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Murray Plains Division of General Practice - Version 1

Organisation Context

Tip: The information that PHCRIS collects about your Division is available via your Division Profile, such as your Division key characteristics. There you will also see links to other information such as the PHIDU Population Health Profiles. This information may help you to produce your Division Context. See the Resources page in Help for other sources of information that may be of use to you.



Key Characteristics

Key characteristics are values that are used in the Result Tables for some indicators. These values are taken from different sources as shown below.

Total number of practices in Division’s catchment area
20 
Source: 2007-08 Annual Survey CTXT.2 Practices
Total number of GPs in Division’s catchment area
59 
Source: 2007-08 Annual Survey CTXT.3 GPs
Total number of RACFs in Division’s catchment area
22 

Source: Datapack from Department of Health and Ageing

PHCRIS will import the RACFs figure from the datapack once it has been released by the Department.

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Please include key matters relevant to your Division, which may include local workforce, areas of growth, distance or matters relating to other health services.
The Murray Plains Division is situated in the Central North of Victoria and Southern New South Wales; the Division is spread across a large geographical area - 24,000 sq kms, population is approximately 80,000. Industry in the western sector ranges from dry land farming, grains, sheep, wool, beef cattle, dairy, pigs, and poultry, in the last 5 years primary production has diversified to more intensive forms of agriculture and horticulture including wine grapes, tomato growing, olives, oil seeds, pulses, and fodder crops; to the more eastern areas which have agriculture, forestry & fishing, manufacturing, construction, wholesale & retail trade, transport & storage; accommodation, cafes, restaurants, education, cultural & recreation services. Most of the Murray-Plains has been drought affected for the past six years or so. The areas of Echuca, Moama and Mathoura have continued population growth; in all other areas population is static or contracting.
 
 Larger centres such as Echuca and Deniliquin have in the main adopted group practice structures, whilst many smaller towns can only support solo practices. Answering the requirements of a large area with a small population spread, has seen practitioners combining normal practice undertakings as well as outreach services into small or disadvantaged communities. Several communities including Lockington, Pyramid Hill and Tongala that have a District Nursing Service, aged care facilities or outreach GP services located within their township are still requesting assistance of the Division in providing or increasing General Practitioner levels.
 
A significant number of General Practitioners are involved in delivering procedural services for the Hospitals. This means there is a greater level of responsibility and time taken up in providing their community’s primary and secondary care.
 
Until recetly there was a significant shortage of GP Registrars in this Division with numbers decreasing from 11% of members in December 2004 to under 5% in 2006/2007 and has now returned to 12% at June 2008. The percentage of GPs who are International Medical Graduates (IMGs) (subject to location restrictions on their provider numbers) is around 25%. The General Practitioner workforce has been relatively stable, with a slight increase over the last 7 years from 47 GPs in June 1999 to 59 in June 2007December 2007. The Murray-Plains Division workforce situation while currently stable is always fragile and needs constant monitoring and support.
 
There is no major tertiary receiving centre in the Murray-Plains Division, general practitioners generally refer to Bendigo Health Care Group a 40 minute response or more to many areas by helicopter retrieval service and up to 2 hours by road, Deniliquin generally refers to Albury 2 and a quarter hours by road or Bendigo 2 hrs by road. Occasionally patients will be transferred to Swan Hill or Shepparton.
 
MRI is not available within our Division boundaries: Bendigo has no service at present, and Shepparton has a private MRI service. A good range of sophisticated imaging services are available in Bendigo and Shepparton. Specialist Medical services including Dermatology, Cardiology, Physician, Paediatric, and Specialist Surgical services. Although many of these services visit the larger communities smaller communities have fewer visits. Through MSOAP visiting services physician and surgical are supplied to Kerang and Cohuna, the Murray-Plains Division contributes to the planning and delivery of MSOAP services 
 
 
Local Government Areas:
Included within the Division's boundaries are the Shires of: Campaspe, Loddon, Buloke, Gannawarra, Wakool, Murray & Deniliquin and the City of Greater Bendigo
 
Health Service Areas
Loddon Mallee Region and East Wimmera Health Services, Victoria, the Greater Southern Area Health Service NSW,
 
Hospitals:
There are 11 hospitals servicing the Division based in the townships of: Charlton, Kerang, Inglewood, Cohuna, Wycheproof, Echuca, Boort, Kyabram, Rochester in Victoria and Deniliquin and Barham in NSW.
 
