Annual Report - Outcome 5

Table of contents

Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 5 aims to provide Australians with access to quality, cost-effective primary care that is evidence-based and coordinated with other forms of care, such as specialist and aged care services. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Programs Administered Under Outcome 5 (Program Objectives in 2008–09)

Program 5.1 – Primary Care Education and Training

Support general practice vocational training of doctors.
Update the skills of general practitioners who are re-entering the workforce.
Provide incentives to registrars to work in rural and remote areas of Australia.

Program 5.2 – Primary Care Financing, Quality and Access

Improve access to areas of primary care need.
Provide initiatives that influence the quality and standard of services.
Address key priority areas such as chronic disease management, prevention and integration.

Program 5.3 – Primary Care Policy, Innovation and Research

Fund research into primary care.
Improve service delivery and help general practitioners to access current best business practice.

Program 5.4 – Primary Care Practice Incentives

Encourage general practices and primary care professionals to deliver services supporting targeted primary care priorities.
Provide financial incentives to general practitioners for undertaking targeted activities such as cervical cancer screening, and asthma and diabetes management.

This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 5 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 5 was managed in 2008–09 by the Primary and Ambulatory Care Division, the Health Workforce Division, the Medical Benefits Division and the Mental Health and Chronic Disease Division. General Practice Education Training Ltd, which produces its own annual report, also contributed to the achievement of this outcome.

Major Achievements for the Outcome:

Awarded funding for 19 GP Super Clinics nationwide, so that building could commence on facilities that will deliver integrated multidisciplinary patient centred care that is responsive to the needs of local communities (see Implementation of the GP Super Clinics Program);
Contributed to the development of the Draft National Primary Health Care Strategy which aims to deliver better frontline care to families across Australia (see Development of a National Primary Health Care Strategy);
Offered grants to 100 health service providers to assist with the operating costs of delivering after hours general practice services (see Ensuring Access to High Quality, Cost-effective and Appropriate Primary Care Services); and
Assisted an additional 75 doctors to pursue a career in general practice by introducing new training places through the Australian General Practice Training Program (see Supporting Training for GP Registrars in Rural and Urban Areas).

A Challenge for the Outcome:

A lower than anticipated number of non-vocationally recognised medical practitioners undertaking continuing professional development (see Performance Information for Outcome 5 Administered Programs).

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Key Strategic Directions for 2008–09 – Major Activities

Maternity Services

While Australia is one of the safest places to give birth or to be born, the Australian Government has identified the need for nationally coordinated maternity services to improve the quality of care available, particularly for rural and Indigenous women and babies. In 2008–09, the Department conducted the Maternity Services Review as the first step in developing a comprehensive plan for maternity services into the future. Led by the Commonwealth Chief Nurse and Midwifery Officer, the review canvassed issues such as antenatal services, birthing options, postnatal services up to six weeks after birth, and peer and social support for women in the perinatal period (refer to the Outcome 3 Access to Medical Services and Outcome 12 Health Workforce Capacity chapters for further details).

In conducting the review, the Department managed a consultation process during which stakeholders including consumers, clinicians, and non-government organisations, provided written submissions in response to a discussion paper prepared by the Department, and attended round table forums. The Department drew on stakeholder feedback, research and expertise from other sources to produce a report which was publicly released by the Minister for Health and Ageing in February 2009. The report (accessible at www.health.gov.au) highlighted the importance of reform in maternity services taking place within a strong framework of safety, quality and collaborative care.

During 2009–10, the Department will implement a package of maternity reforms to provide women with more choice in safe, high quality maternity care and alleviate pressure on the maternity workforce. The Department will work with the states and territories, and key stakeholders, to build on the findings of the review to ensure a coordinated approach across Australia.

Funding for the above activities was sourced from Program 5.2 – Primary Care Financing, Quality and Access. Further information relating to maternity services can be found in the Outcome 3 Access to Medical Services and Outcome 8 Indigenous Health chapters.

