Medicare Locals Research Articles

Regional primary health care organisations and migrant and refugee health: the importance of prioritisation, funding, collaboration and engagement

ObjectiveThis paper examines whether Australian regional primary health care organisations – in this case, Medicare Locals (MLs) and Primary Health Networks (PHNs) – have engaged with migrant and refugee health, and what factors encourage work in this area. Methods:The study used mixed methods with surveys of ML (N=210) and PHN staff (N=66), interviews with ML (N=50) and PHN (N=55) staff, national consultations with migrant and refugee organisations (N=8 groups with 62 participants), and analysis of ML and PHN documents. ResultsNeeds assessment documents identified migrant and refugee health issues in 46% of MLs and 74% of PHNs. However, 48% of MLs and 55% of PHNs did not report any activities on migrant health, and 78% and 62% did not report any activities for refugees, respectively. Key factors identified by participants as associated with whether ML and PHN focus on migrant and refugee health were the determination of local priority areas, policy context and funding, collaboration with migrant and refugee organisations and communities, and mechanisms for engagement. ConclusionsDespite the importance of primary health care for migrants and refugees, there was relatively little attention paid to these population groups in MLs and PHNs, with a small number of notable exceptions. Implications for public healthThe paper concludes with a range of recommendations for improving regional primary health care organisation engagement with migrant and refugee health.

Interagency collaboration in primary mental health care: lessons from the Partners in Recovery program

BackgroundCollaborative care is a means of improving outcomes particularly for people with complex needs. The Partners in Recovery (PIR) program, established in Australia in 2012, provides care coordination to facilitate access to health and social support services for people with severe and persistent mental illness. Of the 48 PIR programs across Australia, 35 were led by Medicare Locals, the previous Australian regional primary health care organisation and nine involved Medicare Locals as partner organisations.AimsTo identify features which enabled and hindered collaboration in PIR programs involving Medicare Locals and determine what can be learnt about delivering care to this population.MethodsData were collected from 50 interviews with senior staff at Medicare Locals and from eight focus groups with 51 mental health stakeholders in different Australian jurisdictions.ResultsSuccessful PIR programs were based upon effective collaboration. Collaboration was facilitated by dedicated funding, a shared understanding of PIR aims, joint planning, effective network management, mutual respect and effective communication. Collaboration was also enhanced by the local knowledge and population health planning functions of Medicare Locals. Jurisdictional boundaries and funding discontinuity were the primary barriers to collaboration.

Collaborative population health planning between Australian primary health care organisations and local government: lost opportunity

Objective:To examine the strength and extent of collaborations between primary health care organisations and local government in population health planning. Methods:Methods included: a) online surveys with Medicare Locals (n=210) and Primary Health Networks (n=66), comparing the two using two‐level mixed models; b) interviews with Medicare Local (n=50) and Primary Health Network (n=55) executives; c) interviews with members of local government associations and Primary Health Network board members with local government experience (n=7); and d) review of 54 Medicare Local and 31 Primary Health Network publicly available annual reports. Results:Despite partnership being a policy objective for Medicare Locals/ Primary Health Networks, they reported limited time and financial support for collaboration with local government. Organisational capacity and resources, supportive governance and public health legislation mandating a role for local governments were critical to collaborative planning. Conclusions:Local government has the potential to tackle social factors affecting health; therefore, their inclusion in population health planning is valuable. Legislative mandates would help to achieve this, and PHNs require a stronger Federal Government mandate backed by sufficient resources and a governance structure that supports collaboration. Implications for public health:Improving primary health care and local government collaboration has great potential to improve the quality of health planning and action on social determinants, thus advancing population health and health equity.

How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations

BackgroundWorldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems’ responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011–2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning.MethodsWe reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff.ResultsDespite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals’ performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity.ConclusionsThere are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in such a way that the impact of the social determinants on health and health equity are taken into account. The policy environment favours a focus on clinical services to the detriment of health promotion informed by a social determinants focus.

A framework for regional primary health care to organise actions to address health inequities.

Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015). The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents. The framework encompassed equity in planning, collection of equity data, community engagement, and strategies to address equity in access, health outcomes, and social determinants of health. When the framework was applied to Medicare Locals, their inclusion of equity as a goal, collection of equity data, community engagement, and actions improving equity of access were strong, but there were gaps in broader advocacy, and strategies to address social determinants of health, and equity in quality of care. The equity framework allows a platform for advancing knowledge and international comparison of the health equity efforts of regional primary health-care organisations.

Implementation of oral health initiatives by Australian rural communities: Factors for success.

In this paper, we consider factors significant in the success of community participation in the implementation of new oral health services. Our analysis draws on data from the Rural Engaging Communities in Oral Health (Rural ECOH) study (2014-2016). We aimed to assess the Australian relevance of a Scottish community participation framework for health service development; Remote Service Futures. Internationally, community participation in planning of health initiatives is common, but less common in new service implementation. Health managers query the legitimacy of "lay" community members, whether they will persist, and whether they can act as change agents. Our data provide evidence that helps answer these queries. Six communities, located within regions covered by two large rural primary healthcare organisations (Medicare Locals), were selected in two Australian states. Two university-based facilitators worked with a group of local residents (for each community) to monitor implementation of new oral health initiatives designed through participatory processes. Data about implementation were collected through interviews with 28 key stakeholders at the beginning of implementation and 12months later. Data were coded, themed and analysed abductively. Five themes emerged; the inter-relationship between community motivation to participate with the fortunes of the oral health initiatives, having the "right" people involved, continuing involvement of sponsors and/or significant people, trusting working relationships between participants and perceiving benefits from participation. Findings provide evidence of a role for community participation in implementing new community services if solid partnerships with relevant providers can be negotiated and services are seen to be relevant and useful to the community.

Lessons from Medicare Locals for Primary Health Networks.

Lessons from Medicare Locals for Primary Health Networks.

Commissioning and equity in primary care in Australia: Views from Primary Health Networks.

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context.

Monitoring of Chronic Disease in the community: Australian Telehealth Study on Organisational Challenges and Economic Impact

