28
Apr
2015

Consumer and community engagement in Primary Health Networks

by Stephen Duckett


Published in Issue 16, April 2015 of
Health Voices – Journal of the Consumers Health Forum of Australia
‘PHNs – will they be good for our health?’ (p 10-11)

There are two key documents which have shaped the design and implementation of the new Primary Health Networks (PHNs) — the Horvath report and the documents associated with the Invitation to Apply (ITA) for funding as a PHN.

The documents are quite strong on clinician engagement:
I consider it essential that GPs have a significant presence within the corporate structures of any future primary health care entity. My preference is for locally relevant Clinical Councils to be established that have a significant GP presence and broad clinical membership, including from LHNs. These Councils would interact directly with the …Board. …The voice and opinions of the Council will directly inform the deliberations of the … Board on matters such as, local and regional priorities, investment strategies, and primary health care professional and business support needs. (Horvath). PHNs will establish and maintain GPled Clinical Councils that will report on clinical issues to influence PHN Board decisions on the unique needs of their respective communities, including in rural and remote areas… Clinical Councils will assist PHNs to develop local strategies to improve the operation of the health care system for patients in the PHN, facilitating effective primary health care provision to reduce avoidable hospital presentations and admissions. Clinical Councils will be expected to work in partnership with LHNs in this regard. Clinical Councils will also be expected to report to and influence their PHN Boards on opportunities to improve medical and health care services through strategic, cost-effective investment and innovation.

The language is not so strong on community engagement:
Community Advisory Committees, based on the same catchments as Clinical Councils, will provide a community voice into the Board decision-making and activities, particularly in regard to service gaps (Horvath) Community Advisory Committees will provide the community perspective to PHN Boards to ensure that decisions, investments, and innovations are patient centred, cost-effective locally relevant and aligned to local care experiences and expectations (Funding Guidelines)

The Invitation to Apply implies that both bodies will be influential:
In addition, applicants should outline the framework, reporting obligations and degree of influence of the Clinical Council and Community Advisory Committee on the PHN Board, specifically, how the PHN Board will act on recommendations as appropriate, (Invitation to Apply)

Another important issue is how the new PHNs will operate. The emphasis is that PHNs will principally be commissioning rather than service providing organisations.

THE IMPLICATIONS FOR CONSUMERS

Although the interests of clinicians and consumers are not necessarily in conflict, the Horvath report and the ITA used much stronger language about clinical compared to community involvement. Neither discussed consumer engagement. What is important for consumers (and communities) is that they seek to have the same level of engagement as clinicians. It could be very easy for PHNs to slip into ‘provider capture’, assuming that providers, such as GPs, speak for and in the interests of consumers and communities.

THE IAP2 SPECTRUM

Best practice in public engagement is now influenced by the ‘Spectrum of Public participation’ developed by the International Association of Public Participation (http://www.iap2.org.au/ resources/iap2s-public-participationspectrum). This spectrum provides for five levels of engagement: Inform, Consult, Involve, Collaborate, Empower. The higher levels of the spectrum represent greater levels of public participation and greater levels of engagement. The different levels are associated with different goals and techniques. Consumers (and PHNs) should clarify the goals of consumer engagement for each engagement opportunity.

THE COMMISSIONING CYCLE

PHNs are to be principally commissioners — purchasing services from existing (or newly created) providers rather than directly providing services themselves. Commissioning involves a number of distinct steps including identifying what needs to be purchased, procuring the service and monitoring the contract. The commissioning cycle used at Northern Melbourne Medicare Local is shown in the figure.
The commissioning cycle provides a framework for identifying consumer and community engagement opportunities.

Figure: Northern Melbourne Medicare Local Commissioning Cycle

The cycle starts with Assessing Needs. At the broadest this is about the PHN identifying what are the critical issues in the area. These might be information flows (hospital to GP in discharge planning), priority populations (people with chronic conditions, early years, domestic violence) or functions (prevention). Consumer and community engagement should be at the higher end of the spectrum at this stage of the cycle.

At other stages of the cycle (e.g. Managing performance) consumer engagement might be at the opposite end of the spectrum. Setting key performance indicators might also be at the higher end, selecting tenders in the middle. Community Advisory Committees PHNs are required to have Community Advisory Committees envisaged as being in parallel with Clinical Councils. It is important that PHNs don’t operate as if their Advisory Committees are the community engagement strategy. They should not be. It is better to describe the role of Community Advisory Committees as one of developing and overseeing a consumer and community engagement strategy.

The strategy should identify what are the goals of community and consumer engagement at each point of the commissioning cycle. The Community Advisory Committee (and PHN Boards) should receive reports on the nature of consumer engagement.

NEXT STEPS

The new PHNs will be developing their strategies in the next few months. Consumer and community groups should be working out what their goals for engagement with the PHNs are. Now is an opportune time for existing consumer organisations (including hospital network consumer advisory committees) to identify what engagement they would like with PHNs and how they would like to shape the consumer and community engagement structures and strategies of the new PHNs.