Implementation of the GP Super Clinics Program

GP Super Clinics will bring together general practitioners, nurses, visiting medical specialists, allied health professionals and other health care providers, to deliver care that is tailored to the needs and priorities of local communities. They will support primary health care providers to deliver multidisciplinary team based care, and aim to better integrate Australian, State and Territory Government funded services. In 2008–09, the Department worked to establish GP Super Clinics around the country, collaborating with State and Territory Governments, and consulting with relevant stakeholders. A major achievement during 2008–09 was the signing of 19 funding agreements under the GP Super Clinics Program, so that a total of 21 GP Super Clinics were commissioned by mid 2009.
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Collaboration with the State and Territory Governments

The Department worked closely with the relevant state and territory departments of health to implement the GP Super Clinics Program. In 2008–09, the Department executed funding agreements with the Tasmanian Department of Health and Human Services to establish the Hobart Eastern Shores – Clarence GP Super Clinic, and with the Northern Territory Department of Health and Families to establish the Palmerston GP Super Clinic. The Department also worked with SA Health to establish clinics in Modbury and Noarlunga, and with the Western Australian Department of Health to establish the Wanneroo and Midland GP Super Clinics.

State and territory health services also played a role in the information and consultation sessions held in all locations identified for a GP Super Clinic. In 2009–10, the Department will continue to work with State and Territory Governments and funding recipients as the GP Super Clinics are built and become operational, to enhance integration between privately practising health care professionals working in the GP Super Clinics and state and territory funded services.

Consultation Processes

In 2008–09, the Department held 29 information and consultation sessions to inform stakeholders about the GP Super Clinic Program, and the funding process for each location. The sessions provided the Department with the opportunity to hear from community members and local health care providers, so that the range of services provided through each GP Super Clinic addressed their local needs and priorities. The Department maintained a website with information about the roll-out of the GP Super Clinics Program at www.health.gov.au which it will update throughout 2009–10.

Funding for the above activities was sourced from Program 5.2 – Primary Care Financing, Quality and Access.

Development of a National Primary Health Care Strategy

The purpose of the National Primary Health Care Strategy is to look at ways in which to best deliver frontline care to the community. Priorities include prevention, promoting the evidence-based management of chronic disease, and helping patients with chronic disease to manage their condition. In 2008–09, the Department developed the draft strategy which aims to: support general practitioners; address the growing need for access to health professionals such as practice nurses and allied health professionals; and encourage multidisciplinary team based care. The Department also reviewed primary care items on the Medicare Benefits Schedule at the same time as developing the draft strategy.
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Strategy Development

A major achievement for the Department in 2008–09, was the development of the draft strategy and supporting report, which were provided for the Minister of Health and Ageing’s consideration. The draft strategy was developed by the Department with the assistance of an External Reference Group of health experts. The draft strategy outlines a long-term view of what the public can reasonably expect from Australia’s future primary health care system. It also intends to establish a shared vision for governments, health professionals, and others involved in health care, of a modern primary health care system with coordinated effort, that identifies needs and implements change to meet those needs. The supporting report provides a background for the draft strategy’s direction as well as evidence to support future investment in, and reform of, the primary care system.

The Department’s role in developing the draft strategy and supporting report included convening and providing secretariat support to the External Reference Group, which met regularly. The Department also facilitated stakeholder participation to inform the draft strategy’s development, by releasing a discussion paper for comment in October 2008 which generated more than 260 submissions from State and Territory Governments, professional groups, Divisions of General Practice, consumers, health care practitioners, public health/community health services and special interest groups. In addition, the Department prepared a background report about primary health care in Australia, which included information received from stakeholders.

Funding for these activities was sourced from Program 5.3 – Primary Care Policy, Innovation and Research.

