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Mission Statement To further the delivery of quality General Practice to the Blue Mountains community. Executive Summary Up to 31 December 1997 the Blue Mountains Division of General Practice received funding for specific projects. On 1 January 1998 the Division entered a transition period of 18 months leading to a move to Outcomes Based Funding. During the transition period the Division received General
Funding based on its Transition Plan of outcomes and goals which was submitted in March 1998.
From 1 July 1999 the Blue Mountains Division of General Practice will be adopting Outcomes Based Funding and will be funded accordingly. In preparation for this new arrangement, the Division has utilised its continuing needs assessment process to redefine its core business and respond to GP, consumer and other stakeholder needs.
The needs assessment incorporated the following factors:
ø Demographic characteristics of the Blue Mountains.
ø Health status of the Blue Mountains population.
ø GP population in the Blue Mountains.
ø Availability of health services particularly Mental Health.
ø Health and service priorities.
ø Management of certain conditions in GP surgeries particularly Diabetes.
ø GP Practice support and computerisation.
The Division's Strategic Plan has been developed taking into account the conditions of grant, GP needs surveys, community consultation through focus groups, health needs analyses held by the Blue Mountains Council and evaluation of current and past projects carried out by the Division. As a result the Division has identified the following programs for its Strategic Plan:
1. GP/ Practice Support
ø Accreditation
ø Education
ø Computerisation
ø GP surgery / administrative support in the areas of contaminated waste management, health services directory, receptionist training.
2. Public Health / Disease Focus
ø Immunisation
ø Mental Health
ø Diabetes
3. Management / Organisation Support
ø Division Management Board
ø Division staff
ø GP participation in Division activities
4. Liaison/Communication/Networking
ø local health planning
ø collaborative programs with Wentworth AHS
ø promote Blue Mountains Division
ø communication with consumers Background The Blue Mountains Division of General Practice (BMDGP) was incorporated on 18 November 1994. The Division is based in Katoomba and is located within the Blue Mountains District Hospital. The Division also occupies an office at Springwood, which is located in the Community Health Centre. This office is used by the Diabetes Nurse Educator. There are 71 doctors who form 30 practices within the Division. Fifty-nine doctors are members of the Division (83%).
The Management Board consists of nine members who are GPs and the Executive Officer.
The Management Board meets once a month in the evening. The Division employs an Executive Officer who oversees the general administration of the Division. The Division also employs a Projects Officer, a Diabetes Nurse Educator, a part time Accounts Officer and a part time Administrative Assistant. All staff other than the Diabetes Nurse Educator are based at the Katoomba office.
The Blue Mountains Division received project funding since its inception. Some of the projects were Palliative Care, Physiotherapy Outreach, Consumer Liaison, Diabetes, Mental Health, and Health Services Directory. In December 1997 project funding ceased and the Division was allocated transitional funding in January 1998 and submitted its Transitional Plan in March 1998 for the period 1/1/98 to 30/6/99, leading to its move to Outcomes Based Funding (OBF) on 1/7/99. Postcodes 2773, 2774, 2776, 2777, 2778, 2779, 2780, 2782, 2783, 2785 Geographic Spread The Blue Mountains Division of General Practice covers an area of 1405 square km and comprises an elongated urban development of small townships extending along a sandstone ridgeline approximately 100 km long from Lapstone in the east to Bell in the west and Mt. Irvine in the north. The Mountains area is characterised by a cold and wet climate, with changeable weather patterns, long winters and a high concentration of storms. It is a high bush fire risk area. Demography Based on the 1996 Census the Blue Mountains population was 72,506. This was an increase of 4.4% from the 1991 Census (pop. 69,380). During the same period the population of NSW increased by 5.4% and the population of Australia increased by 6.2%.
