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Mission Statement Guiding Principle
The guiding principle of the Barwon Division of General Practice is to support its GPs in improving the health outcomes of the population within the Barwon Division.
Mission Statement
The Barwon Division of General Practice will provide a selected range of education, health, management and workforce programs for its GPs aimed at increasing their professional satisfaction and the health status of the region's residents.
Vision Statement
The BDGP will be recognised for its excellence in providing leadership, support to its members and for its program, financial, human resource and information management.
The organisation aims to:
Improve communication between GPs in the region
Bring together the knowledge, experience and skills of rural GPs to maintain and improve General Practice standards in the community
Support General Practice throughout the Division by providing education and health project activities
Support the relationship between GPs and the community, hospitals and other health professionals and State and Federal Governments. Executive Summary The 2004-2007 Strategic plan has been formulated by the Board to address current workforce and health issues as identified by the 2004 Needs Assessment, address Commonwealth priorities and build upon current Divisional activity.
The 2004 Division Needs Assessment and 2004 Division More Allied Health Services Evaluation and Needs Assessment indicate that the Barwon Division provides a program of activities that are well managed, of a high quality and which meet GP and patient needs. Recommendations from the two reports were:
The Barwon Division of General Practice
ø Continue its quality performance management
ø Focus on Continuing Professional Development, workforce issues and More Allied Health Services
ø Lobby relevant organisations for the provision of visiting medical specialists in the fields of obstetrics/gynaecology, paediatrics and psychiatry
ø Lobby relevant organisations and/or seek funding for the provision of (visiting) allied health services in the areas of counselling, occupational therapy, podiatry, psychology and speech pathology
ø Evaluate its current community publicity activities in terms of reaching target audience with intended health message
ø Persist with liaison with appropriate stakeholders with a view to increasing the participation of Aboriginal and Torres Strait Islander people in the MAHS program.
Division activity for the next three years has been grouped into 3 program areas:
1. Management
2. Population Health
3. GP Support
Management
The Division will continue to strive to excel in corporate governance and management. Governance and financial education will be provided over the three year period to ensure all Directors are aware of their responsibilities and educated so that they may fulfil them. The Division Constitution and Board structure is already under review to ensure it continues to meet Corporations Law and accommodates the changing face of the Division.
The Division will continue to increase the profile of general practice as a major stakeholder in health planning at all levels (local, state and national) through support to attend relevant meetings with key stakeholders. Consumer feedback will be sought for all levels of Division activity through the development of a Consumer Advisory Committee. Regular communication with senior management of key local organisations, such as the New England Area training Services, the Area health Service, neighbouring Divisions, Aboriginal Health and local Councils will increase Division knowledge of other health activity, improve relationships between organisations that will assist with health outcomes and workforce planning, and decrease duplication of services to GPs and the community.
In line with Government requirements for continued quality performance the Division will implement a local set of quality indicators and strive to excel in all areas of activity.
Population Health
The Division will continue to implement programs that meet the assessed health needs of the community while promoting the GP as an integral part of primary care. Current programs include Immunisation, Diabetes Integrated CAre, More Allied Health Services (incorporating the Lifestyle Program) and Chronic Disease Management. The Division will work in partnership with other health organisations to ensure a coordinated approach to the management of population health. The Division will promote opportunities to work with Aboriginal organisations to target key health issues whilst keeping abreast of the changing face of Australian health e.g. the increase in obesity amongst children, the increase in youth mental health problems, aged care, and implement and adapt programs to target these growing health concerns. A Consumer Advisory Committee (CAC) will be formed to provide advice on all aspects of Division program activities. The CAC will report to the Division Board of Directors.
New program development will centre on the health needs of the community as well as National priorities. A Childhood Obesity program is already in the planning phase and will be rolled out early in the 3 year funding period. Funding is to be provided to the Division Network to support better access to primary medical care for residents of Aged Care homes and to enable GPs to work with homes on quality improvement strategies for the care of all residents.
Although the Division has not had a specific Aboriginal program the Division programs target health issues that meet the health priorities of the local Aboriginal population. The Division would like to see the development of an Aboriginal project during the period covered by this strategic plan. It recognises that this will take time as much liaison will be required with the appropriate Aboriginal organisations and GPs to identify the health needs of the Aboriginal Communities, outcomes that are achievable and sustainable and ensure a duplication of services does not occur.
GP Support
The Division will continue to provide GP members with workforce support, the level of such support will be dependent on the level of workforce funding received by the Division (as yet unknown). However the 2004 Needs Assessment identified a perceived increase in occupational stress by the GPs when compared to the 1997 Needs Assessment. This increase is stress is due to a considerable number of factors:
ø An increased pressure of time due to the decreasing rural procedural workforce and increasing paperwork requirements to justify the work that GPs do both to the government and financially.
ø Increasing pressure due to patients as they demand perfection in their health treatment because of advances in medical treatment and medical technology.
ø Increasing pressure due to this demand for perfection and the society of blame in which we live leading to increased pressure associated with medical indemnity.
ø Increasing pressures surrounding staffing issues and Occupational Health and Safety.
ø Increasing pressures from practice accreditation, changes to the PIP, maintaining enough points for VR status, coordinating and supervising Overseas Trained Doctors and GP Registrars.
ø Increased pressure from lack of access to other health professionals such as Allied Health staff and Medical Specialists and the difficulties in therefore providing adequate care.
ø Increasing pressure in the provision of VMO services as hospitals struggle to maintain adequate staffing to maintain obstetric and theatre services 24 hours 7 days a week.
ø Increasing pressure to cover on call responsibilities which may be 24 hours 7 days a week for obstetrics and a 1 in 3 first or second on call for A & E due to workforce issues. The pressure to be in two places at once, both in the surgery and the hospital as people cannot get an appointment with a local GP.
ø Increased stress created by government decisions inappropriate and poorly thought out that impact on the GPs ability to be retained as a rural procedural practitioner.
The Division will continue to provide GP members with support to look after their own health, support to access education essential for them to continue practicing procedural medicine, support to assist them to supervise medical students and GP registrars the potential rural GPs of the future, support to towns in crisis from a medical workforce shortage, and support to provide community education. We will provide practice support to assist accreditation, practice management, practice nurse and staff education, and information management support. The division will investigate alternate ways of providing/employing a roving practice manager to assist practices in need of support.