Review and Simplification of Medicare Arrangements

Another priority was to review primary care items in the Medicare Benefits Schedule, to help streamline the schedule, reduce complexity or ‘red tape’ for doctors, and encourage more preventative care through longer patient/doctor consultations. The Department reviewed the size, complexity, and administrative barriers of the relevant parts of the schedule.

An outcome that was implemented on 1 January 2009 removed the requirement for chronic disease care planning item rebates to be claimed before allied health service rebates were paid. This change has helped patients who were previously inconvenienced by this technicality.

While these activities are aimed at addressing the National Primary Health Care Strategy goals under Outcome 5, funding for the above reforms was sourced from Program 3.1 – Medicare Services. Discussion relating to this program can be found in the Outcome 3 Access to Medical Services chapter.

Ensuring Access to High Quality, Cost-effective and Appropriate Primary Care Services

While access to primary health care services is predominantly funded through the payment of Medicare benefits, other funding models and infrastructure development are required to support the provision of certain types of care. In 2008–09, the Department worked to ensure access to high quality, cost-effective and appropriate primary care services through the expansion of the National Health Call Centre Network, and the funding of specific after hours grants.
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National Health Call Centre Network

The National Health Call Centre Network (healthdirect Australia, telephone number 1800 022 222) is being established throughout Australia to provide people with health advice, 24 hours a day, seven days a week. Registered nurses, supported by electronic decision support software and algorithms, provide health triage, information and advice to callers. The network will improve care in the community, particularly for people in rural and remote communities, and mobile populations.

During 2008–09, the Department worked with the states and territories and the National Health Call Centre Network Ltd to further implement the telephone service. The network became fully operational in New South Wales, and services started to come on-line in Tasmania, adding to the services that were already available in the Australian Capital Territory, the Northern Territory, South Australia and Western Australia. Queensland and Victoria are yet to formalise their commitment to the network.

In 2009–10, the Department will continue implementation of the network through the joint working arrangements with the participating states and territories, and liaison with the National Health Call Centre Network Ltd. The Department will also work with all stakeholders to explore new initiatives that can be delivered through the network’s infrastructure platform, which has the capacity to support add-on services and assist in health threats and emergency situations.

After Hours General Practice Services

In 2008–09, the Department aimed, through the implementation of the General Practice After Hours Program, to improve people’s access to doctors outside of normal business hours by providing grants to support the viability of after hours general practice services. The new program merged the former After Hours Primary Medical Care and Round the Clock Medicare: Investing in After Hours GP Services initiatives and will provide funding for up to 100 grants each year, to assist new and existing after hours general practice services to meet their operating costs. These grants are for a maximum of $100,000 (GST exclusive) over two years.

A major achievement for the Department in 2008–09 was the offering of grants to 100 health service providers such as general practices and medical deputising services, following a competitive, merit-based selection process. By 30 June 2009, the Department had executed funding agreements with 75 of these services, thereby improving after hours services access to more communities across Australia.

In addition, the Department administered funding arrangements for 14 after hours services originally funded under the former After Hours Primary Medical Care Program, and 172 grants awarded to after hours services under the previous Round the Clock Medicare: Investing in After Hours GP Services Program.

Funding for the above activities was sourced from Program 5.2 – Primary Care Financing, Quality and Access.

Supporting Preventive and Early Intervention Health Activities

Detecting lifestyle risk factors and physical health issues early, and facilitating early intervention strategies are important for achieving improved health and wellbeing outcomes in the community. During 2008–09, the Department supported a number of preventive and early intervention health activities, through Medicare benefits arrangements, including the Healthy Kids Check and type 2 diabetes risk evaluation. The Department also looked at refocusing primary care towards prevention and early intervention, to drive accountability for improvement in health outcomes in local communities.
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Healthy Kids Check

The Healthy Kids Check initiative, introduced on 1 July 2008, aims to ensure that every four year old child in Australia has a basic health check, to see if they are healthy, fit and ready to learn before starting school. The check assists with the early detection of risk factors, such as delayed development and illness; and provides the opportunity for early intervention strategies and parental guidance on healthy lifestyles.

