Imagine a health system where people came first and their health issues were seen within the context of their life and their wellbeing. In health policy, we spend most of our time tinkering around the edges of a system that is based on a mixture of crisis intervention and throughput driven incentives with no measures of real health outcomes or consumer (patient) experience of care.

Consumer engagement and participation in Medicare Locals has to start by asking ‘what are we trying to achieve and for whom?’ We have had enough of the take it or leave it throughput based service model. We cannot put health consumers at the centre of the health system unless we actually measure their experience, not as an extra activity, but as a way of working with people to get things done. This goes to the heart of tackling expressions of unease about the industrial scale of health care, the depersonalisation of providers, and the vulnerability of consumers within our health system.

Primary health care should not be seen as limited to those who have the time, inclination or money to make an appointment with a doctor - most commonly middle aged middle class women. Young people, people with chronic conditions, the mentally ill, the aged, the drug dependent, post natal mothers, these are the kinds of people primary care has historically not been as responsive to.

Rethinking how a primary care service should operate within the community should be the first duty of all Medicare Locals. When we design the system to fit the needs of the community it is meant to be serving, when we begin to put the experiences of health consumers at the centre of the services provided, then we will have taken a massive step forward.

More information about the Consumers Health Forum can be found at <www.chf.org.au/>