The loss of the Rural and Remote General Practice Program funding from the Rural Doctors Network for locum support and Continuing Professional Development will have a major impact on the support the Division can provide to its GP members in this area. The 2004 Needs Assessment revealed a marked increase in GP satisfaction with the Division locum program. Unfortunately this extremely necessary and worthwhile program will now cease due to lack of funding. The Division will continue to assist GPs to locate locum services and provide support where possible. In a climate of increasing occupational stress the ability for the Division to support GPs to "take a break" is of high priority.
The Division will continue to provide a Continuing Professional Development program that enables GPs to access quality education locally. Opportunities for sharing of Continuing Professional Development with organisations such as the New England Area Training Service will be investigated to reduce costs as the sponsorship dollar decreases (or is non existent) for rural GPs. Medical students and Registrars will be supported to attend Division CPD events and social activities.
The Division will continue to work with local and state organisations who have an interest in maintaining and increasing the current GP and Allied Health workforce and will continue to assist visiting medical specialists to provide services to local towns should the Medical Specialist Outreach Assistance Program (MSOAP) continue. Should MSOAP funding not continue then, although the Division will no longer be able to support the medical specialists financially, we will continue to lobby relevant organisations for the provision of services especially in the areas of obstetrics/gynaecology, psychiatry and paediatrics.
The Division will support the Quality Use of Medicines and MMR programs through subcontracting of services to the Queensland Rural Medical Support Agency. The MMR program will be extended to support a new collaborative pharmacist/GP Residential Medical Management Review (RMMR) Scheme that will see the provision of education and information to GPs, Pharmacists and Aged Care staff.
Division funding, initially supplied to provide general practitioners and general practice support through education, health programs and workforce to better support their patients, is being asked to be spread further and further to support not only GPs but other specialist and allied health services and organisations such as the Area Health Service who see the Division as a means to fix all GP issues. As I write the Commonwealth has just released its response to the Divisions Review and whilst recommending that Divisions participate in rigorous quality evaluation and peer review, no additional funding is to be allocated to cover the extra staff hours required to perform these additional tasks. We are already over burdened with reporting and justifying expenditure of the Commonwealth dollar and precious staff time is being eaten up with paper work that could be better spent getting out there and "just doing it", as we have done. Unfortunately the Division Network has started down the red tape pathway and if not careful the days of producing quality health programs to meet local needs will be a thing of the past. The Barwon Division will resist becoming yet another health organisation overloaded with processes of accountability that prevent the speedy recruitment of appropriate staff and the production of meaningful outcomes that make a difference to the community.
That said, we will continue to strive with the small amount of funding that we receive, to produce activities of a high quality that support GPs to continue practicing high quality rural procedural medicine under increasingly difficult conditions and providing the residents of the Barwon Division with medical care of the highest standard. Background History
The Barwon Division of General Practice was formed in 1993 to give GP's a stronger role in meeting the health needs of the communities in the Barwon region. Incorporation of the Barwon Division of General Practice took place on the 26th October 1993. Moree and Narrabri Medical Staff Councils became local branches of the Division, each other town in the Division was deemed to have a local branch.
The Barwon DGP originally had a Management Committee which consisted of two members from each of the larger towns, Moree, Gunnedah and Narrabri and one member from each of the eight small towns. The Chairman/Medical Director rotated between towns on a yearly basis.
In November 2000 the Barwon Division of General Practice became a Company Limited by Guarantee. Incorporation introduced more accountable directorship and management and expanded the capacity of the Division to apply for a greater range of grant opportunities. A new constitution introduced a 2 year term for the Chairman providing continuity and stability. Members were required to join rather than opt off.
Staffing of the Division in the initial years consisted of an Executive Officer working from a home based office in Moree. With the introduction of Outcome Based Funding (OBF) in 1999 the Division employed a part time Program Manager and a full time Administration Officer. Additional funding such as the More Allied Health Services program and the expansion and maturing of Division programs such as the Integrated Care for Diabetes, has resulted in a rapid increase in the capacity of the Division and hence a marked increase in staffing. The Division now employs 14 people in full time, part time and casual positions and contracts the services of 10 private Allied Health providers. Whilst the majority of staff work from the Division office in Moree, 4 casual registered nurses and the Allied Health providers provide services from other towns within the Division area.
The Division currently has 39 GPs living and working in the Division area, 38 are registered members, an increase of 7 since 2000-2001. 29 of the 39 GPs are full time, 3 of which are female. 10 GPs are part time,7 of which are female. The Division currently has 11 GP Registrars working from practices throughout the Division area and 8 Overseas Trained Doctors. The full time equivalent GP number is currently 32.5 with 8.8 FTE Registrars. There are 17 Medical Practices within the Division varying from solo medical practices in the one-doctor towns through to multi-doctor practices in towns with two or more practices.
The Division has always enjoyed close to 100% membership with many members active on local, state and national committees such as Area Health Service Board, the Rural Doctors Network, Rural Doctors Association of Australia and the Regional Training Consortium.
A wide disparity of services are available within the towns of the Barwon Division of General Practice, with some of the smaller towns providing excellent general practice and non procedural services to their community, and some of the larger towns providing quite significant, surgical, anaesthetic and obstetric services to the patients of their area. Some of these larger towns also provide a referral service for some of the smaller towns in the local area.
All the hospitals within the region are under the Rural Doctors Association package 1987 and are in the category of RRMA 4 or 7 (these are other Rural and Remote Rural Practices). The referral Base Hospital for the area is Tamworth Base Hospital which is up to 300 or more kilometres from some towns within the Division area.
In 1999 the Division ran 5 programs - Diabetes Integrated Care, Cardiovascular Risk Factor Screening, Immunisation, Continuing Medical Education and Locum Support. All these programs continue today with the exception of the Cardiovascular Risk Factor Screening program. Other programs the Division has implemented since 1999 include Cervical Screening, Bowel Cancer Screening, Information Management for General Practice, Mental Health GP Liaison Program, Primary health Care Peer Support Program, and GP Registrar Accommodation Program.
Current Division Programs include the More Allied Health Services Program, Diabetes Integrated Care, national Diabetes Improvement Program, Chronic Disease Management Program, Workforce Support for Rural general Practice, Immunisation, Quality Use of Medicines, Home Medication Review, Medical Specialist Outreach Assistance program, Continuing Professional Education Program, Consumer Media Liaison, Mental Health Peer Support and the Combined Senior Executive program.
