Ensuring the skills and resources in relevant departments match the requirements is recognised as critical in policy implementation.25 The funding for the GP Super Clinics Program did not include funds for its implementation. This gap was addressed by the Primary and Ambulatory Care Division of the Department of Health and Ageing by the flexible re-allocation of staff within the Division.
Critical to the implementation of the GP Super Clinics Program was the early identification of skills and resources required for managing capital programs. Some skills were available more broadly in the Department, and partnerships with a focus on contract management, tendering and communication were established. The engagement of a construction advisor may have added value to the establishment aspect if it had occurred concurrently with the contracting for construction of GP Super Clinics in the 2007-2008 tranche. General practice advice was needed and obtained as part of the development of the GP Super Clinics National Program Guide 2008 and was included in the ITA processes. These partnerships were invaluable in supporting staff within the GP Super Clinics Branch.
Many of the successes of implementation appear to relate to the commitment, knowledge and now corporate history of staff in the GP Super Clinics Program. Succession planning, is of course, a routine component of management within the Department of Health and Ageing. However, there are significant risks to the Program if staff leave, necessitating the need for rigorous systems to ensure protocols are in place to manage staff turnover.
The learnings of program implementation appeared to have been incorporated into systems within the Branch and, indeed, in other branches within the Department of Health and Ageing. For example, training in managing construction projects is now standard in orientation within the Branch, and amendments to the tool-kit of the Program Funding and Procurement Service have been made, reflecting Program learnings. These are indicative of an evolving program willing to apply lessons as part of an overall approach to improvement.
The development of the GP Super Clinics National Program Guide 2008 provided an overview of the national arrangements for the Program including the funding arrangements and processes for application.2 The GP Super Clinics National Program Guide 2008 was deliberately broad and demonstrated the flexibility within the Program. This was critical for attracting applicants and enabling them to propose models which they believed suited the needs and context of local communities. It was developed through a consultative process and in line with guidelines and requirements for probity.
There was some confusion about content, timing of requirements and expectations for Project Plans after the establishment aspect. This may in part relate to the evolution of the GP Super Clinics Program over time, and the evolution in requirements reflecting learnings as the program progresses. Availability of all documents for desk reviews was not possible, and confusion in terms of the different plans has occurred. Contractual arrangements, including funding and reporting requirements, have developed over time. While there was evidence of this development in documents, it is timely to review all requirements for GP Super Clinics beyond the 2007-2008 tranche.
Two critical factors in GP Super Clinics achieving program objectives are clinical leadership and alignment between the clinical and the business models. These factors are described in detail in Section 7.4. In at least one GP Super Clinic this leadership was not evident. While the ITA process was transparent and sound and included rigorous assessment, it is difficult to capture the qualities related to leadership and alignment between the clinical and business models. If future GP Super Clinics were to be established this suggests the need for ensuring these as factors in the assessment processes.
2 GP Super Clinics National Program Guide. . Canberra: Australian Government: Department of Health and Ageing; 2008.
25Implementation of Programme and Policy Initiatives: Making Implementation Matter - Better Practice Guide. Canberra: Department of Prime Minister and Cabinet and Australian National Audit Office;2006.