Table: Blue Mountains population breakdown into areas
Area 1 Area 2 Area 3 Area 4 Area 5 Total
5,485 18,148 9,783 20,546 18,544 72,506
8% 23% 13% 28% 26% 100%
[Source: Social Profile of the Blue Mountains, 1998, Blue Mountains City Council]
Area 1 - Blackheath, Megalong Valley, Mt Victoria, Bell, Mt Tomah, Mt Irvine, Mt Wilson
Area 2 - Wentworth Falls, Leura, Katoomba, Medlow Bath
Area 3 - Linden, Woodford, Hazelbrook, Lawson, Bullaburra
Area 4 - Valley Heights, Springwood, Yellow Rock, Hawkesbury Heights, Winmalee, Faulconbridge
Area 5 - Lapstone, Glenbrook, Mt Riverview, Blaxland, Warrimoo
Age Structure
The age structure of Blue Mountains (BM) residents is very similar to that of NSW as a whole. However, the Blue Mountains has a higher proportion of children aged 0-14 (BM 23%, NSW 21.4%), and adults aged 45-64 (BM 22%, NSW 21%) than NSW as a whole.
The median age in the Blue Mountains is 35. This compares with 34 for both NSW and Australia.
Country of Birth
According to the 1996 Census, 79% of Blue Mountains residents were born in Australia. Eleven percent were born overseas in English-speaking countries, while only 6% were born overseas in non-English-speaking countries. This compares with 13% of Australian residents born overseas in non-English-speaking countries.
Aboriginal and Torres Strait Islander population
In the 1996 Census, 1% (702 people) Blue Mountains residents reported to be of indigenous origin. This compares with 2% (352,907 people) of the Australian population as a whole.
Income and Employment
According to the 1996 Census, the median individual income for Blue Mountains residents was $315
per week (compared with $298 for NSW and $292 for Australia).
The median annual household income for the Blue Mountains was $45,000pa. Median incomes increase as one goes down the mountains, with average incomes ranging from $33,540pa in the upper mountains to $55,276pa in the lower mountains.
In 1996, the unemployment rate for the Mountains was 7%. Medlow Bath to Wentworth Falls (Area 2) had the highest unemployment rate (10%), while Faulconbridge to Lapstone (Areas 4 and 5) had the lowest (5%). The areas between Mt Wilson and Blackheath (Area 1) and between Bullaburra and Linden (Area 3) both had an 8% unemployment rate.
Pension Recipients
According to the Blue Mountains City Council's Social Profile, 17% (12,105) of Mountains residents received some form of pension in 1997. Medlow Bath to Wentworth Falls (Area 2) had the highest number of recipients of all pension types (4269 people, or 23% of its pop). The percentage of pension recipients decreases as one goes down the mountains. 10.7% of residents from Warrimoo to Lapstone (Area 5) receive a pension.
Family Structure
According to the 1996 Census, the average family size in the Blue Mountains was 2.7 people, the same as the average for Australia and for NSW.
There were 18,897 families living in the Blue Mountains. One in ten families (1,945 families) is a sole parent family with dependent children; one third (6,195) are couples only; and 44% (8,213) are couples with dependent children. Medlow Bath to Wentworth Falls (Area 2) has the largest proportion of sole parent families with dependent children (15% of families), while the lower mountains areas (Areas 4 and 5) each have the smallest proportion of sole parent families (8%).
Children
According to the 1996 Census, children aged 0-12 years represent 20% of the Blue Mountains population.
Medlow Bath to Wentworth Falls (Area 2) had the largest number of children aged 0-12 (4,450), followed by Mt Wilson to Blackheath (Area 1) (3,751). The area between Warrimoo and Lapstone (Area 5) had the lowest number of children (1,070).
People with disabilities
The Disability, Aging and Carers’ Survey, undertaken by the Australian Bureau of Statistics in 1993 estimated that 18% of people in Australia have a disability, with 4% having a severe and profound disabling condition. Under this formula, there are estimated to be around 10,000 people living in the Blue Mountains with a disability. Membership There are 71 GPs in the Blue Mountains of whom 59 are members of the Division (83%). Thirty one (44%) of the 71 GPs are women. Australia wide, the female GP population is 33% of all GPs.
There are 30 Practices in the Blue Mountains. Eleven GPs (15%) are in solo practices and 60 GPs are in group practices. The Australian average of solo GP practice is 30%.
The locations of the solo practices are: Blackheath (1), Katoomba (3), Leura (1), Springwood (1), Winmalee (1), Blaxland (2), Glenbrook (2).