In the past 5 years the Division has achieved much for a small rural Division. Funding provided through the Department of Health and Ageing to assist GPs to raise the immunisation rate has seen the Division rate rise from 72.4% in 1999 to a current rate of 93.9%. In 2001 the Division held the highest immunisation rate for the whole of Australia, having held the number 1 position in NSW for some time. This was achieved with an Aboriginal population of 9% and a small number of GPs. The Division employs 4 registered nurses to assist the GP practices with data cleansing,education and cold chain monitoring. Over the past 7 years the Division has produced a comprehensive advertising campaign promoting the immunisation schedule for childhood vaccination and other programs as they were introduced eg. Q Fever, Hepatitis B, Flu.
The Integrated Diabetes Care Program, which was in its infancy in 1999, has developed into a highly successful recall/reminder register based around a HIC accepted care plan. Over 1000 patients are now registered on the database, 17% of which are of Aboriginal and Torres Strait Islander descent. 90% of Division GPs participate in the database. The development of the More Allied Health Services Program around the diabetes program has resulted in an enhanced program well supported by the provision of Podiatry, Dietetics, EPC Nurses and Physiotherapy services. The recent introduction of a lifestyle program coordinated by the Division Dietitians further enhances the program through education and assistance to make lifestyle changes and reduce risk factors. Funding recently awarded to the Division through the National Diabetes Improvement Program will see the development of self management resources.
The More Allied Health Services Program has gone from strength to strength since it's inception 4 years ago. The Division now employs 3 Dietitians (1.3 FTE) and 3 casual EPC nurses. Podiatry, Physiotherapy and Psychology services are contracted through private providers. Over the past 4 years the Division has also provided Speech Pathology and Mental Health services. Services are provided according to need as indicated by a yearly Needs Assessment. Recently the scope of the program has been broadened with the introduction of the Lifestyle program and the soon to be released Schools Program.
The introduction of Chronic Disease Management funding enabled the Division to provide education and support to practice nurses and GPs in the areas of Asthma, Diabetes, Cervical Screening and Mental Health. Numerous community advertising campaigns covering all 4 areas have screened on local television stations and in movie theatres, as well as appearing in local papers. GPs and practice nurses have been up-skilled in diabetes, asthma and cervical screening care. 6 GPs have completed level 1 training in the Better outcomes for Mental Health Initiative and 4 of these GPs have completed level 2 training.
Under the Medical Specialist Outreach Assistance program the Division currently provides Outreach Surgical Services, a Paediatric Specialist, Ophthalmology Upskilling. Generalist Physician, Haematology and Gynaecology services to numerous towns within the Division area.
The division continues to run a comprehensive education program based on a GP member needs assessment and utilising Medical Specialists from local referral centres i.e. Tamworth. In later years pharmaceutical companies have made the quest for the sponsorship dollar more and more difficult for small rural Divisions without a major centre, as the ability to attract large numbers of GPs is difficult.
The Division continues to experience a significant workforce shortage with a steady exit of GPs. To date most have been replaced but the quest for Australian trained procedural GPs who wish to practice country medicine is becoming harder. The development of the New England Area Training Services for the New England region has attracted more GP Registrars to the Barwon area to complete their rural term. The Division was very involved with the setting up of the New England Area Training Services, for GP Registrars, and has a representative on the Board. The fight to have a training unit in the Northwest has been long and arduous, but the Division has a number of dedicated GPs with many years experience as RACGP supervisors and they are determined that our Regional Consortia will succeed.
The formation of relationships with local Councils, the Area Health Service and Education Departments has seen a more coordinated approach to support for new GPs to the area. The communities of Warialda, Moree, Gunnedah, Narrabri, Boggarbi, Manilla, Bingara and Wee Waa (some in partnership with the Division) provide housing for GP Registrars, locums and Overseas trained Doctors, and some COuncils provide locum accommodation and free accommodation to GPs new to the area for a fixed term.
A significant amount of work has been done by the Division in the area of relationship building in the past 4 years. The development of the Combined Senior Executive (CSE), a committee consisting of the Chair and Executive Officer from the Barwon, North West Slopes and New England Divisions that meets quarterly with the CEO and Director of Mental health and Community Services from the Area Health Service, has created a forum in which to debate a number of cross Divisional issues with the Area Health Service with satisfactory results. The Committee was also the parent body from which the New England Area Training (NEATS) Consortia developed. From this forum various opportunities for shared programs have arisen including the Warialda Primary Care Program, the Regional Health Services primary Care Project and Clinical Risk Management for Small Rural Hospitals. The three Divisions involved in the partnership are known to have one of the best GP/Area Health Service relationships in NSW.
During the past 5 years the Division has been asked to present at various forums and community meetings on various topics ranging from workforce initiatives, the rural doctor shortage, and Division activities and programs. The Division provided the key note speaker at the NSW Summit on the rural GP shortage, "Finding a Cure", held in Tamworth in 2001, and also in Tamworth on the 14-15 th September, 2001.
During this same period a number of meetings were held with the Honourable John Anderson, Deputy Prime Minister and local Member for Parliament regarding various issues effecting rural GPs. Meetings have also been held with Ian Sinclair to progress the Rural Health Implementation Group (organised from the NSW Summit to progress the recommendations). Over the years the Division has collaborated with the New England Area Health Service on a number of projects e.g. Regional Health Strategy, Medical Specialist Outreach Assistance Program (MSOAP), Chronic Disease Initiatives, More Allied Health Services, Immunisation and Diabetes. Several meetings with the Rural Doctors Network have been held to discuss workforce issues, MSOAP and locums as well as ongoing liaison to encourage GPs into towns of Gunnedah and Wee Waa.
The Division has been represented on several New England Area Health Service (NEAHS) committees and working parties such as the Strategic Planning and implementation committees, Critical Care Committee, Area Medical Staff Council, Regional Health Services Primary Care Steering Committee and Working Party , Diabetes and Chronic Care Committees.
The Immunisation and Diabetes programs provide support to the Aboriginal communities in Moree, Toomelah and Boggabilla. Immunisation data cleansing is provided on a regular basis to the three communities and, when available, MAHS services are utilised to provide diabetes clinics at the Moree Aboriginal Medical Service. The recent employment of a GP at the Moree AMS and the receiving of additional funding from the Office of Aboriginal and Torres Strait Islander Health has seen support provided to the Moree AMS for practice accreditation and EPC education. The Division plans to explore opportunities for an Aboriginal health program that meets a health need identified by the local Aboriginal community and GPs.
