In the week that two major reports have stressed the importance of primary health care, it is more than a touch ironic that the new members of the National Health and Medical Research Council were also announced – without a single member there to wave the flag for primary health care.
You can see the new Council’s members here. To question the composition of the Council is in no way intended to cast aspersions on the individual appointees. I have no doubt that they are quality people with eminent and well-deserved reputations.
My back-of-the-envelope analysis is that the Council has:
• 10 Federal or State government employees (Rosemary Bryant, James Bishop, Kerry Chant, John Carnie, Jeanette Young, Paddy Phillips, Simon Towler, Craig White, Charles Guest, Barbara Paterson)
• 4 medical specialists (James Best, Sandra Hacker, Ron Trent, John Horvath, although perhaps John Horvath should have been counted as a Government employee as he is listed as Principal Medical Consultant for the Australian Department of Health and Ageing)
• 3 scientists/academics (Michael Good, Kerin O’Dea, Cindy Shannon)
• 1 consumer (Anne Cahill Lambert)
• 1 business rep (Andrew Cuthbertson, R&D Director and Chief Scientific Officer of biopharmaceutical company CSL Limited)
To be fair, many of the members have experience across diverse fields – Barbara Paterson, the chief health officer for the NT, has a background in general practice.
But the omission of explicit primary health care expertise seems rather strange, especially at a time when it seems there may finally be some action to match the longstanding rhetoric about the importance of primary health care in improving both quality and equity in health care.
If the community and primary health care is where it’s all meant to be at, why isn’t the NHMRC there as well?
I will see if NHMRC ceo Warwick Anderson wants to comment, and let you know…
In the meantime, here are some other peoples’ thoughts on the appointments:
Professor Mark Harris, Professor of General Practice, University of NSW:
“It was disappointing that there was not more representation from primary health care given its importance in the health reforms and need for research especially health services research. Barbara Patterson is on Council as CHO for NT and on the NHMRC and has a background in GP. However it would have been useful to have representation from PHC to inform NHMRC’s contributions to the new PHC.”
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Robert Wells, Director Menzies Centre for Health Policy at the ANU (and formerly a secretary of the NHMRC):
“It is is now a very narrow Council dominated by doctors and government employees. They have appointed 19 people of whom 14 are medical doctors (all of whom are either specialists or public health physicians). The government appointments (Cwlth & states) dominate (11 of 19), esp as Rosemary Bryant the Cwlth Chief Nurse has been appointed & Prof Horvath the immediate past CMO & still holding some official advisory role for DoHA. There is no primary care physician or other health professional from primary care in an era where primary care is one of the Government’s principal areas for health reform. I think there is no allied health professional person (have not checked the c-vs). As I read it, they could have appointed another 5 or so people to broaden the membership had they wanted.
None of this reflects on the qualities of the appointees. However the opportunity to broaden the membership of the Council to reflect better the realities of 21st century health care and research needs seems to have been missed.
The members of principal committees has not been announced and these might provide broader membership and more balance.
The other point to note is that under the Act the Council is essentially advisory to the CEO only and its role as a council is perhaps not as crucial as in previous eras.”
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Dr Chris Mitchell, president, Royal Australian College of GPs:
“Regional and primary care research needs a better focus.
From an AMA policy paper: A survey of public expenditure on primary care research in Australia, New Zealand, the United Kingdom and the Netherlands, found that the average was less than $1.50 per capita per annum, in contrast to the international average expenditure on health and medical research of $28 per capita per annum.
Primary health care research — essential but disadvantaged. Julie J Yallop, Brian R McAvoy, Joanne L Croucher, Andrew Tonkin and Leon Piterman on behalf of the CHAT Study Group. Medical Journal of Australia 2006; 185 (2): 118-120
Australia needs to lift its expenditure on primary health care research progressively over time. More research will help improve clinical practice and provide an evidence base to improve the delivery of primary care services.”
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Associate Professor Simon Willcock, Head, Discipline of General Practice, Northern Clinical School
University of Sydney:
As per the issue that you raise, there was certainly some concern that there were no GPs represented on the overarching NHMRC, although over the subsequent week or so several “panels” were announced including the “primary care” and “preventive care” panels of the NHMRC, on both of which GPs were well represented.
I think in many ways the larger issue is that medicine and patient care are increasingly seen in “silos” of care, despite the evidence that a generalist approach to health care s much more effective in improving outcomes.
The NHHRC Report and Primary Health Care Strategy both recognised this, but are both long on rhetoric and short on detail. Garling’s report in NSW last year was really all about this – patient’s falling between the silos within the public hospital system.
I haven’t seen much evidence so far that “Caring Together” is changing this – to the contrary, the stressed state of our public hospitals seems to relate in fragmented care of patients more than ever.
Don’t we think it’s clever to turn the issue of primary care on its head and rely on consumer input in this important area? It is patronising to think that consumers can’t describe a primary health care system that they would like:
– with or without nurse practitioners and a range of allied health professionals;
– intersecting neatly with the secondary and tertiary services that are essential for those with chronic conditions;
– genuinely engaging them as partners or indeed leaders in their own health care.
I for one am sick of reading reports and research that demand consumers or patients take responsibility for their health and well being, but the system that has been built around them prevents this.
(And I’m the newly appointed consumer representative on the Council.)