The Australian health care environment suffers from change fatigue and we are about to see the most massive dose yet experienced in primary care in Australia. I love change, opportunity and innovation. But I have learned that change has to be at a pace that is manageable and where the motivation is understood and embraced. The real problem on the ground is that change occurs at lots of levels – within the organisation, locally and at State and Commonwealth level. If you want to sink, guarantee failure, it is best to ensure that change takes place at all levels at once – oh and add multiple dimensions to really twist the knife.
This is my situation – from where I read the Federal Budget. I work in a GP Super Clinic, a non-profit, that is owned jointly by two universities and supplies 24/7 services to a rapidly growing local community with huge industrial development 30 Kms south of Darwin. The service is evolving into a training and primary centre provider throughout the Top End of the NT. We have a few specialist general practitioners, 5 registrars, 9 medical students coming and going, our PGPPP doctors are no more, and our solid group of IMGs are now under the pump. We have contracts with the somewhat fluid NT Department of Health, who after the Federal budget changes will no doubt be reviewing our arrangements. We now have a relationship with a Hospital Network faced with delivering on budget (never happened before) and our Medicare Local. Both are just finding their feet, the NT Medicare Local recently emerging like a phoenix from a merge of Divisions which itself only lasted a couple of years. NT Medicare local is already a formidable alliance of interests that is aiming to support general practice better and working hard on closing the gap. They are working closely with NTGPE – our soon to be dissolved local training provider which has been a pillar of stability lasting over 10 years! NT Medicare Local is now being dissolved to form a new PHN whatever that means. OMG – does anyone in Canberra know what it is like out here?
I cannot imagine the cost in capital, social and human terms of this change. Add to that a $7 copayment which will cause problems with our local community, many of whom will not pay – no way. Is anybody happy? What is this for?
I know that this sort of upheaval is happening around the country in one form or another. WentWest Medicare Local in Western Sydney has been a trail blazer in provision of integrated Medical Local services and GP Training – the result of considerable planning and negotiation. But when there is only political impulse and convulsion, how can we plan? Should we say enough is enough? Should we plea to the tax payers of Australia that these changes amount to massive waste?
The price of change at this pace is staggering. What should we do?