Lynelle Hales CEO South Eastern Sydney Medicare Local

Medicare Locals: Planning and Coordinating Primary Health Care

Planning and Coordinating Primary Health Care (PHC)

• Set the Context: PHC

• Role and Potential of Medicare Locals

• Examples in South Eastern Sydney

Australian Health System

• National Health and Hospital Reform Commission, June 2009

• National Preventative Health Strategy, June 2009

• National Primary Care Strategy, 2010

• Australia’s Health 2012

What the Reports Say:

• Primary health care is typically the first health service visited by patients with a health concern

– Includes most services not provided by hospitals

– Involves a wide range of professions, such as GPs, pharmacists, ambulances, community health workers, Aboriginal health workers, practice nurses and dentists.

• The service delivery, funding and governance arrangements for primary health care continue to be complex

What the Reports Say:

• The majority of health-care services are provided through the primary health-care system, including

–130 million services subsidised by the MBS

–200 million prescriptions subsidised by the PBS and RPBS.

• In 2010–11, 39% of hospital emergency department presentations were for GP-type consultations

• Private health insurers offered rebates for a range of allied health services, including

–28.4 million dental services

–8.6 million physiotherapy services

Historic Patient Journey

Chronic Disease Management

Barnett et al. Epidemiology of multimorbidity and implications for health care, research, and medical

education: a cross-sectional study. The Lancet, Volume 380, Issue 9836, Pages 37 - 43, 7 July 2012.

Available at: www.knowledge.scot.nhs.uk/media/CLT/.../MM%20Final_SSPC.ppt

Navigating the Health System

Navigating the health system...

• Increasing complexity of

health and social care

• Funding of healthcare

changing

• Need to work differently

and in partnership

• Coordination of Care an

essential component of

care provision

• Increasing need for

health intelligence:

– Health literacy

– Navigation tools:

Diagnostic / treatment

Providers, Services

Challenge or Opportunity...

Role for Medicare Locals

Medicare Locals are primary health care organisations established to coordinate primary health care delivery and tackle local health care needs and service gaps. They have been established to:

• Drive improvements in primary health care

• Ensure that services are tailored to meet the needs of local communities

• Improve coordination and integration of primary health care in local communities

• Address service gaps

• Make it easier for consumers to navigate their local health care system

Role of Medicare Locals in Primary Health Care

Planning

Coordinating Care

Delivering Care

• Population

• Workforce

• Health Partnerships

• Health Intelligence

• Proactive Care

• Areas of Shortage

South Eastern Sydney Medicare Local

Officially launched on 1st July 2012

SESML region consists of four local Government areas : Sutherland Shire, Hurstville, Kogarah and Rockdale, comprising 400 square kilometres

Total population of the region is 442,864 (2011 Census) with a higher than average representation of those aged 65+

3 Public and 8 Private hospitals within SESML

196 General Practices, 492 GPs, 105 Practice Nurses

1000 Allied and Community Health Professionals, including 120 pharmacies

60 Residential Aged Care Facilities

3 Aboriginal specific services

One of 2 Medicare Locals in the SESLHD

Vision

Strategic Priority Areas

Initiatives

1

2

3

Developed a concise description of the strategic change programme that the SESML is aiming to achieve in next two years

Agreed priority areas and actions to drive achievement of the vision – including improved health gains, reduced inequalities and improved quality of care

Established the team to deliver the strategic priority areas in the context of the strategic programme of change and impact on health outcomes

SESML Establishment

ML

Planning

• Undertaken a comprehensive needs assessment , highlighting key priority areas within South Eastern Sydney Medicare Local:

– Improvements in proactive care of chronic and preventable diseases

– Mental health services – particularly targeting increased support for co-morbidities – both health and drug and alcohol

– Aged Care services – improving access to services particularly through better coordination between services.

– Navigation: strong call for improved health intelligence, through health literacy tools, diagnostic and treatment tools and navigation tools for services and support at different stages of the patient journey

• Workforce Mapping and Strategy Development: looking at different ways of working (PHC networks, virtual integration, HealthOne)

Practice Support Program

• Education programs (small groups and CPD events for both GPs and Allied Health)

• Chronic Disease Management initiatives led by practices

• Ehealth: SESML has undertaken a wide range of activities to assist in increasing awareness and use of the national Personally Controlled eHealth Record System in the region.