The Department worked with State and Territory Governments to ensure that the Healthy Kids Check complemented local government provided child health assessment services. The Department also wrote to over 580,200 families with preschool children advising them of the Healthy Kids Check and the Get Set 4 Life – habits for healthy kids guide, which provided information about healthy living habits, and age appropriate development for young children, including healthy eating and physical activity.

As at 30 June 2009, 40,031 Healthy Kids Check Medicare Benefits Schedule services had been provided. In 2009–10, the Department will work to integrate the Medicare Benefits Health Check Item with existing state and territory services. It will also continue to promote the initiative to the parents of four year old children.

Type 2 Diabetes Risk Evaluation

The Department introduced the Type 2 Diabetes Risk Evaluation Medicare item on 1 July 2008 to support general practitioners to address the health needs of people aged between 40 to 49 years who are at high risk of developing type 2 diabetes. The item enables general practitioners to review a patient’s risk factors and, if appropriate, refer them to a lifestyle modification program to assist with the prevention of the disease.

A Type 2 Diabetes Risk Evaluation includes a number of components: the patient must have been assessed as being at ‘high risk’, as determined by the Australian Type 2 Diabetes Risk Assessment Tool; and undertake examinations and investigations in accordance with relevant guidelines. Their general practitioner will make an overall assessment of their risk factors; initiate interventions where appropriate, including referrals and follow ups; and provide advice and information on how to achieve lifestyle and behaviour change. As of 30 June 2009, 11,257 services had been claimed for the new item.

Funding for the above activities was sourced from Programs 5.2 – Primary Care Financing, Quality and Access and 3.1 – Medicare Services.
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Refocusing Primary Care Towards Prevention and Early Intervention

Throughout 2008–09, the Department worked with the Divisions of General Practice to introduce a set of national performance indicators for the Divisions of General Practice Program, with the aim of collecting data to monitor health outcomes in local communities. The indicators focus on prevention and early intervention at the general practice level, targeting priority areas such as diabetes, heart disease, childhood immunisation, adult and Indigenous health checks and cervical cancer screening. Divisions will start reporting on the performance indicators in 2009–10.

Funding for the above activity was sourced from Program 5.2 – Primary Care Financing, Quality and Access.

Supporting Patients with Chronic Disease

Improving the clinical and business systems that underpin the prevention and management of chronic disease can help general practices to deliver better patient care and health outcomes. Through the National Integrated Diabetes Program, the Department funded the development and review of evidence‑based clinical guidelines, in areas such as type 1 and type 2 diabetes, stroke, and cardiovascular absolute risk management. To achieve this, the Department worked with the Australian Diabetes Society, the Australasian Paediatric Endocrine Group, the Baker Heart and International Diabetes Institute, the National Stroke Foundation, and the National Vascular Disease Prevention Alliance through the National Stroke Foundation.

The Department also worked with the Royal Australian College of General Practitioners and the Rural Health Education Foundation to implement and disseminate evidence-based clinical guidelines on type 2 diabetes, and supported 37 projects to integrate the principles of chronic disease self-management and self-management support into the primary health care system through the provision of education and resources to the existing and future workforce.

Three units of competency for chronic disease self-management were introduced to support vocational education in the health and community services industries. For example, the Department worked with Flinders University on a Capabilities Toolkit for Primary Health Care Professionals to Support People to Self-Manage their Chronic Diseases, which will be used in 2009–10 to train healthcare providers to support their patients to manage chronic diseases. The Department also worked with the Australian General Practice Network and the eight state-based organisations representing the Divisions of General Practice, to coordinate the Chronic Disease Self Management Support Network, which promotes improved patient self-management support within primary care.

