Access to doctors and bulk billing in North West Belconnen

History

The West Belconnen community that has been developing a health co-operative and health and wellbeing centre, on Canberra’s northern fringe, since 2004. The energy for this co-operative came from the community following persistent concerns raised by residents about the lack of affordable GPs and health services in a disadvantaged outer metropolitan area of Canberra close to the ACT-NSW border.

Active community members convened an initial public meeting in September 2004 through the local Neighbourhood Watch and school Parents and Citizens association That meeting resulted in the formation of a steering group to investigate community needs and possible solutions. The Charnwood Community Health Community (later theWest Belconnen Community Health Committee) identified a primary target area of six suburbs with 22,000 people, and no practising GPs at the time.

The committee initially assessed community needs and interest in a co-operative through a survey of 8000 homes.

The committee then tested various health delivery models and the viability of the preferred model (a co-operative) through a Feasibility Study and Business Plan prepared with the help of a professional practice management consultant and a $15,000 ACT government grant.

Key findings of this and subsequent research were:

* there was a lack of services relative to need (one pharmacy, one dentist, one oversubscribed medical practice)
* a trend towards corporatisation and centralisation of services away from fringe areas (four medical practices have moved from the area) leaving just 1 local GP on average per 11,000 people
* a high level of disadvantage including 19% public housing and growing populations of both elderly and children
* bulk billing was at the lowest rate for any Australian electorate (47% compared with national average of 77%)
* 63% of respondents found GP cost too high, 18% didn’t have a GP and used the local hospital instead
* 685 households (2205 people) said they would, and 163 households (525 people) might, join a bulk-billing co-op
* a health co-operative was the preferred organisational structure for running a one-stop health and wellbeing centre
* the proposed centre with three full-time equivalent GPs was viable provided the set-up and infrastructure costs could be met without any significant debt and
* great benefits have been achieved from similar ventures among other disadvantaged communities, for example at the Westgate Health Co-op, Melbourne and Winnunga-Nimmityjah indigenous health service in Canberra.

Following the positive feasibility report and some initial funding commitments, the Committee went through a lengthy process of establishing the co-operative under the ACT Co-operatives Act 2002. West Belconnen Health Co-operative Ltd was formed in November 2006.

Following a number of unsuccessful funding submissions in 2006 and 2007, funding for set up of the centre was achieved through a partnership between the community, governments (Australian and ACT) and businesses. Viability will be achieved through bulk-billed Medicare rebates, fee-for other services and rental income from co-located services.

Vision, values and principles

Vision …

Working together for better health and increased community strength.
Mission

To operate an affordable, community-owned centre providing a range of quality health and related community services.
Objectives …

* to create a quality, viable bulk-billing general practice in NW Belconnen
* to build a broad-based membership
* to facilitate affordable allied services
* to have a financially viable business
* to attract and retain quality, complimentary community partners

Values and principles

The West Belconnen Health Co-op endorses the seven key co-operative principles as outlined by the International Co-operative Alliance and included in the ACT Co-operatives Act 2002.

In particular, we are:

* Inclusive—we value the involvement or membership of all who accept the rights and responsibilities of that involvement/membership.
* Participative—we encourage people to participate and to be active in the operation of the co-operative
* Democratic—we apply democratic principles and encourage our people to have an equal say and vote at meetings
* Co-operative—we work co-operatively with each other and those outside the organisation, to achieve mutual benefits
* Quality care—we provide high quality care and administration at an affordable price
* For people not profit—we care for people and our main concern is meeting their needs through services and facilities rather than generating commercial profits
* Self-reliant—we develop capacity, responsibility and self-reliance within people and the community (building on existing strengths)
* Accountable—we uphold honesty, openness and accountability
* Sustainable—we are committed to providing socially, economically and environmentally sustainable practices and operation.

The co-op model

Co-operatives are jointly-owned and democratically-controlled associations of people who are united voluntarily to meet common economic, social, and cultural needs. Members often have a unifying interest and form a co-operative to tackle problems or derive benefits that are difficult alone.

Co-operatives are found across the globe ranging in size from small scale to multi-million dollar enterprises. Co-ops employ more than 100 million men and women and have more than 800 million members.

Members of co-ops usually help fund the enterprise through a share or membership fee and benefit from the services provided. Members may receive dividends on their capital but this is usually less important than the benefits derived. This is a key difference between a co-op and a investor-owned enterprise that exists to maximise profits.