• Quality Improvement in clinical practice including roll out PenCAT tool to improve data quality and supporting immunisation and quality use of medicines

• Practice Nurse support

• Allied Health support – education and connectivity

• Workforce planning and exploration of options to support provision and coordination of primary health care: e.g. Virtual integration, nurse led clinics

Coordinating Care through Effective Partnerships

MLs

LHN Community

Services

Understanding the role of

individual organisations,

where there are common

interest and where unique

role in supporting PHC

Strategic Collaboration

• Eastern Sydney Medicare Local

• South Eastern Sydney Medicare Local

• South Eastern Sydney Local Health District

– Including Sutherland and St George Hospitals, War Memorial Hospital, Calvary Health Care

• St Vincent’s Hospital Network (Darlinghurst)

• Sydney Children’s Hospital Network (Randwick)

• UNSW Centre for Primary Health Care and Equity

Agreed Partnership Principles

Sharing information

and interests

Joint needs assessment

and planning

Sharing priorities and

actions

Governance Structure and Processes

Connecting Care:

providing more effective health management for people aged 16 years and over with chronic diseases who are at high risk of unplanned hospital admission.

• Care Coordination

• Specialist Clinics

• White Board meetings

• Access and Referral Centre

• Future work with the CCSS Program

• Hospital Avoidance

• Integrated care supporting GPs

Providing access to services for our younger population: two headspace Centres

Led consortium of 10 to establish two

headspace centres for young people :

Miranda and Hurstville

• GP Clinic

• Sexual health clinic

• Psychology Services(ATAPS)

• Drug and Alcohol services

Partners in Recovery (PIR) has been designed to help improve the supports provided to people living with severe and persistent mental illness who have multiple support needs, by focusing on improving the response of the system to meet their needs.

SESML led consortium of 15 – working together to improve pathways to accessing support and ensuring that the services supporting a person, are working together in a coordinated and recovery orientated way, meeting the full range of their support needs.

Access to Allied Health Services in Aged Care Program

• Regional Medical Advisory Committee(RMAC)

• Liaison with all RACFs in area

• Strategic partnerships

• Coordination of AHP

• Education in RACFs

• GP access into RACFs

• Stepping on program and GPERS

• Identify gaps:

• Dementia/Palliative/HACC rep.

Improving Access to Primary Care After Hours Services through partnership

• Two local GP run after hours clinics: Kareena and St George

• Improved availability of home visiting services and universal access for RACFs.

• Provision of incentives for increased opening hours and improving access to services after hours

• Support and coordination for after hours service improvements including accreditation of after hours services and funding of practice nurse on weekend after hours.

ATAPS

Through a hybrid model of directly employed psychologists and 40 contracted psychologists, SESML has increased access to mental health services through the ATAPS program facilitating 6,496 sessions of short-term psychological services over the last 18 months.

• Group or individual treatment programs

• Up to 12 “free” individual sessions with Allied Health Professional per

calendar year with review by GP after each 6 sessions

• Additional 6 sessions in exceptional circumstances

• AHPs of various disciplines

• Therapy: Psychological Therapy or Focussed Psychological

Strategies predominantly Cognitive Behaviour Therapy based.

During this last year, SESML has effectively introduced the ATAPS Clinical Governance Framework requirements with centralised triage and introduction of a Client Management System.

Closing the Gap Program

• Working together to Close the Gap

• Embedding Aboriginal and Torres Strait Islander health priorities across all PHC programs.

• Indigenous Chronic Disease Package aims to achieve a reduction in the chronic diseases for Aboriginal and Torres Strait Islander people through support to the health sector and increasing access to health care

• Indigenous Access to Mainstream Primary Care Program: improving access to culturally sensitive mainstream primary care services

In Summary: the Future of Primary Care

• Need to work differently

and in partnership

• Need to become patient

focused rather than

disease focused

• Coordination of Care is an

essential component of

care provision

• Increasing need for health

intelligence: Health literacy

Navigation tools

Improved data

In Summary: Role of Medicare Locals in PHC

Planning

Coordinating Care

Delivering Care

• Population

• Workforce

• Health Partnerships

• Health Intelligence

• Proactive Care

• Areas of Shortage

The direction is clear. MLs have built a strong base to build from

The work going forwards is fully focused on achieving maximum impact in primary health care

There are great opportunities for us to work collaboratively with our communities to improve health care integration and outcomes.

Thankyou.

www.sesml.org.au