Concept design for Act 1, part of Nicholas Roerich's designs for Diaghilev's 1913 production of Le Sacre du printemps - Wikipedia

Igor Stravinsky’s Rite of Spring, was first performed in Paris at the Théâtre des Champs-Élysées on 29 May 1913. It broke with many of the established musical traditions and challenged the perceptions of the traditional supporters of the ballet while being enthusiastically embraced by the avant-garde.

During the opening night’s performance arguments developed between the two groups. Forty members of the audience were ejected in the fracas and one member of the orchestra reported, “Everything available was tossed in our direction, but we continued to play on”.

The advent of the Spring season sees a new beginning for the North Coast Primary Health Network. In August Julie Sturgess took over the role of Chief Executive from interim CE, Sharyn White, following the departure of Dr Vahid Saberi. Julie has had extensive experience in corporate roles in eHealth, Aboriginal health services and community care. Prior to to joining the NCPHN she was the CE of Northern Australia Primary Health Limited (NAPHL) that delivered primary health care to the people of northern Queensland through contractual arrangements with the Northern Queensland PHN. On page 5 Robin Osborne reports on the challenges Julie faces as she takes the helm at the NCPHN.

Springtime also sees new arrangements for the funding of activities previously provided directly by PHNs. NAPHL is a leader in commissioning and procurement, the mechanism favoured by the federal government for delivering human services. Under the arrangements that commenced on 1 July, 2018 the NCPHN will now oversee the awarding of contracts for health services to third parties through a competitive tendering process. Julie’s experience in her previous roles will be invaluable in this new environment.

Tendering is not without its critics, however, and general practices will already have had some secondhand experience of this through their patients’ involvement with aged care services and now the NDIS. New arrangements take some time  to bed down and there is the risk of both under and over provision of services, often with an associated mismatch in funding. On page 25 we review the Department’s goals for the system and consider some of the criticisms levelled at commissioning.

We have given considerable coverage to the Northern Rivers Doctors group (Nordocs) that held its inaugural meeting on 30 June at UCRH. More than a dozen speakers, GPs and specialists, presented on issues they felt were of importance to improving health care on the North Coast. The format of the day was that of an “Unconference” where the attendees are the speakers and the forum is open to any who wish to present. The day was considered a success by the attendees, and future gatherings are planned.

The Unconference talks were recorded and are being progressively released, along with the accompanying slides and articles on the Nordocs Facebook page and in GPSpeak. The intention is to make the material more widely available, particularly to those who could not get along and to those who have an interest in a particular topic.

The meeting was financed with funding from the NCPHN, the Northern NSW Local Health District and the Northern Rivers General Practitioner Network and administrative support was provided by North Coast GP Training. The venue was made available at no charge by UCRH and the day was made possible by the generous volunteer work of the organising committee.

One of the new commissioning tasks for the NCPHN will be to fund workforce development. In late August it put out a tender for expressions of interest in developing and supporting professional development, intra-professional networking opportunities, the establishment and maintenance of local clinical societies and consulting with organisers of other relevant educational activities. It is hoped that the Nordocs will qualify for support for its future activities under these new arrangements.

The My Health Record (MHR) three-month opt out period commenced on 16 July 2018. The change in format has been roundly criticised by privacy advocates and received widespread media coverage. As a result the government decided to extend the opt out period by one month and change the legislation to require other government agencies to get a court order to access data held in the record.

The risk to privacy from the MHR is greatest for the young and healthy, while the greatest potential is for those with multiple complex medical conditions. On page 28 Associate Professor Bronwyn Hemsley writes of her research into using the MHR as a repository for legally binding Advance Health Directives and the legal and clinical implications.

Our cover story describes the excellent work being done by the local chapters of PASH and HARP - not widely known acronyms - in conjunction with the NSW STI program unit in detecting asymptomatic chlamydia in young people (page 27). It’s a tribute to their innovation that STI testing can have a ‘fun’ element.

Recent political upheavals and a Federal election due within the next nine months will almost certainly bring about further changes to the Australian healthcare system. As in other countries politics has become more polarised and policy will almost certainly shift from the middle ground after the next election.

It takes several years for a new government to implement changes to health policy and it is largely unknown what the Australian Labor Party thinks of the current arrangements regarding primary health care funding. Inexplicably, the direct or indirect provision of health services is unlikely ever to be an election issue and as such we will have to await the election’s outcome. Both parties have promised to restore partial indexation of Medicare rebates but given past experience the profession would be wise to consider these non-core promises.

In any event Spring is upon us, mercifully with some early rain, at least in coastal areas.. It is a time for a new beginning, a time to try new things. The Rite of Spring influenced musical composition throughout the 20th century and challenged the old order. It is still remembered for its experimentation “in tonality, metre, rhythm, stress and dissonance”.