Accordingly, a co-operative is a self-help organisation that integrates social and economic objectives by generating mutual benefits. Democratic control means that members can control the affairs of the co-operative with one vote allocated per member regardless of their investment or use of services.

Co-op profits are either distributed to members in proportion to use of its services, or retained in the co-operative and not distributed. Profits in an investor-owned enterprise are usually distributed as a return on capital invested.

Co-operatives may be for-profit or not-for-profit, but all aim to operate profitably. Co-ops operate in sectors as diverse as transport, agriculture, energy, water, broadcasting, retail, health, housing, child care and community services.
The Health Co-operative

A health co-operative is an organisation registered under state or territory co-operatives act for the purpose of delivering health benefits to its members. Bringing people and service delivery together under a health co-operative umbrella provides the possibilities of:

* holistic and integrated care
* rationalisation of government costs and decentralisation of services
* affordable services that respond to specific community need because those who use the services can control the services
* a focal point for community activity that encourages members to be active in better health, wellbeing and sustainability.

Health co-ops are well established in Europe, the USA, Canada, Japan and Brazil, with applications ranging from local community operations to national health systems. Europe, as the birthplace of the modern co-operative, has been home to co-operatives in various sectors and organisational forms for two and a half centuries.

In Europe, co-operatives have proven to be particularly suitable for providing social services and decentralising welfare provision in response to needs to rationalise spending.

Unimed Brazil is the biggest co-operative medical system in the world. It has 367 local member co-operatives operating in more than 80% of Brazil’s counties, employing 98,000 doctors and servicing 12 million patients. Beginning with local co-operatives, the system has developed federations and a confederation spreading widely the principles of social responsibility, sustainable development, the preservation of the environment and cultural diversity and reducing social inequalities. The Brazil experience shows that health co-operatives can be very prolific and successful.

In Australia, health co-operatives are currently rare but by no means new.

Co-operatives of some shape or form have been a part of Australia’s life and health for more than 100 years.

Co-operative-like organisations such as friendly societies and lodges were successful in providing members and their families with medical services in the 1900s. Some of these organisations had agreements with doctors to provide medical care at a low cost to their members and they reached a peak of popularity in the 1920s. However many of the friendly societies folded or became health insurance organisations after the 1950s when the Commonwealth legislated fee-for-service medicine.

One of Australia’s health co-operative success stories has been the Westgate Health Co-op (formerly South Kingsville Health Service co-op).

The Westgate venture began in 1980 when a group of active residents in Melbourne’s western suburbs set up a health co-operative to try to attract affordable doctors and health services to a disadvantaged area. The co-op started with one doctor, health and social outreach auspiced by Baptist Social Services.

Twenty years later this co-operative operates two clinics, and provides general practice medicine, dentistry and a range of ancillary services such as acupuncture and naturopathy. It has become a hub of the community, boosted local capacity and benefits, improved health care and a patient focus and allowed doctors to get on with their job.

Renamed the Westgate Co-operative in 2005, that co-op now has 25 staff including 11 GPs, two dentists and three practice nurses, 8000 members, more than 25,000 consultations and a turnover of more than $2 million each year.

Opportunities
Best Practice’ opportunity in ACT

Practitioners who would like to work at the forefront of community-based practice are invited to express an interest in this dynamic new practice opening in Canberra from mid year

The West Belconnen Health and Wellbeing Centre welcomes enquiries from professionals about this practice featuring:

* GPs at the centre of integrated health services
* attractive salary and lifestyle opportunity
* full administrative support
* professional practice management
* a non-government ‘community’ model.

To express an interest or for further information contact info@westbelconnenhealth.coop.
Allied service partners

Several opportunities exist for ‘like-minded’ partners to deliver compatible allied services from the Co-op centre. If you think that you or your organisation could provide a complementary service or could be a suitable co-located service please contact the co-op at: info@westbelconnenhealth.coop
Co-op members

A number of opportunities are now available for co-op members who would like to assist with tasks relating to establishment of the centre, communications and recruitment of members. If you interested in helping with these or other volunteer activities of the co-op, please contact the co-op at: info@westbelconnenhealth.coop

Contacts

For more information or a membership application:

Email: info@westbelconnenhealth.coop
Phone: (02) 6258 0355
Postal: West Belconnen Health Co-operative Ltd
PO Box 6865
Charnwood ACT 2615

Where are we?

20 Cartwright St, Charnwood (the old Charnwoood High School).