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Mission Statement The Melbourne Division of General Practice, through its members who provide primary and continuing whole-patient care, is committed to improving the health of individuals living, working or studying in, or visiting Greater Melbourne. The Division provides education and integration as well as professional and personal supports to doctors in Greater Melbourne. Executive Summary MDGP continues its commitment to the unique population health needs of the inner urban area of Melbourne, and has refocussed its activities to have a greater emphasis on its GP member's needs and interests. Accordingly we have organised our activities into four program streams that reflect the four Outcomes Based Funding quadrants of activity. These are:
Services to GPs – a program that aims to improve the efficiency and effectiveness of both the organisational and clinical components of general practice through General Practitioner upskilling, practice accreditation, utilisation of practice nurses, increased utilisation of information management, improved hospital and primary care community linkages with GPs, and delivery of two-way relevant and timely communications with and between GPs.
Services by GPs – a program that aims to assist GPs improve the clinical management of patients through relevant education and linkages to general practice in cardio vascular health, diabetes, asthma, mental health and gender health.
Population Health – a program designed to develop strategies and capacity within general practice to address population health issues including immunisation, emergency & disaster planning, aged care, ATSI issues, recalls, and CALD issues.
Division Management and Operations – a program designed to ensure that MDGP achieves and embraces best practice organisation management.
Of interest since the last strategic plan is the changes in the population of greater Melbourne. The resident population has increased largely with the expansion of living areas in and around the Docklands and the program of urban infill. The wealth of the area has also undergone a noticeable shift as a consequence of the growth. Nonetheless Melbourne still retains a significant population of economically and socially disadvantage groups giving rise to particular demands on the services offered and skills of our General Practitioners.
MDGP is committed to continually monitoring our membership for comment upon the quality and relevance of our services and activities, and participating with our stakeholders and neighbours to design and deliver programs and activities of direct relevance to our membership and catchment area.
Postcodes 3000 3001 3002 3003 3004 3005 3006 3008 3010 3031 3050 3051 3052 3053 3054 3055 3056 3057 3065 3066 3067 3068
3121 3207 Geographic Spread Description of Geographical Spread
The Melbourne Division of General Practice covers the entire Melbourne CBD area, and a substantial part of inner-urban Melbourne.
The Melbourne Division catchment area covers 3 separate council areas:
The City of Melbourne – in its entirety
The City of Yarra – greater than two-thirds of the geographical area of this Council; and
The City of Moreland – approximately one third of the geographical area of this Council.
Demography The population information and statistics referred to below have been compiled from the following two sources:
The Australian Bureau of Statistics, 2001 Census data, amalgamated across all the postcodes referred to above in “postcodes included in the division”
“HealthWiz”, National Social Health statistical data library, version 6.2.9 (February 2004)
Population – Number
Table: Population as at 2001 Census Date, and Population Growth over time
Census Year Total Population of the Division
2001 192,810
1996 161,748
1991 139,898
Above figures are Census Data sourced from Australian Bureau of Statistics, amalgamated over all of the postcode areas comprised in the primary catchment area of the Melbourne Division of General Practice
Analysis:
Between the 1996 Census and 2001 Census, the division's population increased by 31,062 – an increase of 19.2%. In other words, the Melbourne Division catchment area experienced a “population explosion”.
In particular, there appears to have been a rapid influx of residents in the Melbourne CBD itself, as well as in inner urban areas.
The ABS Census data ignores an additional substantial daily “transient population”, given that many people who reside in other parts of Melbourne commute on a daily basis into the Melbourne Division catchment area.
Table: Commuters not accounted for in ABS Census data for Melbourne Division General Practice catchment area (approximate figures only):
Nature of commuter Number Source of data
Paid workers in Melbourne CBD 324,000 City of Melbourne Data, 2002 Census
Volunteer workers in Melbourne CBD 9,000 City of Melbourne Data, 2002 Census
University of Melbourne students and staff 40,000 University of Melbourne Data, approximate, as at 2003
RMIT University students and staff 40,000 RMIT University Data, approximate, as at 2003
Total (approximate) 413,000
Accordingly, in addition to the resident population of 192,810 persons located within the Melbourne Division of General Practice catchment area, there is a daily transient population of in excess of 400,000 people. These commuters place an additional burden on general practitioners and other health services located in the Melbourne Division catchment area.
Employment Data
Employment Statistics from the 2001 Census confirms that employed persons resident in the Melbourne Division of General Practice catchment area are employed predominantly in:
ø white collar office jobs; and
ø service industries.
At the other extreme, as noted above, there is a large proportion of unemployed (and potentially underemployed) persons resident in the Division.
Table: Occupation of all employed persons resident within the Melbourne Division of General Practice catchment area (2001 Census)
Occupation Males Females Total persons
Professionals 16,127 16,003 32,130
Intermediate clerical, sales and service workers 5,382 9,036 14,418
Associate professionals 6,398 5,386 11,784
Managers and administrators 6,240 3,798 10,038
Elementary clerical, sales and service workers 2,844 4,305 7,149
Labourers and related workers 2,639 1,310 3,949
Tradespersons and related workers 4,056 927 4,983
Intermediate production and transport workers 2,664 650 3,314
Advanced clerical and service workers 522 2,513 3,035
Inadequately described 384 269 653
Not stated 455 370 825
Total (Melbourne Division working Population) 47,711 44,567 92,278
Figures obtained from the 2001 Census, amalgamated by the Australian Bureau of Statistics over all the postcode areas comprised in the Melbourne Division of General Practice catchment area.
Table: Industry of Occupation of Persons Resident within the Melbourne Division of General Practice catchment area (2001 Census)
Industry Males Females Total Persons
Property and business services 10,204 8,279 18,483
Retail trade 4,474 5,417 9,891
Health and community services 2,742 6,471 9,213
Manufacturing 5,721 3,081 8,802
Education 2,959 4,733 7,692
Accommodation, cafes and restaurants 3,425 3,254 6,679
Finance and insurance 2,995 2,724 5,719
Wholesale trade 2,820 1,784 4,604
Cultural and recreational services 2,298 2,056 4,354
Government administration and defence 1,524 1,831 3,355
Transport and storage 1,851 1,109 2,960
Personal and other services 1,316 1,447 2,763
Construction 2,307 357 2,664
Agriculture, forestry and fishing 301 172 473
Communication services 1,476 906 2,382
Electricity, gas and water supply 250 145 395
Mining 171 99 270
Non-classifiable economic units 286 191 477
Not stated 624 528 1,152
Total (Melbourne Division working Population) 47,744 44,584 92,328
Figures obtained from the 2001 Census, amalgamated by the Australian Bureau of Statistics over all the postcode areas comprised in the Melbourne Division of General Practice catchment area.
Aboriginal and Torres Strait Islander population
Table: Aboriginal and Torres Strait Islander Population in MDGP catchment area
(2001 Census)
Male Female Total
Aboriginal 341 288 629
Torres Strait Islander 36 22 58
Both Aboriginal and Torres Strait Islander 15 12 27
Total Indigenous Persons 392 322 714
Figures obtained from the 2001 Census, amalgamated by the Australian Bureau of Statistics over all the postcode areas comprised in the Melbourne Division of General Practice catchment area.
Compare this to the 1996 Census: the total Aboriginal and Torres Strait Islander population in the Melbourne Division of General Practice catchment area 704 persons. In other words, the Aboriginal and Torres Strait Islander population in the Melbourne division area has grown, but not significantly.
Geographic spread of Aboriginal and Torres Strait Islander population:
According to the 1996 Census, the Division's Aboriginal and Torres Strait Islanders population was spread across all postcodes of the Division. The greatest concentration of that population occurred in Richmond, Clifton Hill, Collingwood, Brunswick and surrounding suburbs, Carlton, and Flemington/North Melbourne.