Wycheproof, Inglewood, Boort, Rochester and Barham have no working theatres and no longer provide birthing services. 
 
Community Health Services:
A good relationship exists with each of the Community Health Services - these are: Echuca Regional Health; Inglewood & Districts Health Service, Northern District Community Health, Rochester & Elmore District Health Service, West Goulburn Community Health, Kyabram Community Health, East Wimmera Health Service in Victoria and the Greater Southern Area Health Service servicing Barham and Deniliquin in NSW. These services provide a Community Health Services Representative to the Board of Management of Murray Plains Division, providing the Board of Management greater insight into the scope and integration of community health.
 
Cross Border Issues
As a Division that straddles state borders we experience a rannge of cross-border issues.  Most particularily problems arising out of Deniliquin and Barham where the nearest services available are in Victoria and are not immediately accessible. This relates to Mental Health, although there has been a great deal of work done to try and address this issue, the Division has played a major role in the development of Cross Border Mental Health Agreements. Mental Health is still under funded and under staffed despite the valuable services provided through our ATAPS Mental Health program. Urgent specialist psychiatric consultation is still difficult to obtain. Other areas that are still disadvantaged are: immunisation (differences in Immunisation Schedules across State borders remains an issue for providers to ensure the correct Schedule is maintained when patients live in one State and attend General Practitioners in the adjoining State and they are also affected by the supply of free vaccines which differs from State to State), broadband & telecommunication connectivity (through the Victorian based Loddon Mallee Health Alliance – this is only available in Victoria and the NSW townships of our Division remain severely under-serviced. Primary Care Partnerships in Victoria are progressing service co-ordination but their modest efforts still exceed that which is provided to their New South Wales counterparts. 
 
For a Division of General Practice there are considerable duplications associated with engaging and contending with two differing state health systems and the burden of time and resources to attending to this situation is not reflected in support funding recognising this fact - which distinctly disadvantages Divisions that contend with dual state areas.
 
Research
With no university campuses within the Division, research projects lack near-by support.
 
Personal & Professional isolation
Personal and professional isolation are issues for Division members, which the Division continues to strive to address
 
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Please include key matters relevant to your Division, such as demographic trends, population dispersal, Aboriginal and/or Torres Strait Islander population, social and cultural diversity.
The Australian Bureau of Statistics data for 2001 outlines the following population and Index of Relative Socio-Economic Advantage/Disadvantage (SLA) distribution for the Local Government catchment areas within the states of Victoria and New South Wales. "The Index of Relative Socio-economic Advantage/Disadvantage is derived from the 2001 Census of Population and Housing and measures aspects of social and economic conditions in an area"..."the average index value for SLAs across Australia is 994; an index value exceeding 994 indicates that an SLA is more advantaged than the Australian average, while a value of less than 994 indicates that an SLA is more disadvantaged than the Australian average" (AusStats:1379.0.55.001 National Regional Profile, 19/03/2004: page 4).
 
1. Buloke Shire
Total population:      6982
RRMA classification: 5
SLA rating:             941.8
Age distribution: 55% of the population of Buloke Shire is aged over 40 years of age. Statistically the largest group of people in the shire now are well over 54 years of age, and this ageing population will significantly increase the burden on the existing facilities and services in the next 5-10 years. Ageing in place, community and home care services and in-patient services will be required to be developed or improved to assist this community
 
The small indigenous population is less than 1% (27) of the total Buloke population.
 
The Geographical spread of the shire is less than 1 person per sq km.
 
The Victorian Government report “Vic Futures” predicts that the Buloke Shire will incur a 10.1% decrease in its population by 2012.
 
 
2. Campaspe Shire
Total population:      34610
RRMA classification: 4 (Echuca), Others 5
SLA rating:             945.7
Age distribution: 46% of the population of Campaspe Shire is over 40 years of age. Statistically the largest group of people in the shire now are under 40 years of age, and this group will require further obstetric and paediatric services, although these are being reduced in the rural landscape. Although Echuca has a strong level two obstetric service, the towns of Rochester and Elmore have none.
 
