Max Lee Hume Whittlesea PCP

The Jerusalem Effect

1978

 WHO Alma Ata Declaration as the seminal statement about primary health care.  For the first time - notions of equity, community involvement, needs and standards = framing health care services as tools and process for achieving community well being.

’s

Throughout the 1990’s an international view emerged focusing on the integration of social and health services. The new focus sought the following outcomes efficiency; user satisfaction; better outcomes; addressing cross-system care problems; improving co-ordination of services; ensuring better access to services; and preventing cost-shifting. (Leutz, 1999, pp )

1992 –1999

Kennett Liberal Victorian State Government (1992 –1999) interpreted this view with a strong focus on efficiency = delivering more services, more cost effectively. The Primary Health And Community Support system, (PHACS) was the Government strategic programme response and established a unambiguous free market approach to reform.

The PHACS Programme was part of a broad state government agenda that preferred larger community based agencies servicing population catchments of 300,000 or more.

PHACS goals: 1. Compulsory service amalgamations and restructuring to simplify the purchasing process for government and to simplify local government from the perspective of the state. 2. Targeting of services to those communities most in need, including a shift of funds from metropolitan community health services to rural and outer metropolitan growth corridor community health services

2000 onwards

 Change in Victorian state government in October 1999 from Kennett to the Bracks Labor State Government.  The PHACS redevelopment was reviewed by Hayden Raysmith and then re-launched by the Bracks Labor Victorian State Government as the Primary Care Partnerships Strategy (PCPS).

In 2000 the Primary Care Partnerships Strategy aims were : 1.Inclusive of consumers and the community (Consumers in prioritisation of health issues, planning and evaluation roles). 2.Integrating service providers (Collaboration). 3.Focusing on social determinants of health (Risk factors and reducing preventable illness). 4.Address the diversity of the Victorian community (including cultural, ethnic, religious, linguistic and rural and metropolitan specific needs). 5.Focussed on government’s role in planning, not purchasing.

How ?

Community Public Health Plans (CPH) per PCP catchment. Community Health Plans were the regional service planning and co-ordination tool and provided the tool for defining and managing service partnerships.

PCP’s were expected to lead Community Health Plan development and the Plans were designed to specifically focus on emerging ‘pillars’ : 1.Service planning (including health promotion and integrated disease management). 2.Service coordination - coordinating local infrastructure development such as information management and referral. 3.Service partnerships - defining how the wider partnership will implement the Community Health Plan. 4.Consumers – a partnership approach to client focussed service design.

Mid 2000’s

Highly dynamic changing policy and practice environment – for example

1. Service Coordination – SCTT driven PPPS change, shift to proprietary based IT platforms Connecting Care, S2S, Jadeware = cross – product interoperability, ICT vertical integration with Commonwealth, Services as ‘purchasers’ of proprietary software platforms. 2. Re-defining and re-discovering the Consumer Collaboration ‘pillar’ 3. Chronic Disease Alignment - Integrating PCP ICDM with HARP Programmes and EiCD = increased service complexity

“ The PCPS reform will only have a limited impact if it becomes captured by a focus on an administrative reform agenda. Administrative reform in health service policy and delivery is a necessary parallel but not a substitute for genuine change in primary health care delivery that provides measurable improvements inequity, community involvement and wellbeing.” Merrian Oliver-Weymouth is a Policy Officer at Health Issues Centre, 2001

References – Health Issues, 2001, Number 67, pp Primary Care Partnerships: New Directions in Victorian Primary HealthCare Merrian Oliver-Weymouth = &rep=rep1&type=pdf Victorian Burden of Disease Study and its application to Primary Care Partnerships Dr Theo Vos and Sylvia Barry