Outcome 5 - Primary Care

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Access to comprehensive, community-based health care, including through first point of call services for prevention, diagnosis and treatment of ill-health, and for ongoing management of chronic disease

Major Achievements

• Established 61 Medicare Locals across Australia.
• Created the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund.
• 38 GP Super Clinics were operational, providing early services, or were under construction, by 30 June 2012.
• Extended the after-hours GP helpline to residents of Queensland and Victoria through their 13HEALTH and NURSE-ON-CALL state-based nurse triage services.
• Finalised 332 Primary Care Infrastructure Grants.

CHALLENGE

• Implementing the integrated, team-based primary health care services within the Redcliffe GP Super Clinic capable of meeting the health needs and priorities of the Redcliffe community.

Outcome Strategy

Outcome 5 aims to provide cost-effective, community-based primary health care with emphasis on chronic disease, an ageing population and work force pressures. This Outcome also focuses on inequalities in health outcomes and access to services. The Department worked to achieve this Outcome by managing initiatives under the programs outlined below.

Program 5.1: Primary Care Education and Training

As a result of a review of departmental administered arrangements, the only activities funded through Program 5.1 are discussed in Outcome 11 – Mental Health.

Program 5.2: Primary Care financing, quality and access

Program 5.2 aims to establish Medicare Locals and undertake activities under the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund; improve access to after-hours primary care through the introduction of a telephone-based after-hours GP medical advice and diagnostic service; undertake activities under the Single Point of Contact for Health Information, Advice and Counselling Fund; implement reforms to improve the coordination and integration of primary health care services across the health system; and improve primary health care infrastructure in Australia.

Establishment of Medicare Locals and Creation of the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund

Establish a Network of Medicare Locals

Medicare Locals are primary health care organisations that have been established around Australia to coordinate primary health care delivery and meet local health care needs and service gaps. They will drive improvements in primary health care and ensure that services are better tailored to meet the needs of local communities.

On 1 July 2011, the Department established 19 Medicare Locals. An additional 18 Medicare Locals commenced on 1 January 2012 and the remaining 24 Medicare Locals commenced on 1 July 2012.

Each Medicare Local is a locally run, independent organisation and each is responsive to the local health care needs of their population group. The table below provides the location of the 61 Medicare Locals nationally.

Medicare Locals are working to make it easier for patients to navigate the health system. They are providing improved planning and coordination of services at the local level, supporting the delivery of a range of primary health care initiatives, including addressing service gaps and inequities, and improving collaboration between practitioners and service providers across the health system.

In February 2012, the Minister for Health announced that the Australian General Practice Network would form the national body, to be known as the Australian Medicare Local Alliance (the Alliance). On 1 July 2012, the Department established the Alliance to act as a lead change agent for the Medicare Local network, and to support Medicare Locals to achieve their objectives, to work as a cohesive network and to respond to evolving Government priorities.

In 2012-13, the Department will continue work with the Alliance and Medicare Locals to ensure primary health care services are designed around the needs of patients, and are strongly orientated towards prevention, early intervention and high quality integrated care located in the community.

The Department requires Medicare Locals to provide strategic plans, annual plans, budgets, and bi-annual progress reports which provide detail of planned activities and the progress of a Medicare Local. In 2011-12, all Medicare Locals met the Department’s performance reporting requirements.

Existing contractual arrangements for the programs consolidated into the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund continued throughout 2011-12. The Department implemented an interim needs assessment process for tranche one and two of the Medicare Locals. These assessments inform annual service delivery plans and identify priority needs for local communities.

The Department provided regular and consistent written guidance and advice on administrative processes to Divisions of General Practice during the transition phase to Medicare Locals.

Creation of the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund

The Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund (the Fund)⁷³ was established on 1 July 2011, consolidating activities from a number of existing primary health care, afterhours and rural support programs.⁷⁴

The objective of the Fund is to help make it easier for all Australians to access the right health care at the right time, through the provision of funding to Medicare Locals to improve the availability, appropriateness, coordination and integration of primary health care in their local community.

In 2011-12 the Department consulted with stakeholders on implementation arrangements and established administration for the Fund. From 1 July 2012, the Department has provided flexible funding to all Medicare Locals through the Fund.

The Department released a public discussion paper to inform the development of the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund between December 2011 and January 2012. A total of 47 submissions were received from a range of organisations and individuals. Stakeholder’s views were incorporated into the Fund guidelines.

The Department released operational guidelines for the Fund on 25 May 2012. The guidelines are available on the Department’s website.

The Department finalised a total of 19 funding agreements with Medicare Locals which commenced on 1 July 2011. An additional 18 commenced on 1 January 2012. The remaining Medicare Locals commenced on 1 July 2012.

