Primary Care Reform: Implications for Public Health

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Barriers

•  Medico-legal
• Training
• Power structures & role definitions
• Payment methods
• Lack of information systems
• Inadequate use of evidence-based guidelines/protocols and quality improvement
• Fear of losing resources (public health, physicians)
• Lack of vision and effective leadership:
  • ‘plurality’ solutions – a thousand points of light
  • Much thinking and dithering – no action
  • No political will to make the necessary investments in change management and IT
  • No appropriate organisational structure

How to move ahead?

• Common vision & mental model– improving the health of the population together
• Improved training
• Organisational change, build on successes, top-down/bottom-up approach
• Different payment scheme – FFS + capitation + ?performance incentives
• Sort out medico-legal issues & professional roles
• Information systems
• Evidence

Implications for public health

• Better integration with primary care
• Better information technology/systems
• Protected funding & resources