Introduction : Commonwealth Scientific & Industrial Research Organisation (CSIRO) of Australia was tasked to lead a National Telehealth Trial for chronic disease in the community to investigate models of care, health service utilization and economic impact on the Australian health system. Chronic and aged care accounted for over 70% of Australia’s $155bn expenditure on healthcare during 2013–14, and is projected to dramatically increase into the future. Australia’s hospital-centric public health system is unnecessarily burdened by the management of chronic disease, which should occur in home and community settings. Telehealth services delivered through home Telemonitoring have been demonstrated to deliver cost effective, timely and improved access to quality care. They also reduce social dislocation and enhance the quality of life within communities and their sustainability by allowing chronically ill and aged members to stay in their homes and communities longer. The development of a robust business case and business models for large scale commercial deployment of Telehealth services based on solid economic evidence is essential if these services are to be scaled up nationally to have any impact on the escalating costs of health service delivery and the increasing deficit in clinical work force. Description of practice change : Trial was designed with the aim of demonstrating how Telehealth services for chronic disease management in the community can be deployed nationally in a range of hospital and community settings, by piloting services in six different locations across five Australian states with a range of health service provider’s, including a hospital, Local Health Districts, Medicare Locals and aged care organisation. The intervention was the provision of Telemonitoring equipment for the collection of vital signs and the administration of questionnaires. Control patients received normal care. In this trial we analysed and compared the performance, across four distinct groups with one hospital site, two community based services, two GP managed Medicare Local coordinated services and one Aged Care focused service. Key Findings : Based on a before and after control intervention (BACI) case matched design this trial evaluated health outcomes, impact of workplace culture and capacity for organizational change management. The project recruited 113 chronically ill patients with multiple co-morbidities and remotely monitored using Telehealth. These patients were compared with 174 patients acting as matched controls who were tracked for periods 6-18 months with at home telemonitoring of vital signs and clinical symptoms. Telehealth monitored patients’ demonstrated: a. Reduction in health services utilisation observed towards the later part of the trial (after 8-9 months) by reduced number of GP visits, specialist consultations, laboratory tests and procedures performed. b. Reduction in primary healthcare costs were demonstrated by the reduction of Medicare benefit costs by more than AUD600/year/patient and pharmaceutical dispensing cost by more than $300/year/patient at end of trial. c. Reduction in hospital length of stay by more than 7 days d. Reduction in rate of hospitalisations by 1 less event e. There were improved Quality of life metrics/Human factors /Useability and acceptability to patients and clinicians Highlights : At all trial sites the Telehealth technology was well accepted by patients. The key barriers were related to integration of Telemonitoring into existing models of care was at the services provider level. These barriers included the capacity to implement/participate in new programs within health organisations and one of our trial sites had to be decommissioned. Main highlight was the continuation of Telemonitoring at three sites post-trial, offering Telehealth as a mainstream service for chronic disease management of patients in their home. This is a big win from the trial where three health service providers have integrated Telehealth as an ongoing sustainable service for chronic disease management in the community. Conclusions : Telemonitoring can be deployed for management of chronic disease in the community as a cost effective alternative. From the experience throughout the trial has demonstrated that successful deployment of remote Telemonitoring of chronic disease requires the following success factors: − Importance of a new Clinical Care Coordination role to centrally coordinate optimal response to caregivers as demonstrated in this trial − Strong support and leadership from the health service management team and the formation of strong clinical governance for the service − Strong alignment of workplace culture and values with the objectives of Telemonitoring. This will often require the implementation of extensive training and education programs − A clear “ownership” and engagement not only with the patient, but with the patient’s carers who may include relatives, neighbours, community nurses and GPs. − Clear governance protocols and lines of communication between the clinical care coordinator and the patient’s care team, in particular the patient’s GP. − Support for Telemonitoring services through automated risk stratification protocols that can identify with high probability patients who are demonstrating an exacerbation of their condition and may require immediate attention to avoid an unnecessary hospitalisation.

A self-reported survey on the confidence levels and motivation of New South Wales practice nurses on conducting advance-care planning (ACP) initiatives in the general-practice setting.

Nurses are well positioned to initiate and conduct advance-care planning (ACP) conversations; however, there has been limited research on practice nurses performing this role in Australia. The aim of the present study was to understand the beliefs, attitudes, perceptions, confidence, training and educational needs of New South Wales practice nurses with regards to involvement in ACP. A cross-sectional online survey was conducted in August to October 2014. Nurses were recruited through nursing organisations and Medicare Locals. There were 147 completed surveys (n=147). Participants were mostly female registered nurses, with a median age of 50, and 6 years of practice-nurse experience. Practice nurses were generally positive towards their involvement in ACP and believed it would be beneficial for the community. Their confidence in initiating ACP increased as their familiarity with patients increased. They showed a high level of interest in participating in training and education in ACP. Barriers to their involvement in ACP included the lack of a good documentation system, limited patient-education resources and unclear source of remuneration. Nurses were also concerned over legalities of ACP, ethical considerations and their understanding of end-of-life care options. Nevertheless, they were highly receptive of integrating ACP discussions and were willing to enhance their skills. These findings uncover a need for further training and development of practice nurses for ACP discussions.

Variation in coronary angiography rates in Australia: correlations with socio-demographic, health service and disease burden indices.