In June 2011, the Minister for Health announced that there would be a network of 62 Medicare Locals nationwide. Following strong support from stakeholders, on 1 July 2012, the Hunter Urban Medicare Local expanded its operations to include the Hunter Rural Medicare Local catchment and will operate as a single Hunter Medicare Local. This brings the total of Medicare Locals nationwide to 61.

Table 5.1: Medicare Locals Commenced from 1 July 2011⁷⁶

Medicare Locals After-Hours Program

The Department through Medicare Locals, aims to improve coordination and integration of face-to-face after-hours primary health care services. Central to the program is the improvement of access for all Australians, regardless of where they live, to effective after-hours primary health care services. In 2011-12, the Department funded 37 Medicare Locals to address known priority gaps in after-hours services within their region.

In 2012-13, the Department will work with all 61 Medicare Locals to address priority gaps in after-hours services. Medicare Locals will link their strategy for delivering after-hours services closely with the after-hours GP helpline which is provided through the National Call Centre Network.

The first 19 Medicare Locals commenced implementing their after-hours activities in January 2012. The next 18 Medicare Locals were funded from January 2012 to plan and address priority gaps in after-hours primary care within their regions after they were established.

The Department established the final group of Medicare Locals on 1 July 2012 and also implemented funding plans to address priority health gaps within their boundaries.

Health Information Lines, including the GP After-Hours Service and Creation of the Single Point of Contact for Health Information, Advice and Counselling Fund

Creation of the Single Point of Contact for Health Information, Advice and Counselling Fund

The Single Point of Contact for Health Information, Advice and Counselling Fund (the Fund)⁷⁷ was established on 1 July 2012, consolidating into one flexible funding pool activities previously undertaken by separate information, advice and counselling programs.⁷⁸

The objectives of the Fund are to provide people with access to accurate advice and information about health, illness, and health and community service availability so they are better able to care for themselves and their families.

During 2011-12, the Department consulted with stakeholders on implementation arrangements, established administration arrangements and provided services through the National Health Call Centre Network.

The Department met separately with National Health Call Centre Network Ltd and Alzheimer’s Australia, the two stakeholders of the Single Point of Contact for Health Information, Advice and Counselling Fund to discuss the objectives of the Fund, and how the activities to be undertaken under the Fund would affect them.

The Department established the administrative arrangements for the GP after-hours service and for the creation of the Single Point of Contact for Health Information, Advice and Counselling Fund. The Department is revising the guidelines as a result of a 2012-13 Budget decision.

after hours GP helpline

On 1 July 2011, the Department established the after hours GP helpline to improve community access to after-hours primary care through a telephone-based after hours GP helpline.

The after hours GP helpline was not initially available to residents in Queensland and Victoria. The Department successfully negotiated with the National Health Call Centre Network Ltd, Queensland and Victoria to connect these states to the after hours GP helpline, through their state-based nurse triage services. The 13HEALTH and NURSE-ON-CALL now ensures residents of both states have access to the same telephone GP after-hours primary care as the rest of the nation.

During its first year of operation, the after hours GP helpline received 154,543 calls nationally.

In 2012-13, the Department will expand the after hours GP helpline to provide a video consultation capability, which will initially be available to selected residential aged care facilities. This capability will be expanded over the year to selected consumers, to ensure user acceptability, before being extended to all Australians.

The Department commenced the after hours GP helpline in most states and territories on 1 July 2011. In 2012, Queensland (6 March) and Victoria (30 April) connected to the after hours GP helpline through their state based nurse triage services, 13HEALTH and NURSE-ON-CALL respectively. For people living in Tasmania, access to the after-hours GP telephone advice is available through the GP Assist service.

The Department established videoconferencing capability to selected residential aged care facilities on 1 July 2012 as an extension of the after hours GP helpline. The Department will expand capability to selected consumers during 2012-13.

In mid-2013, all Australians will be able to utilise the videoconference enabled after hours GP helpline from their homes, provided they have the required technology.

The after hours GP helpline exceeded the target of 150,000 calls in 2011-12. Healthdirect Australia, 13HEALTH and NURSE-ON-CALL transferred 154,543 calls to the after hours GP helpline in 2011-12.

National Dementia Helpline

The Department through the National Dementia Helpline aims to provide quality information, counselling and support to the Australian public through a helpline and associated web material.

On 1 March 2012, Alzheimer’s Australia provided the Department with a progress report which demonstrates a commitment to provision of quality information, counselling and support. Additionally, activity on the Alzheimer’s Australia website has continued to increase, with frequent access to help sheets and email enquiries. Engagement with group and one-on-one counselling services has exceeded targets and remains in high demand.

