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Planning & Report Summary for the year 2004 - 2005

Division Details | Listed Programs

Mission Statement

Vision Statement: To improve the health of our community by empowering general practice

Mission Statement: The Division's core business is to optimise the capacity of general practice to improve the health of the community by providing a range of effective and relevant services and by working with key stakeholders

Executive Summary

The Hastings Macleay Division of General Practice aims to improve the health of our community by empowering general practice. The Division's core business is to optimise the capacity of general practice to improve the health of the community by providing a range of effective and relevant services and by working with key stakeholders.

The Division has identified the following Program Areas as its priorities for this Strategic Plan:
* Program Area 1: Governance and Management
* Program Area 2: Practice Enhancement Program
* Program Area 3: Population Health
* Program Area 4: More Allied Health Services

The above program areas address the 5 sectors DoHA expect Divisions to cover in their plans (Population Health, Infrastructure, Services to GPs, Services by GPs to patients and Allied health)

Our Plans address four of the five National Health Priority Areas: (Mental Health, Diabetes, Asthma, Cervical Screening). Cancer is not addressed

Our plans have a mix of programs that address local needs (GP and Community)

Background

Efforts to establish a local Division of General Practice commenced in May 1993 with the Division being registered as a public company limited by guarantee in February 1994 and achieving Income Tax Exempt Charity and Deductible Gift Recipient status in 2003. The Division is governed by a Board of eight GP Directors elected at the Annual General Meeting. The Board of Directors sets the Strategic Direction of the Division and allows the Division staff and Committees under the direction of the Chief Executive Officer to implement the Business Plan.

The Board of Directors for 2003-2004 and their allocated specific portfolios of responsibility are as follows:

Dr David Gregory: Chairman, Media Spokesperson and IM/IT
Dr Peter Ackerley: Deputy Chairman and More Allied Health Services
Dr Keith Beck: Population Health
Dr Robert Clarke: Financial Director
Dr John Fone: Mental Health
Dr Lisa Skrebels: Education Liaison Officer
Dr Stephen Young: Services to GPs
Dr Fares Samara ANSWD Rural Chapter Representative

Division Committee and Program Appointments for 2003-2004 are as follows

Services to GPs Committee:
* Dr Stephen Young (GP Director)
* Dr Lisa Skrebels (Education Liaison Officer)
* Dr Robert Clarke
* Dr Sandy McColl
* Resourced by Division Staff - Ms Libby Mackintosh and Ms Kere Easton
* Consumer Representative - Mrs. Di MCDonald

Mental Health Committee:
* Dr John Fone (GP Director)
* Dr Fares Samara
* Dr Carol Booth
* Resourced by Division Staff - Mr Bob Boss-Walker
* Consumer Representative - Mr. Garry Thomas

Population Health Committee:
* Dr Keith Beck (GP Director)
* Dr Trina Gregory
* Dr Warwick Wickham
* Resourced by Division Staff - Mrs Bev Buckridge, Christine Cox, and Margaret Hollis
* Consumer Representative - Mrs Anne Gaffney

MAHS Committee:
* Dr Peter Ackerley (GP Director)
* Dr Carolyn Cain
* Dr Colin Farquharson
* Resourced by Division Staff - Paul Ward, Ms Sue Baughman, Sue Alcock (in attendance Kirsty Ross)
* Consumer Representative - Mr. John Bowell

Home Medication Review Project Advisory Group
* Dr Trina Gregory
* Mrs Virginia Soffer (Pharmacist)
* Division Staff - Ms Kere Easton

National Prescribing Service Project Advisory Group
* Dr Trina Gregory
* Mrs Leslie Burrett (Pharmacist)
* Division Staff -Ms Kere Easton

Division Staff:

Mr Paul Ward, Chief Executive Officer
Ms Libby Mackintosh, Administration Officer
Ms Kere Easton, Receptionist
Mrs Christine Cox, Practice Support Program Officer
Ms Beverley Buckridge, Aged Care and Consumer Liaison Program Officer
Mr Bob Boss-Walker, Mental Health Program Officer
Mrs Margaret Hollis, Diabetes Shared Care Program Officer
Mrs Sue Alcock, MAHS RN (foot care)
Ms Sue Baughman, MAHS Psychologist

The Division has produced a comprehensive Policy and Procedure Manual that underpins how the Division runs as a corporate entity. Members and Division staff are encouraged to obtain a copy of this manual so as to be familiar with Division requirements in regard to protocol, payments, etc. The Division is a respondent to the Divisions of General Practice 1999 Award and all staff have individual employment contracts with the Division.