Variation in the provision of coronary angiography is associated with health care inefficiency and inequity. We explored geographic, socio-economic, health service and disease indicators associated with variation in angiography rates across Australia. Australian census and National Health Survey data were used to determine socio-economic, health workforce and service indicators. Hospital separations and coronary deaths during 2011 were identified in the National Hospital Morbidity and Mortality databases. All 61 Medicare Locals responsible for primary care were included, and age- and sex-standardised rates of acute coronary syndrome (ACS) incidence, coronary angiography, revascularisation and mortality were tested for correlations, and adjusted by Bayesian regression. There were 3.7-fold and 2.3-fold differences between individual Medicare Locals in the lowest and highest ACS and coronary artery disease mortality rates respectively, whereas angiography rates varied 5.3-fold. ACS and death rates within Medicare Locals were correlated (partial correlation coefficient [CC], 0.52; P <0.001). There was modest correlation between ACS and angiography rates (CC, 0.31; P = 0.018). The proportion of patients undergoing angiography who proceeded to revascularisation was inversely correlated with the total angiogram rate (CC, -0.71; P <0.001). Socio-economic disadvantage and remoteness were correlated with disease burden, ACS incidence and mortality, but not with angiography rate. In the adjusted analysis, the strongest association with local angiography rates was with admissions to private hospitals (71 additional angiograms [95% CI, 47-93] for every 1000 admissions). Variation in rates of coronary angiography, not related to clinical need, occurs across Australia. A greater focus on clinical care standards and better distribution of health services will be required if these variations are to be attenuated.

The new Australian after-hours general practice incentive payment mechanism: equity for rural general practice?

In July 2015, a national scheme for after-hours incentive funding for general practices was re-introduced in Australia, 2-years after funding was transferred to regional primary health care organisations (Medicare Locals). The re-introduction was recommended in a 2014 review of after-hours primary care reflecting the “overwhelming desire” among general practice. Given the centrality of after-hours care provision in rural and remote practices identified in the review, we compare and contrast the current and historical after-hours incentive funding mechanisms focussing on fairness towards rural general practices.While there are similarities between the current and historical mechanisms, significant differences exist. The comparison is not straightforward. The major consistency is utilisation of practice standardised whole patient equivalents (SWPE) as the basis of funding, inherently favouring large urban general practices. This bias is expected to increase given a shift in focus from practices with no option but to provide 24/7 care to any practice providing 24/7 care; and an associated increased funding per SWPE. Differences primarily pertain to classification processes, in which the realities of rural service provision and recognition of regional support mechanisms are given minimal consideration.Rapid introduction of the new general practice after-hours incentive funding mechanism has led to inconsistencies and has exacerbated inherent biases, particularly inequity towards rural providers. Impact on morale and service provision in non-urban areas should be monitored.

Population health performance as primary healthcare governance in Australia: professionals and the politics of performance

ABSTRACTA range of institutional and financial instruments has been used to drive population health outcomes in primary health care in Australia. However, GP sovereignty and the corporatized nature of general practice have generated major challenges. The core of government reform strategy since 1992 has been the creation and financing of Primary HealthCare Organizations (PHCOs), in various forms, to provide an organizational basis to connect GPs to population health performance, and a closer link between the state and GPs. The shift from Divisions of General Practice, the first PHCO, to Medicare Locals (MLs) in 2011 was notable. The latter constructed the object of performance as a raft of broader population health goals, which were framed in terms of accountability to communities through public reporting. Drawing on interviews with Federal government, health professional associations, ML executives and GPs, this paper examines the ways in which such performance instruments were imagined and understood, and areas of contestation. The findings show the different rationalities at play and how different actors seek control of the policy space. They also demonstrate the political precariousness of PHCOs, and the wider difficulty of steering market-based professionals in the achievement of population health objectives.

The new Australian Primary Health Networks: how will they integrate public health and primary care?

On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities.

Commissioning: perspectives from the ground.

Primary Health Networks (PHNs) have been tasked with two key objectives to be achieved through commissioning. Public value aims can be achieved by developing operational capability in the context of an authorising environment. Public value will need to focus on system level outcomes from multiple perspectives, including a consumer perspective. The authorising environment will require policymakers to allow time for PHNs to mature into their role. It will require an environment of effective collaboration amongst multiple stakeholders including consumers. The operational capability will need to ensure highly competent managers and clinical leadership working in a symbiotic relationship. Although some Medicare Locals demonstrated commissioning capacity and capability, this will need to be scaled up at-pace in the new healthcare landscape in order for PHNs to optimally fulfil their roles.