The geographic spread of the Melbourne Division's Aboriginal and Torres Strait Islander population across all MDGP postcode areas was as follows
Table: Geographic spread of Aboriginal and Torres Strait Islander population in Melbourne Division of General Practice catchment area
Postcode/Area ATSI population
3000, 3005, 3050 Melbourne (City) 14
3001 Melbourne GPO 0
3002 East Melbourne 7
3003 West Melbourne 18
3006 Southbank 3
3031 Flemington 58
3051 North Melbourne 45
3052 Parkville 42
3053 Carlton South 35
3054 Carlton North 34
3055 Brunswick West 33
3056 Brunswick 62
3057 Brunswick East 31
3065 Fitzroy 39
3066 Collingwood 63
3067 Abbotsford 18
3068 Clifton Hill 71
3121 Richmond 90
3207 Port Melbourne 41
Total Aboriginal and Torres Strait Islander population Melbourne Division of General Practice 704 (as at the 1996 Census)
Figures obtained from HealthWiz version 6.2.9; Australian Bureau of Statistics, Census 1996.
Other cultural and ethnic groups
Table: Birthplace (by Region)
Country/region Persons
Australia 104,491
Other Oceania & Antarctica 4,482
United Kingdom 6922
Ireland 602
Other Europe 15,611
North Africa 880
Sub-Saharan Africa 2838
Middle-East 2453
South-East Asia 15,412
North-East Asia 6463
Southern & Central Asia 2336
Northern America 1,468
South America 733
Central America 250
Caribbean 40
Figures obtained from the 2001 Census, amalgamated by the Australian Bureau of Statistics over all the postcode areas comprised in the Melbourne Division of General Practice catchment area.
Languages spoken at home
The 2001 Census data indicates that the vast majority of persons resident in the Melbourne Division of General Practice catchment area speak English only (109,915), there are a very broad range of other languages spoken.
These languages include: Arabic, Australian indigenous languages, Chinese (of a variety of dialects), Croatian, French, German, Greek, Hindi, Hungarian, Indonesian, Italian, Japanese, Khmer, Korean, Macedonian, Maltese, Netherlandic, Persian, Polish, Portuguese, Russian, Samoan, Serbian, Sinhalese, Spanish, Filipino, Tamil, Turkish and Vietnamese.
Aside from English, the most commonly spoken languages at home are as follows:
Table: Language Spoken at Home (percentage of individuals out of total resident in MDGP Catchment Area)
Language Percentage
Greek 4.2%
Italian 4.2%
Chinese (Cantonese) 3.0%
Vietnamese 3.0%
Chinese (Mandarin) 2.4%
Arabic 1.7%
Indonesian 1.2%
Turkish 0.7%
Spanish 0.6%
Figures obtained from the 2001 Census, amalgamated by the Australian Bureau of Statistics over all the postcode areas comprised in the Melbourne Division of General Practice catchment area.
Analysis:
ø While the majority of residents are English-speaking, the population of the Melbourne Division catchment area has a great ethnic diversity.
Geographical “Spread” of the Population
The most populous areas in the Division's catchment area are:
1. Brunswick, Brunswick East and Brunswick West
2. North Melbourne, Kensington and Flemington
3. Richmond and East Melbourne
4. Carlton, Parkville, North Fitzroy and Clifton Hill
The first 2 suburb categories listed above appear to have a greater concentration of persons with a lower socio-economic status, and appear to have a greater ethnic diversity than other areas in the Melbourne Division catchment area.
By contrast, the last two suburb categories listed above appear to have a higher proportion of well-to-do residents.
Of particular interest is the growth of the population resident in the CBD area itself (ie the 3000 postcode). As at the 1996 Census date, a total of 7,882 persons were resident in the Melbourne CBD area. By contrast, as at the 2001 Census date, that population had increased to 18,265 persons. This represents an increase in the resident population in the CBD area of 230%.
Membership GP Information and Statistics
Eligibility for Membership
Membership of the Division is open to all GPs:
ø who work in, or provide services in the Melbourne Division catchment area; or
ø reside in the Melbourne Division catchment area; or
ø choose to be a member.
Associate (non-voting) membership of the Division is open to medical practitioners and other persons who support the work of the Division.
Number of GPs within the MDGP catchment area
Total: approximately 605 GPs located within the MDGP catchment area.
Table: Geographic Spread of GPs located within the MDGP catchment area (as at 1998/1999)
Postcode/Area No of GPs
3000, 3005, 3050 Melbourne 97
3001 Melbourne GPO 2
3002 East Melbourne 19
3003 West Melbourne 0
3006 Southbank 2
3031 Flemington 35
3051 North Melbourne 8
3052 Parkville 11
3053 Carlton South 67
3054 Carlton North 13
3055 Brunswick West 27
3056 Brunswick 66
3057 Brunswick East 10
3065 Fitzroy 31
3066 Collingwood 28
3067 Abbotsford 3
3068 Clifton Hill 53
3121 Richmond 112
3207 Port Melbourne 21
Total No GPs (Melbourne Division of General Practice) 605
Figures sourced from HealthWiz version 6.2.9 (this data itself sourced from the Commonwealth Department Health and Aged Care as at 1998/1999). Accordingly, there may have been some fluctuation between the date of this data having been compiled and the date of this report.
Number of GPs are located in areas adjacent to the primary MDGP catchment area
MDGP provides ongoing support and services also to GPs in areas adjacent to the primary MDGP catchment area. There are a total of 128 GPs in these “adjacent” areas. These “adjacent areas” include the following postcode areas: 3058 (Coburg, Merlynston, Moreland); 3070 (Northcote); 3071 (Thornbury); 3078 (Alphington, Fairfield); and 3205 (South Melbourne).
Issues Local health services, hospitals, community health etc
1. Local health services
Three health care networks operate within the divisional region, these include nine hospital campuses including, in addition to two major tertiary campuses, a large range of specialist campuses: Peter MacCallum Cancer Institute, Royal Victorian Eye and Ear Hospital, Royal Park Psychiatric Hospital, North-Western (aged care) Hospital, Mercy Hospital for Women, Royal Women's Hospital and the Royal Children's Hospital. In addition there are numerous private hospitals in the region. The division has established formal “Heads of Agreement” with four of these public campuses. GPs are employed in liaison positions in a number of the hospitals.
The division's boundaries overlap with six local government areas (Melbourne, Moreland, Yarra, Moonee Valley, Darebin and Port Phillip) and the division works with each of these authorities in program planning and development. There are six Community Health Centres in the region including: Yarra Community Health Service, Moreland Community Health Service, Doutta Galla Community Health Service, Northcote Community Health Centre, Richmond Community Health Centre and North Richmond Community Health Centre. Division members are employed in each of these services and a number of collaborative projects have been funded in the past.
In terms of specialised services with responsibilities beyond local boundaries, there is a large number of mental health service and organisations based within the division. These include: the Early Psychosis Prevention and Intervention Centre, the Mental Health Legal Centre, the Schizophrenia Fellowship of Victoria, VICSERV – Psychiatric Disability Services of Victoria Inc, the Mental Health Foundation of Victoria, and the Victorian Transcultural Psychiatry Unit. These agencies choice of location was not by chance, given the high levels of serious mental health problems and related problems of homelessness, poverty and substance misuse in the region. For these reasons the division has a long-standing commitment to mental health and homeless issues and has undertaken an extensive range of collaborative projects.
