Dr Michael Wright’s public health journey started early with a serious conversation with Snow White. These days he’s serious about breaking down silos.
Dr Michael Wright is big on breaking down silos, in part because he has unique access to a multitude of different perspectives across the health system.
Dr Wright is chair of the Central and Eastern Sydney Primary Health Network, is a health economist at UTS, and practices as a GP. A self-confessed “portfolio doctor”, Dr Wright is also the chief medical officer of medical indemnity group Avant and deputy chair of the RACGP’s NSW/ACT branch.
What have you changed your mind about since working with a PHN?
It’s given me a healthier respect for understanding where there are gaps in the system.
Our PHN has done some good work in trying to support the people who were potentially slipping through the cracks in the system – whether it’s culturally and linguistically diverse populations, Aboriginal and Torres Strait Islander peoples or people living with homelessness.
Even mental health services, where people weren’t getting services through the hospitals and were potentially getting missed in the community – that has been one of the great benefits of putting targeted funding to those populations to provide them with better access.
What do you think PHNs could do differently or better?
PHNs have great potential. Predominantly, they are funded on targeted programs from priorities identified by the Commonwealth. So, they commission services in those areas. However, there is a lot of potential for them to more broadly understand the needs of the local community beyond those priority areas, if there was more flexibility in the funding to support those kind of services.
Do you see duplication between PHN and LHD/HHS activities?
The PHN does a needs assessment focusing on the areas that it can influence and can fund, according to what the government wants it to do. LHDs and HHSs do a needs assessment from their perspective.
Some alignment through a regionally based needs assessment for the whole health system would be an improvement on what we get now. It makes sense to want to know all of the health services in an area through a broader needs analysis rather than dividing it up as it currently is.
With all the multiple roles I have, I want to collaborate. I want to try and work through this together, to create common messages around the importance of breaking down the silos and pushing in the same direction. The more conversations we can have about this, the better.
What can you tell us about coordinated care models?
We know that team-based care works and most GPs do it within their practices because they can share information within their four walls. However, one of the barriers is Medicare – the Medicare consultation numbers largely only pay for the time that GP provides to the patient, not what the other members of the team do.
That’s a change that we could introduce that would free up the GPs’ time while still providing safe care within a practice.
It would also be great to reduce the duplication by sharing information more broadly but I wouldn’t call that low-hanging fruit. There’s potential for major cost savings but only if the IT systems work across the whole health system.
How are other countries funding team-based care?
I don’t think anyone’s got it completely right. Unfortunately, in Australia, one of the things that we overlook is that we’ve been a bit slow to learn our own lessons from previous reforms.
We’ve tried multiple models of coordinated care trials going back to the 1990s like the diabetes care project and the healthcare homes trial. All of them have shown that if you change the funding model, the GPs will respond. It also shows that GPs are happy to delegate care when it’s not financially disadvantageous to them.
However, what all of these trials have also shown is that implementing new systems doesn’t save money in primary care, at least in the short term. It’s a long-term game to change health outcomes from primary care.
We do know these programs are likely have an impact on the cost curve 10 or 20 years down the track. Because these short-term pilots, unfortunately, don’t show savings short-term, their learnings haven’t been implemented more broadly.
Is it naive to expect preventive care programs to show short-term savings?
That’s why we need a shared agreement about what the priorities are, knowing that we’ve got multiple funders and many players providing healthcare.
International evidence suggests that systems with a focus on primary healthcare have better health outcomes and lower health costs.
We need to have another discussion about what is the best way to invest health funding, particularly when you see the shifts that have happened in the review of government services in the last year, decreasing investment into primary care and increasing investment into tertiary care.
Wildcard: What’s your favourite childhood memory of school holidays?
I have lots of happy memories of going to Noosa with my family when I was a kid. However, the highlight was a trip to Disneyland when I was five or six.
I was very insistent to Snow White that she should not eat the poisoned apple.
Snow White said, “Oh, thank you, thank you,” while looking at me quite intently as if to say, “Don’t give the story away”.
I feel like that was perhaps the start of my public health messaging.