Medicare Locals Research Articles

When big isn't beautiful: lessons from England and Scotland on primary health care organisations

United Kingdom primary care trusts resembled the primary health care organisations (PHCOs) that have been proposed for Australia--for example, Medicare Locals. They resulted in a loss of innovation, creativity, motivation and morale among general practitioners and other front-line staff. English primary care trusts are being abolished and £80 billion will be handed over to GP commissioners. Management theory and practical experience shows repeatedly the dangers of reorganising into larger units. Lessons for Australia are to defer deciding on the size of PHCOs until their purposes are clear, to enshrine the principle of subsidiarity, and to opt for networking of the current Divisions of General Practice over mergers. So far, debate on the functions and structures of PHCOs has been muted. It is now time for vigorous debate.

Divisions of General Practice: will they transform, or die?

Divisions of General Practice are a significant part of Australia's health care sector. The Australian Government intends to establish "Medicare Locals" (MLs), which will assume many of the roles currently undertaken by Divisions. MLs will, on average, be larger than Divisions and are likely to have different ownership, governance and accountability arrangements. While some Divisions may find transformation into an ML an appealing and relatively straightforward option, others may wish to follow alternative paths that allow them to maintain many of their current characteristics. Evidence suggests that the move to MLs might jeopardise the level of clinical involvement attained by Divisions.