“Unmanaged conflicts of interest” and baffling decision-making have eroded any goodwill that GPs had toward federally funded Primary Health Networks.
If the federal government’s Primary Health Networks are ever going to work as intended, they need a fundamental restructure, says the RACGP.
It did not pull many punches in its submission to the Department of Health and Aged Care’s review of PHN business models, alleging that “the bulk of GPs do not have a good experience with their local PHNs” and that “unmanaged conflicts of interest and unclear decision-making have undermined GP trust in the capacity for PHNs to self-manage these issues”.
Luckily for PHNs, the RACGP has some ideas.
Australia’s 31 PHNs, which were established in 2015, are ostensibly there to improve coordination between primary and secondary healthcare systems and improve the efficiency of the healthcare system for vulnerable patients.
While PHNs have the potential to deliver significant improvements to First Nations healthcare through supporting Aboriginal Community Controlled Health Organisations, the RACGP claims that some are doing the exact opposite.
“In some regions, PHNs have been seen as diverting funds away from Aboriginal and Torres Strait Islander run services and towards mainstream services which undermines the community-controlled sector,” it said.
The college’s suggested solutions included mandated minimum numbers of GPs and Aboriginal or Torres Strait Islander PHN board members, as well as a requirement to report on the advice given by clinical advisory councils and on regional needs assessments.
PHN governance – which can vary – was another source of contention for the college.
While it acknowledged some have “robust structures” held in high regard by local communities, it said others were “mired with controversy”.
The RACGP did not name names, but in 2022 the North Queensland PHN was at the centre of a scandal when it emerged that the then-board chair and PHN representative on a pharmacy prescribing trial committee had not disclosed that he co-owned a pharmacy chain in the area.
More recently, GPs in southeast Queensland raised concerns when Country to Coast PHN awarded the contract for Hervey Bay’s Medicare Urgent Care Clinic to a corporate clinic that had not officially opened yet, which they felt was taking business away from locally run practices.
To that end, the RACGP recommended implementing mandatory governance processes for conflicts of interest and to strengthen evaluation requirements to ensure minimum evidence-based processes are being used.
The college also addressed what it saw as a growing trend of PHNs being required to locally implement policies that were designed at a federal level, with limited capacity to adapt programs to a local context.
One of its recommendations was to develop criteria for when PHNs should be directed to implement nationally consistent programs or policies, adding that “PHNs must be focused on regional health priorities”.
Funding for long-term projects – or lack thereof – was brought up, as was the lack of federal support for PHNs to scale up successful initiatives.
The review itself closed for submissions in January, after being open for just over one month.