Major Health Services that are Lacking
ø A medical response plan that specifically involves general practitioners (and their patients) who are located in the Melbourne Division of General Practice catchment area in emergency and disaster planning. In the current world climate Melbourne CBD and inner urban Melbourne are potentially terrorist targets if only because Melbourne has a number of very high profile activities attended by large numbers of the populace in particular the forthcoming Commonwealth Games.
ø Difficulty accessing mental health crisis services and inpatient services is endemic in Victoria and the Melbourne division is no exception. In terms of drug and alcohol services most categories of service were considered to be difficult or impossible to access, particularly non-residential support services.
ø Difficulty accessing publicly funded allied health staff such as dieticians and physiotherapists was considered to be a problem for health promotion and the management of chronic illness.
Relationship or links with the local area health authority
The local area health authority is the Victorian State Department of Human Services.
The Melbourne Division of General Practice maintains close links with that Department and the Primary Care Partnerships (PCPs):
ø Moonee Valley Melbourne Primary Care Partnership
Northern Central Metropolitan Primary Care Partnership
Partnerships & Alliances
Agreements have been made with the following agencies for ongoing exchange of information and collaboration:
Divisions of General Practice
ø Inner East Division of GPs
ø Inner South East Division of GPs
ø North East Valley Division of GPs
ø Northern Division of GPs
ø North West Division of GPs
ø Western Division of GPs
ø Westgate Division of Family Medicine
Local Government
Cities of
ø Darebin
ø Melbourne
ø Moonee Valley
ø Moreland
ø Port Phillip
ø Yarra
The Division has a range of arrangements with the Cities of Melbourne, Moreland and Yarra.
Ethnic Health
ø Australian Red Cross
ø Australian Vietnamese Women's Welfare Association
ø Centrelink
ø Centre for Culture, Ethnicity and Health
ø East Preston Community Health Centre NTRE
ø Ecumenical Migration Centre
ø Koori Health Unit
ø Moreland City Council
ø Northcote Community Health Centre
ø North East Region Migrant Resource Centre
ø Richmond Community Health Centre
ø Victorian Foundation for Survivors of Torture
ø Women in Industry & Community Health
Acute Health:
ø Acute Health Division of Human Services
ø Inner and Eastern Health Care Network
ø Mercy Hospital for Women
ø North Western Health Care Network
ø Royal Melbourne Hospital
ø Royal Children's Hospital
ø Royal Women's Hospital
ø St Vincent's Hospital
ø Homeless Health
ø Department of Human Services, SAAP
ø Flagstaff (formerly Gill Memorial)
ø FrontYard
ø Ozanam House
ø Regina Coeli – Women's Shelter
ø Royal District Nursing Service's Homeless Program
ø St Vincent's Cottage
ø The Action Centre
Service Delivery:
ø North Yarra Community Health Centre
ø Doutta Galla Community Health Centre (Kensington)
ø Health Issues Centre
ø Moreland Community Health Centre
ø Northcote Community Health Centre
ø North Richmond Community Health Centre
ø Richmond Community Health Centre
ø Royal District Nursing Service
Women's Health:
ø D.V.I.R.C. (Domestic Violence & Incest Resource Centre)
ø Pap Screen, Anti-Cancer Council,
ø Sexual Health Unit
ø Specialist Programs, Department of Human Services
ø W.I.C.H. (Women in Industry and Community Health)
ø W.I.R.E. (Women's Information Referral Exchange)
ø Women's Health and Sexual Assault Worker
ø Women's Health Victoria – Rose Sorger
ø Women's Health West
ø Other ongoing arrangements
ø Drug and Alcohol Services
GP training contracts from State Human Services with four divisions, St Vincent's Hospital & Turning Point. Youth detox services with Jesuit Social Services.
Victorian Advanced Training for General Practice Program
ø Monash University Department of General Practice and Centre for Rural Health
ø Melbourne University Department of General Practice
ø Victorian Primary Health Care Research, Evaluation Partnership
Major Alliances:
"Diabetes Alliance Group" – consortium including Northern, North West Melbourne, Western Melbourne and Westgate Divisions of General Practice, Diabetes Australia Victoria and Royal Melbourne Hospital. DAG-HARP is one of the Alliance's projects (part of the Victorian government “Hospital Admission Reductions Program”)
Diabetes Australia-Victoria
Northern Division of General Practice
North West Melbourne Division of General
Royal Melbourne Hospital
Western Melbourne Division of General Practice
Westgate Division of General Practice
ø "Respiratory Alliance Group"
Northern Division of General Practice
North East Valley Division of General Practice
North West Melbourne Division of General
Western Melbourne Division of General
ø Partners in Hospital Admission Risk Programs (HARP)
Northern Division
Mental Health Programs
MOU for a range of activities proposed from July 04 onwards.
Melbourne Health (Royal Melbourne Hospital)
Mental Health Step-down Project
ED Frequent Attenders with complex psycho-social needs
Falls prevention following ED presentation
COPD
Diabetes-related Foot
Prevention of Stroke recurrence shared-care
Chronic Heart Failure management in community
Community Consortium
Community Asthma Program for young people
Health Network for Kids
St Vincent's Hospital
ALERT
Risk screening and discharge planning based in ED
COACH - Coaching patients On Achieving Cardiovascular Health
HIT - HOLDING IT TOGETHER
Client-led Care in Mental Health, Drug and Alcohol and Homelessness
TRAAC - TREATMENT, RESPONSE AND ASSESSMENT FOR AGED CARE
RHP - Restoring Health Project
An integrated model of care for chronic disease
St Vincent's Hospital Community Hospital Liaison Project
Pharmacist in the community
Quality Use of Medicines
Alfred, Austin and Royal Melbourne Hospitals Medication Alert Project
Needs GP Needs
Needs of GPs located within the MDGP catchment area are established through direct contact with individual GPs, as well as through annual surveys of the MDGP GP population.
The results of the Division's GP needs assessment are as follows:
(a) GP needs – Support to GPs and their practices
ø IM/IT training and practice visits
ø Accreditation assistance
ø CDP/PIP - support in implementation
ø Immunisation support and practice visits
ø Health services directory for inner Melbourne (prepared and published by the Melbourne Division of General Practice)
ø CPD/education programmes
ø Weekly fax Updates on major health issues and major events/training sessions
ø Improving coordination between General Practice and hospitals
ø Improving the ability of GPs to work with pharmacists and the pharmacy profession
ø Assisting in training of practice nurses, practice management and other initiatives to improve quality of practice
ø Assisting GPs to find locum cover when GPs go on holidays/retire
ø Focusing on enhancing the commercial viability of GP practices and increasing GP income (such as through introducing bulk "buying"/discount programmes for computers, software, internet access, other consumables used in daily practice)
ø More face-to-face contact between Division Staff and individual GPs
(b) GP Needs – Public Health Issues
ø Infectious diseases - obtaining rapid information updates (as in SARS, avian influenza, meningococcal infections etc)
ø Diabetes educators
ø Immunisation
ø Mental health - access to crisis assessment teams and other hospital services
ø Asthma and respiratory
ø Cardiovascular health
ø Drug and alcohol use
ø Culturally and linguistically diverse patients - health and communication issues
ø Women's health/gender Health
ø Aged care
ø Health planning/Health coaching
(c) GP needs – Advocacy
ø Liaison with hospitals - GP/hospital integration
ø Reduction of the administrative burden/paperwork and "red tape"
ø Increasing MBS rebates
Community Needs
ø Aged care and nursing homes/arthritis
ø bulk billing/cost of medical care - especially in less affluent areas of the Melbourne Division catchment area
ø GP/patient ratios - to be maintained at manageable levels for GPs, to ensure that patients are able to their own GP, to ensure continuity of care (particularly any issue given the rapidly increasing population of the Melbourne Division catchment area)
ø Specific cultural and linguistic groups found being the Melbourne Division catchment area - Health issues directly relevant to such populations (such as, for example, lack of vitamin D in the case of new migrants and Muslim women)
ø Mental health
ø Youth health
ø Asthma
ø Cancers
ø Disabilities - both children and adults
ø the diseases of the "urban professional/office worker" (such as obesity, diabetes, cardiovascular health, depression/anxiety) - given that a significant proportion of the Melbourne Division population are white-collar workers doing desk jobs (see the discussion on demography above)
ø Recalls (improving population health screening and preventive activities)
ø Emergency and disaster planning - engagement of GPs in emergency and disaster planning, given that Melbourne is potentially at risk of a terrorist attack
Division Needs
ø GP involvement - encouraging GPs to have a more direct involvement in the running of the division and direct input into Division programmes
ø Corporate governance - ensuring that MDGP adopts and maintains best practice and transparent corporate governance procedures and protocols
ø Internal accreditation, to ensure high operational standards and accreditation levels and high staff morale
ø Financial viability/prudent financial management
ø Information collection and analysis (to aid planning)
National Health Priority Areas
ø Diabetes
ø Asthma/respiratory ailments
ø Immunisation
ø Mental health
ø Drug and alcohol/substance abuse
ø Smoking
ø Cancers
ø Cardiovascular health
ø Obesity
ø Youth health
ø Gender health
Report Summary Melbourne Division has enjoyed a vigorous and stimulating year. Members of the staff have been involved in grass roots change and development, whilst at the same time continuing to deliver high quality well received programs and services.
