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GPV is a QIC accredited organisation Current Issues Bill Newton CEO Network 20 March 2009.

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Presentation on theme: "GPV is a QIC accredited organisation Current Issues Bill Newton CEO Network 20 March 2009."— Presentation transcript:

1 GPV is a QIC accredited organisation Current Issues Bill Newton CEO Network 20 March 2009

2 Current Issues Reform agenda Funding formula, rurality and other changes Network performance

3 Reform agenda Inputs AGPN’s PHC Position Statement Commissioned papers –Harris, Kidd & Snowden –Jackson & O’Halloran –Swerissen –Dwyer & Eagar Other papers & reports –Centre for Policy Development –Expert Ref Group, Primary Health Strategy Interim Report

4 AGPN Position Statement (p 35) New regional enterprises will –Receive pooled funds; allocate regional budgets for services –Plan population health, primary health care activities, workforce. –Increase community engagement and intersectoral linkages –Contract providers to deliver services –data management; evaluation; quality monitoring. Div Network: national infrastructure supporting primary health care delivery in Australia...will play fundamental part in regionalisation –Divs expand roles to a wider membership base; take on greater responsibilities for the health and wellbeing of the population Options for divisions 1.Become the regional enterprise 2.Be one of several members of regional enterprise 3.Service providers competing for funds from regional enterprises

5 Commissioned papers Harris, Kidd & Snowden (RACGP) Divisions of General Practice become Divs of Primary Health Care, representative of all involved in Primary Health Care (cp UK & NZ). Jackson & O’Halloran Regional Health Councils, (500,000 to 1 mil), to fund and be accountable for all heath care. Members from –Area / District Health –Division –public hospital –private sector –indigenous community –community health sector –Local community

6 Swerissen New governance and organisational arrangements to plan and fund primary and community care Register and accredit providers for access to funding Monitor and manage provider performance and care outcomes Report to government, consumers and the community on primary and community care performance Must be Big enough to complement and integrate with hospital and specialist services and to have the organisational capacity to develop and manage the service system at arms’ length from service providers primarily focused on governance, development of system capacity, management and accountability rather than service provision

7 Dwyer & Eagar Regional Health Funding Authorities (HFAs) whole states (Tas, NT, ACT, SA) or across state boundaries (eg FNQ, the North NT, North WA) plan, commission, fund and regulate health care providers in their region Commission, but not deliver, all services from prevention to palliation to the regional population funds networks or other collaborations among the region’s health service providers

8 Centre for Policy Development Regional Healthcare Organisation (RHO) 200,000-400,000 people (=50 to 100 RHOs ) identify regional health needs, service utilisation patterns, and health spending Fund services to meet needs Board: local government, divisions, area health services or equivalent, CHCs, ACCHS, plus citizens/consumers to prevent domination by interests

9 External Reference Group, Primary Health Care Strategy (green discussion paper) Regional organisation to Plan & co-ordinate services Deliver programs Allocate funding to local services

10 NHHRC Interim Report Regional structures to enhance service coordination and population health planning; big enough to have a critical mass of clients and to provide efficient and effective coordination Divisions of Primary Health Care, evolving from or replacing Divisions of General Practice. These will need to be of an appropriate size and take into account –alignment with state and territory health region boundaries –natural regions across state borders –their capacity to deliver on their core role and –their ability to facilitate networks

11 Implications for the Network Some form of regional organisation likely Purchaser provider split Divisions must –Be of sufficient size and capacity –Align with other (health) boundaries –Consider natural regions across state borders –Develop and facilitate networks

12 Divisions Network Funding Formula Predicted to be introduced from 1 July 09 Will use 2006 ABS population data Winners and losers; no additional funding Extent of change will depend on SEIFA, rurality, loadings, etc Phased introduction? Ministerial announcement expected in March, but timing said in February not to be certain

13 Rurality, RRMA and ARIA RRMA will change to ARIA+ Likely disadvantage for Victorian –Divisions –Practices –GPs Only relates to the geographical factors No information about –loadings for disadvantage, health needs, etc –Phased introduction? Awaiting minister’s decision

14 Implications for the Network The only certainty is that changes are coming Speculation based on previous work since the RIC (2004-05) suggests divisions in Victoria, Tasmania and SA will lose funding overall Uncertainty about planning for 2009-10 Anxiety among staff, possible loss of skilled staff Increased pressure and uncertainty for rural GPs

15 Network Performance Minister Roxon: performance not consistent Phillip Davies: failure to tackle network weaknesses; some divisions struggle to demonstrate value; strong as weakest link, etc David Butt’s paper (20/11/09) –government is prepared to give divisions greater roles and responsibilities but the network needs to demonstrate its ability to deliver high quality services consistently and cost effectively across the country –key risk to the future role of the Network is poor performance in a few divisions having potentially profound consequences for the entire network.

16 Network performance (2) Stronger response from DoHA to perceived inadequacies and failures to deliver on contract More specific performance indicators in contracts Terry Findlay’s project Not new issues; many raised by the Philips Review and the Review Implementation Committee (2004-05) So, what would a high-performing division look like?

17  Accredited Governance features  Contested elections  Board members trained in governance  Members judge division as well governed  Regular turnover of board membership  Including non GPs on Board  Strategic plan independent of contracts  Forward financial plan  Benchmarks governance structures and processes What a good division would look like (Vic/Tas CEOs 2006)

18  A CEO virtually full-time  Qualified CEO  A comprehensive monitored communication system with the members  A database that monitors practices, including –Location –Accreditation status –PIP status –IM systems –Immunisation levels etc –GPs –Practice nurses –Practice managers –other staff –Division contact with all people in all practices Management features What a good division would look like (Vic/Tas CEOs 2006)

19  An integrated multi-disciplinary CPD program  Provision of a Practice Nurse network  Provision of a Practice Manager network  All program staff understand and use the research evidence for practice capacity (see UNSW CGPIS research, Wagner and Grol-the theoretical basis for division work)  Benchmarks programs and services  Capacity to meet contractual requirements demonstrated  Diverse funding sources Management features What a good division would look like (Vic/Tas CEOs 2006)

20  Involved in joint collaborative projects with key stakeholders  Division recognised by stakeholders as key point of contact re GP  Engagement with communities Stakeholder relations What a good division would look like (Vic/Tas CEOs 2006)

21 Next steps for Victorian divisions? Discuss with boards Strengthen member engagement Consider criteria for –Joint work, formal and informal linkages with neighbouring divisions –Linkages with other services –Boundary re-alignment –Extension of membership


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