The quality and outcomes achieved by the Barwon Division programs and the persistent effort to create productive relationships with key health organisations has seen the Division become the recipient of a number of awards:
Highest Immunisation Rate in NSW 2002
Moree Professional Business of the Year 2003
The Inaugural John Aloizos Medal - Dr Grahame Deane 2003 Postcodes 2340, 2343, 2346, 2347, 2356, 2379, 2380, 2381, 2382, 2383, 2385, 2386, 2387, 2388, 2390, 2391, 2394, 2397, 2398, 2399, 2400, 2401, 2402, 2404, 2405, 2406, 2407, 2408, 2409, 2411, 2833 Geographic Spread The Barwon Division of General Practice covers a wide area of northwestern New South Wales. From the south the main town is Gunnedah, stretching to the north to the Queensland border including the small town of Mungindi and further to the west to Collarenebri. The area covered is approximately 44,132 square kilometres; inside that area are 53744 (plus Collarenebri) patients who seek their medical care within the region. Neighbouring Divisions are New England, North West Slopes and Outback Divisions of General Practice.
85% of the population reside in outer regional NSW while 15% reside in remote NSW Australia. The population spread varies from .6 persons per km squared (Yallaroi Shire) to 1.5 persons per km squared (Manilla shire). 6 of the 7 local government areas covered by the Division area have experienced a negative population growth since 1997. Demography Population based on the ABS 2001 Census of Population & Housing: Census Basics: Place of Usual residence is 53186. ABS data based on Local Government Areas suggests that the gender mix is 50% males and 50% females. 10.4% of the population are of Aboriginal and Torres Strait Islander descent based on the ABS 2001 Census of Population & Housing: Census Basics, Place of Enumeration (Figures were not available for Collarenebri).
Age distribution
0-14 23%
15-24 12%
25-44 28%
45-64 24%
65 and over 13%
While the New England Health area has the third highest proportion (5.83%) of Aboriginal and Torres Strait Islanders of any statistical division within New South Wales, the proportion of Aboriginal and Torres Strait Islanders residing in the BDGP area (10.4%) is almost double that of the New England Health area. Great regional variations also exist in relation to the proportion of Aboriginal and Torres Strait Islanders within the BDGP area, ranging from 1.6% in the Bingara Local Government Area to 18.2% in the Moree Plains Local Government Area.
The BDPG's area 'index of Relative Socio-Economic Disadvantage (IRSED) is 984, which is well below the IRSED for all of NSW of 1007. This means that morbidity and mortality rates will be higher for BDGP residents than for all residents of NSW, let alone residents of NSW urban centres. Residents of the NEAHS area have a significantly higher mortality rate in respect of respiratory diseases. Male residents of the area have significantly higher mortality rate in respect of asthma, coronary heart disease and injury and poisoning. Female residents had a significantly higher mortality rate in respect of melanoma of the skin. It is important to keep in mind that BDGP residents are more disadvantaged than NEAHS residents and therefore, critical health outcomes for BDGP can be assumed to be slightly worse than those of NEAHS residents.
In terms of unhealthy behaviour patters which contribute to ill health, it can be noted that, compared to all female residents of NSW aged 16 years and over, female NEAHS residents are significantly more likely to be overweight and obese and male NEAHS residents are significantly more likely to engage in risk drinking (alcohol use) than their NSW counterparts.
As far as suicide is concerned, the NSW mortality rate (1990-1993) was significantly (p<0.05) higher for males living in other rural and other remote areas (rate ranging from 26 to 43 per 100,000) than for males living in Sydney (rate of 19 per 100,000).
According to data presented by the Australian Bureau of Statistics report '1995 national health Survey', the residents of the New England Health area showed the lowest proportion of any statistical division within NSW of taking action for their health, the lowest proportion of consultations with other health professional and the third lowest proportion of doctor consultations.
Based on the ABS 2001 Census of Mean Taxable Income and Mean Net Tax by Local Government area ranges from $27,525/yr to $35,945/yr. The total unemployment rate (5.4%) is slightly higher than for NSW (5.3%), with differenced across the age range:
NSW North west NSW
15-24 years 10.3% 11.9%
25-44 years 5.1% 5.9%
45-64 years 3.1 1.9%
65 years and over .2% 0%
The main employing bodies are agriculture, forestry and fishing, manufacturing, retail, education and health.
The lack of public transport for people who do not drive a vehicle is a constant source of discontent to rural communities and has been identified by Division residents to be a major issue in accessing health services. Membership 39 Gps are eligible for Division membership. The Division currently has a membership of 37 GPs. All GPs living and or practicing within the Division area are eligible for membership. There are 35 resident General Practitioners and 5 non resident GPs working in the BDGP, serving a population of 53186 of whom 5466 (or 10.4%) are Aboriginal or Torres Strait Islanders. The GP gender mix is 29 Males, 9 females. The age mix is Males: average age 45 years Females: average 36.7 years Combined average age: 48.5 years. There are five husband/wife teams. The FTE GP resident number is 32.5. 8 of the Division Gps are Overseas Trained Doctors. The majority of Division GP members are procedural GPs providing obstetrics, Anaesthetics, surgical and Emergency services to local hospitals. Because of the rural nature of our Division, some GP's provide medical services outside the Division boundaries (eg GP service to Lightening Ridge, anaesthetic services to Coonabarabran). In addition to this, some GP's also provide services to the Aboriginal Medical services located within the Division.
Another unique feature of the Barwon DGP is that there are no resident medical specialists in the Division. The Division currently enjoys the support of 11 GP Registrars.
The BDGP area's centres from which medical and allied health services are provided fall within RRMA classifications 4 to 7. The BDGP FTE GP to population ratio is 1:1620 (or 61.7 FTE GPs per 100,000 population) which is not only worse than the FTE GP to population ratio of 1:1507, (or 78 GPs per 100,000 population) for the whole of the New England health service area but, perhaps even more importantly, way above the benchmark calculated by the Australian Medical Workforce Benchmarks report for this region of 1:1116
GP to population ratio per LGA (including GP Registrars):
Barraba 1.4 for 2183 = 1:1559
Bingara 2.1 for 2058 = 1:980
Gunnedah 6.1 for 12090 = 1:1982
Manilla 3.7 for 3234 = 1:874
Moree Plains 12.1 for 15457 = 1:1277
Narrabri 10.1 for 13932 = 1:1379
Yallaroi 3 for 3192 = 1:1064
Collarenebri .9 for 520 = 1:577 (underestimate as figures based on population for the town only not the district)
These figures significantly underestimate the full time equivalent GP to patient ratio due to the procedural nature of rural general practice and hospital responsibilities.