It is a pleasure to review the progress of Melbourne Division in the light of these past 12 months.
Successes. Melbourne Division's successes this year include:
ø An invigorated, committed and productive staff.
ø An engaged and strategic Board.
ø All program/projects have established written program folders incorporating: program plans linked to Strategic Plan, systems, policies, procedures, resources, and where appropriate evaluative frameworks/mechanisms.
ø Minister for Health The Honourable Tony Abbott MP launched Practice Nurse Recruitment CD-Rom.
ø Seven Melbourne Division staff and three Directors participated in the Australian Divisions of General Practice Conference in Adelaide 2004. Five members of staff presented posters at the conference.
ø Melbourne Division holds 11 in house training events; 10 staff meetings; 10 practice support team meetings.
ø All Melbourne Division staff attend relevant GPDV forum/training events/seminars; Melbourne Division staff encouraged to and attend relevant professional development opportunities.
ø 685 people attended 28 Melbourne Division education seminar/training event
ø 406 unique attendees at one or more Melbourne Division education seminars/training
ø 217 unique GPs attended one or more Melbourne Division education seminar/training event
ø 225 practices represented one or more Melbourne Division education seminars/training
ø 100% Melbourne Division Practices received a copy of the Practice Nurse Recruitment CD-Rom
ø 100% practices eligible for PIP Practice Nurse incentive visited by Division's Practice Nurse Coordinator to determine assistance requirements for a support program now under development (trial a nurse).
ø 100% non-accredited practices visited and/or contacted to determine assistance requirements vis a vis registering for practice accreditation.
ø 100% catchment member practices responded to survey resulting in cleaning of database information, interest details and practice/GPs.
ø 100% HIC registered pharmacies visited by QUM Manager
ø 91% of practices engaged in childhood immunisation activities received telephone or personal support from Immunisation Officer.
ø Identified 100% of practices (122) and therefore GPs (360) and practice nurses (53) who give childhood immunisation, and are now able to target immunisation activities to this relevant group.
ø Pathways for Mental Health service referrals mapped and GP specific resource developed, loaded to website and under distribution.
ø Quality of data and results for participating practices puts Melbourne Division in top 3 Divisions participating in NPCC Program Australia wide.
ø Developed well received Supervised Clinical Attachment for Geriatric Experience program to develop GP interest in, and knowledge of, the provision of Aged Care services.
ø Establishment of a robust Divisional IT system, including training in time efficient software for all staff
ø Division commences Accreditation with QICSA and is notified within 12-month period that Accreditation will be granted.
ø Division-wide review of policies and procedures resulted in evaluation of current practices and indicated areas for development.
ø The business management system has been completely overhauled with extensive policies and procedures under development or completed for finance and human resources functions.
ø Developed a Certified Work Place Agreement for the consideration of Staff.
ø 85% or more of participants in 28 education events ranked them as very good or better.
ø 70% general practices in catchment are registered for accreditation or have received accreditation
ø 72% catchment member GPs participated in at least one education event.
ø 66% catchment practices received at least one practice visit.
ø 44% people who attend education events are practice staff.
ø 23% of catchment GPs participated in focus groups or qualitative research into member's perceptions of Division.
ø 20% of practices with practice nurse receive in-house orientation and/or training of their practice nurse from Practice Nurse Coordinator
ø 15% increase in number of practices registering for Accreditation.
ø 407 visits are made to practices during the year across the programs.
ø The Melbourne Division rates higher than the national average in positive trends in the best practice use of antibiotic prescribing.
ø Electronic template articulating service referral pathways to adult and child mental health services providers in the catchment area developed.
ø Cross-sectoral mental health reference group established.
Barriers. Melbourne Division experiences the following barriers in pursuing and achieving its goals:
ø Qualitative research into GP engagement with Division reveals difficulty Division faces in bringing its message to the attention of catchment GPs. Plethora of competing communication is a barrier to gaining GPs meaningful attention.
ø GP Engagement continues to be a problematic area. GPs have many competing priorities and increasing demands.
ø IT/IM - GPs have a great need for resources to support at an individual level their uptake and best practice utilisation of IT/IM in their practices.
ø A lack of adequate resources to provide IT/IM infrastructure in the health sector in general, particularly in the hospitals, and consequent absence of common software, platforms and training opportunities contributes to the on going difficulties with flow of timely, private patient information.
ø Over the last six months, Victoria has experienced a state-wide trend towards reduced coverage rates for immunisation. Australian Childhood Immunisation Register has not yet identified the causes. Melbourne Division's immunisation coverage rate has decreased further than the trend. This is attributable Melbourne City Council's data upload problems incurred as a consequence of software updates.
ø Melbourne Division's immunisation rates are impacted negatively by the characteristics of inner urban areas (eg medium density housing, high transient population types, high numbers of refugee/immigrant CLD populations and high numbers of families that move out of the area before completion of childhood immunisation program). These characteristics form a barrier to achieving the goal of 90% coverage.
Foreshadowing the Year Ahead
Melbourne Division will be exploring the following opportunities, projects and activities in the coming year:
ø Redesign of Melbourne Division web site which will:
ø have a map and practice level promotional material
ø create a members only area containing valuable information and resources
ø warehouse Melbourne Division GP, practice nurse, practice staff resources
It is planned to seek demographic and practice information in exchange for listing to the public area, and access to the member's area.
ø GP Engagement - creation of Practice Capacity Program Officer role for three year period, with attendant opportunities to increase practice capacity and enhance engagement of GPs and their staff.
ø Chronic Disease Management - creation of Health Programs manager to develop and implement a project across six chronic diseases, interfacing with two hospitals with a view to improving systems, processes, protocols and resources for GPs and with Hospitals.
ø Relationship with IT/IM provider to provide consistent, credible IT/IM assistance to practices and the Division, consistent with other work in the area of uptake and improved utilization of recalls and registers.
ø Expansion of Practice Nurse activities to include one on one training to practice nurses in clinical areas. Facilitation of new practice nurses to visit clinics such as wound clinics etc to expand relevant knowledge.
