Purpose of the FrameworkThe National Primary Health Care Strategic Framework (the Framework) promotes a new approach for the Commonwealth, states and territories to work in partnership to better integrate health care across care settings and to improve health outcomes for all Australians.
For the first time, it provides a mechanism for coordinated action at the Commonwealth, state and local levels to enable a more harmonised approach in primary health care planning and service delivery.
The Framework specifically builds on the National Primary Health Care Strategy, which was released in May 2010 following a comprehensive national consultation process. This Strategy and its suite of supporting papers discusses in more detail many of the issues raised within this document.
The aim of the Framework is not to duplicate the work of the Strategy, but to bring into focus key priority areas identified in the Strategy as national challenges most in need of action that we can address over the upcoming years.
Scope of the FrameworkThe National Primary Health Care Strategic Framework takes a broad and comprehensive view of primary health care.
The Framework recognises the central role of General Practitioners (GPs) and evolving models of general practice in the primary health care system of the future. It also recognises that the concept of primary health care is wide and extends beyond the traditional ‘general practice’ focus of care. Recognising that GPs will continue to build on their pivotal role in primary health care, the Framework acknowledges there is also a whole suite of other skilled health care professionals and organisations providing primary health care services to the Australian community.
The Framework also recognises the role of the consumer and carers. The absence of a patient centred focus from health care services can lead to fragmented care, consumers who are poorly informed about their care needs and options, and gaps and or duplication of services received. Through being engaged and having access to reliable and appropriate information and support, consumers are better placed to adhere to treatment regimes and manage lifestyle related risk factors, which will lead to better clinical outcomes and better quality of life.
The Framework acknowledges the need to improve equity of access to health services and is designed to encompass the full range of health care services that are provided in the home and community setting. This includes: health promotion, prevention and screening, early intervention, treatment, support for independent living, management of chronic health conditions, such as diabetes, mental illness, and cancer, and lifestyle factors including obesity, smoking, and diet.
It also recognises the needs of specific population groups, including: parents and children, young people, older people, people living in rural and remote areas, Aboriginal and Torres Strait Islander people, people of lower social or economic circumstances, refugees and people from culturally and linguistically diverse backgrounds. Specific needs of Aboriginal and Torres Strait Islander people will be targeted through the new National Aboriginal and Torres Strait Islander Health Plan. This Plan will assist governments to develop policy and design programs to improve the health and social determinants of health for Aboriginal and Torres Strait Islander people.
The Framework acknowledges the interactions between primary health and other parts of the health care continuum, including specialist care, acute, sub-acute and non-acute care sectors, aged care, disability, early childhood, population health and Indigenous health services, and that some models of care seek to deliver sub-acute and acute services in the home and community settings. The Framework also acknowledges the interactions between primary health and other social and welfare services and notes effective pathways between these services are an important part of addressing the social determinants of health and assisting disadvantaged people.
The role of Australia’s new primary health care organisations, Medicare Locals, and the opportunities they bring for future primary health care are also clearly acknowledged.
National Health Care Reform – Where does the Framework fit?The National Primary Health Care Strategic Framework has been developed within the broader context of the National Health Reforms agreed by the Commonwealth and the state and territory governments (referred to as the ‘States’).
The National Health Reform Agreement 2011 (NHR Agreement) sets out the intention of governments to work in partnership towards improving health outcomes for all Australians, and to ensure the sustainability of the Australian health system.
The Agreement outlines major structural reforms needed to build the foundations of Australia’s future health system, including national initiatives such as the introduction of activity based funding, and the establishment of the Independent Hospital Pricing Authority, the National Health Performance Authority, and the Australian Commission on Safety and Quality in Health Care.
It also supported the establishment of local governance mechanisms, such as the Local Hospital Networks and Medicare Local primary health care organisations, to improve responsiveness and accountability of health services to the community at a local level.
The NHR Agreement identified the need for the Commonwealth and States to work in partnership to develop this Framework in order to guide policy directions across priority areas in primary health care.
Primary health care is a vital component of the comprehensive health care system in Australia. While significant reform has occurred across the health and aged care system, a nationally agreed approach on primary health care has, so far, been missing.
A high quality, high performing health system needs a strong, integrated primary health care system at its centre. Health systems with strong and effective primary health care can achieve better health outcomes at a lower cost, than health systems that are more focused on acute and specialist care.
Building a strong, responsive and cost-effective primary health care system is essential if we are to maintain a healthier population and ease the burden on hospitals. By supporting health promotion and education, early diagnosis and treatment and chronic condition management, primary health care contributes to reducing the risk of conditions progressing to the point where more intensive and expensive interventions may be required.
Australia’s health system is characterised by a complex interaction of public, private and non-government organisations providing services that may be funded by the Commonwealth, the States, and through private payments by individuals. This complexity can lead to health service planning and delivery occurring in an uncoordinated and poorly integrated fashion, creating service fragmentation and gaps, and potentially less than optimal outcomes for consumers. It is this context that makes it imperative that we turn our efforts towards improving primary health care.
Responsibilities in Primary Health CareToday, all levels of government continue to make significant contributions to primary health care services.
In accordance with the NHR Agreement 2011, the Commonwealth has lead responsibility for:
- system management, policy and funding for primary health care;
- establishing Medicare Locals to promote coordinated primary health care service delivery at a regional and local level;
- working with each State on system-wide policy and state-wide planning for primary health care services; and
- promoting equitable and timely access to primary health care services.
The Commonwealth also provides funding for hospital services and public health activities managed by States, including new growth funding arrangements.1
State and territory governments are responsible for system management of public hospitals, including managing Local Hospital Network performance2. The States are also responsible for funding and providing a range of community health services including prevention and health promotion services and services that help maintain community health and wellbeing3. Traditionally, some of these community health services have also included primary health care-type services.
The Commonwealth and States have a shared responsibility to ensure that all parts of the system operate in a coordinated and integrated way for the benefit of all Australians.
Details from the National Health Reform Agreement 2011 that outline responsibilities relating to primary health care (Schedule D – Local Governance (clauses D29 to D43 on Medicare Locals) and Schedule E – GP and Primary Health Care) are at Attachment A.
Medicare Locals – primary health care organisationsA key primary health care initiative under the national health reforms is the establishment of a network of primary health care organisations, known as Medicare Locals.
This network was created in response to an identified significant need in the Australian health system. This need was for a body that could operate at a regional level and had the authority and accountability to plan, integrate and coordinate primary health care services on a local basis.
Medicare Locals, as the primary health care partners of Local Hospital Networks, will assist in supporting and enabling better integrated and responsive local primary health care services. As independent bodies, they will be working across boundaries in primary health care and creating interfaces with the acute and aged care sectors.
Medicare Locals also have responsibility for: population health planning and needs assessment for their regions, identifying gaps in primary health care services, and developing and implementing strategies, in collaboration with communities, population groups and service providers that address these service gaps.
For consumers and population groups, this will mean more equitable access to a safer, high quality health system that is better organised and integrated around their needs.
More detail on the Medicare Local primary health care organisations is available through the www.medicarelocals.gov.au website.
1 Commonwealth of Australian Governments (2011), National Health Reform Agreement, Clauses 10; A1-A4
2 Commonwealth of Australian Governments (2011), National Health Reform Agreement, Clause 8.
3 Commonwealth of Australian Governments (2012), National Healthcare Agreement, Clauses 24-27