|Primary Care Collaboratives|
|Implemented in this survey?|
The National Primary Care Collaboratives is a coordinated program of rapid change management to improve service delivery in general practices, especially in the management of chronic and complex conditions, and to spread those improvements beyond the originally participating general practices. Initially it will focus on the prevention and management of diabetes and cardiovascular disease, and also access to GPs, and will involve 600 general practices over three years.
The national primary care collaboratives program, announced in 2003 by the Commonwealth Government, is now being implemented. It is a large-scale coordinated program of rapid
change management to improve service delivery in general practices, especially in relation to the management of chronic and complex conditions, and to spread those improvements beyond the originally
participating general practices.
Initially the program will focus on the prevention and management of diabetes and cardiovascular disease in primary care, and also access to GPs (especially, reduced wating times), and will involve practices of the approximately 4,300 general practices across Australia over three years. Divisions of General Practice - local area-based organisations representing GPs - have been invited to be the local organisers of collaboratives, and each Division will recruit 24 general practices to take part in the program.
The Australian Primary Care Collaborative Program (APCCP) will aim to:
The APCCP will provide funding to GP Divisions and general practices to compensate for specific time and travel/accommodation costs involved, but no other financial incentives.
The funding will cover: the salary of a Collaborative Program Manager in each Division ($178,000 over 3 years); an allowance for practices to cover the cost of time spent on collaborative workshops and activities ($8,250 per practice); and travel and accommodation costs to participate in learning workshops.
Participating GP Divisions, GPs and other staff at participating practices, Patients at participating general practices
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
If the Australian Primary Care Collaboratives Program achieves similar impressive improvements to the one pioneered in the UK, then it will be a policy idea to watch and adapt for improving
clinical and business practice in other disease areas and other sectors of Australian health care.
Collaboratives are acknowledged to be an expensive method of quality improvement in health care, but the evaluation will hopefully shed light on this aspect.
Primary care and particularly, with an ageing population, the improved management of chronic and complex conditions, is an increasing focus for health services development in Australia.
The National Primary Care Collaboratives aim to improve care in national priority disease areas, and encompass other key policy goals such as: greater intergration between providers in the
primary care sector, a focus on prevention through better chronic disease management, and accessible primary health care.
There is growing frustration at the lack of impact of other strategies for encouraging GPs to implement best practice care, and experience from the UK's NHS Primary Care Collaborative has been highly influential in the origins of this program.
$15 million have been committed to the program for the next 3 years.
|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 the
NHS Modernisation Agency, National Primary Care Development Team) the USA, and in Europe where it has been used to improve primary care service delivery. Indeed, John Oldham, the Director of
the UK NHS program had several high-level meetings in 2002 with the Australian Department of Health Ageing.
The quality improvement 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 examples of the use of collaboratives in health care Australia (e.g. National Institute of Clinical Studies's hospital Emergency Department Collaborative, and the NSW government Clinical Excellence Commission'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 approach of the idea is described as:
renewed: Institute for Health Improvement, USA.
It is too early to tell how important stakeholders will respond to this initiative. In particular, the willingness of GP Divisions to participate is not yet clear, especially since many
already have clinical quality improvement programs focussed on the same disease areas. However, the representative body of all GP Divisions - the ADGP - is fully endorsing the program and
working closely with the implementing organisation, Flinders Consulting.
Because the policy has been rolled out so rapidly it is probable that some stakeholders have not had a chance to reflect on what the program is and whether they support it.
|Primary Care Division (of Department of Health and Ageing)||very supportive||strongly opposed|
|Australian Divisions of General Practice||very supportive||strongly opposed|
|The 25 GP Divisions chosen to participate||very supportive||strongly opposed|
No legislative changes will be necessary.
|Primary Care Division (of Department of Health and Ageing)||very strong||none|
|Australian Divisions of General Practice||very strong||none|
|The 25 GP Divisions chosen to participate||very strong||none|
Flinders Consulting Pty Ltd, which is the commercial consulting arm of Flinders University in Adelaide, was commissioned in mid-2004 by the Department of Health and Ageing to implement the
project at a national level. They were selected after a competitive tendering process. The project team at Flinders Consulting is lead by a professor of general practice with experience
of the UK NHS's Primary Care Collaborative, and the team is supported by an Interim Steering Committee.
At a local level, general practice Divisions, employing specially trained Collaborative Program Managers, will be key agents in the successful implementation of the program.
The national managers of the program also have formal ties to the UK NHS's Primary Care Development Team, for ongoing implementation advice.
In September 2004 there was a call for tenders by the government for appropriately qualified centres or individuals to perform a national evaluation of the Australian Primary Care
Collaboratives Program (APCCP), to last until until June 2007.
The tender request indicates that the evaluation will assess the:
Evaluator yet to be appointed. Interim evaluation report expected September 2006. Final "summative evaluation" report expected (by Department of Health and Ageing) by June 2007.
Too early to assess probable effects.
If the Program is shown to be successful in participating Divisions and practices, problems may remain in how to further disseminate and encourage best clinical and business practices in Divisions or general practices that are reluctant to take part in collaboratives. Hopefully the evaluation will begin to highlight what types of Divisions and general practices will be ready to benefit from the collaborative process.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The impact ratings are very tentative, but based on similar programs elsewhere, and historical patterns of differential take-up of quality improvement by both Divisions of General Practice and general practices in Australia.
On the Australian Government's Department of Health and Ageing web pages:
On the web pages of Flinders Consulting (Flinders University, Adelaide), who are implementing the program on behalf of the government:
|Primary Care Collaboratives|
Process Stages: Idea, Pilot