Funding for the above activities was sourced from Programs 5.1 – Primary Care Education and Training, 5.2 – Primary Care Financing Quality and Access, and 5.3 – Primary Care Policy, Innovation and Research.
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Supporting Training for General Practice Registrars in Rural and Urban Areas

The Department supports vocational training opportunities for general practice registrars, to improve the quality of primary care delivery and make more general practice services available in rural and urban areas. In 2008–09, the Department provided funding to General Practice Education and Training Ltd to deliver the Australian General Practice Training Program, a regionalised, high quality postgraduate vocational education and training program. An increase in the number of training places to 675 in 2009 provided an additional 75 doctors with the opportunity to pursue a career in general practice.

The Department also provided opportunities for prevocational doctors to experience working in a general practice before choosing a vocational training path through the Prevocational General Practice Placements Program; and helped provide 360 training places in the 2009 academic year to encourage junior doctors into general practice.

Funding for the above activities was sourced from Program 5.1 – Primary Care Education and Training.
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Performance Information for Outcome 5 Administered Programs

Program 5.1 – Primary Care Education and Training
Indicator:	Increased number of non-vocationally recognised medical practitioners undertaking continuing professional development. Measured by the number of practitioners accessing the A1 Medicare rebate through general practice incentive programs that require participants to undertake continuing professional development.
Reference Point/Target:	An increase of 21% from the previous year.
Result: Indicator not met.
In 2008–09, 725 non-vocationally recognised medical practitioners undertook continued professional development activities. This compares with 697 in 2007–08 (representing a 4% increase) and 609 in 2006–07. The indicator was not met as the number of Other Medical Practitioners on the programs where it is compulsory to undertake continued professional development has fallen. In addition, a recent review of one of the Other Medical Practitioners programs suggests low awareness of the after hours program among eligible practitioners.

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Program 5.2 – Primary Care Financing, Quality and Access
Indicator:	Improve access to health services through the implementation of a range of primary care services particularly for communities in need.
Reference Point/Target:	Commission 20 GP Super Clinics by June 2009. The National Health Call Centre Network which will provide access to health triage information and advice will be available to 75% of Australia’s population during 2008–09.
Result: Indicator substantially met.
In 2008–09, the Department signed 19 formal funding agreements, bringing the number of GP Super Clinics commissioned by the end of the financial year to 21. The National Health Call Centre Network provided access to health triage, information and advice to 55% of Australia’s population by the end of 2008–09. Full network services were available to people in New South Wales, the Australian Capital Territory, the Northern Territory, South Australia, Western Australia and Tasmania. The indicator for 2008–09 was not entirely met as services in Queensland and Victoria did not commence in 2008–09 as anticipated.
Indicator:	Improve access to health services through the implementation of a range of primary care services particularly for communities in need.
Reference Point/Target:	Support up to 320 after hours general practice services in 2008–09.
Result: Indicator substantially met.
The Department supported 286 services through the new General Practice After Hours program.
Indicator:	Increased uptake of primary care Medicare financing initiatives.
Reference Point/Target:	Increase from previous year in uptake of relevant Medicare items.
Result: Indicator met.
In 2008–09, there were 63.6 million claims by general practitioners for services bulk billed to children under the age of 16 years, and Commonwealth concession card holders. This compares with 61.4 million claims in 2007–08, and 57.7 million claims in 2006–07. A total 5.5 million practice nurse services were claimed in 2008–09 compared with 5.2 million in 2007–08, and 3.7 million claims in 2006–07.
Indicator:	Improved access to primary care for Aboriginal and Torres Strait Islander people, measured by the number of claims of Aboriginal and Torres Strait Islander people Medicare items.
Reference Point/Target:	Increased number of claims of Aboriginal and Torres Strait Islander people Medicare items.
Result: Indicator met.
In 2008–09, 37,783 health assessments were provided to Aboriginal and Torres Strait Islander people, which is an increase of 16.8% over the 2007–08 total of 32,343.

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Figure 2.3.5.1: Medicare Bulk Billing Incentive Services, 2004–05 to 2008–09

Source: Medicare Australia, Medicare Statistics, 1984–85 to June quarter 2009.