Since 1997 the Barwon Division has lost 29 GPs and gained 23. Some towns continue to experience a shortage of GPs e.g. Gunnedah, while others are facing a future crisis e.g. Moree. The 2004 Needs Assessment revealed that 6 GPs intend to leave the Division in the next 2 years. The Division has experienced an acute shortage of GPs in recent years and it is only in the last 12-18 months that GP numbers have returned to the levels of 1997. Having said that a number of Division GPs have indicated that they wish to retire in the next 1-2 years, with others indicating they will be leaving due to schooling. 3 of the retiring GPs are GP surgeons from Moree. Should they leave and not be replaced Moree could face a loss of surgical and obstetric services. Succession planning is underway in the town of Moree with organisations such as the Health Service, Local Councils, GPs and the Division involved. In the town of Gunnedah a 3rd practice is being established within the Health Service grounds to enable additional GPs to practice, as rooms are not available in current practices.
Whilst 80%-95% of GPs are very satisfied/satisfied with their job/remuneration, 78% considered their occupational stress to be a health concern. This is an increase from 67% in 1997. Whilst shortages in GP services have declined in the past few years, workforce continues to remain a major issue for the Barwon Division with the average GP age being 48.5 years. The Barwon Division will continue to work with key stakeholders to encourage younger GPs to rural areas, whilst trying to support the current workforce.
The 2004 Needs Assessment indicated that the provision of locum services has improved: down from 75% of GPs who found it difficult/impossible to obtain a locum to 43% of GPs in 2004. The most improved BDGP program related to locum support (up from 35% of GPs who assessed it as very good/good to 95% of GPs). Nevertheless, considering the increase in the percentage of GPs who consider their occupational stress to be a health concern, the provision of locums and locum support remains a high priority for the Barwon division. unfortunately funding received from the Rural Doctors Network that enables the division to provide locum support will not continue for the 2004-2005 year. This will seriously effect the Division's ability to provide locum support as OBF funding has not increased to compensate. The Division will investigate ways in which it can continue supporting the provision of locums to GP members. Issues The following health care facilities operated by NEAHS are located within the BDGP:
two district hospitals, providing a total of 89 beds
two community acute hospitals, providing a total of 70 beds
three community non-acute hospitals providing a total of ..... beds
two multipurpose services providing .......38+
three community health centres and four primary care posts.
There is no base hospital within the BDGP area and two of its three major towns (Gunnedah and Narrabri) are classified RRMA 5 with Moree being RRMA 4.
The 2004 Needs Assessment highlighted deficits in medical specialist services such as obstetrics, gynaecology, paediatrics and psychiatry as a continuing concern and deficits in allied health services including counselling, occupational therapy, physiotherapy, podiatry and speech pathology remain high.
The Barwon Division's major stakeholders:
New England Area Health Service - Combined Senior Executive, Warialda Primary Care project, Regional health Services Primary Care Project, Broadband, CLinical Risk Management
Local Councils - GP accommodation projects, GP Entity
University of New England - Better Outcomes in Mental Health Allied Health Initiative
Rural Doctors Network - GP Coordinator, locum funding, workforce support, Combined Senior Executive
New England and North West Slopes Divisions of General Practice - Combined Senior Executive, resource sharing information sharing, support.
New England Area Training Services - GP Registrar training
Aboriginal Medical Service - Immunisation and diabetes programs, practice accreditation, EPC education
Community Health Centres - Shared MAHS personnel, Immunisation support, diabetes integrated care program.
Report Summary 2004-2005 has been a year of change for the Barwon Division, both internally and externally. Board structure and staff structure were reviewed and altered to accommodate the increased program activities of the Division as well as the additional demands for accountability from funding bodies. Externally the Area Health Service underwent amalgamation which resulted in a change in relationships at a senior management level, the interruption of a number of programs and the loss of what was a very positive working partnership between the Area Health Service and the Division.
2004-2005 has also seen the introduction of 'performance monitoring' through the introduction of Key Performance Indicators and Accreditation. More and more staff hours are spent reporting, analysing and justifying, with less time being available for 'just doing'. Outcomes and progress are achieved through action and enthusiasm and Divisions need to be careful that they don't become non productive, bureaucratic, paper shuffling organisations that cease to produce the excellent outcomes that they have to date because they are too busy completing paper work to justify their existence.
Amongst the change the Barwon Division has continued to strive for excellence in program activity and service to it's members. Whilst staff changes have effected some program outcomes, on the whole the Division has continued to maintain long term program outcomes whilst developing new programs to meet the health needs of the community through general practice support.
Management
The Governance structure of the Division has undergone change with the introduction of a new Constitution. The Division Board of Directors felt that the Board structure as it was, maintained the focus at an individual town level instead of the Division as a whole. A Constitution Committee was formed in February 2004 to redraft the Division's Constitution. The Constitution was presented at a General meeting of the membership on the 22nd September 2004 and passed by 78% of the membership. The Board structure now consists of 7 Directors (reduced from 13) from any town within the Division area, with no more than 2 Directors from any one town. On the 14th November 2004 the new Board was elected resulting in a mix of experienced, long serving Directors and new Board Directors. 100% of Board Directors are trained in level one Governance, with 70% having undertaken finance training. A Consumer Advisory Committee is currently being elected to provide advice on Division activity and report to the Division Board.
A review of staff positions was conducted in May 2004 and a more vertical structure introduced in July 2004 to provide management responsibility at a lower level. A second Program Manager was recruited and an Education and Support Officer. In July 2005 the restructure was implemented and it was hoped that CEO's administrative and reporting time would be reduced in an attempt to increase time spent on true CEO duties. This failed to occur as the Program Development Officer found the additional duties difficult to handle and resigned from the position. The structure has returned to it's original horizontal structure to be reviewed in 2005-2006. The employment of additional staff has however assisted to relieve the workload of the CEO and Program Manager.
New staff attended Occupational Health & Safety training in February 2005. OH&S remains an agenda item at every staff meeting and is now a standing agenda item for Board meetings. The Risk Management Plan is continuing to be updated against the AS/NZS 4360:2004 Risk Management Guidelines to meet Insurance requirements. Policy & Procedure continue to be updated as required. The Division registered with ACHS for Accreditation survey and the self assessment will be undertaken in March/April 2006.
