Strengths and risks of the Primary Health Network commissioning model
Shona Bates
A D * , Michael Wright B and Ben Harris-Roxas C
A Accounting Discipline Group, UTS Business School, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
B Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
C School of Population Health, Faculty of Medicine and Health, UNSW Sydney, NSW 2052, Australia.
D Present address: Social Policy Research Centre, UNSW Sydney, NSW 2052, Australia.
Australian Health Review 46(5) 586-594 https://doi.org/10.1071/AH21356
Submitted: 1 October 2021 Accepted: 4 February 2022 Published: 19 April 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To explain how the Primary Health Network commissioning model works, and factors likely to affect its success.
Methods The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region.
Results The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed.
Conclusions This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community.
Keywords: commissioning, contracting, governance, health services management, outsourcing, primary health care, primary care, public administration.
References
[1] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83 457–502.| Contribution of primary care to health systems and health.Crossref | GoogleScholarGoogle Scholar | 16202000PubMed |
[2] UNSW, Monash University, EY. Evaluation of the Primary Health Networks Program Final Report. Prepared for Australian Government Department of Health; 2018. Available at https://www.health.gov.au/resources/publications/evaluation-of-the-primary-health-networks-program
[3] Smith J, Sibthorpe B. Divisions of general practice in Australia: How do they measure up in the international context? Aust New Zealand Health Policy 2007; 4 15
| Divisions of general practice in Australia: How do they measure up in the international context?Crossref | GoogleScholarGoogle Scholar | 17626642PubMed |
[4] Henderson J, Javanparast S, MacKean T, Freeman T, Baum F, Ziersch A. Commissioning and equity in primary care in Australia: Views from Primary Health Networks. Heal Soc Care Community 2018; 26 80–9.
| Commissioning and equity in primary care in Australia: Views from Primary Health Networks.Crossref | GoogleScholarGoogle Scholar |
[5] Horvath J. Review of Medicare Locals. Report to the Australian Government Minister for Health and Minister for Sport. Department of Health; 2014. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/review-medicare-locals-final-report
[6] Department of Health, Australian Government. Primary health networks: Grant programme guidelines 2016 Version 1.2. 2016. Available at https://www.health.gov.au/resources/publications/primary-health-networks-phn-grant-program-guidelines
[7] Gardner K, Davies GP, Edwards K, McDonald J, Findlay T, Kearns R, et al. A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: Implications for Australian policy. Aust J Prim Health 2016; 22 40–9.
| A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: Implications for Australian policy.Crossref | GoogleScholarGoogle Scholar | 27469052PubMed |
[8] PwC (PricewaterhouseCoopers), The Kings Fund, University of Melbourne. Challenges and Lessons for Good Practice: Review of the History and Development of Health Service Commissioning. Prepared for Australian Government Department of Health; 2016.
[9] NSW Health. NSW Health Commissioning for Better Value Strategy 2021–24. NSW Ministry of Health; 2020.
[10] Blaikie N. Designing Social Research. Cambridge, UK: Polity Press; 2000.
[11] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19 349–57.
| Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups.Crossref | GoogleScholarGoogle Scholar | 17872937PubMed |
[12] Williamson OE. Transaction-cost economics: The governance of contractual relations. J Law Econ 1979; 22 233–61.
| Transaction-cost economics: The governance of contractual relations.Crossref | GoogleScholarGoogle Scholar |
[13] Williamson OE. The Economic Institutions of Capitalism: Firms, Markets, Relational Contracting. 1st edn. New York, US: The Free Press (MacMillan); 1985. p. 450.
[14] Coghlan D, Brydon-miller M. Strengths-Based Approach. In: The SAGE Encyclopedia of Action Research. Sage; 2014. p. 733–5.
[15] Bates S. How an intermediary model manages the tension between low contractibility and probity when outsourcing human services. Aust J Public Adm 2022.
| Crossref |
[16] Anstey M, Burgess P, Angus L. Realising the potential of health needs assessments. Aust Health Rev 2018; 42 370–3.
| Realising the potential of health needs assessments.Crossref | GoogleScholarGoogle Scholar | 28501047PubMed |
[17] Nankervis R, Alexander H, Briggs D, Turner C, Martin A, Baillie J, et al. COVID-19: Perspectives from the experience of one Australian Primary Health Network. Asia Pac J Health Manag 2020; 15 1–10.
[18] Ritter A, Berends L, Chalmers J, Hull P, Lancaster K, Gomez M. New Horizons: The Review of Alcohol and Other Drug Treatment Services in Australia (Final Report). Drug Policy Modelling Program, National Drug and Alcohol Research Centre UNSW. Funded by Australian Government Department of Health; 2014. Available at https://www.health.gov.au/resources/publications/new-horizons-review-of-alcohol-and-other-drug-treatment-services
[19] Perkins N, Coleman A, Wright M, Gadsby E, McDermott I, Petsoulas C, et al. The 'added value' GPs bring to commissioning: A qualitative study in primary care. Br J Gen Pract 2014; 64 e728–34.
| The 'added value' GPs bring to commissioning: A qualitative study in primary care.Crossref | GoogleScholarGoogle Scholar | 25348997PubMed |
[20] Deloitte Risk Advisory. Review of headspace Melton commissioning process. Prepared for Australian Government Department of Health; 2018.
[21] Jackson C. Review of After-Hours Primary Health Care. Report to the Australian Government Minister for Health and Minister for Sport. Department of Health; 2014.
[22] Dubois A, Gadde LE. Systematic combining: An abductive approach to case research. J Bus Res 2002; 55 553–60.
| Systematic combining: An abductive approach to case research.Crossref | GoogleScholarGoogle Scholar |
