Strengths and risks of the Primary Health Network commissioning model

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.

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

“…Enablers to co‐commissioning include having clearly defined objectives, strong relationships, commitment from leadership and staff, dynamic governance, and a commitment to complete the initiative (PwC and Commissioning NSW, 2020, p. 12). While commissioning itself is a relational process and relies on engagement with key stakeholders (Bates et al., 2022; Meurk et al., 2018; Robinson et al., 2016), co‐commissioning relies on deep collaboration which requires both time and resources to achieve (Cheverton & Janamian, 2016). The CasePHN, being a relatively new organisation, in terms of region and governance, has taken time to establish new relationships with key stakeholders in its region.…”

“…This can potentially be managed by having common IT infrastructure (Greener, 2015) to support service delivery and easy reporting; however, there are risks that this leads to the use of multiple systems when infrastructure provided does not meet the needs of service providers, and ‘obviously the less systems you can use the better’ ( Service Provider ). Finally, the way services are commissioned and managed can determine and be determined by the expertise and knowledge of commissioners and service providers, the types of relationship between them (such as the ability to use bureaucratic and relational controls), affecting the identification and resolution of risks, opportunities to innovate, and ultimately the effectiveness and efficiency of services (Bates et al., 2022; Regmi & Mudyarabikwa, 2020; Silburn & Lewis, 2020).…”

“…Transaction attributes are identified as asset specificity (specific assets that cannot be redeployed), uncertainty (difficulty specifying and measuring; disturbances), frequency (one‐off or recurrent contracts), and probity (integrity). Primary healthcare services are likely to have low contractibility as they require significant investment in human capital and systems (high asset specificity); are often idiosyncratic, making them challenging to specify and measure and difficult to program (high uncertainty); are likely to be subject to disturbances impacting both service needs and service delivery (high uncertainty); are likely to be contracted for short periods due to government funding cycles (high frequency); and are likely to be subject to probity requirements arising from the source of funding as well as clinical governance requirements (high probity) (Bates, 2022; Bates et al., 2022).…”

“…TCE theory assumes contracting hazards will occur because of human naturerationality may be bounded by cognitive competence, and opportunism may arise (Williamson, 1979(Williamson, , 1985. The extent of contracting hazards is determined by transaction attributes (the nature of the activity being contracted); transaction attributes are identified as asset specificity (specific assets that cannot be redeployed), uncertainty (difficulty specifying and measuring activities; disturbances to activities), frequency (one-off or recurrent contracts), and probity (integrity) (Bates, 2022;Bates et al, 2022;Williamson, 1985). The way the same services are contracted by one organisation may, because of human nature, vary from another organisation due to both their cognitive competence and risk appetite in relation to opportunism.…”

Characteristics and Health Service Use of a Longitudinal Cohort of Carers Aged over 45 in Central and Eastern Sydney, Australia

“…Tere are a range of services provided for carers; however, the responsibility for these arrangements does not sit clearly with one level of government. Further, many of these services are administered by social service departments and/or agencies, rather than health ones; for example, the Carer Gateway is a service funded by the federal government and provided at a regional level by contracted social service agencies [7], whereas general practice is provided by private providers who are partly funded by the federal government primarily on a feefor-service basis, but with some support from regional Primary Heath Networks [8]. Te efect of this is that (i) the role of health services in supporting carers can be unclear; and (ii) the systems that carers have to navigate, for both their own needs and the needs of the people they care for, can be complex and fragmented [9,10].…”