Hastings Macleay Division Programs have evolved to a point whereby we are able to meet the needs of both local GPs and the funding body by focusing a significant amount of our efforts on improving health outcomes for patients by supporting GPs in their practices. It has been recognised from discussions with and surveys received from GPs and practice staff that more support to practices is required to enable them to work more efficiently (smarter not harder), increase job satisfaction (improved lifestyle and health for GPs), take advantage of the new Medicare Item Numbers (help in deciphering the Government information on these, implementing the initiatives and increase practice revenue using these Items) and ultimately improve patient outcomes (keeping the funding body happy as patients are kept healthy in the community and out of the hospitals).

We have refined our GP Support Program whereby our current support activities in the areas of Immunisation, Information Management, Chronic Disease Management, Accreditation, Service Incentive Payments (Asthma, Cervical Screening and Diabetes), Practice Incentive Payments, Practice Managers Meetings, Practice Nurse Liaison, Doctors Health, EPC, After Hours, Locum Support are developed into a coordinated Program that is adequately resourced in terms of staff and funding to achieve its outcomes. In addition we have implemented a Practice Audit Program whereby our staff conduct practice audits and from the information gained make recommendations to the practice on how they can do things more efficiently and profitably.

Our Division also runs a continuing education program for GPs and facilitates access to upskilling activities. We have Education Subsidies that allow GPs to have the costs of upskilling subsidised. We also have several programs that address specific, identified areas of priority. These include Mental Health, Diabetes, Immunisation, Home Medication Review, National Prescribing Service, Health Promotion, Chronic Disease Management, Practice Enhancement and More Allied Health Services.

A vital role of the Division is to facilitate communication and act as an information source for GPs and other health service providers. To achieve this we act as a conduit for transfer of information to General Practice thereby ensuring that GPs are kept up to date with the latest from all stakeholders in the health industry. We also facilitate and actively promote the inclusion of GPs and Division input into local health planning and service delivery. We have GPs and Division staff on several Mid North Coast Area Health Service Committees. Over the years the Division and the MNCAHS have worked collaboratively on a number of programs and have developed an excellent working relationship. The Division considers this collaboration as being essential in formulating/developing joint approaches to health service delivery in the Hastings Macleay region. 2004-05 will see the signing of a Memorandum of Understanding between the two organisations that cements this collaborative relationship.

Communication is a two way process so we equally promote stakeholder participation into our planning. The Division has consumer representatives on all Division Committees and we invite the Area Health Service, Hospitals, Aboriginal Medical Services and other stakeholders to contribute to our planning process.

Over time the Division has increased its profile in the Community to such a level where our input is requested on numerous occasions. Our role has become more recognised and I feel that the next few years will see some further enhancement to the role we play in the health system.

Postcodes

2444, 2443,2446,2440,2431,2898, 2441

Demography

The Hastings Macleay Division of General Practice covers the Local Government Areas (LGAs) of Hastings and Kempsey, extending from South West Rocks in the north to Laurieton in the south. Lord Howe Island is also included in the Division area. The total area covered by the Division is 7,060 square kilometres.

The area has a total population of 88,933


The Hastings LGA covers an area of 3,684 square kilometres with a Census 2000 population of 60,488 of which 2.0% are Aboriginal and Torres Strait Islanders. The Hastings LGA stretches from Point Plomer in the north to Diamond Head in the south and west to the Great Dividing Range. Port Macquarie (pop. 37,982) is the largest coastal town and is a major tourist destination. Wauchope (pop. 9,500 - includes outlying areas) is the major inland centre for the LGA. On the southern coast lies the Camden Haven area (pop. 9,406) that includes Dunbogan, Laurieton, North Haven and West Haven. Lake Cathie (pop. 3,600) lies 12 Klms south of Port Macquarie.

