Stakeholder viewsThe approach to service proposal identification, development and implementation differs significantly between states/Northern Territory. There are two main ways that service proposals are being generated:
- through the initiative of service providers
- through active development by fundholders.
Most fundholders considered that the development of new proposals was based on a need based process, reflecting expressed needs of local communities. They recognised that there were often restrictions in developing new services based on workforce availability, that is, the willingness of specialists to go to particular communities.
Fundholders commented that recruitment of potential service providers has been challenging when programs are undergoing significant expansion, such as with the initial establishment of MSOAP Core and the recent establishment of MSOAP-ICD. Creating appropriate matches between a specialist and a community was considered challenging and relied on good networks into the specialist community and into local communities. Fundholders found that developing long term relationships, for example, with specialist colleges, has been important in being able to access suitable service providers. There are emerging challenges in finding allied health professionals for various ICD service proposals, and additional challenges in creating team based service provision arrangements.
In some cases the role of recruiting the actual clinical service provider is allocated to an intermediary organisation (such as a regional Division of General Practice or a local hospital service). This has sometimes worked well, but in some instances these organisations have struggled to find service providers willing to participate.
Several stakeholders not directly involved with the program indicated they believed that most new service proposals were generated as a result of the initiative of specialists rather than reflecting local need. A small number of stakeholders felt that the program was too much of a closed shop, and that it should be opened up to new specialists willing to undertake outreach services.
Evaluation findingsFundholders need to ensure the mechanisms through which service providers are recruited are effective and open. This should be an issue reviewed on an ongoing basis by fundholders and advisory fora.
Recommendations - Recruitment of service providers19. Fundholders and advisory fora should regularly review the mechanisms through which service providers are recruited to ensure:
- a. The mechanisms are open to possible new service providers.
b. Where fundholder arrangements are being rationalised that there are good linkages into either the public or private sectors.
c. There are relationships with fundholders in other states where there may not be an adequate supply of service providers within the state/territory.
d. There is an appropriate system for managing succession when service providers decide not to continue providing outreach services.