The indigenous population is less than 2% (645) of the total population in the shire.
 
The Geographical spread of the shire is 7.6 persons per sq km.
The Victorian Government report “Vic Futures” predicts that the Campaspe Shire will have a 4.1% increase in its population by 2012.
 
3. Gannawarra Shire
Total population:      11394
RRMA classification: 5
SLA rating:             932.1
Age distribution: 50% of the population of Gannawarra Shire is aged over 40 years of age. Statistically the largest group of people in the shire now are over 30 years of age, and this group will require a complete range of services including ageing in place and obstetric services and acute in-patient services to allow the population to be cared for in the near future.
 
The indigenous population is less than 1.5% (139) of the total population in the shire.
 
The Geographical spread of the shire is 3.3 persons per sq km
The Victorian Government report “Vic Futures” predicts that the Gannawarra Shire will incur a 2% decrease in its population by 2012.
 
4. Loddon Shire
Total population:      8197
RRMA classification: 5
SLA rating:             916.3
Age distribution: 55% of the population of Loddon Shire is aged over 40 years of age. Statistically the largest group of people in the shire now are well over 54 years of age, and this ageing population will significantly increase the burden on the existing facilities and services in the next 5-10 years. Ageing in place, community and home care services will be required to be developed or improved to assist this community. Acute in-patent services will need to be maintained because as people age their need for acute in-patient beds increases.
 
The indigenous population is less than 1.1% (90) of the total population in the shire.
 
The Geographical spread of the shire is 8 persons per sq km
The Victorian Government report “Vic Futures’ predicts that the Loddon Shire will suffer a 3.7% decrease in its population by 2012.
 
5. Wakool Shire
Total population:      4930
RRMA classification: 7
SLA rating:             941.7
Age distribution: 50% of the population of Wakool Shire is aged over 40 years of age. Statistically the largest group of people in the shire now are well over 54 years of age, and this ageing population will significantly increase the burden on the existing facilities and services in the next 5-10 years. Ageing in place, community and home care services as well as acute in patient services will be required to be developed or improved to assist this community
 
The Geographical spread of the shire is 1.6 persons per sq km
 
The indigenous population is 1.8% (84) of the total population in the shire.
 
The New South Wales Department of Planning & Natural Resources, SLA Population Projections –2004 Release predicts that the Wakool Shire will incur a 0.5% (4800) decrease in its population by 2011
 
6. Murray Shire
Total population:      6160
RRMA classification: 7
SLA rating:             953.8
Age distribution: 50% of the population of Murray Shire is aged over 40 years of age. Statistically the largest group of people in the shire now are well over 59 years of age, and this ageing population will significantly increase the burden on the existing facilities and services in the next 5-10 years. Ageing in place, community and home care services and acute in patients services will be required to be developed or improved to assist this community
 
The Geographical spread of the shire is 0.7 persons per sq km
The indigenous population is 3.2 % (188) of the total population in the shire.
 
The New South Wales Department of Planning & Natural Resources, SLA Population Projections –2004 Release predicts that the Murray Shire will incur a 2.9% (7110) decrease in its population by 2011
 
7. Deniliquin Shire
Total population:      8330
RRMA classification: 5
SLA rating:             946.7
Age distribution: 47% of the population of Deniliquin Shire is aged over 40 years of age. Statistically the largest group of people in the shire now are over 30 years of age, and this group will require a complete range of services including ageing in place and obstetric services and acute in-patient services to allow the population to be cared for in the near future.
 
The Geographical spread of the shire is 1.4 persons per sq km
The indigenous population is 2.6% (205) of the total population in the shire
The New South Wales Department of Planning & Natural Resources, SLA Population Projections –2004 Release predicts that the Deniliquin Shire will have a 2.6% (8260) decrease in its population by 2011
 
 
8. City of Greater Bendigo
Only a very small proportion of this local government catchment is included in our Division area, therefore we have not included figures for this locality.
 
The SLA ratings for LGAs within the Murray Plains catchment demonstrate that the population of the Division is well below the national average for socio-economic status.
 
