs of provider not patients, resulting in a plethora of disconnected programs. The health sector tends to be inward looking, lacking in perspective from patients and outside interests, as highlighted by John Menadue – The guest sees in one hour what the owner of a house does not see in a lifetime. These ideas are expressed in more detail on the New Matilda website www.newmatilda.com
Understanding and improving patient and carer experiences was a prominent theme in the program. Jane Grey from the NSW Clinical Services Redesign Program used a powerful story to demonstrate that patient outcome can be poor even if formal measures of system performance and patient flow indicate no problems. Karen Honson showed how one carer's experience can lead to strong advocacy about the compelling need for systemic change and improvement.
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