ø Continue to work with partners in development of role of GPs in disaster and emergency.
ø Implement rigorous evaluation frameworks in Immunisation and Practice Nurse Programs.
Significant changes to annual plan
ø Outcome 2.1.5.1 has been changed to incorporate Gender Health. Initially described as to improve the management of STIs it has proved to be too narrow for the interests of GPs and expanded to Gender Health.
ø Outcome 3.1.3.1 - Aged Care program is now in Program 5.
ø Outcome 3.1.6.1 Replaced by:
ø 3.1.6.1.1 Provide best practice information and resources to GPs to assist in the management of CLD Patients.
ø 3.1.6.1.2 Provide training to GPs in culturally sensitive practice in Mental Health
Standard Data Items:
Number of GPs in Division area
MelbDiv postcodes 430
Claimed postcodes 108
Number FTE unknown
Number of GPs who are members of the Division 551
Number of GPs actively participating in Division activities 291 unique GPs
Number of GPs paid by Program 57 unique GPs
Hourly rates paid to GPs by Program $110 per hour
Number of FTE staff employed by Division 17.86
Number of GPs received a service by the Division by program
Program 1 100% GPs in database
Program 2 >208 GPs
Program 3 607 GPs
Program 4 100% of practices
Number of CME activities 28
Number of GPs undertaking non fee-for-service delivery zero
Total amounts paid for:
Staff $1,160,545
Contractors $202,409
GPs $27,692
Overview of Programs/Projects
Program 1 - Services to GPs
Hospital Integration
In this reporting period Melbourne Division participated actively with The Royal Women's Hospital, The Royal Children's Hospital, Melbourne Health, and St Vincent's Hospital through various committees, HARP projects, GPLO meetings, stakeholder meetings and other opportunities. The strength of the relationships can been seen in our joint hosting of GP Focus Groups, willingness of Hospital representatives to participate on our recruitment and selection committees, and willingness of Hospital representatives to participate on our Program Reference Groups.
In addition to our focus on hospital integration, various of our programs have strong linkages into relevant hospital points of contact such as the Immunisation Program, Mental Health Program, Aged Care Program, Quality Use of Medicine Program, Diabetes in Co-Management Program (cross Divisional program) and Coach Program. The result is improving referral and discharge information, and the establishment of appropriate protocols or at least the inclusion of the Division in the development of protocols - albeit slowly.
IT/IM
The IT/IM Program experienced some changes during the year. The in-house IT consulting services promoted by both Northern and Melbourne Divisions jointly to our GPs did not to generate the interest anticipated and was ceased in midyear. Division staff focus on the disease register/recall message when visiting practices, GPs and staff and the Collaboratives, Diabetes Co-Management in General Practice, Coach and Quality Use of Medicine Programs give particular emphasis to this element of IT/IM.
Staffing changes during the year highlighted that GPs do not seek out IT/IM visits unless cold called by Division staff. Consequently the Board, in reviewing the demand by GPs, elected to cease providing IT/IM services through the provision of a Medical Director Trainer. Instead the focus has shifted to identifying service providers and training opportunities for practices and GPs, encouraging the correct utilising of registers and recalls, and uptake of Broadband for Health.
PCP
Melbourne Division sit within three Primary Care Partnerships (PCP) catchments and actively participates on the Moonee Valley Melbourne PCP, representing both North West and Melbourne Divisions. In this capacity we have contributed to our partner agencies and their projects. In particular we have contributed to:
ø PCP steering committee
ø service coordination planning, discussions and refinements
ø e-referral projects in particular one directly with a GP practice
ø chronic disease management projects
ø community health plans and cross sectoral planning
ø participating in project submissions (diabetes and e-health projects)
ø CLD mental health strategy
ø Paediatric Asthma project
ø Vitamin D project and information distribution
ø Immunisation projects and activities, including activities with maternal and child welfare officers
The relationship with the PCP is strong, the Division sublets office space from the PCP. Partner agencies are aware of the Division interest in linking our GPs into relevant resources. PCP material has been distributed to GPs, and also to Practice Nurse through two separate Practice Nurse forums arising from PCP work.
Practice Support
Practice support initiative has grown over the period with the formation of the Practice Support Team. This team comprises those staff who undertake practice visits to deliver the Division's core programs. These programs include IT/IM training, immunisation, practice accreditation, promotions of blended payments (EPC, PI, SIP and new incentives such as Practice Nurse and Mental Health) and other externally funded programs like the National Collaborative, Coach Program, Aged Care and Diabetes Co-Management program. The notion that only some services were of the core businesses have now expanded to any program that entails some form of communication and support function to the GP practices. Practices visited by all staff are presented with a kit, which includes promotional and resource material for all Melbourne Division's programs.
A new 'fax back' version of the Practice Support Request form was developed in consultation with the team. This form also worked as a counter for most requested services or support from the practices. Importantly, compulsory Practice Support Group bimonthly meetings have been scheduled for the team. These meetings have become the corner stone for the Division's strategic business; show casing presentation on incentives and initiatives available to general practice, and an operational arm of the how best to deliver services without duplication of practice visits and an awareness within the team about client practices and the services and support they are receiving from Melbourne Division.
A major focus in this period has been Accreditation to practices, especially to small and solo practices. In this period practices were segmented and those need immediate support or encouragement to take up Accreditation were targeted. The Practice Support Team were recruited to reinforced the benefits of Accreditation, and a complementary strategy was employed to follow-up all unaccredited practices. Unaccredited practices were divided into three groups:
1. Registered practices but no activity towards accreditation
2. Practices that showed some interest in accreditation over the last two periods but had not registered
3. Solo practices that did not show any interest in Accreditation
All practices in these three categories were contacted and supported to continue with Accreditation. There has been relative success with groups 1 and 2 but insignificant progress in the 3rd group, which accounts for 40% of our practices. The practices in the 3rd group have been reluctant to enroll in the accreditation process for various reasons and therefore it is reasonable to conclude that these practices may not consider accreditation in the near future.
The positives have been the steady climb of the practices registered for accreditation - in the period for July 2004 to June 2005 an increase of 13% was recorded, with large practices such as the Victorian Aboriginal Health Services undertaking Accreditation with the support of Practice Support Team. The number of practices that have achieved accreditation is relatively slow compared to those registering.
In other areas of practice support, there have been great improvements in communications in both print (weekly fax outs, an email version of fax out and Dr News newsletter) and the web. The web has counters and has been kept up-to-date. There are visions for the web to extend to an integrated, and secure database application in the near future. The homepage also highlights urgent and important news pertinent to GPs and the practice.
Quality Use of Medicines
A recent survey of Melbourne Division GPs conducted by the National Prescribing Service (NPS) on the use of Proton Pump Inhibitors (PPI), a pre and post the academic detailing program on 'Optimal use of Proton Pump Inhibitors in general practice' showed a trend towards optimal prescribing. Increased levels of knowledge on the evidence for optimal prescribing and use of PPIs were noted in particular to “lifestyle advice”, “H.Pylori statements” prescribing points on initiation, and review and cessation of the drug therapy and the use of lower doses. HIC data indicates evidence that the messages provided to, and subsequent increased knowledge of, GPs has translated into improved prescribing practice.
A challenge for the continued use of Home Medication Review (HMR) (MBS item 900) has been the pharmacist reporting to GPs. Accredited pharmacists are 'licensed' to conduct reviews of patient's medications on a GP referral if they have passed a stringent 'clinical' assessment. Melbourne Division feels this process gives the wrong message to the pharmacists concerning the aim of a GP referral in respect to helping the patient achieve better health outcomes from the medication regimen. Many, if not a majority of reports going back to the GPs, give a 'clinical' opinion and suggest changes to the treatment that are unrelated to the patient's management. GPs are wary of the legal implications of disregarding the suggestions, albeit uncalled for, and without the knowledge of the reasons for the original clinical prescribing decision.