The Division has continued to develop relationships with other stakeholder organisations including neighbouring Divisions, Area Health Service, New England Area Training Services, and the University of New England. The Combined Senior Executive Meeting is held quarterly and involves the Chief Executive Officer and Medical Director from the Barwon, New England and Northwest Slopes Divisions. It continues to provide an excellent medium for sharing of resources and ideas, and regular access to the executive of the Area Health Service to discuss common issues that effect all three Divisions. Due to the restructure of the Area Health Service a similar committee (GPAC) has been developed across the Hunter/New England Area Health Service with 5 Divisions - Barwon, New England, North West Slopes, Hunter Rural and Hunter Urban Divisions. The General Practice Advisory Committee (GPAC) meets quarterly and involves stakeholder representation from the NSW Rural Doctors Network, the Newcastle University, the regional training services, the Area Health Service and the Divisions. An initial meeting was held in April 2005 and several working parties were developed to investigate more closely issues such as workforce retention and recruitment, education, Primary Care, After Hours Care, and Chronic Disease.
Major activities with other stakeholder organisations for the 12 month period include the Warialda Primary Care Committee (a 12 month funded program to set up coordinated primary care across a small town), Electronic Discharge and Referral Service (in partnership with the Area Health Service and neighbouring Divisions) and Clinical Risk Management for small rural hospitals (in partnership with the Area Health Service and neighbouring Divisions). The Better Outcomes Initiative for Mental Health - Allied health Services program was run in collaboration with the University of New England, the Education Department and Gwydir Shire Council. The Division also assisted the Aboriginal Medical Service to gain Accreditation. In the second half of the year the Division, in partnership with the Rural Doctors Network and Murrumbidgee Division undertook the coordination of the placement of RDN locums throughout NSW. In May and June 2005 the Division provided consultancy hours for the Wollongong University to investigate the capacity of rural practice within the Division area to accommodate long term medical students from their newly formed rural Medical School.
The Division continues to promote topical health issues and Division activities through the local media and other advertising channels. Three rolling advertisements were screened in local movie theatres promoting the chronic disease initiatives to the public. Several media articles were placed in local papers however this activity will cease and be replaced with media releases concerning topic health issues and Division activities as required.
Population Health
Immunisation
The Division finished the year with an immunisation rate of 93.1%, a drop of 0.4%. For the first time in 7 years the Division immunisation rate has decreased. The Division Immunisation nurses continue to visit GP Practices every quarter to assist with data cleansing and monitoring of performance through the ACIR 032A report. 100% of Division practices are utilising this report to monitor immunisation rates. Annual Cold Chain audits were completed in January with 100% practice compliance. Two meetings were held between the Division Program Manager and the Immunisation nurses for education and peer support. 13 of 16 (81%) GP practices have an immunisation rate >90% (previously 94%). 8/16 (50%) have an immunisation rate >95% (previously 37.5%).
Reasons for the decrease in immunisation rate are currently being investigated and a program will commence in 2005-2006 aimed at increasing the awareness of the 4 year old schedule.
Liaison and assistance continues to be provided through the Division program to Community Health centres at Boggabri and the Aboriginal Medical Service at PIUS. A small number of practices are transferring electronic immunisation data. An Immunisation Clinical Audit with the RACGP was completed for those GPs wishing to participate. 25 CA points were awarded.
Chronic Disease Management
Activity continues under the Chronic Disease program to promote the GP uptake of the SIP and SOP for Diabetes, asthma, cervical screening and mental health. The Division has provided training to practice nurses in Asthma, Cervical Screening, Home Medication Management Review, Immunisation and Diabetes and a networking day for practice nurses was held in July. A regular practice nurse newsletter is compiled and disseminated by the Division.
An intensive health promotion campaign has continued including print media, electronic advertising and movie theatre advertising. Topics covered have been asthma, diabetes, lifestyle, and cervical screening. The Division ran a rolling advertising campaign in three movie theatres within the Division area, covering Diabetes, Cervical Screening and Asthma. During the 12 month period over 80,000 people viewed the advertisements.
The GPs continue to utilise a small laminated resource developed by the Division to assist with the item numbers.
In August the Division attended the Gunnedah Agricultural field day offering lifestyle assessments and advice. 3 GPs, the Division Dietitian, EPC Nurses and program staff attended and assessed 309 people.
Summary of results:
Number of people assessed 309
Average age 46.9 years
Average BMI 27.73
Number of people with BMI>25 52 (17%)
Number of people with random BSL>7 45 (15%)
Number of people with detected skin spots 101 (33%)
Number of people with diastolic BP>90 30 (10%)
The Division continues to implement the Diabetes Integrated Care Program which involves 1383 Diabetes patients being recalled according to the NSW Guidelines for the Treatment of Diabetes and the MBS item Numbers. Through the Division Diabetes Care Plan and Recall/reminder register 382 patients were referred to a Dietitian, 253 to a Diabetes Educator, 431 to an Ophthalmologist, 47 for Renal checks and 322 to a Podiatrist (all MAHS funded). 83% Division GPs are participating in the Division recall/reminder database. 13% of the total registrations are patients of Aboriginal and Torres Strait Islander descent. The Diabetes Program was to be evaluated by the Newcastle University but after some delay both parties decided that local evaluation would be more efficient and politically correct. Evaluation was completed in January with the report finding that all 4 goals guiding the Barwon Division Diabetes recall/reminder program had been successfully met:
ø The BDGP database enables effective recall mechanisms of patients and close monitoring of clinical practice and local outcomes
ø GPs were successfully assisted in improved management of their diabetes patients
ø Effective networking with allied health professionals provided coordinated service delivery
ø Patients were satisfied with the services provided as well as their illness management.
Recommendations from the report were:
ø Improved completion of clinical and patient referral data by the GPs
ø GP education to increase the range of medical data currently being recorded, participate in the electronic transfer of data, and jointly develop protocols relating to the establishment of an electronic data base.
The Division was successful in obtaining a grant under the Strengthening GP Involvement in Chronic Care to fund redevelopment of the diabetes database. This project will be undertaken in partnership with the New England Division of General Practice and Hunter New England Area Health. The year long project aims to give birth to a more electronically integrated and multi functional diabetes database and recall/reminder system.
The National Diabetes Improvement Program concluded in December 2004. 53 Consumers participated in 9 focus groups ( 5 Indigenous and 4 non-Indigenous) to investigate the need for a resource that would assist with patient self management of diabetes. The result was the production of two comprehensive patient support manuals - a non-indigenous and indigenous manual. The manuals were trialled by 18 Indigenous and non-indigenous diabetics and feedback received was very positive. Unfortunately when the funding was applied for a small patient diary was envisaged as the outcome. Instead a comprehensive support manual has been developed to meet the consumers needs. As a consequence the cost of printing the manual is far beyond the scope of the program budget. As a result a reduced number of manuals were printed and distributed to GP practices. Feedback from GPs has been extremely positive concerning the quality and usefulness of the manuals.
