The Australian Financial Review (19 November 2015) reported comments made by two former Treasury Secretaries about the state of Australia's public service. Recent redundancies and increased outsourcing have left the Department short of senior management expertise and there has been a general loss of corporate knowledge. Dr Parkinson noted that junior staff are missing out being properly mentored, "Becoming an effective policy advisor requires learning by doing under the guidance of experienced hands - an apprenticeship if you will".
The slash and burn approach of the Abbott years has similarly affected primary health care and training. The philosophy of the Liberal / National coalition is to reduce the Public Service and the direct provision of services by government. Fostering a competitive market is their preferred mechanism for delivering health and social services.
Thus the awarding of the contract for GP training to a single provider for the whole of NSW came as quite a surprise. It is hard to see this arrangement fostering a market that competes on quality as well as cost, as Dr Mitchell notes in the article on changes in GP Training (p5).
The 2015 Beach report into general practice activity (reviewed p15) highlights the central place of general practice in co-ordinating patient care for improved outcomes. It recommended further investment in this area. The importance of this is also recognised by NSW Health with its $130 million dollar investments in Integrated Care programs around the state, by the RACGP (see Dr Edwin Kruys, Queensland Faculty Chair, Let's talk about integrated health services p17) and most controversially by Dr Norman Swan in his recent 4 Corner's program, Wasted.
The Robinson MBS review and the Hambleton Chronic Care review have yet to be delivered. They may however define the financing arrangements necessary to underpin a new integrated health system.
To move to this brave new world will require courage and leadership from the profession. However, it will also require a genuine commitment from the Federal government to finance quality primary care.
It would be unwise for any reforms under a Turnbull government to slash primary care funding and burn the profession's trust in the process.