The locations of the group practices which total 19 are: Blackheath (2), Katoomba (2), Leura (1), Wentworth Falls (2), Hazelbrook (1), Faulconbridge (1), Springwood (4), Winmalee (2), Blaxland (4).
The Blue Mountains population to GP ratio is 993:1. The Australia as a whole ratio of 755:1.
Table 2: Age profile of Blue Mountains GPs compared with whole of Australia.
< 35 35-54 55+
Blue Mountains 6% 78% 16%
Australia 18% 60% 22% Issues The Blue Mountains Division of General Practice is one of three Divisions in the Wentworth Area Health Service (WAHS) geographical area. The other Divisions are Nepean and Hawkesbury. There is liaison and collaboration between the three Divisions; however, due to the different population mix and the differing needs, opportunities for jointly run projects/programs are limited. The three Divisions hold regular meetings throughout the year where ideas are shared and exchanged.
The Blue Mountains Division has a good working relationship with Wentworth Area Health Service and has conducted a number of joint programs, eg. Diabetes Management and Cervical Screening. A number of GPs from the Division are members of various committees and working groups: NSW Cervical Screening Committee, WAHS DOCFAX Committee, Child Protection Committee, Domestic Violence Committee, Hepatitis C Reference Group, Blue Mountains Hospital Medical Staff Council, NSW Physical Activity Committee, Blue Mountains Hospital Obstetrics Committee, Youth Injury Prevention Committee.
The Division has also developed partnerships and collaboration with other health service providers and the community and has links with other general practice organisations including the Royal Australian College of General Practitioners (RACGP) and the Australian Medical association (AMA). The Division is actively represented at the New South Wales Urban Division forums.
A Divisional Newsletter is published once a month and is sent to all GPs in the Division, neighbouring Divisions, and other organisations associated with the Division. The Division also publishes a Consumer Newsletter every 6 months which is sent to all GPs, all chemists in the Division, health care providers, community health centres, community groups in the Division and organisations associated with the Division.
There are two public hospitals within the Division, namely Katoomba and Springwood. Katoomba hospital, known as the Blue Mountains District Anzac Memorial Hospital, is an old hospital and is currently undergoing renovations and refurbishment which will result in a new emergency department, new operating theatres and upgraded surgical and general wards. Various programs are conducted at Katoomba hospital, eg. cardiac rehabilitation, Aged Care Assessment Team, shared ante natal care, shared palliative care. A number of GPs from the Division are members of various committees of Katoomba hospital and contribute to the establishment of programs and projects. Springwood hospital is an acute care hospital which accepts admissions under local GPs. It has a Palliative Care Unit. It offers outpatients services, physiotherapy, occupational therapy and dietician services.
There are three Community Health Centres within the Division namely Katoomba, Lawson, and Springwood. These centres provide various services to which GPs can refer patients and health consumers. Needs The Blue Mountains Division of General Practice, as a core part of its business, has undertaken assessments of both GP and community needs as follows.
ø A survey of all Blue Mountains GPs in January 1998.
ø A survey of all Blue Mountains GPs in January 1999 on computerisation.
ø Analyses of existing datasets: age structure, income and employment, people with disabilities, ethnic and indigenous population, pension recipients, death data, hospitalisation rates, midwives data, immunisation rates, cervical screening rates.
ø Community consultation through focus groups.
ø Analysis of health needs highlighted by focus groups with special needs, held by the Blue Mountains Council.
ø Evaluation of the Division's previous and current projects.
The key findings from the GP surveys were:
ø GPs reported that they were satisfied with the education activities provided by the Division and would like to see them continue.
ø Future education topics should include: dermatology, minor operations, mental health, diabetes and palliative care.
ø Strong interest shown for small group discussions with specialists.
ø GPs would like the Division to continue to provide administrative support to their practice, eg. contaminated waste collection, practice information sheets, reception training, accreditation, etc.
ø GPs want improved communications links with hospitals.
ø The use of computers by GPs/practices is limited.
Issues identified by the community were:
ø A wholistic and team approach to health care including better networking, better communications between GPs, consumers and other health care providers.
ø Better communications between GPs and their patients.
ø Improve GPs knowledge of other services available.
ø Ongoing education of GPs.
ø Education of consumers about the health system.
ø Addressing long waiting periods for GP appointments.