The Kempsey LGA, often referred to as the Macleay after the it's major river, covers an area of 3,377 square kilometres with a June 1998 population of 28,090, of which 8.5% are Aboriginal and Torres Strait Islanders. The Kempsey LGA extends from Point Plomer in the south to Scott's Head in the north and west to the Great Dividing Range. Kempsey is the largest town (pop. 20,400 - includes rural) and is the major centre for the area. South West Rocks (pop. 6,500) and Crescent Head (pop. 1,190) are coastal towns and popular tourist destinations.

This region has a number of unique characteristics that include:
* High percentage people >65 years -Kempsey 16.7%, Camden Haven 37%, Port Macquarie 23%, Wauchope 15.7%
* Increasing numbers of indigenous people - Kempsey 8.5% and Hastings 2.0%
* High percentage of people on low incomes
* High population growth in the Hastings
* High unemployment rates - Kempsey 16.5%, Port Macquaire 10.2%, Camden Haven 15.2% and Wauchope 11.4%
* Very high percentage of children and young people under 15 years

The towns of Wauchope and Kempsey are rural in nature with economies largely dependent on primary industry (agriculture and forestry). Port Macquarie and the other coastal towns have significant tourism industries and are also influenced by the large number of people who move to the area to retire. Other issues for the area are the decline in rural industries and the very limited public transport services available.

The Hastings-Macleay shares common boundaries with the NSW Police local area command, Department of Education and Training, the RTA as well as sector boundaries within the Mid North Coast Area Health Service.

Both LGAs rate well below the NSW average, often at or below the 25 percentile, on each of the five socio-economic indicators developed by the ABS.

Membership

92% of GPs in this area are members of the Division (109 out of 118). Of these full and part-time GPs about 75% are based in the Hastings and 25% in the Macleay.

All GPs who practice within the boundaries of our Division are eligible for membership. Membership to GPs is free.

The GP numbers are updated six monthly on the Divisional GP data base by the Division staff. GP movements are noted and the data based altered accordingly.

In February 2004 the HMDGP Workforce Statistics were as follows:

Town Dec 2004 Population FTE GPs Jan 2005 Patient/GP Ratio AMWAC Ratio including IRD Shortfall of GPs

Port Macquarie 48,246 34.84 1:1,1385 1:1,215 4.87
Wauchope 10,367 6.78 1:1,529 1:1,062 2.98
Camden Haven 11,354 8.88 1:1,278 1:1,062 1.81
Hastings SLA Total 69,967 50.5 9.66
Kempsey 20,175 14.44 1:1,397 1:1,157 3.0
Crescent Head 1,229 1.0 1:1,229 1:1,013 0.21
South West Rocks 6,503 5.69 1:1,143 1:1,013 0.73
Kempsey SLA Total 27,907 21.13 3.94
Lord Howe Island 355 1.0 1:355 1:889 (0.4)
Total HMDGP 98,229 72.63 13.2

Issues


The boundaries of the Division initially coincided with the boundaries of the Macleay Hastings Health District. With the reorganisation of rural health districts into Areas, the Division now occupies the Central Sector of the Mid North Coast Area Health Service.

Three hospitals in the area provide public hospital services:

*Port Macquarie Base Hospital, 161 bed, Level 4
*Kempsey District Hospital, 105 bed, Level 3
*Wauchope District Hospital, 30 bed, Level 2

There is also a fully accredited 84 bed private hospital in Port Macquarie which includes a post natal unit.

The nearest teaching hospital is John Hunter Hospital in Newcastle a distance of some 250 km by road.

There are seven Nursing Homes in the area and ten hostels, including one dementia specific unit.

