When the Greater Metro South Brisbane Medicare Local decided to prioritise action on the social determinants of health, this led to an innovative partnership that has translated into much-needed services for homeless people.

The project has shown both the high needs of this group of people, as well as the importance of collaborations, says Tam Shepherd, ceo of the Greater Metro South Brisbane Medicare Local.


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Acting on the social determinants of health

Tam Shepherd writes:

Recently I was invited to speak at the National Primary Health Care Conference in Adelaide on the approach the Greater Metro South Brisbane Medicare Local has taken on integrating the social and other determinants of health into our programs.

Staff recognised very early on that for our work to be effective, addressing the social determinants of health was paramount to any lasting or meaningful change.

Getting all the elements right is paramount to success.  Key elements of the plan have to include:

  • A strong Governance structure;
  • A qualified and committed team;
  • Funding priorities to improve health outcomes and access;
  • Engaging and collaborating with effective partners;
  • Integrated planning; and
  • An evidence-based needs assessment.

When developing our Three Year Strategic Plan, in addition to the five Key Performance Indicators given to the Medicare Locals from the Department of Health and Ageing, our staff agreed to a sixth indicator – to integrate the social determinants into healthcare planning.  This was in recognition that health can affect the quality of an individual’s home life, education, ability to work and financial security.

One of the best examples of all these elements coming together is GMSBML’s Homeless to Home Healthcare partnership with Micah Projects and the Mater Health Services Brisbane to establish an after-hours clinical nursing service to work alongside Micah’s  Street to Home team.

Our community needs assessment showed the homeless community to be an urgent priority in our region.  The Street to Home team at Micah Projects was already established but had no after hours service.

Thanks to this innovative partnership, and with funding support from the Department of Health and Ageing and Metro North Brisbane Medicare Local, the Street to Home team provide primary healthcare to homeless and formerly homeless people each night from 6:00pm to midnight, seven days a week.

It is a prime example of action equalling results.

The statistics for the first five months of operation for the service have been overwhelming.  There have been:

  • 1631 occasions of care provided;
  • The youngest client was 14 years old and the oldest 86 years old;
  • The average age of patients was 44 years; and
  • For the months of June and July 2012 over 60% of people treated identified as Aboriginal and/or Torres Strait Islander.

The primary care intervention the service provides includes:

  • General assessments;
  • Clinical Care;
  • Wounds Care;
  • Medication management assistance;
  • Health education;
  • Health and welfare checks;
  • Counselling support;
  • Social and housing support; and
  • Assistance with presenting mental health and drug and alcohol problems.

Other referrals have been made to GPs, the local Aboriginal and Torres Strait Islander Health Service, Street to Home case managers, the Brisbane Homeless Service Centre Clinical Service Nurse, Queensland Ambulance Service, Murri Watch Diversionary Centre and mental health services.

All of these interactions with service providers, both non-Government and Government, working together, have made a real impact on the community.

Medicare Locals have an opportunity to address the social determinants of health, which is why our staff requested the sixth KPI.

It is a reminder to us that our planning and programs are strengthened by a bigger picture point of view.  To succeed, we need to join our resources with those of our partners to make a lasting and tangible difference.

I encourage all of you, if you have not seen it, to watch this You Tube clip produced by Micah Projects about this very issue.


It is a very powerful and moving statement about how making these issues everybody’s business can lead to positive change.

• Tam Shepherd is CEO of the Greater Metro South Brisbane Medicare Local

• See here for previous Croakey articles on Medicare Locals




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