Missing the good old days of GP divisions, GPs quite love to dislike PHNs, if they think about them at all. But they probably should like them and think about them a lot more.
According to a few aggregated surveys we have done or seen over the years, and other stuff going on behind the scenes, GPs think their PHNs are either pretty good to great, or pretty bad to hopeless, but overall, a lot more GPs aren’t engaged at all with their PHN than are engaged.
Whenever I run into one of these GP PHN detractors, I understand why they feel the way they do, but almost always feel that they aren’t aware of the back story. And if they were, they might be a little more forgiving.
But who has time for that if you’re a GP? A PHN is either helping and effective or it isn’t.
A lot of GPs think they aren’t.
At last week’s Australasian Institute of Digital Health’s Primary Care Digitally Connected conference in Sydney, co-commissioning consultant Jay Rebbeck, who has worked extensively with PHNs over the years gave us a pretty succinct explanation for why some GPs struggle to understand PHNs.
The Commonwealth commissioned a $2m review of PHNs from big C consulting firm BCG, which was delivered early this year, and was promptly stuffed in a locked bottom drawer somewhere in the bowels of the Department of Health, Disability and Ageing.
Mr Rebbeck explained the likely reason.
“If you look at the National Audit Office report, there was a lot of criticism about the PHN movement more broadly. We read the report, most of the criticism was actually about the Department.
“It was basically saying that there isn’t a clear strategy, lack of clear indicators, lack of performance regime.
“I think the problem with the [BCG] report is that … it didn’t actually look at what needs to change at a Commonwealth level,” he said.
“A more fruitful conversation to be had is one that actually looks at what needs to happen nationally, what needs to happen at a state level, what needs to happen at the local level.
“And that strategic conversation, from my understanding, did not happen as part of that [BCG] report.”
Mr Rebbeck said the current model of co-commissioning between PHNs and state hospital systems often started from a position of significant tension, at least on the PHN side.
PHNs control budgets with a lot less 0s on them and say they’re often treated as junior partners, while hospitals operate on an activity-based funding model that rewards activity rather than collaboration.
Funding drives behaviour, and hospitals dwarf PHN funding and any ability to influence proper connectivity to primary care.
“A more fruitful conversation to be had is one that actually looks at what needs to happen nationally, what needs to happen at a state level, what needs to happen at the local level,” said another panel member, Dr Toni Weller, a member of the Royal Australian College of GPs’ expert committee on practice technology and management.
“And that strategic conversation, from my understanding, did not happen as part of that [BCG] report.”
Other panellists at the AIDH GP meeting agreed that the BCG report – when, or if, it’s ever released – represented an opportunity to reimagine how healthcare was structured. They hoped it recommended a “guardrail” governance model, one that sets clear outcomes and partnership metrics but gives flexibility for local innovation.
“It’s starting to look at measures like how the PHN actually can innovate, what its relationships are like with its community and its providers, so bringing in some of those metrics,” Dr Weller said.
Mr Rebbeck agreed.
“There’s an awful lot of stifling of innovation that happens because of the number of forms that are filled in.”
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Ultimately, they hoped the future contained a more radical and transformational and bold vision of what PHNs should be.
At the moment this all seems like wishful thinking.
The BCG report mandate was never to look at whether the department was managing them poorly, which it is if you look at what the department says PHNs do, and what the department actually does with them.
“There needs to be a clear 10-year strategy about shifting care upstream, about moving care out of hospitals. There needs to be a differentiated way of actually working with different PHNs,” according to Mr Rebbeck.
“Potentially, you can have an earned autonomy model where those that are performing better, you give them actually more flexibility so that they can actually deliver funds where their needs are.”
GPs are a busy bunch of course. They don’t have any time to reach out to PHNs and help them with their problems, which mainly stem from them being regional deployment units for a lot of weird and changing whims of the DoHDA.
I wrote a slightly less articulate piece (rant) on this problem here recently.
If you actually ever get to interact with PHN people and leadership what you nearly always get are people who have a lot of passion, IP and intent to help.
Like Mr Rebbeck says, there’s a lot of latent potential for system good here that it would be good to somehow release.