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Before examining how to arrest, and reverse, the decline in GP

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Before examining how to arrest, and reverse, the decline in GP

Submission to the Inquiry into Access to

Primary Health Care Services

About ACTCOSS

    ACTCOSS acknowledges that Canberra has been built on the traditional lands of the Ngunnawal people. We pay our respects to their elders and recognise the displacement and disadvantage traditional owners have suffered since European settlement. ACTCOSS celebrates the Ngunnawal’s living culture and valuable contribution to the ACT community.

    The ACT Council of Social Service Inc. (ACTCOSS) is the peak representative body for not-for-profit community organisations, people living with disadvantage and low-income citizens of the Territory.

    ACTCOSS is a member of the nationwide COSS network, made up of each of the state and territory Councils and the national body, the Australian Council of Social Service (ACOSS).

    ACTCOSS’ objectives are representation of people living with disadvantage, the promotion of equitable social policy, and the development of a professional, cohesive and effective community sector.

    The membership of the Council includes the majority of community based service providers in the social welfare area, a range of community associations and networks, self-help and consumer groups and interested individuals.

    ACTCOSS receives funding from the Community Services Program (CSP) which is funded by the ACT Government.

    ACTCOSS advises that this document may be publicly distributed, including by placing a copy on our website.

Contact Details

    Phone: 02 6202-7200

    Fax: 02 6281 4192

    Mail: PO Box 849, Mawson, ACT 2607

    E-mail: actcoss@actcoss.org.au

    WWW: http://www.actcoss.org.au

    Location: Level 1,

     67 Townshend St,

     Phillip, 2606, ACT.

Director: Roslyn Dundas

    Deputy Director: Kiki Korpinen

    Policy Officer: Caterina Giorgi

June 2009

? Copyright ACT Council of Social Service Incorporated

    This publication is copyright, apart from use by those agencies for which it has been produced. Non-profit associations and groups have permission to reproduce parts of this publication as long as the original meaning is retained and proper credit is given to the ACT Council of Social Service Inc (ACTCOSS). All other individuals and Agencies seeking to reproduce material from this publication should obtain the permission of the Director of ACTCOSS.

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Acronyms

    ACT Australian Capital Territory

    ACTCOSS ACT Council of Social Service

    CALMS Canberra After Hours Locum Medical Service

    FWE Fulltime Workload Equivalent

GP General Practitioner

    MBS Medicare Benefits Schedules

NHHRC National Health and Hospital Reform Commission

    NHWT National Health Workforce Taskforce

NP National Partnership

NSW New South Wales

PHC Primary Health Care

    PBS Pharmaceutical Benefits Scheme

QLD Queensland

    ROGS Report on Government Services

TCH The Canberra Hospital

    VNPP Victorian Nurse Practitioner Project

WHO World Health Organisation

WiC Walk-in Centre

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Table of Contents

    Submission to the Inquiry into Access to Primary Health Care Services ....1

    About ACTCOSS..............................................................................2

    Contact Details ...............................................................................2

    Acronyms ......................................................................................3

    Table of Contents ............................................................................4

    Summary of Recommendations .........................................................5

    Introduction ...................................................................................6

    Primary Health Care: Not Just GPs .....................................................7

Understanding the Health Policy Environment: Commonwealth and ACT

    Initiatives ......................................................................................9

    Challenges Facing Primary Health Care ............................................. 14

    Primary Health Care in the ACT: Gaps and Challenges ........................ 18

    Possible Solutions: Learning from other Regions ................................ 22

    Conclusion ................................................................................... 25

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Summary of Recommendations

    1. Ensure that this Inquiry considers all primary healthcare services

    beyond the provision of care by GPs.

    2. Acknowledge that the challenges experienced in the ACT are common

    to many other jurisdictions and consider the national perspective in

    primary health care planning.

    3. Acknowledge the supply and demand factors contributing to the

    health workforce shortage when planning future primary health care

    services.

    4. Ensure that people in the ACT community who are experiencing

    disadvantage are considered when planning future primary health

    care strategies and models of care.

    5. Ensure that future primary health care services take into

    consideration the barriers to access facing people experiencing

    disadvantage including cost, availability and location. 6. Develop further primary health care services that do not involve an

    up-front cost for consumers to access.

    7. Develop alternative access points to primary health care that do not

    depend upon accessing a GP.

    8. Develop primary health care services that are available outside of

    business hours.

    9. Ensure that transportation is considered in future primary health care

    planning.

    10. Develop alternative transport options for consumers to access

    primary health care services.

    11. Ensure that health planning does not result in the centralisation of

    health care around The Canberra Hospital campus.

    12. Improve the coordination of planning and development for health

    policies and services.

    13. Adopt a social determinants approach to health care that focuses on

    the consumer.

