A recent article in the News Ltd press demonstrates the political, media and public relations challenges facing Medicare Locals (MLs) in the review of their roles and functions, currently being overseen by former Chief Medical Officer Dr John Horwath.

The article extensively covers the AMA’s submission to the review, including the results of a ‘survey’ undertaken by the AMA on its members.  Leaving aside the credibility of these type of AMA push polls (and bearing in mind that less than 50% of GPs are AMA members), the article makes no substantial arguments against Medicare Locals.

The best case it mounts for change are the fact that ‘some sites are underperforming’ and ‘staff hate the name’(!)  Nevertheless, the article labels MLs and “Labor’s dud Medicare Locals” and is overwhelmingly negative about their future.

Shadow Health Minister Catherine King is quoted in support of MLs in the piece but there are no comments from a representative of a Medicare Local or its national peak body AMLA.  The journalist also made no effort to include any examples of actual activities being undertaken by MLs – easily obtained through calling any Medicare Local or via the AMLA website.

The end result of this sloppy and biased journalism is an article that positions MLs at the centre of a political debate between the Coalition and Labor over services vs red tape.  The needs of the community for high quality, effective and equitable primary care services are invisible in this debate.

Also ignored are the significant achievements of the majority of MLs which in a very short timeframe have evolved from Divisions of General Practice to include consumers, allied health workers and other stakeholders in a nationwide primary health care infrastructure.  Clearly, there are areas for improvement and it is also true that some MLs have performed more highly than others.  This is to be expected when making such a broad and system-wide change.

Hopefully, the Review will be able to identify and address these issues constructively, without being unduly influenced by the public relations efforts of the AMA and other groups seeking a return to the days when GPs did not have to share the primary health care landscape with others (and Australia had a worse childhood immunisation rate than Indonesia).

Given this environment, it is vital that MLs are given a voice to outline how they are equipping our primary health care sector to meet the challenges of the future – such as increasing rates of chronic disease and multi-morbidity.

For example, the following piece contributed by Jason Trethowan, CEO of Barwon Medicare Local, which addresses the criticisms made in the News Ltd article.  He writes:

Coming into what is being forecast as tough budgets (both for the State and Federal governments) there is the inevitable debate (and subsequent media) about a sustainable health system, with growing health care costs; governments are looking for efficiencies to make up the shortfall.

Medicare Locals have been in the spotlight since the Federal election campaign, as an area where efficiencies could be made, currently being reviewed with findings to be published in March. Formed in 2011-12, Medicare Locals have worked hard in primary health initiatives to try and keep people healthy and out of the more expensive hospital system.

I don’t doubt that there could be improvements, and some Medicare Locals might be performing better than others, but international evidence shows that the sustainability of any health system is improved by strengthening primary health – treating health problems before they become acute and need more expensive hospital care. Saving hospital resources for those who need them is essential for the future of a safe and quality health care system.

Medicare Locals exist to strengthen primary health care. Through local partnerships, Medicare Locals are enabling challenging conversations to occur. The kind of conversations not had before and they are following through with positive action.

Medicare Locals around the nation will have many examples of their achievements in strengthening primary health, tailored to meet the needs of  their regions. In the Barwon region, we have worked hard to build partnerships across primary and secondary health systems.

Local health systems are increasingly influenced by historical relationships between clinicians, increase in medical specialisation, over servicing of patients in the acute hospital system, poor awareness of General Practice capacity and lack of GP knowledge of treatment options and pathways for care. This has led to inefficiencies in the coordination of care between primary and secondary health care providers and contributed to communities experiencing poor access and long delays for treatment.

In response, Barwon Medicare Local launched HealthPathways in August 2013.  HealthPathways is the online ‘go to’ central source for GPs providing specific information on assessment, management and local referral options for GP use during consultation.

HealthPathways aims to build a stronger primary care sector through improving communication between all health care providers, supporting and empowering GPs and ultimately delivering quality care to our community. Partnering with Barwon Health to facilitate its development, implementation and evaluation,  HealthPathways has been jointly developed by GPs, specialists and other primary health care providers. This collaboration between primary and secondary health care is key to its success.

Our collaboration with Barwon Health and Deakin University has also been key in the launch of Primary Mental Health Partners. Primary Mental Health Partners was developed to create improved efficiencies and access for patients and ease of referral for our local GPs. Priority for access is for people who may have difficulty accessing mental health services due to financial, cultural or other constraints. The centralised entry approach allows GPs to refer to a ‘ one stop shop’, accessing a range of mental health services, focusing on early intervention, reducing the onset of more severe mental health issues for the secondary health system – if left untreated.

While recently in the media, Medicare Locals have been labelled by some as just another unnecessary ‘health bureaucracy’, I would argue the opposite, as would the vast majority GPs and allied health professionals.

All Medicare Locals are actively strengthening our local primary health system, reducing the demand for more expensive secondary hospital care and providing better, more efficient access to quality health services for our communities.

We do not operate in a command and control environment. We put relationships before quick wins and sound bites. This way Medicare Locals build the respect and credibility resulting in meaningful outcomes for patients.

Disclaimer: Jennifer Doggett was Communications Manager at the Australian Divisions of General Practice from 2000-2004 and has previously provided consultancy services to the Australian Medicare Locals Alliance. She also once worked with the AMA on an anti-smoking campaign targeting young women.

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