Continual feedback to accredited pharmacists and to HMR management has not resulted in much change when the accreditation process is implying something else other than a professional review of the patient's ability to administer medications prescribed and monitor over the counter and complementary therapies taken in conjunction with prescribed medication by the patient.
Of particular concern in Melbourne Division is that the HMR numbers have fallen back and complaints from GPs have indicated the reason is that what they had expected of a referral was not delivered.
The national rates of antibiotics prescribing are down over four years (from HIC with MBS and PBS data) monitoring. Figures indicate a stronger trend in Melbourne Division compared with national figures for this positive movement. The same trend is repeated for the prescribing of amoxicillin - the preferred antibiotic with the most evidence for use in URTIs. The National trend for amoxicillin use is upward as it is in the Melbourne Division. However, the trend in the Melbourne Division is stronger than the national trend.
The initiative taken to educate GPs and the public on antibiotic use and resistance appears to have been heeded, with the Melbourne Division rating higher in positive trends than the national average when comparing prescribing rates per 1000 patients.
Program 2 - Services By GPs
Better Outcomes In Mental Health
The Better Outcomes in Mental Health (BOiMH) has had an interesting year. This year the project was conducted over two Divisions - Melbourne and Northern Divisions. Melbourne Division had a long and successful history of mental health involvement over time and contributes significantly to upskilling GPs in dealing with mental health, drug and alcohol, and gambling addictions. Our Gambling CD-ROM continues to be requested by agencies and this period we received requests from the CPA Society of Australia, Life Line Queensland, and the Advocate for Responsible Gambling for Victoria as well as some of our PCP partner agencies for our resource.
Significant achievements of the project in this period include:
ø A quality assurance component, clinical supervision of contracted psychologists, was included in the project consistent with best practice.
ø A new service delivery model was designed and implemented in response to the previous year's experience of this program. As a consequence, and in part through renewed assertive promotion of the program, referrals increased dramatically in the last three months of the year. Referrals totalled 84 patients. The Division has also attracted three new GPs to commence referring through the scheme bringing the pool of referring GPs to 12.
ø The total number of GPs who have completed Level 2 training increased nearly four fold over the year (10 in 03-04 to 47 in 04-05).
ø Development of an electronic template articulating service referrals pathways to adult and child mental health services providers in the area.
ø Design and implementation of a youth mental health program.
ø Establishment of a cross-sectoral reference group with representation from key mental health services in the area.
Practice Nurse Network
Over the twelve month period six joint Melbourne Division and NDGP Practice Nurse (PN) Network Meetings where held. Overall 73 nurses attended one or more sessions. Each session was evaluated through a feedback form and all sessions rated very good or better.
Melbourne Division is aware of 64 practice nurses employed within 24 practices in our catchment. During the year a survey was conducted to evaluate the network sessions. The questionnaire's aim was to gain information on the perceived value of sessions by the target audience and to understand why attendance rates were not higher. All 64 practice nurses on the current database were sent the questionnaire with a response rate of 45.3%. In a nutshell, nurses attend sessions if they are interested in the topic, and those that have attended sessions rate them highly as learning forums.
In the last 12 months, the Practice Nurse network has incorporated information sessions generated through the work of our Primary Care Partners. Sessions on the pediatric asthma community project, Vic Fit and lifestyle activities, continence management, HMR and e-referral to primary care agencies were held. The PN network is an appropriate forum in which to promote these services and health issues, and is an important conduit for our primary care partners.
Stakeholder engagement and participation in stakeholder activities of mutual benefit has been evidenced this year. In particular the Continence Foundation of Australia undertook a project designed to increase the engagement of GPs and practice nurses in continence management. A number of Melbourne Division's staff, particularly our Practice Nurse Coordinator, participated actively in this project. Other stakeholders engaged in the Practice Nurse work at the Division include the Australian Association of Practice Nurses, Royal College of Nursing, Royal District Nursing Service, Royal Australian College of General Practice, other Divisions of General Practice, Wound Management Foundation of Australia and the International Diabetes Institute.
Of particular interest in this reporting year is the service offered to support new practice nurses. In five practices Melbourne Division's Practice Nurse has provided in-house orientation and support to newly engaged practice nurses. In three practices, this practice nurse was the first the practice had engaged.
Feedback from all education provided indicated all sessions were rated highly. The sessions advertise to nurses and general practices the expanded role nurses can potentially have in primary health care. .
Melbourne Division of General Practice Kit Project. The past twelve months has seen the completion of the Div 1 Practice Nurse Recruitment and Induction kit project. The launch of the kit by the Federal Health Minister for Health, and its impending development into a national resource, highlighted the success of this project.
Trial A Nurse. Preliminary evaluation and planning for the “Trial a Nurse” scheme was undertaken over the last six months. A service model has been proposed, and in the new reporting year details will developed. The inclusion of a robust evaluation program at the commencement of this activity will enable the provision of rigorous evidence concerning the impact of practice nurses. 100% of PIP eligible practices have been involved in the development of this project, as well the broader Divisional practices.
The COACH Program
The COACH Program has been in place at the Division since December 2003. During the current reporting period The COACH Program has continued to focus on the promotion of the program to GPs within the Division. This has been achieved through CPD events, practice visits and numerous articles in Division publications. These articles not only inform GPs of the existence of The COACH Program, they also provide updates comparing the risk factor levels of patients in the program to the National Heart Foundation of Australia coronary risk factor targets.
Almost 300 patients have been referred into The COACH Program, of which 122 have been referred during this reporting period. The program receives support from GPs, with 19 GPs regularly referring patients.
Results for patients who have been coached for at least a 6 month period indicate there has been an increase in the number of patients achieving each of the risk factor targets. Specifically:
ø 6% increase in patients achieving a total cholesterol < 4.0 mmol/L;
ø 14% increase in patients achieving a total cholesterol < 4.5 mmol/L;
ø 17% increase in patients achieving a LDL cholesterol < 2.5 mmol/L;
ø 16% increase in patients achieving a blood pressure < 140/90 mmHg;
ø 5% increase in patients achieving a body mass index < 25 kg/m2;
ø 8% increase in patients not smoking; and
ø 14% increase in patients participating in regular walking for exercise.
During this reporting period the patient recruitment criteria was narrowed. Now only patients with known coronary disease, non-coronary vascular disease and diabetes are eligible for the program. The decision to exclude the majority of primary prevention patients was made because:
ø It appeared only the “worried well” were being treated;
ø Primary prevention patients have less chance of showing significant reductions in their coronary risk factors and meeting the National Heart Foundation of Australia targets; and
ø Secondary prevention patients have more incentive to make changes to their lifestyle and subsequently more can be expected of them.
Despite the change made to the recruitment criteria, resources still need to be provided to GPs and their high-risk primary prevention patients who would have previously been referred to The COACH Program. Consequently, the Division is currently developing a Primary Prevention Pack. This pack will provide GPs with information and resources regarding physical activity and nutrition to give to their primary prevention patients.
The next reporting period will focus on relaying the change in recruitment criteria to GPs and further promotion of The COACH Program and the Primary Prevention Pack.
