Ensuring Primary Health Networks work well in rural and remote areas

Thursday, 12 June 2014

The Alliance has published a Discussion Paper on the importance of the forthcoming transition from 61 Medicare Locals to a small number of Primary Health Networks (PHNs).

These new entities, to be established on 1 July 2015, will take on board responsibility for putting some of the principles which are fundamental to fair and effective health services into practice in rural and remote areas.

The first of these principles is that the ready availability of well-coordinated primary care is necessary for good health. The second is that this care should be delivered by a multidisciplinary team with people’s local health service providers at its heart. Third, the means must be provided for local people to be closely engaged in the establishment, management and evaluation of their local health services.

In all parts of the nation Primary Health Networks will in the future be judged by the extent to which they contribute to the implementation of these high-level goals.

The challenges to be met in rural and remote areas are of a different order. Coordination of primary care is arguably a little easier with fewer professionals on the ground, but its ‘ready availability’ is, for the same reason, a problem. Providing access for patients to a multidisciplinary team is also difficult where there are workforce shortages. And the practicality of real local engagement of local people is difficult where the framework – now to be provided by Primary Health Networks – stretches across large areas and sparse populations.

The move from Medicare Locals to Primary Health Networks is the Federal Government’s response to the Horvath Review. In his report released on 4 March 2014, former Chief Medical Officer, Professor John Horvath, argues that a ‘one size fits all’ approach to primary healthcare will not work. His view is that Primary Health Networks must collaborate with local communities and healthcare professionals and services so as to “accommodate local circumstances”.

The NRHA supports the view that healthcare services should be responsive to local needs, with the focus on ensuring that rural and remote areas are adequately serviced. For people in rural and remote Australia who are, on average, less healthy than those who live in the major cities, the delivery of an adequate amount of first-class primary care services is vital.

In consultation with Clinical Councils and Community Advisory Committees, as well as Local Hospital Networks, Primary Health Networks will play an important role in developing and implementing health promotion and illness prevention programs. There is concern about the extent to which existing programs of this sort are working in rural and remote areas as distinct from the major cities. It will therefore be important for Primary Health Networks with rural and remote communities within their borders to design and deliver health promotion in ways that work well in those areas.

It is of fundamental importance that Primary Health Networks servicing rural and remote areas are adequately funded to ensure they can meet the challenges of integrating primary care services across vast and isolated geographical areas. Their resourcing should recognise the increased costs of providing and evaluating services in rural areas caused by large geographic size, higher unit-cost of service provision, the socio-economic situation of communities and the higher percentage of Aboriginal and Torres Strait Islander population.

It is of the utmost importance to the 6.7 million people living in rural and regional Australia that the Primary Health Networks in those areas are successful. Should they be allowed to fail, rural people will again be disadvantaged – in health service principle as well as practice.

Comments

The above brief acknowledges the recognition of higher unit-costs and challenges in rural areas. Please ensure there is representation of the local community and that the more isolated community representatives are not the people who consistently have to travel 3-4 hours to attend every meeting. Often the most appropriate representatives are time poor due to multiple commitments and travelling long distances to a "central place to meet" often means the place where there is the highest concentration of people - which of course is the city. Teleconferencing and IT must be used in innovative ways, and remote locations supported to use this technology to improve equity of health at all levels of access and administration. (Please note, this comment is initiated through first hand experience serving on the Medicare Local Stakeholder reference Group.)
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