To Market, To Market

To market to market went my PHN
when somebody threw a tomato tha'd b'en  
all soft and squishy; ‘twould not hurt the skin
But alas, I'm afraid, this was wrapped in a tin

July 1st 2018 marked the first day of the next phase in the North Coast Primary Health Network’s transition to a commissioning body. The transition began two years ago and the latest development sees a major change to the organisation’s structure.

In line with the Coalition's philosophy of competitive markets PHNs are gradually devolving their activities through a tendering mechanism to external parties. The government believes this has worked well in telecommunications, aged care and disability services. It brings market forces to bear on the provision of human services of all types.

The core activities of the PHNs, as defined by the government, fall into six key areas:- Mental Health, Aboriginal and Torres Strait Islander Health, Population Health, Health Workforce, eHealth and Aged Care. However, the Minister for Health, Greg Hunt, has also added a seventh category, Alcohol and Drugs.

The Department is focusing on addressing patients’ needs while minimising waste within the system. The key activities are:

1. Engage patients and carers as active partners in decisions about their health and wellbeing.
2. Ensure service and funding models are based on best practice to maximise patients’ health improvement, service safety and quality, and allow flexibility.
3. Deliver efficient health care, eliminating waste and duplication.
4. Ensure potentially avoidable hospitalisations are minimised.
5. Facilitate integration and coordination of patient care across care settings and support health care professionals to work as multidisciplinary teams.
6. Encourage all primary health care professionals to work to their full scope of practice.
7. Support the collection, reporting and use of primary health care outcome.

These are laudable aims but as always the devil will be in the detail. It is to be hoped that a market approach to service delivery will bring about the necessary changes within the system in a more timely manner. A threshing machine soon sorts the wheat from the chaff.

The NCPHN has already made significant strides in some of these areas. It continues to gather extensive data about our community to better target health issues specific to our region.

It also has an active eHealth program, with the promotion of the My Health Record, the development of the Orion Rhapsody system for hospital - community care - primary care coordination and support for improved data transfer in the Tweed Valley from general practice to the hospital.

The Winter Strategy is in full swing for its second year. It aims to keep high risk patients healthier and out of hospital over the winter months. It has used techniques to help patients become more active in their care by monitoring their illness and empowering them to take timely action in response to early indicators of clinical deterioration.

The major change for general practitioners in the current biennium is the transfer of continuing medical education activities to external parties. Support for local clinical societies, the Women in Medicine group and the Northern Rivers General Practice Network has been withdrawn and the NCHPH Executive and Board are considering the best model to deliver continuing medical education, particularly in the areas that are government priorities.

Commissioning is an unfamiliar concept to most clinicians but those wanting to be involved in education will have to structure themselves into an entity that can bid for these contracts. It may be a steep learning curve.

Commissioning has been a boon to governments around the world for over 30 years and has provided great value to those societies, however it is not without problems.

In the June 2, 2018 Saturday Paper Mike Seccombe looked at the issues with commissioning human services in Australia and the UK in his article Privatisation by stealth.

He quotes a UK expert:-
“Long experience – and in this country we now have several decades of experience in the provision of things like employment services – suggests that competition between service providers tends to drive down costs. The greater problem is that it also drives down the quality of the services provided.”

Another commentator with extensive experience in the field notes:-
“If you use simple tender processes for the delivery of complex services, you inevitably over time drive down the price, you endanger the commercial viability of the contracting organisations, and you diminish, incrementally, the quality of the services.”

The model to be adopted by the North Coast Primary Health Network is eagerly awaited by many, but not without some trepidation.