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30 Sep 2010

Submission by Dr. Ken Cho (Fairfield Liverpool Association of Medical Practitioners )

Principles for determining boundaries or catchment areas for Medicare Locals, including potential differences between metropolitan, rural and remote areas (eg size of catchment populations, natural catchment areas)

We believe that creation of a South West Sydney Primary Health Care Organisation based on Bankstown, Liverpool and Fairfield Divisions of General Practice will provide the optimal configuration for state and federal primary health care policy implementation over the next 10 years to 2020 and potentially beyond.

As outlined in the NSW Health and Commonwealth discussion papers, the PHCO will be based on Local Government Area (LGA) and Sydney South West Area Health Service borders, current patient flows, transport corridors, demographic congruence, and projected population growth.

A South Western Sydney PHCO based on the amalgamation of the existing Bankstown and Fairfield-Liverpool Divisions of General Practice will focus on providing services to the well established urban communities in the Bankstown- Fairfield-Liverpool corridor which have a very high proportion of CALD residents and specific areas of health disadvantage due to their relatively low-SES and related social, health and welfare care needs.

Suggestions about the optimum number of Medicare Locals in a particular state, territory or region, including potential boundaries in each area

Our suggestion is that, in the absence of scientific evidence that larger is better for primary health care services planning & delivery, we engage local communities in voicing their preferred geographical alignment of boundaries.

If this creates a number of ‘local’ PHCOs then so be it. The number of PHCOs must be determined on the number required to appropriately customise the primary health care needs of a population and the capacity of the workforce to service that need.

Specific comments on the Carla Canny & Associates report (where relevant)

The issues around merger of our Divisions has been discussed in previous years, most recently in 2008, and it appears now is the ideal time to do this and form the new PHCO. A major factor in this decision to support the formation of a South West Sydney PHCO with Bankstown-Fairfield-Liverpool alignment is the support of the GPs and other members of the Fairfield-Liverpool Association of Medical Practitioners, with over 200 members who support formation of a Bankstown rather than Macarthur-based collaboration. This is clearly a rejection of the Carla Cranny proposal for amalgamation of Fairfield-Liverpool into a Macarthur-based PHCO and Bankstown into an “Inner West & Canterbury Bankstown PHCO” which ignores the historically close working relationships between GPs in this region, particularly those with shared practice arrangements across Bankstown & the Fairfield-Cabramatta migrant communities they are part of. Similarly the historical referral arrangements between the respective Bankstown, Fairfield and Liverpool Hospitals and the close relationship between GPs and the local Councils on similar health matters is not well represented in the Cranny documents.

The Cranny Report failed to recognise and consider the clear demographic patterns and health-needs distinctions of migrants and their next-generation descendents in the Bankstown-Fairfield-Liverpool area when compared to other communities in Central Sydney and Macarthur. Hence we propose a South Western Sydney PHCO based on the amalgamation of the existing Bankstown and Fairfield- Liverpool Divisions of General Practice. This PHCO proposal has significant support from GPs and other stakeholders.

Comments on Local Hospital Networks

We will work with the LHN to improve the coordination of care in our local area.

Other issues

There is currently considerable confusion around Division of General Practice boundaries. The re-election of the Gillard Labor Government is expected to resolve the major policy initiatives going forward (for example, confirming the policy support and funding of GP ‘Super Clinics’) but may not manage the process for resolving geographical boundaries demarcation issues.

These issues are currently being managed by the distribution of information by the Australian General Practice Network, State-based organizations (GP and Health Departments) and local GP Divisions representatives. As a consequence, there is a communication coordination issue for the Commonwealth and these organisations to solve before the PHCO process becomes more unwieldy and less able to collect and synthesise stakeholders views.

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