Primary Health Networks (PHNs) were established with the key objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time.

The South Eastern Melbourne PHN catchment encompasses an area comprising 1.5 million people and stretches from St Kilda to Sorrento and as far east as Bunyip, including the major population hubs of Monash, Dandenong, Moorabbin, Caulfield, Cranbourne, Frankston and Pakenham.

From 1 July 2016 PHNs adopted a commissioning approach to procuring medical and health care services which is based on an assessment of the health and wellbeing needs of the community. This work determines the priority areas and guides the scope of the commissioning process.

SEMPHN invites general practices across the SEMPHN catchment Local Government Areas (LGAs) of Bayside, Cardinia, Casey, Frankston, Glen Eira, Greater Dandenong, Kingston, Mornington Peninsula, Port Phillip, and Stonnington to apply for grant funds to provide care coordination in general practice.

Note: Legal Entities/Contractors named in a Contract Schedule with SEMPHN in the programs CC1 – Care Coordination Implementation, CC2 – Care Coordination Enhancement and CC7 – Care Coordination in General Practice, are not eligible to apply for this activity. The exclusion applies to the legal entity which entered into a contract under these programs and all their respective general practices.

Additionally, General practices with greater than five (5) Full Time Equivalent (FTE) General Practitioners (GPs) are not eligible to apply for this activity.

Care Coordination (the service)

SEMPHN is seeking Expressions of Interest (EOI) from general practices of up to five (5) Full Time Equivalent (FTE) General Practitioners (GPs) (up to 50 GP sessions available per week) to provide the service for a period of approximately 22 months while still working in the current Medicare funding structure.

Note: General practices with greater than five (5) FTE GPs are not eligible to apply for this activity.

Expressions of interest from all eligible respondents will be assessed on the selection criteria and ranked based on the respondents overall scores (see EOI Item 7: Evaluation Criteria). However, if one legal entity/contractor submits multiple applications for their different general practices, the contract may initially only be awarded to the top scoring application submitted by that legal entity/contractor. In the event of undersubscription, SEMPHN may choose to offer contracts to additional general practice respondents that are owned by the same legal entity/contractor. The number of successful respondents selected will be aligned to the maximum available funding.

The funding will provide the practice workforce with dedicated time to improve systems, undertake upskilling, refine work with priority groups and difficult to engage patients.

The primary objective of the service is to support these practices to provide comprehensive care coordination through a focus on patient centred care. Part of this service is the recruitment of a Care Coordinator who has or will develop knowledge of both clinical and non-medical/social services. The Care Coordinator will be guided by the patients’ needs to deliver patient centred comprehensive care and to ensure after hours arrangements are known to patients/carers/family. The patient needs may include addressing barriers to engagement, psychosocial issues and supporting self-management.

The practice will enrol specific patient cohorts to work with over the duration of the program. Practices will have the option to nominate for a total minimum number of patients to enrol, either 50 patients (attracting $125,000 ex GST funding) and/or 100 patients (attracting $250,000 ex GST funding. Successful practices who have nominated for both options, will only be offered one (1) option – either $125,000 ex GST or $250,000 ex GST.