"May you live in interesting times." - Chinese curse.

The past 18 months have been a period of imporatnt consolidation for the Northern Rivers General Practice Network (NRGPN). Our focus has been on keeping our members informed of local medical issues through GPSpeak's multiple presences of website, bimonthly online magazine and fortnightly newsletters. In September this year we extended our reach through the first hard copy edition of GPSpeak in two and a half years. This was truly the ‘re-birth’ of a legend, as the magazine had previously been published for nearly two decades, to significant acclaim.  

We believe, and certainly hope, the print version of GPSpeak will  provide a voice for GPs to make known their views on local health matters, not only to other health professionals but to the community at large.

I have written previously about our new undertaking in the print world and the success of GPSpeak to date but once again I would like to thank our gold sponsors, accountants, Thomas Noble and Russell, and Medfin Finance, and our silver sponsors, Sullivan & Nicolaides Pathology, North Coast Radiology, Embrace Exercise Physiology, Southside Pharmacy and the University of Wollongong. Without their support the NRGPN could not fulfil its obligations under its Constitution.

During the year the Network has become more active in managing its finances. We have developed an investment strategy aimed at achieving a better return on our cash assets. Although this is a higher risk strategy, we believe that it will be one plank in our efforts to sustain the NRGPN in the long term. The Board and I greatly appreciate the work of David Scott from Life Risk Management in giving his generous assistance to setting up these new funds.

I thank the Board for their support over the last 12 months. They have cheerfully tolerated the many technical glitches at the teleconference meetings that are part and parcel of so many rural organisations. Their recommendations and guidance have allowed us to channel our energies into useful paths and avoid going off track too often.

I also acknowledge the invaluable assistance from Leanne Tully, our administrative officer, who is generously provided by North Coast Medicare Local (NCML).

Gillian Smith left the area in September this year and has resigned from the Board. She has been the NRGPN secretary since the loss of our government funding in 2012. Her expertise was frequently called upon to ensure we complied with our various governance requirements. She will be sorely missed but we wish her "bon voyage" and hope to see her again, if and when she returns to the North Coast.

Sustainability has become an issue for nearly all representative organisations in primary health care. Earlier this year the Tweed Valley General Practice Network was wound up after twenty years of representing GPs on the Far North Coast. Its few remaining assets were transferred to University Centre for Rural Health (Tweed Valley) with a request to use the money for the ongoing education of Tweed Valley GPs. 

Major shake-ups are in the wind for other primary care organisations. The Department of Health is to take over General Practice Education and Training in July 2015. Clearly training will have to continue to be vocationally based but the new government hopes to set up a competitive market such as that prevailing in other sectors that provide services to the community. While this may sound reasonable in principle the dislocation of long established relationships will be costly in the short term. 

Changes are also foreshadowed in the funding of Centres for Rural Health, Indigenous Health Services and perhaps even in Medicare payments themselves if the proposed $7 GP co-payment passes through parliament. Nearly all segments of the primary health sector will undergo an "efficiency dividend", a term rapidly becoming part of the modern lexicon. 

The Horvath report commissioned by the Coalition government reported just prior to the May 2014 Federal Budget. It recommended a restructuring of primary care delivery and in June 2015 the NCML, along with all other Medicare Locals around the country, will no longer be funded by the Federal government. 

Medicare Locals will be replaced by Primary Health Networks (PHNs) whose governance and structure is the subject of much speculation. While their exact workings will not be known until early in 2015, they will clearly be different to Medicare Locals. It has been emphasised that the focus will be on the patient and the services needed to keep them healthy and out of hospital.

Good general practice will be the key to achieving this goal and it will be the PHN's role to co-ordinate with Local Health Districts to deliver these programs. 

This approach fits well with the Medical Home model supported and promulgated by both NRGPN and NCML. While increased funding will be needed to make it a reality, this appears likely and may come from the private health insurance industry as well as State and Federal budgets. There will be more money for general practice, if not general practitioners.

One of the key roles of the NRGPN has been to represent Northern Rivers GPs on the NCML. This role will cease on 30 June 2015. Whether it can have a similar role in the new PHN is yet to be determined. My recommendation to the Board and members is that the NRGPN and its communication network continue to function for the foreseeable future as the independent voice of Northern Rivers GPs.

The tag line of the our fortnightly newsletter is "GPSpeak; Keeping the Finger on the North Coast's Pulse". This alone is a worthy cause.