general practice

Sep 2, 2009

What really matters in health?

"Primary healthcare reform is the single most  important strategy for improving our health and making the health system sustainable.  Community-level prevention and primar

Melissa Sweet — Health journalist and <a href=Croakey co-ordinator" class="author__portrait">

Melissa Sweet

Health journalist and Croakey co-ordinator

“Primary healthcare reform is the single most  important strategy for improving our health and making the health system sustainable.  Community-level prevention and primary healthcare is essential to restoring universalism and efficiency in Australian healthcare.”

That quote actually comes from the Preventative Health Taskforce report. I thought it worth mentioning because the draft of the first national primary health care strategy (which is available here, together with a supporting report) is likely to slip off the public radar pretty quickly, more’s the pity.

The Consumers Health Forum has given the strategy a big tick. Executive director Carol Bennett issued a statement saying: “The building blocks for change identified in the draft strategy reflect consumer priorities in health care. We’re delighted to see the focus on better integration and improved access to services, as well as measuring impact and outcomes. One of the strong points in this report is the way it embraces community based service provision that is not just about clinical health or GP services.  This is particularly important for people experiencing chronic relapsing health conditions who often need a wide range of services to meet their health needs.”

But Croakey contributor Professor Gavin Mooney is not so enthusiastic. He has written this analysis for Croakey:

“The national PHC Report and Strategy are overall disappointing. Let me respond to just two aspects.

First there is no grand vision, no overarching set of principles or values. Just a listing of 10 key aspects later reduced to 4 which are “improving access and reducing inequity; better management of chronic conditions; increasing the focus on prevention; and improving quality, safety, performance and accountability.’

How these were arrived at seems to have been in some backroom with, yes, “consultation” – which means anyone or anybody who wants to is invited to write in – predominantly “experts” (like me!) or professional bodies which have a vested interest.

Where is the voice of the informed public? It is their primary health that is at stake and it is their primary health care that is at stake. They are perfectly able to think through the principles and values they want to underpin PHC.

For example the Perth GP Division – the Perth Primary Health Care Network – got me to facilitate a citizens’ jury with randomly selected but well informed citizens being asked to say what they wanted from the network. A simple cheap and effective way to consult – and interesting results – for example their suggestions under the heading of “improved quality of care” included “More holistic care; GPs running on time; better referral systems, especially for mental illness; improved doctor patient relationship (with greater transparency on a number of fronts, particularly the influence of pharmaceutical companies on GPs practice and  greater shared decision making in general).”

In another jury in South Australia in a primary health care setting, one of the very interesting issues they proposed was for the PHC facility to be a point of contact for assistance in gaining knowledge of where to go with particular problems. This was to involve establishing information about and linkages with other services (both health and non-health), identifying gaps and seeking to fill these and advocacy with other (non-health) services to be more cognisant of their potential health role.

The details of the results from these citizens’ juries perhaps do not matter in this context. What does is that people – citizens – have a pretty good idea what they want in PHC. But we will never know if we do not ask them. This national committee do not know because they never asked.

Another issue (and it turns out to be related) in the report and strategy that concerns me is their handling of GP remuneration. The report runs through the arguments for and against different systems – and then basically stops, arguing in essence that there is not enough evidence to justify much by way of change. (There is some suggested change on chronic care and possibly prevention.) The evidence I believe is stronger than they suggest that but that is not my main concern here. We know that different remuneration systems result in different GP behaviour. The question then is: how do we want out GPs to behave? What do we want from General Practice?

Who better to address that than informed citizens! But the committee did not ask. Maybe there is still time?”

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