Priority One - Commission effective and efficient services that deliver health equity

Strategies

• Design, commission and evaluate services that deliver positive outcomes for our communities

• Apply a health equity lens to the procurement of services that responds to the needs of our priority communities

• Assess providers against agreed outcomes

Country SA PHN’s key priority is to commission effective and efficient primary health services that close the gap in health inequity for country South Australians.

As detailed in our Strategic Plan, Country SA PHN’s strategies to achieve this priority include designing, commissioning and evaluating positive primary health services for country South Australians. This involves applying a health equity lens to service procurement, and the effective planning and support of such services.

Commissioning crucial services across country South Australia

Aligned with Country SA PHN’s Strategic Plan’s objective of increasing the efficiency and effectiveness of primary health care services, one of our key tasks is to design and commission services that deliver health equity.

Country SA PHN’s region is extremely large, geographically covering all South Australia outside the metropolitan area – 99.8% of the state geographically and approximately 30% of South Australia’s population. The region includes many small and remote communities. Providing equitable primary health care services for such a disparate region provides its own unique challenges that require a strategic approach.

The commissioning cycle is a key component of the way Country SA PHN adds value to the health system and aims to meet this objective. The cycle focuses on commissioning services using local data, knowledge and relationships to ensure we are maximising access to health and wellbeing services for country South Australians.

The Commissioning Cycle

The commissioning cycle comprises three key phases. It assists Country SA PHN to achieve our aims in accountability, due process, probity and consistency in the use of funding for the commissioning of primary health services. Our cycle encompasses the development of our health service delivery from the health planning stage, through procurement and contracting activities, and comes full circle through the evaluation of programs and services.

Phase 1: Strategic Planning

The first phase of the cycle is strategic planning. This involves assessing the needs of the region and surrounds to identify gaps in services across the varied primary healthcare sector through our Country SA PHN needs assessment report. The 2022-25 report guides our commissioning decisions that were made throughout the 2023-24 period.

Country SA PHN’s Health System Integration and Innovation team is responsible for this early stage of the commissioning cycle, leveraging their population health expertise to ensure the most appropriate and evidence informed decisions are made by the organisation.

In addition to our local needs assessment, we are guided by the Department of Health and Aged Care. PHNs across Australia have seven priority areas:

1. Aboriginal Health

2. Aged Care

3. Alcohol and Other Drugs

4. Digital Health

5. Health Workforce

6. Mental Health

7. Population Health

Phase 2: Procuring Services

The second phase of the commissioning cycle is procuring services. It begins with the development of tender documents, distribution and promotion of requests for tender, review of tender proposals from a variety of external providers, followed by the selection and contracting of a provider to deliver the service. This robust process, performed across Country SA PHN jointly by the Health System Integration and Innovation team, and the Commissioning team, is required to ensure the most efficient and effective services are provided to country South Australians.

Phase 3: Monitoring and Evaluation

The third phase of the commissioning cycle is Monitoring and Evaluation. This phase involves gaining insights from service providers, to ensure effective delivery toward specific health and/or social outcomes in their area of focus. Important to note is that while this is the ‘final’ cycle stage, the work involved in monitoring and evaluation occurs across all stages of the commissioning process, through our performance based commissioning approach.

Performance-based commissioning

Country SA PHN uses performance-based commissioning, drawing evidence from all stages of the commissioning cycle - from the needs assessments, to engaging with stakeholders including service providers and community to ensure appropriate, specific outcome measures are identified, developed, and tailored to each unique local community’s needs.

Steps involved in Country SA PHN’s service monitoring and evaluation, including outcome development and measurement, include:

• Identifying potential desired outcomes based on needs assessment

• Engaging with stakeholders, including state health department representatives, local community members with lived experience, and other stakeholders, to co-design the commissioned service. This engagement also helps inform the outcomes that are monitored and evaluated.

• Consideration of a service or potential service alongside Country SA PHN’s objectives as outlined in the Strategic Plan throughout engagement with stakeholders

• Collaborating with commissioned service providers to further refine the desired outcomes and develop methods for measuring these outcomes in their unique context, location, health area, and other widely varying circumstances.

• Meetings as required and appropriate between Country SA PHN and the service provider to provide monitoring and evaluation support toward achieving the defined target outcomes.

We’re proud of the robust and transparent performancebased commissioning processes in place, and we’re motivated to continue commissioning effective and efficient services for country South Australians, to meet our Strategic Plan’s objectives.

Chief Operating Officer Suzanne Delaney

Mount Barker Medicare Mental Health Centre

The development and implementation of the Mount Barker Medicare Mental Health Centre is an excellent example of performance-based commissioning in action. Its development has involved significant co-design activities facilitated by a range of stakeholders including Country SA PHN, SA Health (Barossa Hills Fleurieu Local Health Network), Department for Health and Wellbeing, the commissioned service provider Summit Health, lived experience representatives, South Australian Ambulance Service and South Australia Police as well as valuable input from the community of Mount Barker and surrounds.

During 2023-24 work toward this new Centre has been in the development phase. This has included fortnightly meetings with the Integrated Clinical Committee with representatives from the key stakeholders listed above. This collaboration has allowed joint decision making across all aspects of service delivery including the development of a plan for community involvement and co-design opportunities and targeted consultation with Aboriginal and Torres Strait Islander people on Centre design and operations through engagement by Imbala Consultancy to ensure the Centre offers a welcoming, culturally appropriate space.

We look forward to offering this new valuable Medicare Mental Health Centre to the people of Mount Barker and surrounds early in 2025.

The commissioning cycle comes full circle

Use of data from the many stages of this outcome-focused monitoring and evaluation are incorporated into future needs assessments. Thus, re-starting the commissioning cycle process with additional tailored, up-to-date information for commissioning future services for country South Australian communities.