South Link Health's controversial proposal for a primary health organisation (PHO) covering Otago, Southland and South Canterbury, which it says would save $1.3 million a year in administration costs, should not be approved "at this time", Brian Rousseau says.
The chief executive of both Otago and Southland district health boards will advise the Otago board, when it meets this week, not to approve the application but to reserve the right to enter negotiations at a later stage.
A shake-up of the existing 10 PHOs in the South seems likely, with representatives of the three boards recently agreeing change is needed because the setup is not delivering what is expected in the primary health care strategy.
While SLH says many GPs are frustrated because community health service development has stalled, some PHOs contend it has been part of the problem.
The representatives of the three boards agreed to develop requirements for effective PHOs in the lower South, an action the Otago board will be asked to approve tomorrow. This review, which will include wide consultation, is expected to take up to six months.
After this, the boards will consider two options - the evolution of existing PHOs, involving negotiating with SLH on its application and with current PHOs over their status, or issuing exit notices to all existing PHOs and calling for proposals to form a new PHO or PHOs which meet the requirements.
South Link Health's proposal would cover the area of 10 existing PHOs, all of which have their own boards and management teams.
SLH chairman Dr Dean Millar-Coote says 89 of the 119 practices in the area have said they would join the new PHO in preference to their existing organisation.
Such support reflected the high level of frustration in existing PHOs because "despite their best efforts they haven't connected with and understood the whole business of general practice", he said.
SLH argues that by cutting existing administration costs for the PHOs from $4.5 million to an estimated $3.15 million, the three district health boards in the area would have more money to spend on other health services.
Asked if the proposal might be seen as SLH trying to justify its continuing existence, Dr Millar-Coote said if the idea had not received a mandate from practices "we would pack up our bags and go home".
SLH considers the small size of some PHOs limits the range of health services they can provide and develop.
In a submission to the Otago board, Mornington PHO chief executive Barbara Bridger asks the board to reject the proposal.
She is critical of South Link Health's management of PHOs and says it was only after PHOs left SLH's management services they started to establish "coalface" initiatives.
Super PHO proposal
What are Primary Health Organisations?
• Non-profit groups introduced in 2002, funded by district health boards to provide community health care services.
• Expected to improve services and access to them and address inequalities of service provision.
What is South Link Health?
• A non-profit independent practitioner association which supports South Island general practices.
• Promotes introduction of a super PHO for South Canterbury, Otago and Southland.
For:
South Link Health says advantages of super PHO would include:
• Increasing the range of community services for patients.
• Integrating community health-care services with a range of hospital services including direct electronic referral by GPs to specialist diagnostic tests.
• Lower administration costs.
• Improving delivery of health care.
• Development of community-integrated family-care centres where different services would be located together.
Against:
Opponents of super PHO say:
• Existing PHOs are doing a good job.
• No guarantee it will make more headway than existing arrangements.
• Collaboration between PHOs to reduce duplication and improve efficiency already occurs.
