Framework for development of Primary Health Care Organisations in Australia Australian General Practice Network Boundary Modelling Project. Parts 1 and 2: Introduction and State and Territory Modelling Prepared by Carla Cranny and Dr Gary Eckstein Carla Cranny & Associates Pty Ltd May, 2010 1 PHCO Boundary Modelling Project Contents Contents ...........................................................................................................................................................i 1 Introduction ............................................................................................................................................1 1.1 Purpose and scope of the PHCO modelling project........................................................................2 1.2 Modelling project methodology .....................................................................................................3 1.2.1 Policy analysis and design criteria...........................................................................................3 1.2.2 Technical modelling ................................................................................................................3 1.2.3 Limitations...............................................................................................................................4 1.3 Report format .................................................................................................................................4 2 Part 1: PHCO modelling and design criteria............................................................................................5 2.1 Policy Context .................................................................................................................................5 2.1.1 Need for national health system reform ................................................................................5 2.1.2 International trends and the role of primary health care.......................................................5 2.2 Primary Health Care Organisations in Australia - definitions and policy settings ..........................6 2.2.1 National Health and Hospitals Reform Commission...............................................................6 2.2.2 National Primary Health Care Strategy...................................................................................7 2.2.3 Nation Health and Hospitals Network Reform Directions ......................................................8 2.2.4 COAG National Health and Hospitals Agreement...................................................................8 2.3 PHCO Planning Principles and Design Criteria ..............................................................................10 2.3.1 Planning principles and assumptions underpinning the modelling......................................10 2.3.2 Planning Principle 1: Form should follow function...............................................................10 2.3.3 Planning principle 2: PHCO Participants, Local Primary Care Networks and Partners ........11 2.3.4 Planning Principle 3: Plan for communities using population planning principles...............13 2.4 Design Criteria...............................................................................................................................14 2.4.1 Design Criteria 1: Align PHCOs with Local Government Areas .............................................14 2.4.2 Design Criteria 2: Align PHCOs with state and territory borders..........................................15 2.4.3 Design Criteria 3: Alignment with State Health Services and Hospital Networks.................17 i PHCO Boundary Modelling Project 2010 2.4.4 Design Criteria 4: Primary Health Care Service Delivery Environments ...............................19 2.4.5 Design Criteria 5: Capability and critical mass ......................................................................21 2.4.6 Local Primary Health Care Service Provider Networks and Branch Offices..........................22 2.4.7 Teaching and training implications .......................................................................................22 2.5 Results of the National Modelling Project ....................................................................................23 2.5.1 Preferred Options .................................................................................................................23 2.5.2 Implementation issues and fine tuning ................................................................................24 3 New South Wales..................................................................................................................................26 3.1 Overview .......................................................................................................................................26 3.2 Demographic Features..................................................................................................................26 3.2.1 Current population................................................................................................................26 3.2.2 Indigenous population ..........................................................................................................26 3.2.3 Projected population and patterns of growth ......................................................................27 3.3 Structure of Health Services..........................................................................................................27 3.3.1 General Practice....................................................................................................................27 3.3.2 Workforce and GP distribution .............................................................................................30 3.3.3 Area Health Services .............................................................................................................30 3.3.4 Aboriginal community controlled health services ................................................................32 3.4 PHCO Design Issues in NSW ..........................................................................................................32 3.4.1 Size and scale ........................................................................................................................33 3.4.2 Cross border flows and communities of interest..................................................................33 3.5 Configuration Options for PHCOs in NSW.....................................................................................33 3.5.1 Option 1: 15 PHCOS with 8 metropolitan, Hunter and Illawarra major regional, 5 rural and flows from south west NSW to Victoria................................................................................................33 3.5.2 Cross border flows to Victoria...............................................................................................40 3.5.3 Strengths and weaknesses....................................................................................................41 ii PHCO Boundary Modelling Project [Year]2010 3.5.4 Option 2: 16 PHCOS with 9 metropolitan, 2 regional, 5 rural and flows from south west NSW to Victoria.....................................................................................................................................42 3.5.5 Strengths and weaknesses....................................................................................................42 3.5.6 Option 3: Cross border flows to Queensland, the ACT and Victoria.....................................43 3.5.7 NSW/ACT Cross Border Options ...........................................................................................43 3.5.8 Option 3a: Cross border PHCO with contiguous NSW LGAs flowing to ACT.........................44 3.5.9 Strengths and weaknesses....................................................................................................44 3.5.10 Option 3b: 14 NSW PHCOs with all of Southern NSW in the ACT PHCO ..............................45 3.5.11 Strengths and weaknesses....................................................................................................46 3.5.12 Suggested approach..............................................................................................................47 3.5.13 NSW/Queensland Cross Border Option................................................................................47 3.5.14 Strengths and weaknesses....................................................................................................48 3.5.15 Suggested approach..............................................................................................................48 3.5.16 Other cross border options considered and rejected...........................................................48 3.5.17 Variations in the number and size of rural PHCOs in NSW...................................................49 3.5.18 Option 4: 15 PHCOS with 9 metropolitan, 2 major regional, 4 rural plus flows to ACT, Victoria and Queensland.......................................................................................................................49 3.5.19 Strengths and weaknesses of 4 rural PHCOs ........................................................................52 3.5.20 Option 5:16 PHCOS 9 metropolitan, 2 major regional and 5 rural .......................................53 3.5.21 Option 6: 17 PHCOS with 9 metropolitan, 2 major regional and 6 rural PHCOs ..................54 3.5.22