General practices' perspectives on Medicare Locals' performance are critical lessons for the success of Primary Health Networks.

Under a health reform after two decades, Primary Health Organisations (PHOs) in Australia were changed from Divisions of General Practice (DGP) to Medicare Locals (MLs). Following a review of Medicare Locals, in July 2015 Primary Health Networks (PHNs) replaced Medical Locals to potentially improve outcomes through supporting primary care and enhancing integration. The aim of this paper was to gather front-line staff's perspectives on MLs and identify any lessons applicable to PHNs. A national purposive sample of 22 high-performing general practices representing all Australian states and territories was selected for semi-structured, face-to-face interviews, and a thematic analysis conducted. Fifty-three interviews were conducted: participants comprised 19 general practitioners (GPs), 18 practice managers (PMs), 15 practices nurses (PNs), and one community pharmacist. Most participants reflected on the difference between the DGP and MLs. Themes that emerged included ambiguity, community needs, professional development and education, communication and support, duplication in services and ignoring existing ones, recruitment and retention, and engagement and involvement. Those MLs that did well continued in an expanded way the work DGP were doing beforehand and made a seamless transition. PHNs will need to build on the strengths of previous PHOs, and create locality structures and processes that maximise the potential for clinical engagement. They will actively guide the dialogue between related microsystems: to achieve this they will have to be clinically led, change management organisations.

Medicare Local–Local Health Network partnerships in South Australia: lessons for Primary Health Networks

To examine the partnerships in population health planning between Medicare Locals (MLs) and Local Health Networks (LHNs) in South Australia, and the factors that facilitated or constrained collaborations, to offer lessons for LHNs and Primary Health Networks. We conducted a qualitative study using individual interviews with key informants (executive or program leader staff) from the five South Australian MLs and the five South Australian LHNs. A total of 34 interviews were conducted between March and July 2014. Significant work was undertaken by MLs in the process of population health planning and needs assessment. Participants from both MLs and LHNs described examples of collaborative work, including data sharing and synthesis, program implementation and community consultation. The focus of LHNs on acute and intermediate care, the lack of system-level strategies to support collaboration, and constant policy and structural changes leading to uncertainty in the primary health care landscape were perceived as key barriers to collaboration. The experience of MLs and their achievements in building relationships and trust with stakeholders in their regions, including LHNs, provide valuable lessons for the new Primary Health Networks in Australia.

P03.10 Working together- primary health care nurses taking the lead in sexual health care

Introduction Primary health care nurses (PHCNs) frequently report being interested in sexual health care, believe sexual health care is important, see sexual health care as part of their role and want to further develop their skills in this field. However recent Australian studies demonstrate that opportunities for PHCNs in sexual health care in general practice appears to be underdeveloped and under supported. Methods The Australasian Society for HIV Medicine (ASHM), NSW STI Programs Unit and Australian Primary Health Care Nurse Association (APNA) consulted PHCNs in NSW about their current role, interest in sexual health care and what they believed would assist to further develop their role in this field. Partnerships were formed between NSW primary health care organisations (Medicare Locals), public sexual health services, Family Planning NSW and training providers to also identify how to respond to the identified need. Results Key strategies identified by PHCNs to enhance their role in sexual health care in general practice included the development of competency standards, provision of online training and strong support from GPs. A multi-pronged approach has been undertaken using competency standards and clinical tools to support education and practice, clinical placements in sexual health services to further develop skills and practical resources such as how to bill patients to support this change of practice. Conclusion PHCN are interested in expanding their role in general practice and are in a pivotal position to lead significant changes in general practice for the provision of sexual health care to the community. Key elements to assist this include effective support from GPs, the provision of clinical tools and education and opportunities to connect with sexual health services. Finally primary health care nurses’ own determination and perseverance to take a lead role in sexual health care is critical to the success of this practice change. Disclosure of interest statement The NSW STI Programs Unit is funded by NSW Health. No pharmaceutical grants were received in the development of this project.

