|Implemented in this survey?|
A national primary care ?collaboratives? program was announced in 2003 (as part of the federal budget) by the Commonwealth Government, to be implemented in four waves between 2004 and 2006. The Australian Primary Care Collaboratives Program will be a large-scale coordinated program of change management to improve service delivery in primary health care, to meet national objectives and goals, especially in relation to the management of chronic and complex conditions.
A national "primary care collaboratives" program was announced in 2003 by the Commonwealth Government, and will be implemented in four waves between 2004 and 2006. The Australian
Primary Care Collaboratives Program (APCCP) will be a large-scale coordinated program of change management to improve service delivery in primary health care, to meet National objectives and
goals, especially in relation to the management of chronic and complex conditions. Initially it will focus on the prevention and management of diabetes and cardiovascular disease, and will
involve 400 of the approximately 4,300 general practices across Australia. In time it may also focus on other chronic diseases and other aspects of the quality of primary care, such as
integration, affordability, and accessibility.
It is being funded under the Primary Care Providers Working Together component of the Focus on Prevention funding package (announced in the 2003 federal budget). The Program will be managed or commissioned by the Primary Care Quality and Prevention Branch of the Australian Department of Health and Ageing. The exact method of funding collaboratives, and/or participating general practices or Divisions, at a local level has not yet been stated. The Australian Department of Health and Ageing has made a 'call for submissions' from individual organisations, or consortia, to design, manage and implement the program (for the first two years).
The APCCP will be a large-scale coordinated program of change management to improve service delivery in primary health care, to meet national objectives and goals, especially in relation to the management of chronic and complex conditions. Initially it will focus on the prevention and management of diabetes and cardiovascular disease in 400 practices.
At present it has not been announced how general practitioners or practices will be encouraged to participate in the collaboratives.
General Practitioners, Patients with chronic and complex conditions, Other primary care staff (clinical and non-clinical)
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
n/a - too early to tell
Primary care, and particularly the improved management of chronic and complex conditions, is an increasing focus for health services development in Australia. There is growing frustration at
the lack of impact of traditional strategies for encouraging GPs to implement best practice care.
Also, experience and results from the UK's NHS Primary Care Collaborative have been influential in the origins of this program.
Focus on Prevention - Primary Care Providers Working Together initiative
|Implemented in this survey?|
The Australian Primary Care Collaboratives Program (APCCP) is clearly inspired by the impressive results emerging from the use of this particular change management methodology in the UK (by NHS
Modernisation Agency), the USA, and in Europe where it has been used to improve primary care service delivery. The term and methodology of collaboratives, however, has its main origins in the
work of the Institute for Health Improvement (IHI) in the USA*. There are also smaller existing examples of the use of collaboratives in health care in Australia (e.g. National Institute
of Clinical Studies's hospital Emergency Department Collaborative, and the NSW government's Institute of Clinical Excellence's Blood Transfusion Improvement Collaborative), but the APCCP will be on a
much larger scale and targeted at a whole sector of the health system rather than a specific service or process.
*The collaborative method consists of a series of learning workshops in which participants work together to plan changes in their practices, interspersed with action periods during which they implement and evaluate these changes. There are many variations on the breakthrough model, but key features of a collaborative include:
An expert reference panel. The panel endorses recommendations that are expected to provide substantial improvements in health outcomes, and provides local leadership and advocacy for the collaborative.
Learning workshops. Participants come together to discuss the recommendations of the expert reference panel and to develop action plans for change in their practices. At subsequent learning workshops they meet to share their experience of what worked and what didn't, and to make further plans in the light of this experience.
Action periods. During the action period following a learning workshop, participants implement their actions plans in their own practices. They collect data to evaluate the changes, and report back at the next learning workshop. The key quality improvement method taught during learning workshops, and implemented during action periods, tend to be the plan-do-study-act (PDSA) cycle (see Langley and Nolan ). Participants are encouraged to undertake more than one PDSA cycle between learning workshops.
Tracking improvements. All collaborative members supply agreed performance data month-on-month to track changes. These data are shared across the whole collaborative.
The approach of the idea is described as:
renewed: The idea of collaboratives was developed by the IHI (USA) in the mid-1990s. It is also in some ways a peer-led extension of some of the ideas of continuous quality improvement.
There has been no detailed policy paper apart from the financial commitment in the 2003 Federal Budget.
There are currently four pages of information about APCCP on the Department of Health and Ageing's web site (www.health.gov.au/pcd/programs/apccp/), plus a transcript of an Industry Briefing which was delivered by the Department (on the 3rd of December 2003) to support a call for submissions from organisations interested in designing, managing and implementing the program for the first two years. (The call for submissions closed on the 19th of January 2004 so an announcement about the successful applicant should be expected soon).
Legislation is unlikely to be necessary for the development of primary care collaboratives.
The public announcement of this initiative within a budget, and with little separate policy promotion activity is hard to interpret. It could mean that the government was committed at a high
level to the broad policy idea, but needed more time to flesh out the detail on what a workable and affordable Australian program might look like.
Also, experience from the UK NHS's National Primary Care Development Team is being formally built into the program's implementation in Australia. It might therefore be expected that key features of the UK's program - such as regional support offices, or a national web-based database of successful practice-level change implementation - might be fostered as part of the Australian program.
There are plans to put "an independent evaluator on board early" so that a formative as well as an outcome evaluation can be conducted (see Industry Briefing 3rd December 2003, p.6).
Intended to improve the prevention and management of chronic and complex conditions.
While the impressive results of the UK NHS's equivalent are to be hoped for, the structure, organisation and culture of general practice are different in Australia - as is the maturity and heterogeneity of the area-based primary care organisations that might support the collaborative process at a local level (i.e. Divisions of General Practice). For these reasons the effectiveness of the Australian program is difficult to predict.
On the planned collaboratives program in Australia: health.gov.au/pcd/programs/apccp/
On the original idea of collaboratives, the Institute for Health Improvement in the USA: www.ihi.org
On the UK NHS's Primary Care Collaboratives: www.npdt.org