Alzheimer’s Australia reported that fewer calls correspond with higher use of the website, with July – December 2011 seeing an increase of 21% compared to the previous six months. More consumers reported having visited the website prior to calling the Dementia Helpline and calls received tend to be more complex. The Dementia Helpline experienced a peak in calls during Dementia Awareness Week.

Improve Primary Health Care Services

System-Wide Policy and State-Wide Planning for Primary Health Care Services

To meet the requirements of the National Health Reform Agreement, the Department has been working with states and territories through system-wide policy and state-wide planning for GP and primary health care services. This work includes the development of a National Primary Health Care Strategic Framework by December 2012. This Framework will set out agreed future policy directions and priority areas for primary health care. The Framework will be informed by bilateral work on state-specific plans, to be completed by July 2013.

In 2012-13, the Department will continue to work with the states and territories on the development of the Framework and state-specific plans. This will involve holding regular negotiation sessions with jurisdictions. These products will contribute to the Australian Government’s objective of delivering a primary health care system that meets the health care needs of Australians, keeps people healthy, prevents disease and reduces demand for hospital services.

Divisions of General Practice Network Funding (Discontinued)

This deliverable has been superseded by new funding arrangements for Medicare Locals.

Improve Primary Health Care Infrastructure

GP Super Clinics

Health systems with strong primary health care have been shown to be more efficient, have lower rates of hospitalisation, fewer health inequalities and better health outcomes including lower mortality, than those that do not.⁸¹ A strong, responsive and cost-effective primary health care system is central to equipping the Australian health system to meet future challenges. The GP Super Clinics and Primary Care Infrastructure Grants initiatives are improving the quality and accessibility of primary health care services in Australia and increasing the capacity to train the future health workforce.

The GP Super Clinics program is establishing over 60 Clinics throughout Australia. These clinics will improve people’s access to primary health care by providing integrated, multidisciplinary, team-based services that bring together GPs, nurses, visiting medical specialists, allied health professionals and other health care providers. These multidisciplinary teams will deliver primary health care that is tailored to the needs and priorities of their local communities.

A total of 38 GP Super Clinics have either opened, commenced providing early services or were under construction by 30 June 2012.

In addition to the funding of infrastructure, the Department will work with operational clinics to promote and monitor the implementation of multidisciplinary, team-based care at each site for 20 years.

For example, the Department has provided additional funds to complete the building of the Redcliffe GP Super Clinic and continued its collaborative work with its Queensland counterpart and community-based primary health care stakeholders to identify service arrangements that will improve access to services within the Redcliffe community.

GP Super Clinics Locations

Table 5.2: GP Super Clinics that have commenced operations, provided early services or were under construction by 30 June 2012.

In 2011-12, the Department executed 12 GP Super Clinics funding agreements for: Canberra (Australian Capital Territory), Blacktown, Broken Hill, Jindabyne, Lismore (New South Wales), Emerald, Gold Coast, Mackay, Sunshine Coast (Queensland), Adelaide (South Australia), Northam and Rockingham (Western Australia).

The 12 GP Super Clinics that commenced delivery of services (including early services) in 2011-12 were: Grafton, Gunnedah, Lismore, Queanbeyan (New South Wales), Bundaberg (Queensland), Berwick, Cobram, Hume City, Portland (Victoria), Karratha, Midland and Northam (Western Australia).

The establishment of 28 new GP Super Clinics was announced in the 2010 election. As at 30 June 2012, the Department had executed 21 funding agreements, three funding agreements were under negotiation with preferred applicants and four assessment processes were underway.

Primary Care Infrastructure Grants

The Department awarded 332 Primary Care Infrastructure Grants (PCIGs) to upgrade or extend existing general practices, primary and community care services and Aboriginal Medical Services. These grants help to improve the quality and accessibility of primary health care services in Australia. Some grants have also improved training facilities and over time they will provide an increased capacity to train the future health workforce. As at 30 June 2012, the Department through the PCIGs program had established a total of 113 projects nationally.

The Department executed 332 funding agreements from the first and second rounds of the Primary Care Infrastructure Grants program.

The Department announced the shortlisted applicants for the second round on 18 November 2011.

Whole of Program Performance Information

The Department through the National Health and Hospitals Network and the National Primary Health Care Strategy produced timely evidence-based policy for the Government’s Health Reform measures. These measures were closely aligned to the recommendation made in the National Primary Health Care Strategy. Measures developed included: the establishment of Medicare Locals, Improving Access to After-hours Primary Care, Improved Primary Care Infrastructure, and Improved Access to Primary Health Care Services for Older Australians.

During 2011-12, the Department actively sought stakeholder participation in the development of a number of key programs, including Medicare Locals and after-hours primary care. This participation included community meetings, submissions from the public on discussion papers and direct consultation with key stakeholders through the establishment of technical working groups.