Indicator:	Implementation of new Healthy for Kids Check Medicare Benefits Schedule preventative Health Care item. Implementation of new Type 2 Diabetes Risk Evaluation for people aged 40 to 49 who have a high risk of acquiring the disease.
Reference Point/Target:	Healthy Kids Checks provided to at least 10% of four year old children in Australia annually. Uptake of the Type 2 Diabetes Risk Evaluation Medicare item. There is no target in the first year of operation as baseline data is required.
Result: Indicator exceeded.
Between 1 July 2008 and 30 June 2009, 40,031 Healthy Kids Check Medicare Benefits Schedule services were provided. This is over 15.5% of the estimated population of four year old children in Australia. The Type 2 Diabetes Risk Evaluation Medicare item was introduced on 1 July 2008. During this year, 11,257 services for this new item were claimed.
Indicator:	Well-targeted and managed incentives and support programs to encourage general practitioners to provide services in rural and remote Australia.
Reference Point/Target:	A range of incentives and support programs for general practitioners to encourage greater provision of services in rural and remote Australia.
Result: Indicator met.
The Department managed a number of programs in 2008–09 that provided financial and other support to general practitioners to deliver services to rural and remote communities. These included: reimbursing 450 doctors to cover their Higher Education Contribution Scheme Reimbursement Scheme debt when they train and work in rural areas. This was a 10.6% increase on the number of participants receiving payments in 2007–08 (407); providing 1,658 doctors with financial grants to maintain their procedural skills under the Training for Rural and Remote Procedural General Practitioners Program. This was a 7.9% increase in the number of doctors receiving payments in 2007–08 (1,537). (Please note that due to the miscalculation of data, the 2007–08 Annual Report reported that 1,890 doctors received payments in 2007–08.); providing 2,190 doctors with financial incentives under the Rural Retention Program, to work as general practitioners in rural and remote Australia. This was an increase of 4.3% over the number receiving these incentives in 2007–08 (2,100); and supporting seven rural workforce agencies to recruit and retain general practitioners in rural and remote Australia under the Rural and Remote General Practice Program. This is the same number of agencies as in 2007–08.
Indicator:	Divisions of General Practice demonstrate commitment to quality improvement through participation in the National Quality and Performance System.
Reference Point/Target:	100% of all organisations funded under the Divisions of General Practice Program meet National Quality and Performance System requirements.
Result: Indicator met.
In 2008–09, all of the 119 organisations funded under the Divisions of General Practice Program met the accreditation requirements of a range of Australian or international quality management systems. All organisations reported against national performance indicators under the National Quality and Performance System (now referred to as the performance framework for the Divisions of General Practice Program). Data collected against the national performance indicators in 2008–09 will provide a benchmark for each organisation in future years.

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Program 5.3 – Primary Care Policy, Innovation and Research
Indicator:	High quality, relevant primary health care research to strengthen the evidence base. Measured by the extent to which research evidence is utilised when developing new policy and providing treatment options.
Reference Point/Target:	Complete the evaluation of the Primary Health Care Research, Evaluation and Development Program in 2008–09.
Result: Indicator met.
During 2008–09, the Department completed the evaluation of the Primary Health Care Research, Evaluation and Development Strategy. The evaluation found that the strategy remained appropriate, effective and efficient, and provides good value for money. The Department also worked with the Australian Primary Health Care Research Institute and the Primary Health Care Research and Information Service, to increase the opportunities to provide evidence to inform policy and practice in primary health care.
Indicator:	Develop the National Primary Health Care Strategy and Medicare Benefits Schedule simplification. Measured by feedback from stakeholders and the Australian Government.
Reference Point/Target:	In 2008–09, establish the Strategy External Reference Group, undertake consultation with stakeholders and advise the Australian Government on progress.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to correct a reference to the External Reference Group, and to indicate that consultation was to be undertaken and not ‘commence’.
Result: Indicator met.
In 2008–09, the Department convened and provided secretariat support for the External Reference Group to assist in the development of a Draft National Primary Health Care Strategy. The Department also held discussions with state and territory health departments and facilitated stakeholder input by releasing a discussion paper for comment. More than 260 submissions were received from stakeholders. The Draft National Primary Care Strategy was provided to the Minister for Health and Ageing for consideration in line with the agreed timetable. The Department also reviewed the Medicare Benefits Schedule to reduce red tape, working in close consultation with stakeholders such as doctors, nurses, allied health professionals and government agencies.

