Primary Health Networks governance: Population health, community input and equity Dr Sara Javanparast Prof Fran Baum Dr Toby Freeman Dr Julie Henderson A/Prof Anna Ziersch Dr Tamara Mackean Prof Richard Reed Southgate Institute for Health, Society and Equity Flinders University Chief investigators Research team Associate investigators Professor Fran BAUM Dr Sara JAVANPARAST Prof Jeff FULLER Prof Richard REED A/Prof Anna ZIERSCH Dr Toby FREEMAN Dr Tamara MACKEAN A/Prof Malcolm BATTERSBY Mr Jeff CHEVERTON A/Prof Wendy EDMONDSON Professor Michael KIDD Professor Ronald LABONTE Professor David SANDERS Critical Reference Group comprising of representatives from the Federal DoH, Health Consumer Alliance of SA, Federation of Ethnic Community Council of Australia, Adelaide Migrant Health Service, Aboriginal Health Council of SA, Adelaide Northern Mental Health 1
Project overview 3 year project (2014-2016), funded by the NHMRC Looking at population health planning processes in Regional PHC Organisations in Australia Focuses on access, equity and social determinants of health Focuses on three population groups: Aboriginal and Torres Strait Islander people New migrants and refugees people with mental illnesses Transition from Medicare Locals to Primary Health Networks Replacement of Medicare Locals by 31 PHNs from July 2015 Larger organisations/change of boundaries Needs assessment and population health planning one of the PHNs objectives Governance (clinical councils and community advisory groups) Involvement of private health insurers and health/hospital networks Commissioning role not service providers 2
What we looked at Partnerships Governance Capacity PHC organisation Social determinants of health Community engagement Funding and resources Methods Selection of case study PHNs 6 PHNs were selected based on geographical location, boundary expansion and previous Medicare Locals involvement interviews with PHNs senior staff (May-Aug 2016) Online survey of PHNs (July-Oct 2016) 55 individual telephone interviews with PHNs Senior Staff in 6 case study PHNs Survey link sent to 31 PHNs for completion CEOs, Board Chair/directors, clinical and community councils, Senior Exec and program managers 67 responses from 17 (54%) PHNs 3
Governance structure of PHNs Clinical advisory council 1 or more councils based on geography, GP led but also comprise other health professionals, advice to the board Community advisory council 1 or more councils based on geography, community organisation and members, advice to the board Board CEO Executive team Skills based (experts in clinical, financial, risk, planning, legal and business management systems) Additional groups e.g. Health priority groups Aboriginal advisory groups Membership advisory groups Board composition Skills based board bringing in diverse expertise Balance between clinical and population health expertise Representation from equity groups Mix of members from previous MLs and independent members Challenges in transition (in the case of amalgamation of 2-3 MLs with different service model and management approach) There is a good mix of board directors from the Medicare Local and then external people as well, to give it that level of independence and sense of new world order that obviously good governance would dictate it should have (CEO) 4
Clinical and Community Councils A requirement by the federal government Lack of clarity in their roles More seen as advisory groups than decision making Mixed ideas on their engagement and effectiveness (e.g. representation) Positive perspective on the power relationships between clinical and community councils but felt too early to comment We already had a variety of groups in place that really for us fulfilled the function So we were a little bit irritated by the edict that we had to do business in that specific way because it actually, to us, was a slightly inferior model. The idea that you have a single clinical council and a single community advisory group that s the be all and end all, that are meant to be knowing and talking about, and reviewing everything, is really quite silly to be honest, it s actually tokenistic. (CEO interview) 5
I think it s very difficult to make these councils useful, and particularly consumer committees because consumers that tend to go on these committees tend to be single issue consumers and it s not really a broad strategic perspective. (Board member interview) Range of works allocated to the councils Reviewing needs assessment documents validating what coming out of the planning process Assisting to develop best community and providers engagement strategies Involving in identifying needs and priority setting Provide comment on commissioning after-hours services to provide better access to after-hours care 6
Communication between different structures Different layers of governance structure and complexity Communication strategies: joint meetings of the councils; minutes sharing; and attendance of board members at meetings The CEO has to manage a range of advice. So I think the trick about that is good communication and very clear definitions or roles and ensuring that those groups have meaningful things to do, not just have them there to float ideas in front of you. (Senior executive interview) We ve got this massive governance structure, ridiculously complex governance structure. Nobody knows how decisions get made. You ve got your internal groups, your internal administration as well. You ve got your board. I m moderately skeptical, and my feeling is what will really happen is that it ll just be - dig a couple of things out of there and just making sure we get a tick on it somewhere along the way. (Chair of Clinical Council interview) 7
Improving population health planning through governance Skills based board helps to bring in different perspectives but the balance between clinical and population health expertise and knowledge is also critical Clarity in the role or clinical and community councils making sure they effectively contribute to population health planning processes Ensuring community and provider representatives provide strategic direction on behalf of the whole group than personal views Balancing the power relationships between community and clinical councils and between GPs and other health providers within clinical councils Some PHNs may not benefit from the imposed governance structure. This need to be reviewed and discussed by the government. 8