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Primary Source, November 2011

Country North ML CEO Kim Hosking has a massive local health service canvas before him. The Country North ML covers a geographical area of 800,000 square kilometres with population clusters of around 1,500 to 2,500 people. This paints a picture of a truly challenging locally driven primary health care service but according to Kim Hosking, their strength is in their local connections.

What’s your strong-point for your Medicare Local?

Despite the sheer size of our Medicare local, the only one with four State boundaries and a population of 200,000 people, (measured in kilometres per person rather persons per square kilometre), we are genuinely creating a model that is ‘local’.

We have appreciated that we cannot be ‘local’ overall, but that we can have lots of local within it through creating networks of local activity. By targeting services and support to these local networks, we aim to improve care coordination and improve the numbers of providers to build local capacity that is sustainable for the longer term.

Mistakenly there is a perception amongst local general practitioners that they are being frozen out of the Medicare Locals. The reality is that GPs are our biggest discipline of service providers, by a factor of four. We have provided for systems and processes that will not simply encourage but will demand engagement by general practice in creating the solutions to our very divergent needs.

What will a Medicare Local mean for your rural area?

Hopefully it will lead to better coordination and effective services and better health promotion. The task is massive as we attempt to negotiate and liaise with 40 local hospitals, 27 community health services, eight health service clusters, 10 aboriginal health communities and 25 health advisory committees, within 28 local government areas, 10 State and three federal electorate areas and not including NGO’s.

Our immediate effort will be to locally coordinate the effort in practical terms, by influencing and enabling better services in small groups of local communities and to influence the change from the top down through the State provided networks of services. This parallel approach, bottom up as well as top down, we hope, will influence better allocation of small dollars to achieve localised outcomes in small communities and demonstrate that these small solutions can be achieved with more effect than bigger dollar solutions attempted globally.

What will be that ‘penny dropping’ moment for communities with regard to Medicare Locals?

These changes will bring about a slow dawning realisation of change. To have these changes to overall health services and delivery recognised is somewhat of  a generational task. The realisation for the public will come as they appreciate that it easier to access a GP than it was last time. Or that there is now ready access to an allied health provider or mental health clinician that wasn’t available the last time.

How will your Medicare Local change what is being done today to what will be done under the new primary health care regime?

Our previous roles as Divisions seeking to meet the objectives of the Commonwealth, led with the willing support of general practice, provided high uptakes of care planning, aged care assessments, medication reviews and the like.

The Commonwealth has provided us with two clear new objectives, being; better coordinated care and an improved patient journey.

Simply promoting the concept and awareness of these issues, as they relate to the average person and promoting this awareness to the average person in the community will create its own momentum for change.

"One doesn’t know what one is missing until one is made aware of what they are missing".

Once aware, they will demand what they have been missing.

Many have experienced the deficiencies in the patient journey and the problems that arise from poorly coordinated care, they just don’t know that it doesn’t have to be that way. We intend to promote awareness of these issues and supplement same with actual on ground strategies to improve coordinated care and the patient journey. Issues such as eHealth have little resonance in the mind of the average person and it will remain that way until they can see practically, the value and potential in same. Promotion of eHealth as part of the better coordination of care and improvements in the patient journey will provide practical application in the mind of the population and give the matter more resonance.

What’s your best example of a program you are running now that exemplifies your ML?

No single program stands out identifiably as our stand out activity, though our mental health services deserve some comment. Without the mental health services enabled through commonwealth funded programs, mental health would be a critical issue for communities and the state alike. We employ 28 FTE of clinicians across the region and deliver services in small local communities and remote areas. The number of actual people on the ground is greater but makes up that notional FTE. There are almost no private providers and a limited number of providers funded from other sources.

The noteworthy aspect of our programs is that we aim to deliver activities locally. We have but one town with a population of 20,000 persons in an area greater than 800,000 square kilometres. Otherwise we have a multitude of small towns of around 1,500 to 2,500 persons and to make our activities relevant we must take and supply the activities locally in these small communities. Our population is not silly or naive and knows that the economies of scale will never exist to enable equitable accessible top end services and that to access same requires travel, primarily to the metropolitan area. But they do seek basic services and our aim is to enable the provision of same. That result is what we will be thanked for.

How important is it to have an overarching body to manage and monitor primary health care services for your region?

The potential for an overarching body in our area, is for improved economies of scale that result in increases in practically applied services to the community. This will become immediately apparent in our mental health clinical services. The consolidation of five Division services is already creating the potential for relocation of clinicians into targeted areas of need and for improved triage and support to clinicians and clients.

While the previous activities of the five Divisions in other areas of activity have been somewhat coordinated in recent years, further coordination and resource sharing is already occurring and will increase. The impact of this on useable effective dollars will permit the Medicare Local to expand its horizons in terms of community services, health promotion and targeted support activities.