Ahead of the ACT election, political jockeying for a vote-winning health policy fix has intensified, with heated debate in the Assembly and the community.
The parties are grappling for a policy edge in the wake of the shock Wanniassa Medical Centre closure and the chronic GP shortage and corporate GP takeovers that are undermining the sustainability of health services.
At the same time as the ACT Standing Committee on Health and Disability inquiry into the Wanniassa closure, the Liberals released an after-hours bulk-billing GP clinics policy hot on the heels of Labor's billion-dollar 'Ready for the Future' health plan and the Liberal's earlier Bulk Billing GPs for Our Suburbs.
The interest in government action and alternative models has heightened now the ACT is in election mode.
Despite the promises and rhetoric, recent history shows both sides, at ACT and federal levels, have been slow to follow-up their talk with sufficient action.
The standing committee heard evidence that government support and new models of sustainable health care would be required to address Canberra's GP shortage and corporatisation. While Labor and Liberal appear to embrace such notions, there's not much proof yet in their puddings.
Better relations and negotiations between the former Liberal federal government and ACT Labor majority could have achieved stronger incentives for GPs to work in Canberra, more university GP training places, and appropriate balancing of corporate, government, traditional and alternative approaches to primary health care.
The Wanniassa closure brought home exactly how devastating it is for communities, particularly in outer metropolitan areas, when a local practice is closed and subsumed into a large corporate practice.
The Wanniassa practice was one of the most significant and popular practices closed in recent times but by no means the only. Many similar practices in outer suburbs have closed or downsized, and their doctors and staff contracted by corporate medical centres at Belconnen and Phillip. Affected practices and communities on the northside include Hall and Kippax.
While the quality and professionalism of staff is not questioned, the corporates are impacting local communities by buying-in doctors from outer area practices and limiting their capacity to return to work in that area.
This means there is no net increase in the number of GPs in the ACT, and we are still at least 60 GPs short. Patients complain of difficulties in accessing their doctors in the new centres due to transport issues and the way appointments are allocated. Patients with chronic or complex conditions have to search for a GP who will take them on.
The result can be that many people, particularly those on low incomes, don't go to a GP but instead call on hospital emergency, ambulance, pharmacy services and hospital inpatient beds.
To avoid such impacts on communities, shopping centres, businesses and private GPs, governments (ACT and federal) have a legitimate role to play in regulating the number, proportion and distribution of corporate practices. This might be possible through licensing and leasing arrangements, location-specific provider numbers or through incentives and support for alternative primary health care approaches, particularly in areas of need and disadvantage.
One exciting approach is the health cooperative a community-based model that has been developed and tested for West Belconnen over the past four years.
The West Belconnen Health Cooperative will introduce three or more bulk-billing GPs, a nurse practitioner, administration and preventative health staff within a not-for-profit ''one-stop'' health and wellbeing centre at Charnwood, supported by community, business and, ideally, government.
The strength of the cooperative is it provides easy access and a community focal point that encourages people to become members and be active in their health and wellbeing. It harnesses the resources of all sectors to meet health needs at a low recurrent cost to government and taxpayers.
The cooperative is modelled on the Westgate Health Cooperative that has successfully assisted health and community wellbeing in Melbourne's western suburbs over the past 20 years.
The cooperative centre is self-sustaining once infrastructure costs are met. The community approach allows quality family care and a holistic, preventative approach, rather than a commercial approach. It relieves GPs of administrative and management load and promises to add to the ACT GP workforce through attractive work conditions and a social model that is particularly relevant to disadvantaged and under-serviced communities.
After partnership commitments from the local community, business and ACT Government, the cooperative was poised to receive federal top-up funding for the start-up infrastructure until recently, when the new Federal Government scrapped the controversial Regional Partnerships Scheme.
Despite recognition of the needs and benefits, and uniform support across the parties at ACT and federal levels, clear opportunities to fund the shortfall have not been taken.
The Canberra Liberals have promised they will fund the amount required if they are elected later this year. ACT Labor has committed funds, depending on a similar federal contribution that shows no signs of coming soon.
It's unclear whether ACT Labor's billion-dollar health plan will be able to support different approaches to primary health care such as this one, which is developed, tested and ready to go.
So the words and political jockeying continue, but the question remains: which party will stand up and put their words into action?
Roger Nicoll is chair of the West Belconnen Health Cooperative, and gave evidence to the Standing Committee on Health and Disability Inquiry into the Wanniassa Medical Centre closure.