    14. Complete the Health Consumer and Carer Participation Framework,

    taking into consideration the recommended changes submitted by

    ACTCOSS.

    15. Ensure that meaningful consultations occur in the planning and

    development of primary health care services in the ACT. 16. Explore strategies being adopted by other jurisdictions to improve

    access to primary health care services and determine whether such

    models would be applicable to the ACT.

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Introduction

    ACTCOSS welcomes the opportunity to provide a submission to the ACT Legislative Assembly Standing Committee on Health, Community and Social Services regarding the Inquiry into access to primary health care (PHC) services (the Inquiry). ACTCOSS believes that primary health care services are an integral part of the delivery of health care as they are the main point of access into the health care system. Traditionally the gate

    keeper role for health care has predominantly been with GPs. However due to the supply and demand factors that are contributing to the decreasing health workforce and increasing demands upon PHC services, it is now time to explore alternative models of health care. ACTCOSS raised the need to develop innovative health care models in their ACT 2009 -10 Budget Submission; Prioritising People: A Person Centred

    Approach to Today’s Challenges, stating that:

    A further challenge (in health) will be the ongoing health workforce shortages

    which will see ACT Health needing to adopt strategies that enhance our

    system, beyond our dependence upon hospitals and General Practitioners

    (GPs). Some of this work has begun, with ACT Health exploring the option of

    introducing Nurse Practitioner-led Walk-in Centres (WiCs). However more 1work is required if we are to ensure that services are timely and affordable.

    In providing a response to the Inquiry, ACTCOSS has chosen to provide a discussion of the broader health policy setting, beyond initiatives that target GPs alone. ACTCOSS believes that PHC planning and discussion need to be had at a whole of community level ensuring the fragmentation of the health system both in the ACT and at the national level, does not continue.

    The focus of PHC reform can not lie with GP recruitment and retention strategies alone, as these methods are not sustainable in the environment 2of global workforce shortages.

    ACTCOSS encourages members of the Standing Committee and ACT Health to continue to consult with the community regarding the future of PHC in the ACT. ACTCOSS also promotes the development of initiatives and policies that support emerging evidence based strategies and encourage the Committee and ACT Health to explore such alternatives.

     1 ACTCOSS, Prioritising People: A Person-centred approach to today’s challenges,

    Submission to the ACT Budget 2009-10, February 2009, p.39 2 National Health Workforce Taskforce, Health Workforce in Australia and Factors

    for Current Shortages, April 2009, p.62

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     Primary Health Care: Not Just GPs

    While the Inquiry claims to explore access to primary health care services, the majority of the ToR for the Inquiry relates to GPs. It is important that the Standing Committee understands that primary health care involves a greater range of health care services than those provided by GPs. PHC includes services that act as the first point of call for consumers. PHC is defined by the National Health and Hospital Reform Commission (NHHRC) as being:

    services in the community accessed directly by consumers. It includes primary

    medical care (general practice), nursing, community health services,

    pharmacists, Aboriginal health workers, physiotherapists, podiatrists, dental

    care and all other registered practitioners. It also covers specialised services

    such as alcohol and drug treatment services, sexual and reproductive health

    services, young people’s services, school health, and maternal and child 3health.

    The provision of healthcare in the ACT has mainly focused upon GPs in the past. This model is no longer sustainable due to the global shortage of GPs and other supply and demand factors. Alternative models of healthcare must now be explored without the focus upon the GP as the gatekeeper to health. The ACTCOSS 2009-10 Budget Submission: Prioritising People: A person-centred approach to today’s challenges

    explored this issue:

    A longer term solution to address health workforce shortages is to develop

    more innovative ways of delivering health services. For example the recent

    ACT discussion paper on WiCs in the ACT, explores the development of Nurse

    Practitioner led centres. Currently within the ACT there are eight practicing

    Nurse Practitioners working in areas of emergency, aged care, wound care,

    sexual health and renal services. ACTCOSS believes that Nurse Practitioners

    can play a vital role in the delivery of health services throughout the ACT.

    Further Nurse Practitioner positions are required in the ACT, including

    positions for the 10 registered Nurse Practitioners, who are not currently 4working within that capacity in the ACT.

    It must be noted that ACTCOSS is not opposed to attracting additional GPs to work in the ACT. ACTCOSS welcomes any increase in GP numbers or medical training places. However ACTCOSS acknowledges that a sole focus upon attraction of GPs may not result in an increase in GP numbers, due to the global shortages and challenges in attracting GPs.

    The focus of this Inquiry needs to be broad to encompass the whole PHC sector and possible changes to enhance the services provided and introduce new services. This will ensure focus is not placed simply upon

     3 National Health and Hospital Reform Commission, A Healthier Future for all Australians: Interim Report, December 2008, p.6 NHHRC 4 ACTCOSS, Prioritising People: A Person-centred approach to today’s challenges,

    ACTCOSS Submission to the ACT Budget 2009-10, February 2009, P.42

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    one aspect of PHC, such as GPs, and encourage multifaceted solutions to address the challenges that will face PHC in the near future.

