Tuesday, July 10, 2012


I want to try out an idea with you. 

Everyone I meet is struggling to say what a Medicare Local is and what it should do.  I would like to propose an analogy – that Medicare Locals are like large chamber orchestras – many instruments and an unobtrusive conductor who may be one of the principal players with special leadership skills.  

Many Divisions of General Practice operated well, bringing general practitioners together for fellowship, education and program development and into better working relations with community health and allied health professionals.  But with the advent of Local Hospital (or Health) Networks (or Districts), whose size makes good sense in terms of the skill mix that can be maintained to meet the health needs of the community and managerial effectiveness, we need an organisation in the community that more or less matches the networks in size.  One day, I prophesy, Medicare Locals and Hospital Networks will work together seamlessly and be funded from one source.  Not for now.

The music that Medicare Locals make occurs when the various players are in tune (no matter their instrument) and in time and they stick to a score.  You need many different players and instruments – one of this and half a dozen of that – to get the best results depending on the music.  Rehearsal is critical as is discipline and enjoyment from working well together.

OK – let’s run with the chamber orchestra idea for a bit. What music does it play? 

First let me tell you about a cold winter’s evening a couple of weeks ago when I had the privilege of meeting with about 50 local people in the Carrington Hotel in Katoomba (NOT what you’re thinking!) to talk with them and colleagues from the Nepean-Blue Mountains Medicare Local (ML) about the health needs of their community and how the ML might help to meet those needs.

Once we got over the hurdle of ‘what on earth is a ML?’ the conversation was wonderfully open, focussed, concerned.  I was especially impressed with how often people were thinking well beyond themselves and their own needs, and instead considering the community itself.  Several needs popped up from all over the room – linkage among care providers for patients with continuing and complex problems, mental health and transport. Let’s locate them in the Medicare Local.

Symphony in C Major?  It depends on better linkage among the care providers for people who access different health services.  Time and time again we heard about failed hook-up among providers of care for chronically ill older people.  Yes, yes, I know – when the day of the personal electronic record has fully come all many communication problems will be solved.  In the meantime, we should be thinking about a patient-controlled note book (pen and paper variety) into which the patient puts details of each consultation. 

Many general practitioners have formed informal email and telephone linkages with specialists and other carers and coordinate through those media.  Hospitals increasingly fax or email summaries to general practitioners after patients have been discharged, but more is needed. 

With the pen-and-paper book (and yes, a few will get lost or forgotten) health care professionals may be able to help with summaries that could be printed and stuck into the book, including meds and doses.  By whatever means, we need a common score to play from.

That way when, as one general practitioner put it, a patient with a complex chronic problem consults them, they will be able to go beyond just asking the patient what has been happening to them with other health care providers.

And vice versa – when patients turn up at hospitals at 2 am it would often be helpful to have more detailed accounts of what has been happening.

But you can imagine how much better this symphony would sound if everyone had the same musical score to play from. The RACGP Blue Book gives us a happy precedent: we need something similar for grown-ups.  The ML could help by first sussing out what communication networks exist and work well and where much more work is needed.

Concerto in D Minor?  That must surely be mental health. The Katoomba people perceived many different aspects of this broad-spectrum problem.  Disturbances of mental health come in all shapes, sizes and degrees of severity. We agreed that a blend of community and institutional care is needed and that opportunities for prevention, especially among young people, are frequently slipping through our fingers. How could the ML help?

A comprehensive ML should be in close touch with psychologists, general practitioners, community health, psychiatrists and the education authorities.  This is not impossible and if given real priority could work brilliantly.  All that was said about the need for far better communication among the players in chronic disease symphony can be said for mental health as well. There are so many commissions, reports, inquiries, and task forces that circle the planet like satellites at present that it is hard to know how to use them to best effect.  In the meantime we should focus on the local scene.

Then the third symphony where we need a strong conductor and players recruited from beyond the health arena is transport.  People at the Katoomba meeting meant transport of all forms.  Patients coming from Lithgow – hardly a distant country town – can catch a train to Sydney or Katoomba only once every two hours.  This may be fine if you’re fit but it can impose huge burdens on those who are unwell.  An appointment in Penrith, Westmead or Sydney runs late and you miss a train by five minutes – wait 1 hour and 55 minutes for the next one, with your arthritis, heart failure or COPD.  Tough luck.

Buses often follow routes that do not suit the chronically ill.  Years ago I worked with a bus company in western Sydney that changed its routes after consultation to better serve the needs of older citizens, so change is possible.  By default the ambulance service is pressed into service. 

An ML might seek to learn in detail what transport needs for health care its community has and then advocate with local government and state government departments to organise services better.  That’s a reasonable aim in a democracy.  We bang on about keeping patients with chronic illness out of hospital.  Well, by improving transport for them we may help achieve this goal.

The Medicare Local is not just another institution.  It is a way of organising community-minded health professionals and others interested in the health of the citizenry so that good music follows.  Because of its complexity and function it is a hard idea to get.  Medicare Locals need people to take music seriously – tune up, coordinate, cooperate, read the score (don’t guess), practice and enjoy.  After all the word orchestra literally means ‘a dancing place’ so feel free! 