There are Community Health Centres in both Kempsey and Port Macquarie with outreach services in Laurieton, Wauchope and South West Rocks.

Durri Aboriginal Corporation Medical Service is located in Kempsey and provides a range of health services targeted for the Aboriginal population.

Port Macquarie is fortunate in having a broad range of medical specialists. Kempsey has only one Physician and a number of visiting Consultants. Kempsey District Hospital relies on GPs to provide Obstetric and Anaesthetic services.

Services that are lacking
*Endocrinologist
*Neurologist
*Specialist Dermatology Services
*Improved Public Dental Health Services
*Community Mental Health Services are under staffed and resourced
*Lack of supported accommodation for mental health consumers
*Lack of supported accommodation for people with disabilities
*Lack of respite facilities for the aged and people with disabilities

Relationships with MNCAHS

The Port Macquarie Division has formed a good working relationship with the Mid North Coast Area Health Service. The three Divisions of General Practice in this region (HMDGP, MNCDGP and HRDGP) have formed a Liaison Committee with the MNCAHS. This Committee comprises the CEO and senior program managers from the MNCAHS and the Chairman, Deputy Chairman, EOL and or Medical Directors and Chief Executive Officers from the three Divisions. The committee meets quarterly with a range of issues being discussed that affect health service delivery on the Mid north coast. The MNCAHS has just signalled its intention to appoint a 0.5 FTE GP Liasion Officer who will work very closely with the three Divisions and also resource this Committee We have GP representatives on various MNCAHS Committees and the Division Chief Executive Officer and the MNCAHS Manager for Primary and Extended Care meet on a monthly basis. Information on the activities of each organisation now flows regularly. Several partnerships have been formed in the past (Diabetes, Mental Health, Alcohol ad other Drugs, Immunisation, etc) and it is hoped that some of these will continue in the new triennium.


The Division has formed partnerships with the following stakeholders
*Mid North Coast Area Health Service
*Population Health Unit, MNCAHS
* All Nursing Homes in our region
* Port Macquarie Base Hospital
* Mental Health Service PMBH
* Hastings Council
* Community groups (Hastings Women's and Children's Refuge, Neighbourhood Centre, PCYC, Hastings Interagency Group, Consumer Representatives on most programs, etc)
* Mid North Coast Division of General Practice
* Hunter Rural Division of General Practice
* Hastings Branch of Diabetes Australia

Needs

Planning for 2004-2007

This year the Board decided that the Chief Executive Officer would conduct the Annual GP Survey by using a combination of GP visits and written survey responses. The Board was desirous of achieving maximum responses from GPs prior to the 2004-2007 Strategic Planning process in February 2004. In the past the best response we could expect to a survey has been around 25%.The 2003 Survey achieved a much better response rate. 58% of GPs (60/103) completed the survey. I also asked a number of questions to try to get a feel for how the Division's programs and services offered are received by GPs and sought out GP's thoughts on our role and our future direction as well as asking them what they would like from us in regard to services over the next three years and CPD over the next year.

From the results of the above survey, the views of the stakeholders (consultation day held on 22nd January 2004) and the discussions at the Board/Division Staff Planning day (21st February 2004) the Board of Directors were in a position to set the strategic direction of the Division for 2004-2007 and do so with the confidence that they have balanced the needs of our funding body, our members and stakeholders. GPs and Division staff prepared business cases for programs they would like to see funded in the first year of the new triennium. The Board then formulated the 2004-2005 Business Plan based on the priorities set at the Strategic Planning day, business cases received and known funding that will be available in 2004-2005.

Report Summary

The main challenge facing HMDGP in 2005-2006 will be the implementation of new Program Performance Objectives and Indicators which came as a result of recommendations made in the 2003 Review of Divisions of General Practice. New contracts have been entered into with the Department and Agreement and Annual Plans developed and approved.