ø Service gaps in allied health services, particularly physiotherapy, for people with disabilities.
ø Affordability and accessibility of podiatrist service for older people.
ø Insufficient adolescent family counsellors and adolescent-specific mental health services for young people.
ø Mainstream health services are environmentally alienating for young people (accessibility, equity, hours of operation).
A number of meetings have been held by the Division Management Committee with input from other members to assess and analyse the findings. At a recent planning meeting assistance was obtained from a mentoring Division, Hunter Urban, to facilitate the day and guide the Management Committee in its deliberation. The Blue Mountains Division established a set of principles to which the findings of the Needs Assessment were applied in order to prioritise goals and strategies for the next three years. These principles are:
ø Improve GP resources.
ø Help GPs in the workplace.
ø Improve GPs’ knowledge / expertise.
ø Equity.
ø Sustainability.
ø Does not create more work for GPs.
ø Improve patients health / outcomes.
ø Improve / raise profile of GP role.
ø Develop partnerships / relationships with other health care providers.
ø Develop better relationships with other GPs in the Division. Report Summary The past year has been a busy and productive year for our Division, and again we have achieved a great deal with a small budget and staff numbers. This has been possible because of our committed and hard-working Division staff and Board.
The Division employs 3.2 FTE staff. The executive officer, Rachel Merton (BA Hons, GradDipComm), has a background in project management for the Division, and university administration. She is currently undertaking a masters degree in public health. The immunisation project manager, Pierre Baychelier (DVM), is a veterinary surgeon, with a strong interest in pharmaceuticals and immunisation. Our IM/IT project manager, Paul Crewe (BA, GradDipCompStudies), has over 20 years' experience in the IM/IT industry, and runs his own IT company. Tom Connally (RN), has been a diabetes nurse educator for over 10 years. Elizabeth Dole (BA Hons), our administration officer, has extensive experience in management and administration, and also works as a freelance writer/researcher. Sandra Colless, our accounts officer, has worked in accounts and administration in a range of settings for many years.
The fact we are a small division presents both opportunities and challenges. Being small means that what we can do and achieve is limited by lower resources and staffing compared with other divisions. However, being small also means we can engage effectively with our members, and remain locally relevant, accessible, and potent. We have been instrumental in developing close and valuable networks among the GPs in the Mountains, and feeding information among GPs, the Area Health Service, and other stakeholders.
The Division's main achievements throughout the year have included:
ø maintaining once again the involvement of 80% of all Blue Mountains GPs in our activities;
ø achieving 97% GP membership;
ø enrolling half the estimated diabetic population of the Blue Mountains in our diabetes project, and demonstrating improved glycaemic control for these consumers;
ø facilitating good quality, local education for GPs in a range of topic areas;
ø signing a Memorandum of Understanding with Wentworth Area Health Service (WAHS), with each party contributing funds towards joint projects. This has given rise to four joint projects:
1. IT-antenatal - which will link GP surgeries and WAHS facilities via a secure link to enable electronic transfer of information;
2. Care planning with Community Health services - to help GPs and other primary care services work better together;
3. Education for GPs in management of drug and alcohol programs;
4. Initial discussions with the Population Health Unit about a program to prevent CVD.
The first two are being jointly funded by the Division and WAHS, while the last two are being funded entirely by WAHS. These have been indirect outcomes of the collaborative process of developing the MOU (which involved discussions about potential areas for better working relationships).
We are now entering the final year of our inaugural three-year Outcomes Based Funding period, and we are making good progress towards the outcomes we set two years ago, particularly in relation to collaboration with WAHS and the provision of good quality GP practice support.
Changes to the strategic plan have been made to acknowledge the new initiatives that have come from our improved relationship with WAHS, as detailed above.
The coming year will not be without its challenges. Along with the uncertainty that comes with federal elections and budget initiatives, there are always locally-pressing issues. The Division sits within a context of balancing local and national priorities, and this will always be a challenge. In the Mountains, we are currently suffering a GP shortage, which has placed considerable pressure on our members, leaving them with reduced time to take part in Division programs. A major challenge will be to aim for improved health outcomes, while ensuring that Division (and government) programs aim to relieve the pressure rather than add to it.
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