*Previously published in AusDoc


  1. No wonder why you get so many feedbacks
    get pregnant

  2. Good health care is more than a doctor with access to the latest in technology or the best education from the best university. These are important but so are the human sides of treatment and diagnosis. For a woman, that is especially important, and finding the best women's diagnostic center is essential for the comfort of the patient.Cardio Vascular Health

  3. Thanks for sharing this great content, I really enjoyed the insign you bring to the topic, awesome stuff.

    Add coaching nyc

  4. Thank you sharing your ideas while it is helpful and you are deserve for it. Medsempire Usman

  5. Hi this janzaib and i want sharing some things with all of you and this all about of health and find out Power Prash
    Thank you
    With the best reg:

  6. Excellent sharing.You have shared a really good information.I did get lots of good points from here about exercise.Really exercise is very beneficial for health thanks for sharing such article here.
    Buy HCG

  7. Very informative review. I really appreciate how ways were laid. Very interesting. extensive beststretchmarkcream.co website

  8. I wish people would write more about this as you have done. This is something that is very important and has been largely overlooked by the internet community
    Massage Tables

  9. I've used the NES miHealth as complementary health with one of my regular clients who was wanting to achieve greater comfort in her back - and after using several of the device's in-built programmes, my client is now reporting that she feels more relaxed than she has ever done in her life! thanks to my complementary health a lot........

  10. I'm so happy by visit this site that I’ve already bookmark this site and I will come back again . Thank for your great post.
    For Angel Card Readings please click here
    and you will be helpful by our service like as Angel Card Readings , Removal of Curses, Spells and Evil etc.

  11. Whatever you put on, or in your body, needs to be chemical free. Every product I create is made with 100% organic, natural ingredients. No chemicals have been added or exist in any of the ingredients
    For Ingredients please click here
    and you will be helpful by our natural products and organic products like as 100% Natural Organic Chest Rub , 100% Natural Jasmine Underarm & Body
    and 100% Natural Lavender Underarm & Body Deodorant etc.

  12. Like your blog truly said but for,Diet and hormonal balance has direct impact on the fertility of the body, so the recommended diet plan in the Pregnancy Miracle Guide will not only sweep away the infertility but will also give you the healthy strong body that’s required to sustain this modern lifestyle.

  13. Candida, commonly known as Yeast is a type of Fungi, normally found in human body in small proportions. But the over growth of these yeasts will cause infection called as Candidacies. This infection normally affects the areas such as Skin, Throat, Blood, Mouth, and Genitals. To cure from this type of infection try Yeast Infection No More

  14. Replies
    1. Life Insurance - Insurance Roots
      Life insurance covers the financial effects of unexpected and untimely death. Life insurance can help you to plan for you future without fear.
      Insurance Roots - Educating The World About Insurance

  15. Its good to see blog like this nicely presented.

    Bollywood Movie Downloads

  16. Flat share in Hong Kong
    Canal Road East, Wanchai
    Rent Best rooms in hong kong
    Hong kong room for rent

  17. flate share in hong kong
    Yee Woo Street, Causeway Bay
    flate share in hong kong
    Hong kong room for rent

  18. Room for Rent in Hong Kong
    Pak Sha Road, Causeway Bay
    This is an user interactive service website.

  19. Short Term Rooms for Rent in Hong Kong
    Russell Street, Causeway Bay
    Short Term Rooms For Rent

  20. Flat share in Hong Kong
    Belcher's Street , Kennedy Town
    flate share in hong kong
    Hong kong room for rent

  21. Apartment for rent in Hong Kong
    King's Road, North Point
    Looking for an apartment
    Room for rent in hong kong

  22. Free mp3 skull music


    mp3 skull

    <a href="http://www.mp3skull.info

  23. Free mp3 skull music


    mp3 skull

    <a href="http://www.mp3skull.info


    Top 3 Vital Reasons Why Insurance Is Essential

    Benefits and Requirements of Mortgage Insurance

    Definition of Acceleration Clause in Insurance

    Definition of Accidental Death Benefit in Insurance

    Definition of Active Participant Status in Insurance

  25. Healthy Food Street
    Find Health and Food information. Men health tips, Women's Health care and children health tips. Variety of articles on Healthy Diet Tips, Weight Loss programs and Healthy Recipes are here. For more details visit the following detail articles:-

    Health Tips

    Health Diet

    Men Health

    Weight Loss

    Women Health

    Juices Benefits

    Fruits Benefits

    Healthy Recipes

    Healthy Benefits

    Healthy Diet Tips

    Health and Food information

  26. Travel Insurance - Insurance Roots
    Travel insurance policy covers all possible risks and provides wide range financial protection on all types of risks during travelling.
    Insurance Roots - Educating The World About Insurance

  27. Life Insurance - Insurance Roots
    Life insurance covers the financial effects of unexpected and untimely death. Life insurance can help you to plan for you future without fear.
    Insurance Roots - Educating The World About Insurance

  28. I'm very much impressed with your post. Your post is really informative and relevant.
    I've noted some tips from your post. Hope you will continue writing.

    pure cambogia slim