The Federal Government has set a tough implementation schedule for its health reforms, particularly as so many of the variables involved are beyond its control.

The first batch of primary health care organisations (PHCOs), to be known as Medicare Locals, are due to open shop in July-September next year, with the remainder scheduled for operation by July-September in 2012 (according to this implementation timetable, anyway).

Yet there are still so many questions about how the Medicare Locals will work.

Will they really just be divisions of general practice re-badged, as many fear, or will they represent a step in our evolution towards a genuine primary health care system? (for the differences between primary care and primary health care, and why these matter, see previous Croakey posts).

Some of the more important questions are around whether Medicare Locals will manage to genuinely engage their communities (and particularly their under-served members) in their development and governance, in setting directions and priorities.

For those organisations that are genuinely interested in achieving this, what are the most useful ways of going about it?

The Hunter Urban Division of General Practice is hoping to be one of the first PHCOs off the rank, and wants to hear from Croakey readers if you’ve suggestions for how PHCOs could engage with their communities.

Scott White, the Division’s Communications Manager, writes:

GP Access, the trading name for the Hunter Urban Division of General Practice, is one of the largest and most active divisions of general practice in the country. Our Division has around 450 GPs as members and we provide services to almost 500 000 people living in the Newcastle, Lake Macquarie, Maitland and Port Stephens local government areas.

Our board’s view, based upon the current information is that GP Access will support the evolution of the organisation into a PHCO.

In many ways GP Access already operates as a Primary Health Care Organisation. We have a strong and well developed relationship with the Hunter New England Area Health Service and work with other health providers in our region. We operate an after hours GP service which had around 150 000 patient encounters last year and we employ a number of allied health professionals and nursing staff who coordinate care for patients in conjunction with general practice. Our corporate vision is to achieve an integrated primary health care system, centred around general practice, that delivers improved health outcomes.

As many previous contributors to Croakey have noted, it is very frustrating and disappointing that the mainstream media continues to focus on hospitals in the health reform debate. Australia’s hospitalisation rates are high by international standards – twice those of Canada, and about 25 percent higher than the UK and the USA. Primary health care is what will keep people well and out of hospital. There is abundant evidence that a strong, affordable and effective health system is built upon primary health care.

One of the key issues that will face fledging PHCOs is how will they effectively engage with their local communities to address some of the access and equity issues that have been raised in recent Croakey posts. This is a question I have been discussing recently with Melissa Sweet and Professor Gavin Mooney. We have been examining a number of possible strategies to achieve this.

In our region, Newcastle City Council has recently implemented a community engagement program called Newcastle Voice, which has been extremely successful.

Newcastle Voice is an online community panel where community members can register and the Council will periodically send invitations to participate in a variety of online consultations/surveys. Currently the Council has about 2500 people registered with Newcastle Voice, about half of whom take part in a consultation at any one time. The biggest challenge the Council had in setting up the panel was getting people to register.

As a starting point for developing an online panel, we are planning to hold a public lecture/forum on health reform with the intention of attracting community members who are interested in health issues. We hope that once we have registered community panel members they will act as advocates for our panel and promote it through their online communities.

In this way we also hope to contribute to a more informed understanding of complex health issues in our community.

Of course the online community panel is just one mechanism that could be used to engage our community and, as Melissa and Gavin have both noted, while online consultation is an efficient and cost effective strategy, it does preclude many members of the community.

This is where Melissa has suggested that we engage with the Croakey readership and call on their vast knowledge and expertise to ask for feedback and suggestions.

So it’s over to you…what strategies do you believe a PHCO should be using to help it engage effectively with its community …all contributions most welcome to

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Peter Fray
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