The underspend in this program was due to delays in meeting construction milestones under the GP Super Clinic and Primary Care Infrastructure Grant programs caused by external factors, including local council planning and approval processes, availability of construction workforce and weather conditions. As such, payments tied to milestones were unable to be made.

Reduced services delivery for the Rural Primary Health Services Program due to the non-availability of allied health professionals to deliver services in regional, rural and remote locations was also a factor

Program 5.3: Primary Care Practice Incentives

Program 5.3 aims to undertake activities through the Practice Incentives for General Practices Fund, consolidating several existing program elements, to respond to the general practice incentives which are in the greatest demand.

Practice Incentives for General Practice Fund

The Practice Incentives Program aims to support general practice activities through financial incentives that encourage continuing improvements and quality care, enhance capacity, and improve access and health outcomes for patients.

As at May 2012, 84% of GP patient care was provided by practices receiving practice incentive payments.

The Practice Incentives and General Practice Immunisation Incentive Online Administration System was promoted through the Practice Incentives Program quarterly newsletter.

The Practice Incentives for General Practice Fund (the Fund) was established on 1 July 2011,⁸³ consolidating the activities of several existing Practice Incentives Program elements⁸⁴ to provide one larger flexible funding pool to allow responsiveness to existing and emerging health priorities.

The objective of the Fund is to better support general practice activities that encourage continuing improvements and quality care, enhance capacity, and improve access and health outcomes for patients.

In 2011-12, the Department developed Fund guidelines in consultation with medical professionals and organisations and continued to administer a range of financial incentives to general practices, Indigenous health services and GPs including the Indigenous Health Incentive.

The Department commenced consultation with stakeholders in July 2011. Consultation included a workshop with the Practice Incentive Program Advisory Group and subsequent release of a discussion paper on the development of the fund guidelines was made available to relevant stakeholders.

The Department released operational guidelines for the Fund on 5 June 2012. The guidelines are available on the Department’s website.

Practice Incentives Program Indigenous Health Incentive

In May 2010, the Department introduced the Indigenous Health Incentive to support general practices and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease. Incentives are offered for practices to: undertake cultural awareness training; offer Indigenous patients a health assessment; identify Indigenous patients with chronic disease; undertake and review chronic disease management plans; and provide a target level of care.

The Indigenous Health Incentive is a key element of the Indigenous Chronic Disease Package and forms part of the Council of Australian Governments’ National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes.

Participation in the Practice Incentives Program Indigenous Health Incentive continued to increase in 2011-12 with 2,900 practices registered for the incentive by May 2012 compared with 2,100 practices registered in May 2011.

Practice Incentives Program General Practitioner Aged Care Access Incentive

The General Practitioner Aged Care Access Incentive was introduced in 2008-09 and provides incentive payments to encourage GPs to provide services to residents of Commonwealth-funded Residential Aged Care Facilities.

Participation by GPs in the General Practitioner Aged Care Access Incentive has not been sufficient to achieve this target.

Whole of Program Performance Information

The Department analysed Practice Incentives Program practice participation data to inform and contribute to improvement in policy development.

The Department consulted stakeholders in the development of the Practice Incentives for General Practices Fund and the Practice Incentives Program Advisory Group met on two occasions during 2011-12.

The overspend in this program was due to a higher than expected demand for this entitlement-based program.

Outcome 5 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ‘Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

72. Community needs assessments were completed in May 2012 and will be used to inform service delivery priorities in 2012-13.
73. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
74. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
75. This deliverable was amended in the 2011-12 Portfolio Additional Estimates Statements.
76. 19 Medicare Locals were established in the first tranche, including Hunter Urban Medicare Local. On 1 July 2012, the Hunter Urban Medicare Local expanded its operations to include the Hunter Rural Catchment, forming the single Hunter Medicare Local (included in Tranche 3).
77. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Single Point of Contact for Health Information, Advice and Counselling Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
78. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
79. This indicator was introduced in the 2011-12 Portfolio Additional Estimates Statements. The after hours GP helpline commenced operation in July 2011.
80. The estimated number of calls to the National Dementia Helpline number data was changed in the 2011-12 Portfolio Additional Estimates Statements to reflect the latest trend in the number of calls. While calls might be lower than expected, the duration of the calls received has increased, as the nature of the calls is becoming increasingly more complex.
81. Primary Health Care Reform in Australia: Report to Support Australia’s First National Primary Health Care Strategy, Commonwealth of Australia, 2009, p.8.
82. The estimated number of Primary Care Infrastructure Grants has been revised following the impact of natural disasters throughout Australia in 2011 and the effect these have had on the availability of the construction workforce to undertake small scale infrastructure projects. No Primary Care Infrastructure Grants will be issued after 2012-13.
83. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Practice Incentives for General Practice Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
84. A full list of activities consolidated into each Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.

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