The Murray-Plains Division has very limited populations of culturally or socially diverse peoples within its boundaries.
 
The Koori population is under 2% of the Division population and areas where it nearest or rises above this level are around Echuca, Moama, Mathoura Cummergunja and Deniliquin and Kerang.
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with reference to the demographic and social characteristics of the Division population and the profile of the general practice workforce.
General Practitioner Workforce
The Murray Plains Division works with both the state based workforce recruitment agencies RDN (NSW) and RWAV (Vic) to ensure that GP numbers remain at least stable. Whilst it would still be appropriate to consider that this whole region is currently experiencing a significant GP workforce shortage, we have seen a slight increase in ner GP numbers in the past 12 months.  Specifically  The past three years has seen a small increase in the numbers of GPs, at Cohuna the GP numbers are down from 5 to four. In Kerang the workforce has been steadily rebuilding after a period of significant shortage. Njernda Aboriginal Health Service has sercured part-time General Practitioner services, and the Kerang Aboriginal Elders aspire to providing an Aboriginal Medical Service in the medium to longer term future. While the remaining towns are not actively recruiting, the unplanned departure of a single General Practitioner from any town in the Murray-Plains region would have a significant impact on the community.
 
The GP to population ratio for the Murray Plains Division is approx 1:1450; this figure does not acknowledge the wide range of procedural and non-procedural services our rural General Practitioners deliver to their communities nor thehigh level of transient/tourist populations that seasonally frequent our region. It should be noted that most GPs in this region are procedural and are responsible for most of the services at their district hospital and therefore have less consulting time than urban or provincial GPs.  Of particular concern is the ageing demographic of our exisiting GP workforce and significant challenges will be experienced within the next 5 - 10 years to maintain GP numbers as many current GPs will reach retirement age during this timeframe and it appears without a crop of new GPs being regularly recruited to the area.
 
The percentage of GPs in the division who are in the registrar-training program is 9%. One Murray-Plains board member sits on the board of Victoria Felix, another Murray-Plains board member is the Division Medical Educator and many GPs are supervisors of Victoria Felix Registrar Program. In addition Division staff time is allocated to provide support to the Victoria Felix registrar-training program.
 
The Murray-Plains Division endeavours to improve the personal and professional isolation of our General Practitioners through our education program and through regular National Prescribing Service case study groups, Information Management meetings and clinical risk management program. With no tertiary referral centre within easy access, the GPs within the Murray-Plains region must be able to provide a higher level of care than basic consulting skills. When mandatory QA&CPD points are essential in privileging for anaesthetics, obstetrics and surgery, the Division must provide a quality QA& Continuing Professional Development program to its members.
 
Education General Practitioners must often travel long distances to attend QA& Continuing Professional Development events. To redress this, Murray-Plains Division endeavours to provide sufficient resources to ensure that that quality-targeted education is provided to each GP within a 40 minute drive from their practice.
 
Support for female GPs
Approximately 28% of the GP workforce in the Division is female. The significance of this group to the Division is recognised with the development of programs to support their needs. MPDGP is working on strategies to improve the recruitment of female GPs to the region as well as support their retention through services and activities that particularily encourage the capacity to seek part-time employment to continue to strike appropriate balances between professional and family commitments.
 
Koori Health issues
It has been recognised that the major health concerns for our Koori population are diabetes and heart disease. Our More Allied Health Services program is now more closely focused on managing these issues, for the Koori and broader populations.  MPDGP supports the provision of Diabetes, Dietitian and Mental Health services through Njernda - the local Aboriginal Medical Service.
 
Drought stress
Our region is servely affected by the on-going drought and beyond the economic devestation has also severely impacted upon mental health services.  Our ATAPS program is very well received across our region and waiting lists continue to expand.  The introduction of the "Better Access" initiative has not enjoyed significant take-up in this region due to the low number of private mental health practitioners available in small rural areas and demand continues to grow for our ATAPS service, particularily in our drought stressed communities.  We continue to strive to recruit Mental Health practitioners to the region to supplement the limited number of mental health clinicians in the field within this region.
 