Diabetes Co-Management in General Practice (DCGP) Project
The Diabetes Co-Management in General Practice (DCGP) has received a fourth year's funding until June 2006. The Department of Human Services (DHS) is in the process of mainstreaming Hospital Admission Risk Program initiatives. Chronic Obstructive Pulmonary Diseases (COPD) and complex needs are currently being mainstreamed while diabetes models for mainstreaming are still being developed. The DCGP management team met with the DHS in November 2004 to discuss the progress of the project. The DHS informed the team that they planned to continue with the DCGP model but indicated they would like the DCGP to focus on a higher risk group of patients and involve more GPs. The DCGP has developed and implemented risk criteria to identify patients for assessment. Following assessment by the Diabetes Nurse Educator patients are classified as requiring low, medium or high levels of intervention by the DCGP and followed up as required. Additional practices have also been recruited for nurses currently employed by the DCGP.
There are currently 18 practices and 73 GPs participating in the project with up to three additional practices in the process of being recruited. Over 1500 patients have been recruited and assessed by DCGP nurses. Screening rates for all diabetes complications have improved with the greatest improvements in the area of feet, body mass index, renal function and retinopathy. The proportion of patients meeting management targets for diabetes complications has increased for all guidelines with the greatest improvements in HbA1c, retinopathy and feet.
The DCGP received its third project review report by the external evaluators BearingPoint in April 2005 based on data submitted for the July to December 2004 period. The project review indicated the DCGP was performing well, and managing 154 patients in a six-month period per full time equivalent nurse at a cost of $324 per patient.
The DCGP has been accepted to present an oral presentation and two posters at the Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Forum in September 2005. The DCGP has also been invited to speak at the National Disease Management 2005 Conference.
The DCGP is currently working with other projects and programs in the Northern and Western regions of Melbourne to develop integrated diabetes models of care. The DCGP is also working closely with Melbourne Division's National Primary Care Collaboratives Program to support practices participating in both initiatives and to share the experiences of the Collaboratives with other practices. The DCGP nurses also refer into Melbourne Division's Coach Program.
The DCGP has identified the need to support chronic disease management systems in general practices as an ongoing challenge. The DCGP has developed a practice audit to identify systems issues and possible solutions.
DAG
The Diabetes Alliance Group (DAG) conducted three education evenings, and an eight-week practice nurse course during the period. The DAG underwent a review by the CEOs of member Divisions, resulting in clarified governance and reporting structures and a proposed strategic planning workshop to identify new directions.
RAG
The Respiratory Alliance Group (RAG) organised two education evenings, however due to speaker injury only one evening went ahead. Two Active Learning Modules (ALM) (RACGP Category 1) were conducted attracting 40 GPs and very positive feedback from participants.
Program 3 - Population Health
Immunisation
The Immunisation Program underwent strategic planning, separate from but contributing to, the Division's strategic planning activities during the reporting period. A structured program of evaluation commenced, and the programs strategies and activities were redesigned. As part of this process an in-depth analysis of the Melbourne Division's practices, and their immunisation activities (both adult and child) were identified. The Division can now with great confidence target its immunisation activities to a relevant segment of our total population of practices. In response to the planning the Board agreed to allocate additional resources to immunisation in 05-06, including the establishment of a 4-year old project.
Three education events were conducted this year on immunisation updates with over 85% of respondents rating the event as very good or better. We had 20.5% of the immunising GP population attend, and 33% of immunising practices had practice staff in attendance at these education events.
A local project around the type, value and efficacy of data loggers was undertaken. Subsequently, four data loggers were purchased in June 05 in the new reporting period a strategy to implement data logging and monitor cold chain in practices was commenced.
The Division's immunisation coverage rate remains under the National objective of 90%, currently at 87.3%. An analysis of Melbourne Division of General Practice's immunisation experience has commenced with a view to articulating a cogent and evidenced based rationale for the coverage rates.
Melbourne Division is the lead agency for the Western Metro Region Data Quality Officer Program (WMRDQO), which includes over seven councils, and three Divisions of General Practice. Since inception four years ago immunisation coverage rates have significantly improved and in this reporting period indicate a trend towards plateau. The project has been able to continue to identify data transmission and entry problems which when resolved improved reporting information significantly. This reporting period the project has been able to assist the implementation of new and existing council software, which in turn will contribute to improved reporting to the Australian Childhood Immunisation Register.
Cohorts for children over the four years of the WMRDQO project show:
ø Cohort one (ages 12mths -15 mths) stable
ø Cohort two (24-27 mths) increased 7.2%
ø Cohort three (to 76 mths) increased 2.3%
Melbourne Division is one of three Divisions involved in the Northern Metro Region Data Quality Officer Program, working with another seven councils. Melbourne Division's Immunisation Officer works in close cooperation in particular with the Cities of Yarra and Moreland in their data cleansing activities. Through the provision of Divisional reports, assistance with data cleaning, and targeting of difficult patients the Division's input has lead to an effective relationship with these Councils. Consequently in the new reporting period a joint project targeting difficult to reach CLD GPs around immunisation of their patients will be implemented.
Disaster & Emergency Planning
Contact with agencies involved with Disaster and Emergency Planning increased during the year in anticipation of the Commonwealth Games. This year's work follows on two previous years of negotiation and discussions with hospitals, local councils, state governance, emergency agencies and other divisions. This year Melbourne Division attended meetings with relevant agencies, corresponded with relevant agencies, met politicians and neighbouring Divisions around disaster and emergency planning. It is clear that engaging a body with the relevant funds to employ a person to scope out the role of both GPs and Divisions will prove difficult. However, we are pleased to report that the emergency and disaster agencies are acknowledging the need to include Divisions of General Practice and/or GPs in their emergency and disaster planning, even if they have done nothing further with GPs and disaster and emergency planning.
National Primary Care Collaboratives Program (Collaboratives)
Initially nine practices were recruited for the first WAVE (W1) and two resigned from the program in its early stages. The seven remaining participating practices have demonstrated a strong commitment to the program. Results indicate 100% compliance with submission of data and attendance requirements, compared to a national average of 87%. Additionally, members of participating practices have attend the network evening to further share information at a local level.
W1 has been a learning cycle for all parties: NPCC, the Collaboratives Program Manager (CPM) and the participating practices. Some practices felt they have been overworked, this feeling being exacerbated by the failure of the data extraction tool in the early period. Two major software applications had no tool at all and practices had to struggle manually with their data. This period therefore had problems and but the CPM network were able to overcome some of the problems.
Melbourne Division took the initiative and contacted the head office of one-software vendors to ask for extraction tool with selected queries specific to the NPCC program's needs be built. The biggest challenge apart from data extraction has been the data integrity - it was found that most participating practices nationally did not use the correct protocols to input data, if they were at all using the application for recording clinical information. The principle of 'rubbish in rubbish out' applies. Cleaning and validating the registers and reminders to correct procedures of data input has been a major focus for the CPM.
This program reflects the need for chronic care management using a simple improvement model: PLAN DO STUDY ACT. Some practices in W1 already are working towards being 'lighthouse' practices that may champion the 'spread' to other practices who may wish to provide systematic and quality 'chronic care' to patients in need of chronic management. Engaging practices in an in-depth program also allows the Division practice support framework to be more rewarding.
Program 4 - Division Management & Operations
Governance. The Melbourne Division's focus on governance saw the creation and implementation of a range of policies and procedures, informed by industry standards and best practice. The Governance Working Party, comprising four Board members and the CEO formed a cohesive and committed conduit operating between the work of the staff and the approval processes of the Board. By end of period the Division had developed and implemented a comprehensive set of Human Resource, Board, Finance, Occupational Health & Safety, Information Technology and General policies and procedures. An Annual Reporting and planning cycle for the Division and Board members had been established, and plans for a Risk Management Strategy, Board Appraisal Process, and Board Induction system established. A Board Member's manual, updated as required, captures for Board Members the length and breadth of Melbourne Division's Governance, theories, policies, expectations and plans. Melbourne Division's strong commitment to good/best practice governance underscores all its activities, relationships and decisions.
