What this GP learned working at a PHN

6 minute read

Dr Michael Wright’s public health journey started early with a serious conversation with Snow White.

Breaking down silos is a key focus for Dr Michael Wright, partly because he has unique access to a multitude of different perspectives across the health system.  

Dr Wright is a practising GP, chair of the Central and Eastern Sydney Primary Health Network and a health economist at UTS.

A self-confessed “portfolio doctor”, Dr Wright is also the chief medical officer of medical indemnitygroup Avant and deputy chair of the RACGP’s NSW/ACT branch.  

His research on continuity of care has backed with data what GPs have been saying for years: patients who stick with a GP get better care. It’s just one of the topics Dr Wright is speaking on at Burning GP summit on 14-15 June at Mantra on Salt Beach, Kingscliff.

Is there any low-hanging fruit for enabling a more coordinated care model?

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 Health Care 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 preventative 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.

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?

Some alignment through a regionally based needs assessment for the whole health system would be an improvement on what we get now [separate assessments by PHNs and LHDs/HHSs]. 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.

Your PHN has three urgent care clinics. How are they going?

It’s early days yet. I do want to give it a bit of time to see what they do.

How can PHNs communicate better with GPs?

As a GP, I’m really busy and it’s really hard to keep abreast of all the changes, whether they’re coming from Medicare coming from through PHNs or other regulatory bodies. So, any messages need to be delivered repeatedly and in multiple ways.

Wild Card question: What is your favourite your best 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 not eat the poisoned apple. I feel like that was perhaps the start of my public health messaging.

She said, “Oh, thank you, thank you,” while looking at me quite intently as if to say “Don’t give the story away”.

Want to figure out how to make general practice more like Disneyland? Early bird tickets to Burning GP are now on sale until midnight 7 March. Dr Wright is one of the headline speakers at Burning GP, which will take place June 14-15 at the Mantra on Salt Beach at Kingscliff, Northern NSW. Find the program and tickets here.  

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