 
 
Service Coordination
The Murray Plains Division of General Practice is a leading organisation in the Loddon Mallee region for Information and Communication Technologies (ICT) activities and will continue to be so. MPDGP works closely with the 3 Primary Care Partnerships to develop referral tools and protocols to assist in the implementation of a seamless health care service. The Murray-Plains staff are pivotal in encouraging the uptake of E-referrals and promoting closer working relationships with Allied health and other local service providers.
 
Preventative Health Interventions
MPDGP staff provide ongoing support for General Practitioners and practice staff to provide patients with lifestyle information to improve their health outcomes – the Australian Better Health Initative (ABHI) has seen the roll-out of practice based software to improve data quality and chronic disease managment activity and enhanced internal system improvments in the general practice environment. 
 
Our National Prescribing Service Small Group Case Study meetings provide General Practitioners and Pharmacists with the opportunity to meet with their peers and discuss current evidence and best practice in management of common conditions. This also enables them to engage with service providers across their region to develop strategies for improved patient care.
 
The Murray-Plains Division has an ageing population and supports Practices to improve patient recall and reminders to ensure timely Health Assessments for 75+ age group, and endeavours to improve service co-ordination through Care Planning and Case Conferences.
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For example, access, communication, information exchange, coordination.
As the Murray-Plains Division is a very rural division the GPs have close relationships with their local hospitals. Almost every GP in the Murray-Plains Division of General Practice is a VMO and provides the majority of the acute sector care, with occasional/scheduled assistance from visiting specialists. In Echuca there are 4 interns, 2 IMG surgeons and a medical resident which support the local GP workforce in providing hospital based care. Members are concerned that the loss of GPs from hospital boards has fractured the direct line of communication General Practitioners have traditionally had to the hospital boards of management.
 
Many of the hospitals within the Victorian sector of the Murray-Plains Division, have through the Loddon Mallee Health Alliance, access to GWIP broadband. Ensuring that hospitals maximise the usefulness of this service and encouraging them to integrate their systems with their local GPs will be an aim for the Division. Some of the areas to explore and improve are E-referrals for specialist referrals, treatment & discharge summary at local and tertiary hospitals, continued involvement in clinical risk management and quality improvement support for general practice in the hospital setting and in primary and secondary care level and further integration of hospital staff in the education program, facilitation of admission system development and encouraging use of Medical Director data for admissions.
 
To ensure better patient access to a wider range of services there needs to be continued liaison with the three Primary Care Partnerships and hospitals to coordinate services. The use of resources available through the acceptance/introduction of the LMHA will enhance this process.
 
The Chief Executive Officer of the Murray Plains Division of General Practice will continue to meet with other Divisional representatives in New South Wales, in an attempt to promote these communication technologies to the areas in the south of that state. Success in these areas will ensure that data and information management will be more effective in assisting health planning and promotion in these geographical regions.
 
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Include the directions your Division has decided on to meet needs identified in the profile of general practice, such as workforce recruitment and retention; maintaining or improving the level of engagement with practices, general practitioners and other practice workforce; practice support.
Locum service This popular bookin service has assisted many practices in being able to maintain services to their communities whilst the normal practitioner is on leave. The Workforce Facilitator continually strives to ensure the best Locum replacement service is available to members.
 
Succession Planning
We are encouraging practice principals and managers to develop a succession plan, develop and maintain practice profiles, and to develop information about various GP employment options. In providing practice support for recruitment and retention there will be liaison with local government and community groups to determine if there is anything that may be able to value add to the package offered to potential recruits.
 
 
 
Practice Support
MPDGP provides a comprehensive program of practice support that is enthusiastically embraced by all practices in our region.  Part of this support inlcudes orientation aitcally and where there is also onsite support for new staff and General Practitioners in training in the use of the practice's Patient Management and electronic medical record systems.  Support and training for the introduction and use of E-referrals is provided. MPDP is working with the Campapse Primary Care Partnerships to pilot an e-referral system in Kyabram and through this projects success we expect an increase in referrals via secure email.
 
There is education and support provided for the immunisation program, through regular updates of the changes in immunisation schedules, updated ACIR records for practices, the provision of the fridge logger to validate practice vaccine fridge temperature levels and to implement recall and reminder systems.
 