Recommendation

    Ensure that this Inquiry considers all primary healthcare services beyond the provision of care by GPs.

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    Understanding the Health Policy Environment: Commonwealth and ACT Initiatives

    Due to the interrelated nature of the health system, it is important that initiatives being developed both nationally and within the ACT are understood prior to the development of further strategies.

    Currently within Australia the Commonwealth Government is implementing what they consider to be the most significant reform to the health system in recent times. The reform involves a range of policy changes that may affect the way that the health system is funded, administered and implemented. At the same time, the ACT Government is implementing an ambitious agenda in the form of the capital asset development plan, which sees an investment of over $1 billion into health 5infrastructure spending. A summary of selected Commonwealth and ACT initiatives is provided below.

Commonwealth Initiatives

COAG Hospital and Health Workforce Reform

    The National Health Workforce Taskforce (NHWT) was developed in 2006 in response to the COAG agreement to significantly reform the health workforce. The NHWT is a national body created under the Australian Health Ministers’ Advisory Council, whose role is to undertake projects that inform the development of solutions on workforce innovation and 6reform. In 2008 COAG announced that a new agency would be

    established that would subsume the NHWT, in managing and overseeing workforce reform.

The new agency will have a focus on implementing workforce reform and 7will devise solutions for workforce planning and policy. The agency will

    also implement the necessary reforms to education and training and will operate across the health and education sectors. Under the new agency a national approach to workforce planning will be developed that supports and compliments the work of each jurisdiction.

The Agency will be funded under a new $1.6 billion National Partnership 8(NP) for hospital and health workforce reform. The funding will also be

    allocated to the following areas:

    ; $500 million additional Commonwealth funding for undergraduate

    clinical training;

    ; 605 post graduate training places and/including 212 GP places;

    ; A health workforce statistical register;

     5 ACT Health, Your Health our Priority: Stage 2, 2008, Accessed at

    http://www.health.act.gov.au/c/health?a=da&did=10241971&pid=1216959545 6 National Health Workforce Taskforce, Australian Health Workforce Online,

    Accessed http://www.nhwt.gov.au/nhwt.asp 7 National Health Workforce Taskforce, Recent COAG Reforms, 2008, Accessed at

    http://www.nhwt.gov.au/coag.asp 8 COAG, Communique, November 2008, Accessed www.coag.gov.au

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    ; $175.6 million over four years for capital infrastructure to expand

    teaching and training; and

    ; Funding to train approximately 18,000 nurse supervisors, 5,000 9 allied health and other supervisors and 7,000 medical supervisors.

National Health and Hospitals Reform Commission

    In February 2008 the Commonwealth Government established the NHHRC 10to develop long term health reform for Australia. The NHHRC was tasked

    with providing advice on a framework for Australian Health Care Agreements by April 2008, and developing a report on long term health 11reform by June 2009.

In December 2008 the NHHRC produced an Interim Report on long term

    health reform that outlined four strategic reform themes:

    ; Taking responsibility, including individual and collective action to

    develop good health;

    ; Connecting care, encompassing comprehensive care for people

    throughout their lives;

    ; Facing inequities, developing strategies that address the causes of

    inequities; and

    ; Driving quality performance, involving the production of a more

    efficient health system.

    The report was comprehensive and covered many areas of healthcare. One such area was the development of primary healthcare. The report discusses ‘Creating strong primary health care for everyone, which

    involves a range of suggested reform directions, including:

    ; Improved integration and strengthening of primary healthcare,

    with the Commonwealth assuming responsibility for all PHC policy

    and funding;

    ; Establishing comprehensive PHC Centres;

    ; Improved care coordination for people with chronic health

    conditions, with the option to enroll with a single PHC practitioner;

    ; Establishing of Divisions of PHC, replacing Divisions of General

    Practice;

    ; Facilitating access to care where doctors are scarce, including

    applying medical, pharmaceutical and procedural rebates to nurse

    practitioners and other health professionals;

    ; Establishing a National Aboriginal Heath Authority that would

    promote best practice and quality health outcomes in PHC for

    Aboriginal and Torres Strait Islander people; and 12; Developing a person-controlled electronic health record.

     9 COAG, Communique: Attachment A Health and Ageing, November 2008,

    Accessed www.coag.gov.au 10 National Health and Hospital Reform Commission, National Health and Hospital

    Reform Commission Website, 2008, Accessed at

    http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/home-1 11 Ibid 12 National Health and Hospital Reform Commission, A Healthier Future for all

    Australians: Interim Report, December 2008, p.80

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