Evaluating a Health Care Partnership in Australia

Introduction: Local Health Districts in Australia are responsible for providing publicly-funded community and hospital health services. Medicare Locals support primary health care doctors (general practitioners) and provide other primary health care services. Historically this care has not been systematically integrated. In 2012, Western Sydney Local Health District (WSLHD) and Western Sydney Medicare Local (WSML) signed a Partnership Memorandum committing to integrating health services in this relatively disadvantaged urban area. Theory/ Model: We undertook an evaluation of the consequences of the Partnership using a Program Logic Model (PLM).We met with key stakeholders to define inputs, activities, outputs, outcomes and early impacts and to assign measurable indicators of progress in each component. We collected quantitative and qualitative data from a review of local health and health services data, documents related to the partnership and semi-structured interviews with a range of informants and organisational representatives. We analysed these data descriptively using the PLM as a framework. Interview transcripts were further analysed using an inductive approach to identify areas of achievement and facilitators of the Partnership, challenges and barriers to the Partnership and to make recommendations for its future development of integrated health services. Results: The common geography and therefore population health needs faced by WSLHD and WSML have been key factors in building a shared vision and agreeing on common priorities. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116964 – http://www.ijic.org/ Operationalization of the Partnership has been facilitated by strong governance arrangements. Previous relationships and joint activities contributed to mutual respect, trust, and collegiality. In common with many partnerships at this early stage, the strong leadership provided by senior management, was not always evident at operational levels of the organisations, where resourcing of partnership activities may have been an issue. In addition to new shared oversight arrangements for pre-existing health programs, a number of new services have been established under the Partnership. Focussing on a limited number of agreed health priority areas has driven the implementation of key activities and achievement of early outcomes, although the need for adequate resourcing limited the number and range of these areas that could be actively engaged at any one time. Several initiatives focussed on integration of health information are likely to facilitate integration of health care across primary and secondary/ tertiary settings in the future, however service connectivity including sharing of patient records remains a challenge at present. Discussion: The enormous complexity of this undertaking, noted in evaluations of similar initiatives, has been compounded by policy changes and uncertainty surrounding primary health care organisations in Australia. Despite these challenges the Partnership has clearly articulated its vision of coordination and integration of healthcare across western Sydney, as summarized by the WentWest Chair: “Think as one system and act as if there are no barriers.” Organizational leadership, strong governance and mutual trust and respect have been essential to its early achievements. Differences in organisational size, governance and structure don’t preclude partnership, though integration of services takes longer to achieve and the consequent health outcomes, even longer. Conclusions: Although the Partnership is just one element of a very complex system, after two years the groundwork has been largely established for the Partnership to produce outputs that will benefit health outcomes in region. The findings of this evaluation have been considered by the WSLHD-WSML Partnership Advisory Council and used to inform ongoing Partnership activities. Lessons learned: Establishment and maintenance of organizational partnerships, whilst challenging, provide a basis for health care integration. Time invested early in the course of the Partnership in developing a structured evaluation framework, for example using a PLM approach, enables evaluation of all components of the Partnership, though outcomes and impacts require longer term measurement. The PLM approach provides a useful framework for mapping the Partnership and a valuable tool for evaluation. Evaluation of the inputs, activities and outputs of the Partnership at this early stage has informed review and re-direction of resources and activities. Collection of baseline data related to longer term outcomes and impacts of the Partnership will facilitate future evaluations. Limitations: This evaluation is limited to the first 18 months of a single partnership in a relatively disadvantaged area of urban Australia at a time of considerable policy upheaval. Nevertheless, the study has informed the Partnership’s ongoing development and demonstrates a methodology for evaluation of similar partnerships. Suggestions for future research: The PLM approach provides a framework for longer term evaluation of health service partnerships. Future studies should explore in more depth how the policy environment both constrains and enables effective organizational partnerships.

The Australian primary healthcare experiment: a national survey of Medicare Locals

ObjectiveThe objectives of this study are to evaluate the development and implementation of Medicare Locals as new primary care organisations and consider the implications of these findings for the wider...