14 Division GPs underwent level 1 of Sphere training to enable them to take up the Better Outcomes for Mental Health item numbers. 4 GPs have completed Level 2 training, 7 GPs have registered for the Better Outcomes in Mental health initiative level 1 and 2 GPs have registered for level 2. The Division received funding to provide Allied Health services under the Better Outcomes for Mental Health Initiative, and in partnership with the University of New England, provided weekly Clinical Psychology services to Warialda and Bingara. The Division was unable to recruit to the part time position in Moree, however a private Clinical Psychologist in Gunnedah began providing a service to the towns of Gunnedah, Manilla, Wee Waa and Boggabri late in the 2004-2005 year. The Division has received consent to carry unspent funds into the 2005-2006 year to enable a full time position to be recruited for Moree as well as the expansion of private clinical psychology services.
More Allied Health Services
The More Allied Health Services program has continued to develop and is now seen as one of the main priorities by Division members. In the 12 month period the Division has been able to offer Podiatry, Physiotherapy, Psychology, and Dietetics to a large proportion of the Division population.
Dietetics
Dietetics services have remained stable with the Division employing 1.75 FTE Dietitians. A clinical service has been provided to Gunnedah, Collarenebri, Bingara, Warialda and Moree, and the Division lifestyle program "Ready, Set....Live" has been delivered to Mungindi and Wee Waa. The lifestyle program targets people with cardiovascular risk factors through a 9 week program that provides education on diet, exercise, motivation, preparation of food, and understanding food labels. The Division Dietitian coordinates the program and MAHS workers are utilised to facilitate the exercise and motivation sessions where ever possible. Individual patient risk factors are monitored throughout the 9 week course. The program was evaluated by the Newcastle University and results showed a decrease in BMI and Cholesterol of participants, a high degree of satisfaction with the program (89% said it was excellent, 11% said it was good), and 80% of participants were more satisfied with their body shape at the end then at the commencement of the program. Recommendations from the evaluation pertaining to collection of data will be implemented in a revised program. The Division Dietitians have developed a schools based lifestyle program that will be implemented early in the 2005-2006 financial year.
Podiatry
The Division has continued to provide Podiatry services through 7 contracted private providers (0.55 FTE). The Division has been fortunate in accessing Podiatry services to provide regular visits to Gunnedah, Narrabri, Wee Waa, Mungindi, Barraba, Manilla, Warialda and Bingara. 415 patients were delivered 1095 occasions of service. Due to the increase in referrals of diabetes patients under the MAHS program and the Division Diabetes program, a restriction on the number of sessions a patients may receive under the MAHS program is being considered for next year.
Physiotherapy
Physiotherapy services are provided to Narrabri, Gunnedah, Boggabri, Bingara and Warialda by 4 private contractors (0.3 FTE). 165 patients were delivered 512 occasions of service. Due to increase in referrals and funding shortfalls a limit has been placed on each provider regarding the number of sessions each patient could receive under the MAHS funding.
Psychology
A private Psychologist provides services to Gunnedah, Wee Waa and Boggabri clients (0.1 FTE). 51 patients were delivered 191 occasions of service. Expenditure is on target for the year so far.
Occupational Therapy
No referrals have been received for this service so it has been dropped and funding channeled into the other MAHS services.
Due to a significant increase in referrals to the services employed under MAHS, referrals to the program were ceased in the last month of the year to avoid private providers not being paid for services rendered. Alternative service models are currently being investigated for the 2005-2006 to avoid this situation occurring again. Talks have been held with the Hunter New England area Health Service to establish reasons for long term vacancies and possible cooperative models to assist the Division whilst these vacancies exist. To date no cooperative model has been established.
EPC Nurses
The EPC nurses continue to provide a valuable service to GP practices assisting with care planning and health assessments (0.2 FTE) but are no longer funded under the MAHS program. The uptake of EPC Medicare item numbers for Care Planning and Case Conferencing was 78% (June 2004). More current data was not available. 225 care plans and 45 health assessments have utilised the assistance of the Division nurses. This service is now self funding, however the Government changes to the EPC item numbers will effect the service delivered and the capacity for it to continue to be self funding.
Aged Care
The Aged Care program was implemented late in the reporting period following a needs assessment, August 2004, by the Division of the Aged Care facilities and General Practitioners within the Barwon Division. From the Needs Assessment a priority action list was developed for each facility. Generally the priority issues were access to a GP after hours and access to a GP for new patients. A meeting was held with the CEO, Program Manager and Medical Director to develop a model for the GP panels. This model was presented and approved by the Board. The model provided a GP panel for each town within the Division coordinated by the Division Program Manager and a GP Program Coordinator. The GP coordinator and GP panel members were recruited to each panel according to the Program guidelines. The Division has 9 panels each with one GP panel member and the GP Coordinator. An initial meeting of all panel members was held in November with GP panel meetings commencing with Aged Care Facilities in December. Representatives from the Aged Care Facilities were invited to the panel meetings. One or two priorities were addressed for each facility at the panel meetings with recommended actions being discussed and decided upon. GP panel members were encouraged to promote the CMA item number amongst their peers and this was also promoted within the Division newsletter. The initial outcome from the panel meetings was the development of after hours rosters for a number of facilities. Results from the Aged Care GP panels Initiative 2004 Aged Care homes benchmark survey indicate that there is much work to do to improve GP services to the Aged Care facilities. It is interesting to note that although 100% of Aged Care facilities in the Division area had received numerous phone calls and had been surveyed for their needs, 38% indicated in the National survey that they had had no contact with the Barwon Division and 43% weren't aware of the GP panel program.
Follow up panel meetings were held in May 2005 with 12 of the 14 homes reporting an improvement in patient access to GP services. 3 of the 14 homes continued to report that no issues existed and they were happy with the service provided. 3 homes reported an increase in CMA's.
HIC data indicates that there has been a -2% increase in services by GPs to Aged Care homes during 2004-2005. The reported decrease in services could be due to the fact that 2.5 GPs have left the division area and 1.5 GPs have not been replaced. The sample size is so small that 1 GP ceasing services to the Aged Care facility would influence the statistics negatively. This decrease is in light of a reported increase in services by the Aged Care facilities.