Support for Practice Nurses, ongoing support for practice nurses is provided via the practice visits and information on training events, as well as inclusion in the GP education program. The Division has developed a practice nurse email network which has been enthusiastically embraced by practice nurses and staff.

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Specify how your local priorities address the key issues you have identified above as well as the health needs of Aboriginal and/or Torres Strait Islanders and other socially diverse groups.
Aged Care
Aged care is a key focus of the Division despite the significant reduction is rexource allocation for this important area with the abolition of the GP Panels program.  MPDGP has previously encouraged General Practitioners to provide regular annual Health Assessments and to recommend Home Medicine Reviews when indicated will support older Australians maintain an independent lifestyle for as long as possible. With the narrower focus upon supporting aged care residential access to allied health services, we will continue to endeavour to assist the enhancement of services to aged residents in our region despite the limited funding through this program and dearth of allied health professionals in rural areas.
 
 
Mental Health
MPDGPs Mental Health program continues to provide substaintial primary mental health service in our region.  Through our ATAPS program we directly employ a number of Mental Health clinicians to maximise the availability and access of mental health clinicans to small rural communities on a part-time basis that would otherwise not be able to access such services locally because of their low population bases.  The opportunity to complement Mental Health services through the "Better Access" initiative has significant limitations given the small number of mental health clinicians in the region.  Our range of Mental Health services have been expanded with the allocation of funding for Drought Relief and the late June 2008 allocation of Rural and Remote Mental Health funding for drought affected communities.  This expansion of services and funding has neccessitated the introduction of a specific Mental Health Team Leader to oversee this growing program area.   
 
CDM
To ease the pressure on GP time the Murray-Plains Division has identified the need to encourage practices to adopt a whole of health-team approach by enhancing linkages with allied health service providers as well as improving teamwork within General Practice between General Practitioners, Practice Nurses and all other Practice staff. Some of the vehicles to enable this holistic health care team approach, will continue to be:
  • the pilot program offered by MPDGP through our MAHS program to develop the role of Asthma Educator Practice Nurse role.
  •  Home Medicine Review program (General Practitioners & Pharmacists)
  • Diabetes 12-month cycle of care & Asthma 2+ plans through increased use of nursing skills in general practice environment together with other allied health providers
  • Improved Information Management continues to be a priority with education & training workshops as well as onsite practice training being provided in maximising use of electronic health records. All Practices are encouraged to ensure every patient has a comprehensive Health Summary (whether this is recorded electronically or paper-based). Part of this Health Summary is checking smoking status as well as alcohol status, patient demographics, past medical history, past and current medication list, social history, etc. Encouragement and support for patients to commence smoking cessation interventions has been identified as a priority due to statistical evidence which shows the majority of our Division catchment has higher than State averages for deaths from smoking.
 
To assist in the implementation of these strategies the Area Managers will provide ongoing support to General Practitioners and practice staff around the following priority areas
·         Maximising opportunities for better patient management to be gained by the use of electronic patient records
·         Encourage the use of E-referrals
·         Encourage increased take up of Enhanced Primary Care and related Medicare Items
·         Maximising opportunities for better patient management to be gained by the use of use of a practice nurse.
·         Fostering stronger relationships between practices and Residential Aged Care Homes and other Allied Health Care providers and the Division.
The support will be provided during regular monthly practice visits, via education sessions, information transfer via the Tuesday Facts MPDGP website and Newsletter. Additional support is available by practice visits made by appointment and via ongoing phone support.
 
Koori health remains a priority for the Murray-Plains Division and we have a very strong relationship with the only Community Controlled Aboriginal Health Service in our region - Njernda Aboriginal Health Service based in Echuca (Victoria) Njernda enjoys a wide range of services including those provided by the Murray-Plains Division's More Allied Health Services Koori Health Worker.

 

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Please indicate whether your Division is accredited, registered for accreditation, or not registered for accreditation. If your Division is accredited or registered for accreditation, please specify with which organisation.
Accreditation StatusAccredited
Accreditation ModelQIC
Date AccreditedSep 17 2007
Date Accreditation ExpiresNov 19 2009
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A PDF or other electronic copy of the accreditation certificate if available, otherwise post in a copy.

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