The Annual GP, Practice Manager, Practice Nurse and stakeholder survey was conducted in December 2004 prior to planning commencing for the 2005-2008 triennium. While the response rate was disappointing a number of good ideas were received. These were considered by the Board during it's planning process for the 2005-06 Annual Plan. From our 2004 survey results and from discussions with GPs it has become obvious to us that a large number of GPs do not know the extent of the service the Division provides to GPs and to practices. So, in the April 2005 Digest Division we published an article that highlighted what the Division did for GPs and their Practices. We called this article "Beating the Drum".

Our recently updated (July 2005) GP/patient ratios have shown a shortfall in GPs across the region of 12.94. The number of FTE GPs now stands at 73.63 servicing a population of 97,874 (this does not include the 600,000 holiday makers who visit our area each year and put considerable strain on our already depleted workforce). We have also seen a significant increase in the number of GPs working part-time (52% of our workforce works less than 36 hours or less than 9 four hour sessions per week). Areas that previously had an oversupply of GPs now have shortages. The Hastings Statistical Local Government Area (SLA) has a shortfall of 6.87 FTE GPs and the Kempsey SLA has a shortfall of 1.68. Where workforce wasn't a key issue for this region in the past it is becoming so now and will need to the the focus of ongoing consideration as our population increases at the rate it is now and as GP workforce demographics change.

During the last few months of 2004 the Division participated in the processes that have shaped the structure of the new North Coast Area Health Service (NCAHS). GPs and Division staff actively participated in stakeholder consultations and were on decision making Committees during this process. By doing so we have been able to reinforce the view that GPs are the lynch-pin of primary health care and as such must be consulted and involved in service planning and delivery at all stages and levels. We have formed a Combined Senior Executive with the three other Divisions of General Practice that operate across the NCAHS boundaries which will allow us to take agreed concerns/issues/suggestions, etc to them via the quarterly Liaison Committee Meetings attended by the Chairman, Deputy Chairman and CEO from each Division and the CEO and Senior Managers from the Area Health Service.

The reporting period has seen the development of a Risk Management Plan and a revision of the Division's Policy and Procedure Manual by the HR Working Party. Staff meetings are held monthly in the week preceding the Board Meetings with all Program Officers and GP Directors providing reports via the CEO report. This enables the Board of Directors to be fully appraised of the Division's progress against the Performance Indicators in the Annual Plan and to be able to make adjustments where necessary. Monthly Financial Reports are also presented to the Board allowing them to be adequately appraised of the Division's financial position and be assured of our financial viability.

The HMDGP Board has recognised that one of the greatest strengths of Divisions is the ability to respond to local AND national health needs through general practice and as such has tailored our programs accordingly.

We currently have programs that deliver services in the in the areas of Immunisation, Information Management, Chronic Disease Management, Accreditation, Service Incentive Payments (Asthma, Cervical Screening and Diabetes), Practice Incentive Payments, Practice Managers Meetings, Practice Nurse Liaison, Doctors Health, EPC, After Hours, Locum Support, GP Education Subsidies, CPD (including collaborative programs with NCGPT and the UNSW School of Rural Health), Mental Health, Diabetes, Home Medication Review, National Prescribing Service, Health Promotion and the employment of Allied Health Professionals in our RRMA 4-7 area. A vital role of the Division is to facilitate communication and act as an information source for GPs and other health service providers. To achieve this we acted as a conduit for transfer of information to General Practice thereby ensuring that GPs are kept up to date with the latest from all stakeholders in the health industry. We also facilitated and actively promoted the inclusion of GPs and Division input into local health planning and service delivery. Communication is a two way process so we equally promote stakeholder participation into our planning. The Division has consumer representatives on all Division Committees and we invited the Area Health Service, Hospitals, Aboriginal Medical Services and other stakeholders to contribute to our planning process. Over time the Division has increased its profile in the Community to such a level where our input is requested on numerous occasions.

Lastly please note that the Division was unable to furnish the most up to date HIC statistics for a number of initiatives as the HIC web page is hopelessly out of date for the majority of incentives. Consequently we went with the most up to date figures available as at 29/7/2005.

All in all I feel that the Division is performing at a high level.

Paul Ward
Chief Executive Officer

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