There has also been a decrease in GP services as a ration of FTEs (-4.1% increase), but in real terms this is a decrease by 6 services. Again the small sample size inflates the percentages. The percentage of female GPs providing services to the aged Care facilities has decreased from 27% to 23%. 1 female GP moved to a position with the Aboriginal Medical Service during the reporting period and .5 FTE female GP left the Division area.
There was a 16.7% increase in GPs over the age of 55 years providing services to Aged Care facilities, an indication that the average age of GPs in the Division area is ever increasing.
Practice Support
Workforce Support for Rural General Practice (WSRGP)
The basis of the WSRGP program has been to support GPs to look after their own health, support GP members in times of crisis, support those GPs who take on an educational role in supporting medical students, and support GPs who take on an education role in the community. Liaison with local stake holders who are major players in recruitment and retention of GPs in the area continues with the Division maintaining close association with New England Area Training Services (NEATS), the regional consortia for GP Registrar Training, local Councils and the Area Health Service. A detailed guide to accessing support from the Division has been developed as has an orientation package for new GPs and Registrars.
The funds have enabled the Division to continue providing assistance in the area of accreditation and practice support. The Division has employed for some time a registered Nurse, (currently working as a Practice Nurse in one of the Division practices) to provide consultancy advice on accreditation preparation. Currently 100% of eligible practices are accredited with the majority preparing for or undergoing reaccreditation.
The Division investigated models of practice management provision following a survey in which 50% of the practices indicated that they would like the Division to provide practice management services to their practices. In June 2005 a consultant practice manager was approached to provide a trial initial assessment to a practice within the Barwon Division. The outcome of this visit will be reported to the Board in August but it is expected that a formal association will be developed in order to assist GP practices with practice management.
GPs have also been supported to represent the Division at meetings with stakeholders to discuss workforce issues. The Division is currently experiencing a decrease in GP numbers in it's larger towns - Moree, Gunnedah and Narrabri. Moree has lost one GP in 2004-2005 and expects to lose another two at the end of 2005. The critical problem is the loss of procedural GPs and the difficulty recruiting appropriate replacements. The New England Area Training Scheme is currently providing 14 GP Registrars to the Division, 4 alone to Moree. It is hoped that GP Registrar number can be maintained and increased in the larger towns, which would assist the immediate shortage. Meanwhile the Division continues to work with other stakeholders to attract procedural GPs to the area.
A scholarship fund in honour of Dr William Hunter, a long serving Moree GP Surgeon, has been implemented to provide support to a Medical, Allied Health or Nursing student entering the second year of their training, to assist with education costs and encourage more rural students to return to the country to practice their profession. A small scholarship committee is coordinated by the Division and includes the Chamber of Commerce, Vision 20/20, and a community representative. The scholarship is funded through community donations.
By March 2005 it became obvious that the uptake of funds under the initial WSRGP program plan was slow and funding to some areas of the program would not be required. Consequently an alternative plan and budget was proposed to the Department and accepted. As a result locum support was introduced for those GPs who were not eligible for NSW Rural Doctors Network Locum Support roll out late in 2004-2005.
The Division received funding to assist the Aboriginal Medical Service prepare for accreditation. The AMS was surveyed in December 2004 with conditional accreditation being awarded on the 31st December 2004 and full Accreditation granted in 2005. EPC, PIP and SIP education was provided to staff and the GP and an MOU was developed to formalise the partnership. Assistance has been provided with recruitment of staff for the AMS.
The Division has continued to provide Continuing Professional Development to all GP members, Registrars, Medical Students, Practice Nurses and Practice staff according to the Needs Assessment conducted in December 2004. Education needs were prioritised by town and the program was delivered across the Division area. The Division continues to struggle with accessing sponsorship from Pharmaceutical companies due to distance and small GP numbers. During the reporting period 12 education sessions were held covering topics such as Managing Traumatic Brain Injury in the Community, Neurology, Breast surgery, Women's health, arthritis, drink less, critical evaluation of articles, drug and alcohol, neonatal outreach, chest physician. 75% of Division GPs attended Division CPD. The Division AGM/CPD day held in November attracted 20 (over 50%) GPs and two medical students. BOIMHI level 1 training was provided to 14 Division GPs and Community Mental Health workers. This training was funded through the Mental Health Peer Support money carried from last year. Two training days were held for practice staff covering topics identified on the needs assessment such as Occupational Health & Safety.
Medical Specialist Outreach Assistance Program (MSOAP)
A number of specialist services were provided and assisted with funding through the MSOAP program. This program has been particularly difficult and time consuming to manage due to the manner in which funds are allocated. Services currently being funded include:
Visiting surgical services - Bingara, Mungindi and Warialda
Paediatrics- Gunnedah
Gynaecology - Narrabri, Inverell
Generalist Physician - Barraba
Ophthalmologist - Moree
Endocrinologist - Moree
554 Occasions of Service have been provided through the 7 months of the funding period with 24.5 hours of upskilling provided to Division GPs.
Quality Use of Medicines
The Quality Use of Medicines program continues with the Queensland Rural Medical Support Agency providing the Division with Home Medications Review and National Prescribing Services. 20 (50%) of Division GPs were detailed in October 2004 on Proton Pump Inhibitors and 22 (55%) were detailed in February on.......................... A joint information session was held in Narrabri for GPs and Pharmacists but attendance numbers were poor. GPs were notified of relevant HMR, NPS information via newsletters and fax outs. Whilst the QUM program under NPS funding continues to be well received by GPs, the HMR program under the Pharmacy Guild continues to be poorly received due to the difficulties implementing this program in a rural area where Pharmacists operate from sole practices and cannot access locums to allow them to attend training or leave their practice during the day to undertake home visits. Various options have been investigated with little success. 1 HMR plan was completed during the reporting period.
Locum Program
The Division was successful in tendering for the coordination of the Rural Doctors Network Regional Locum Program in partnership with Murrumbidgee Division and the NSW Rural Doctors Network. The Division was appointed to assign a program manager to coordinate locum placement for the northern region of NSW. Unfortunately the Rural Doctors Network has been unable to recruit a suitable candidate for the role of the rural locum doctor. Late in the reporting period RDN rural subsidy grants were administered to eligible remote practitioners throughout NSW in recognition of the inability of the RDN Locum service to furnish demand for locums in 2004-2005.
The University of Wollongong engaged BDGP in 2005 to report on the current climate of student placements and demographics of the area to inform early analysis of the potential for student placement in practices encompassed by the Division. It is anticipated that further consultation between GPs in selected local government areas in the division and the University of Wollongong will take place in the latter half of 2005.
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