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Program 5.4 – Primary Care Practice Incentives
Indicator:	General practice patient care provided by practices participating in the Practice Incentives Program.
Reference Point/Target:	Increase in the percentage of general practice patient care coverage from previous year.
Result: Indicator met.
The proportion of general practice patient care provided by practices participating in the Practice Incentives Program increased from 81.4% in May 2008 to 81.9% in May 2009.

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Performance Information for Outcome 5 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:	Quality, relevant and timely advice for Australian Government decision-making, measured by ministerial satisfaction.
Reference Point/Target:	Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:	Production of relevant and timely evidence-based policy research.
Reference Point/Target:	Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
During 2008–09, the Department managed the Primary Health Care Research, Evaluation and Development Strategy, which included the following research activities: publication, by the Australian Primary Health Care Research Institute, of various evidence-based research papers to support primary health care policy development; and the development and launch of the first edition of Snapshot of Australian Primary Health Care Research, which includes examples of primary health care research in Australia relevant to policy development.

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Output Group 2 – Program Management
Indicator:	Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator not met.
The actual Administered expenses for Outcome 5 were 1.4% less than budgeted expenditure. There were underspends in a number of Outcome 5 programs.
Indicator:	Stakeholders participate in program development through avenues such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Reference Point/Target:	Stakeholders participate in program development.
Result: Indicator met.
Stakeholders participated in the development of the National Primary Health Care Strategy, and the review of Medicare arrangements. The Department conducted regular meetings with key stakeholders throughout the year, including the Australian Medical Association, the Australian General Practice Network, the Rural Doctors Association of Australia, and the Royal Australian College of General Practitioners. These meetings provided the Department with an opportunity to identify and respond to stakeholders’ concerns and to help shape program and policy development.

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Outcome 5 – Financial Resources Summary

	(A) Budget Estimate 2008–09 $’000	(B) Actual 2008–09 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2009–10 $’000
Program 5.1: Primary Care Education and Training
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	264,057	261,113	(2,944)	160,997
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	5,469	5,447	(22)	6,352
Revenues from other sources	95	133	38	101
Subtotal for Program 5.1	269,621	266,693	(2,928)	167,450
Program 5.2: Primary Care Financing, Quality and Access
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	319,561	299,186	(20,375)	369,551
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	25,343	25,243	100	29,435
Revenues from other sources	442	618	176	467
Subtotal for Program 5.2	345,346	325,047	(20,299)	399,453
Program 5.3: Primary Care Policy, Innovation and Research
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	25,603	24,673	(930)	32,826
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,804	3,790	(14)	4,419
Revenues from other sources	66	93	27	70
Subtotal for Program 5.3	29,473	28,556	(917)	37,315
Program 5.4: Primary Care Practice Incentives
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	309,236	320,345	11,109	293,163
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	2,122	2,114	(8)	2,464
Revenues from other sources	37	52	15	39
Subtotal for Program 5.4	311,395	322,511	11,116	295,666
Total Resources for Outcome 5	955,835	942,807	(13,028)	899,884
Outcome 5 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	11,961	11,996	35	13,871
Output Group 2: Program Management	25,417	25,494	77	29,476
Total Departmental Resources	37,378	37,490	112	43,347
Average Staffing Level (Number)	275	274	(1)	298

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