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A missed opportunity?

The first Medical Locals are expected to commence operations mid next year

With the first Medical Locals expected to commence operations mid next year, some concern has been expressed the government has missed the opportunity to fundamentally reform Australia’s primary health care system.

Instead of going down the health reform path of developing comprehensive primary health care organisations to better target health care to include screening, health promotion and other preventative measures, the government has opted for more of the same, the RCNA said in its submission to the government.

According to the government, the first group of Medicare Locals will evolve from current high-functioning Divisions of General Practice that can “demonstrate the capacity to take on the additional roles and functions expected of the new organisations”. This includes supporting health professionals to provide more co-ordinated care.

Debra Cerasa, RCNA CEO, said RCNA supports the development of genuinely independent primary health care organisations that depart from treatment oriented and medically controlled models of services delivery to enable the system to improve access to care as well as health outcomes by making better use of the health care workforce.

“RCNA has actively promoted the need to reduce fragmentation, duplication and resource wastage within the primary health care sector. We also offer ongoing support for integration of community and primary health care services to promote continuity of care and responsiveness within the health system.”

“But these goals will not be achieved by simply expanding the capacity of the Divisions of General Practice, even the high functioning Divisions,” she said.

“General practice does an exceptional job and has a very important role in the delivery of medical care within our communities, but the scope and reach of their work is limited and treatment focussed.”

She said the RCNA remained unconvinced that the Divisions of General Practice would be able to radically transform to achieve the cultures and attitudes required to evolve into organisations that can effectively coordinate “true primary health care through multidisciplinary health care teams with a health promotion and illness prevention approach”.

And any move to include state-based community and primary health nursing services under the control of Medicare Locals could have detrimental effects on these services and the individuals and communities that benefit from them, Cerasa warns.

To be successful in truly reflecting primary health care, the organisations must be built from the ground up, the ANF said in its submission.

This process has to be based upon a “strong philosophy of primary health care and person-centred care, not on the organisational and administrative structure to support private general medical primary care practice”, the submission stated.

If the government is to ensure the success of Medicare Locals it must change course to create organisations that are genuinely independent, Cerasa said.

They also need to be “culturally and attitudinally committed to creating opportunities to fully utilise the scope of practice of nurses, midwives and the range of allied health professionals within community and primary health care,” she said.

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