Flux, flex and the future

A message from NWMPHN Chief Executive Chris Carter.

The first 3 years of this decade found the Australian health care system beset by 2 unpleasant realities: stagnation and crisis. 

Several years of service strain and value erosion, which saw costs for patients rise as inexorably as returns to general practitioners declined, were suddenly challenged by the widespread, swift and unprecedented actions demanded by the COVID-19 pandemic. 

The demand for health services thus generated further complicated an already difficult situation in which diminishing numbers of primary care providers were already struggling to adequately support a population that was ageing and therefore increasingly presenting with complex and chronic conditions. 

At the same time, Medicare rebates for doctors remained locked in a decade-old formulation, leading to many, perhaps most, practices opting to levy co-payments to patients.

By the start of the new year, additions to primary care infrastructure in the form of GP respiratory clinics and priority primary care centres were making solid contributions to patient care. Funded by state and federal sources, and often facilitated by primary health networks, they represent short-term responses to demand rather than long-term structural reforms. 

In 2023, however, the primary health environment started a process of change that, while still emerging, looks set to bring about the biggest raft of changes since Medicare itself was created in 1984. 

Although coronavirus remains with us, the immediate demands of the pandemic have receded due to a mix of well-tested pathways, high rates of vaccination, and case-induced immunity. After its election in 2022, the Albanese government acknowledged the stress under which the health system was operating and commissioned the Strengthening Medicare Taskforce to consider ways in which health care could be made fairer and more equitable. 

The Taskforce’s recommendations, delivered in early 2023, included a mix of suggestions, included blended funding models, fast-tracking new supplies of GPs and other health care workers, and overhauling record-keeping and communication protocols.   

In response, the Federal Government’s May budget introduced some welcome reforms – notably the introduction of the MyMedicare voluntary patient registration model, and the tripling of the bulk-billing incentive. As these changes come into force, the Health Minister has reconfirmed the position and role of primary health networks as service designers, commissioners and funders. 

And while all this is going on in the world of general practice, a similar flex has been underway in the area of mental health. Of particular note in this field has been the investments made by the Victorian State Government in creating Local Adult and Older Adult Mental Health and Wellbeing Services, or “Locals”. 

One of the big challenges across the mental health ecosystem in the coming months is to work cooperatively with state, federal and privately funded service providers to ensure that additional capacity – while very welcome – does not result in disrupted communications and therefore poorer support for clients. 

The governing principle for NWMPHN’s involvement in mental health – which is deeply enmeshed in Head to Health, CAREinMIND™, headspace and others – is that there must be “no wrong door” for patients. We are pleased to note that this drive is shared by established and new providers in this field and look forward to ensuring that ease of access remains fundamental.

On a global level, yet much related to this, the foundational definition of health care priorities, known as the quadruple aim, transformed into the quintuple aim through the addition of a new principle enshrining health equity. 

This was happily endorsed by NWMPHN, which has long held that equity of access and treatment have to be at the centre of service provision. 

We are guided in our thinking and planning by foundational documents, written and researched by our teams, particularly the Access and Equity Framework, and our triennial Health Needs Assessment. 

Through these we are reminded to always look for ways to better support and enable the physical and mental health of population cohorts otherwise unfairly disadvantaged and powerless. These include Aboriginal and Torres Strait Islanders, members of the LGBTIQ+ community, people from cultural and linguistically diverse communities, older people, refugees and asylum seekers, and people at risk of homelessness. 

The coming years bring with them a curious mix of optimism, and hope. As the months roll by, I hope to see a primary care system revivified. I hope to see service providers across the spectrum better supported and remunerated. And I hope to see residents able to access the health care they need, in the right place, and at the right time. 

This year, like any other, has been typified by challenges and demands placed on the 100-plus staff members here at NWMPHN, our board of directors, clinical and community councils, expert advisory groups and People Bank members.

I thank every one of them from the depths of my heart. An organisation like this is only as good as the people who make it work, advise it and provide it with wise and considered counsel. In all those aspects, we are blessed.