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  1. 1

    Professor Jennifer Reath

    I am deeply concerned that at a time when the Commonwealth Government is seeking input to health care reforms, it is dismantling those organisations that are required to support strong evidence based primary health care.

    We have seen massive cost and time waste and loss of continuity with the transition from Medicare Locals to PHNs. Those that were performing well and have been refunded lost considerable impetus when they had to re-apply for their contracts. Those that were not performing well have been replaced by new organisations that may take many years to build capacity. The decisions about contracts for General Practice specialist training appear to be have been based primarily on financial rather than quality imperatives and the changes in this sector will risk the solid gains of previous years in attracting graduates to a career in General Practice. This is compounded by the loss of the PGPPP rotations compromising the opportunity to ensure that all future sub-specialists have insight into the practicalities of primary medical care and reducing the number of Junior Medical Officer placements available for graduates of Australian Medical Schools.

    PHCRIS and APHCRI have supported Primary Health Care research and we have seen a slow but steady growth in the capacity for research in this area through targeting funding, support of the annual PHCRIS Conference and support for networks including the national Practice Based Research Network. At a time when integration of health services is being supported by State governments, the Patient Centred Medical Home is widely being advocated as a new model for Australian General Practice and changes in the funding of primary health care are being actively considered by government and supported by the professional organisations, building and supporting capacity to investigate the evidence for these initiatives is critical. This is not the time to be dismantling what capacity we have built in Australian academic General Practice.

    I call on the Turnbull government to review the trajectory established by the Abbott government and to salvage and support what we have left of Primary Health Care organisations so that we can participate effectively in the renewal of the Australian health care system.

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  2. 2

    Professor Nicholas Zwar

    Dr Russell is correct that the future of primary health care research in Australia is under threat. Primary health care is essential for an equitable, effective and financially sustainable health system. The fact that Australia spends about 9.4% of GDP on health while the US spends 17.1%, and our health outcomes are better, is in no small part because of the contribution of primary health care. Research that informs both policy and practice is essential to drive innovation, quality and sustainability in primary health care. It can also save money, as decisions made in primary care have important consequences for the rest of the system. An example of this, highlighted in the AAAPC submission to the McKeon Review of Medical Research, was the UK DIGEM randomised trial of blood glucose monitoring for diabetic patients who were not using insulin. This study showed there was no gain from routine monitoring. The trial cost (£0.5M) was a small fraction of the costs of monitoring (£100M/ year in the UK), and would have paid for itself within a few weeks of publishing.

    The prolonged uncertainty about the future of the PHCRED strategy has been damaging to the sector and the impending loss of APHCRI and uncertainty over the longer term future of PHCRIS are further blows. These organisations perform essential enabling roles. Talented and dedicated researchers are being forced to leave the sector and the gains from nearly 15 years of investment in capacity building are at risk.

    Finding sufficient funding for primary health care research through the NHMRC is not a viable option. Most NHMRC funded PHC research falls under the broad description of health services research, but this accounts for only 5% of NHMRC funding. The NHMRC chief executive officer Professor Anne Kelso, speaking at the 2015 Primary Health Care Research Conference, acknowledged that this is a small proportion. Without major change to how the NHMRC functions this is unlikely to grow substantially, and may even decline.

    In 2014 the NHMRC funded only seven project grants and two partnership grants related to primary health care funded nationwide. In 2015 there was no NHMRC grant review panel which specifically had responsibility for reviewing primary health care applications as part of its role and the outcomes of the funding rounds were dismal for primary health care.

    Other countries seem to understand the importance of applied health research, including primary health care research. The United Kingdom invests in applied health research via the National Institute for Health Research, while Canada has a specific Institute of Health Services and Policy Research plus substantial funding from the Canadian Institutes of Health Research. The United States funds clinical effectiveness research through the Patient-Centered Outcomes Research Institute.

    The conclusion seems inescapable that Australia needs a funding agency whose specific focus is applied health research. The creation of such a body could be funded from the initial $1 billion investment in the Medical Research Future Fund. This would be a local first step for the Future Fund as research funded by such an agency would contribute to identifying the savings in the health care system needed to grow the Future Fund over time.

    Reply
  3. 3

    Sam Heard

    Thanks to Jenny and Nick. I am not involved directly with universities at present but stopped around the time PHCRED was introduced ?2000ish. I am very active in learning with registrars and students and use the same nternet as my source. I was not aware of these funding changes or any outputs from these initiatives. This may be my problem but I suspect it is more to do with others.

    I see Trish Greenhalg as the archetypical primary care academic of our times, creating, interpreting and summarizing research for others. Motivating me and informing me. It is now part of the job to get information out there so oth es can access it. Not expecting this to be an add on provided by another agency.

    I do want to have more research in primary care – there is so much to do. I am not sure how to fund it. I am very interested in what the next steps are and I think we need to team up with a philanthropic agency to coordinate the answer. No government money!

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  4. 4

    Hung The Nguyen

    Primary health care is a responsibility of government; primary health care research is the responsibility of government.
    This is quite disturbing news so thank you to those who are bringing attention to the issues.
    Turning to private money is exactly what this government want us to do. Of course private money has a role but the day government take their hands completely off steering primary health care, buttressing primary health care and promoting primary health for its population is the day I do not want to witness.
    There is always a middle path – lets find it.

    Reply
  5. 5

    Laurann Yen

    At the time when research into health systems and health services is most needed- that is, when primary care institutions are being reformed and asked to take on big ‘system’ roles; when review into Primary Health Care and into the full range of MBS items is underway, and when the appetite exists for re-thinking funding models to get better processes and outcomes, the only program that specifically supported primary care research has been dumped- as Lesley Russell says- for some, the doors close at the end of the academic year; for others, there is a 6 months extension, for what precise purpose is unclear. The PHCRED program has provided funding for health services research for the last 12 years, and provides the home for information about primary care research and researchers in Australia.
    A ‘new’ program funded through the Futures Fund may be a good way to keep the capacity, the institutional memory and the momentum going- but it needs to be done soon, explicitly and generously- applied primary care research and integrated systems research will spell the difference between muddling up, muddling through and managing well.

    Reply

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