Accreditation. During June 2004 Melbourne Division committed to undergoing internal Accreditation and after reviewing the options chose to seek accreditation through the Quality Council of Australia (QCA). An accreditation project officer was engaged for 12 months for 1.5 days per week. After several months, another senior staff member joined this project officer for 2 days per week. A time frame was established to achieve accreditation - December 2005. Staff meetings and training sessions were held, Board presentations and plans were established, the Governance Working Party received reports on the progress towards accreditation within Melbourne Division. Assistance was sought from General Practice Divisions Victoria and other Divisions as required. Individual members of staff reviewed not only their own areas of operations, but also participated in reviewing systems and processes in the broader Melbourne Division context. Significant development of policies and procedures took place. Some material was adopted from existing best practice; other material was developed from its beginnings. In May the decision was made to apply for accreditation earlier than the initial time frame, and in late June QCA reviewers attended the Melbourne Division to review its systems, processes and protocols. Melbourne Division was advised that it would be recommended for accreditation with the Quality Council of Australia. Continuous quality improvement is a part of the culture of Melbourne Division and a Quality committee comprising staff members, and on going participation in Quality meetings and seminars are newly emerged feature of the Division.
The systemisation of the programs and projects at the Division was developed in collaboration with the staff, Board and external stakeholders ensuring that they were viable. This process has improved communication between programs staff within the Division, is helping to overcome silos at the Division and fosters clear and speedier communication about our activities and the communities we serves.
GP Engagement. Melbourne Division's relationship with its GPs is a focal point around which our activities are structured. The demographics of both the population served by the GPs, the transient nature of 25% of our GPs, and practice types themselves contribute to a diversity that can make relationship building and retention challenging and characterised by the need to continually renew.
In this year Melbourne Division sought to articulate and strengthen the nature of the existing relationship with its members. To this end the every practice on the database was contacted and asked to provide information to the Division, six GP Focus Groups were held on particular topics, and a semi structured research project in which 24 GPs participated in in-depth interviews for one hour replace the annual survey of member needs. In all, 155 practices (100%) and 101 unique GPs (23%) have participated in the seven focus groups and one in-depth review of the Division and its performance. The results have been positive, and the material generated provides the staff and Board with a rich array of information with which to guide our efforts and our activities.
In a separate exercise, the membership database was analysed revealing differences between members of the Division (ie those people who formally join the Division) and catchment GPs (ie those GPs working in the Melbourne Division catchment area). The information gained from these exercises is being used to strengthen the relationships with all GPs to whom Melbourne Division delivers services and/or activities. GP Engagement will continue to be a dominant theme informing much of Melbourne Division's activities. The new reporting years offers an exciting opportunity to trial the learning's around GP engagement in this year, as well as explore further the relationship with constituent GPs and their practice staff.
Internal Evaluation. Throughout the year Melbourne Division has shifted towards establishing the know-how and frameworks to embed evaluation as a part of the Division's culture. Staff participated in three in-house training seminars during the year. To further progress the work with evaluation, an evaluation consultant from the Department of General Practice at The University of Melbourne was engaged to assist two programs establish and implement robust evaluative frameworks, with a view to providing rigorous information on achievement of outcomes at the end of 05-06. Melbourne Division has articulated the aim to institute the practice of evaluation as a core activity of all programs and projects in order to facilitate future resource and other decisions.
Program 5 -Aged Care GP Panels Initiative
The Melbourne and Northern Divisions of General Practice are working in partnership to implement this initiative. The progress of the Aged Care GP panels project over the first year has been patchy; with some of GPs and Aged Care Homes (ACHs) working well together with enthusiasm while others have no engagement with the project.
Initial set up of the project and needs analysis were completed and a program advisory committee and a panel of GPs interested in working on the project established. Work commenced on a number of areas identified by the needs analysis, though achieving changes in practice is not easy.
A surplus of funds exists in the stream to pay GPs, this will be rolled over to be used in 2005 -6. While we have plans to utilize this money with GP input, the bulk of the project is to engage GPs and ACHs and work towards practice change. This work is generally not of interest to GPs and arguably does not best utilize GP skills. The current funding arrangements are under review and we hope for greater flexibility in using funds to achieve the aims of the project.
Achievements
Mentoring program Supervised Clinical Attachment for Geriatric Experience (SAGE) developed by the GP education project team, with input for ACH and geriatrician, to meet the RACGP requirements for supervised clinical attachment. Four mentoring teams were established, each comprising of a Lead GP and an ACH. Additional specialist mentors provide 2- 4 hours supervision e.g. aged psychiatric services, Aged Care Assessment Service, residential support program. One mentee in Melbourne Division has commenced, and a further one is committed in the new reporting year. There were six enquiries by the end of the reporting period. The program has generated a degree of interest and other divisions have sought to replicate the program.
Barriers/Challenges
Engagement of ACH and GPs. The major barrier is the difficulty engaging both GPs and Aged Care Homes. Both stakeholders have a high level of complexity and competing demands on their time and resources.
A number of Homes have had no engagement with the project. When approached staff have outlined issues the home is dealing with, such as moving, closing down, changing management, staff retention problems.
Strategies to improve engagement with ACHs aim to build on actual benefits for the Home, rather than the project being seen as taking time. Strategies are:
ø Working with acute health sector on delivery of medications in a format that suits the ACH on discharge from hospital, commenced with Melbourne Health as a trial site.
ø Offering assistance and support to all ACHs to establish a medication advisory committee (MAC) if one not already in existence.
ø Increased project staff visiting those Homes visited as part of the needs analysis and who have remained unengaged. It is hoped that proposed changes to funding arrangements will free up funds to allocate to staff time, and to reimburse the home for participation in the project.
The difficulty in engaging GPs also presents a major barrier, with relatively small numbers of GPs active in the project. Practice visits and promotion of concrete gains is probably the best way to engage GPs. The plan to increase GP engagement in the coming year is to:
ø Circulate successes of the project via the divisional newsletter
ø Continue with GP quality meetings at ACHs
ø Promote and support the establishment of MACs
ø Visit practices where GPs provide aged care to talk about the project
ø Employ a GP to undertake practice visits on behalf of the project.
GP Panel model
Neither Aged Care Homes nor GPs have taken up the notion of a panel of GPs working with an Aged Care Homes. GPs working with the project have instead developed project teams to work on areas rather than with ACHs. Aged Care Homes have been interested in resolving their individual issues and needs with their own GPs. A model GP panel may develop over time if accounts of effective models and outcomes are reported, these can be built on in the division.
Restrictive funding arrangements.
A large surplus exists for the GP stream of the budget that cannot, under current rules, be used by the project team, or to pay non-GP participants. The ability to pay the ACH for staff to participate in the project could allow staff to be replaced. This would also acknowledge the value of the ACHs time and may increase participation in the project.
Summary of data
Total number of GPs within Melbourne Division participating with Aged Care GP Panels
15 total, of whom 7 regularly participate
Age and gender of all regularly participating GPs participating on GP panels
Under 35 36-45 46-55 56-65 65+
No. Of female GPs 1 1
No. Of male GPs 1 2 2
GP Payment Mechanisms. GPs paid on an hourly rate at $110 per hour plus GST.
Total number of hours of GPs time for which funds have been provided where remuneration has been on an hourly basis. - 90 hours.
No GPs have received a retainer payment.
No GPs have received an outcome-based payment.
Aged Care Homes participation in the Aged Care GP Panel arrangements?
Aged Care homes have had varying involvement with the Aged Care GP Panels project.
15 ACHs, out of 28 have had with some engagement
ø 6 with substantial involvement
ø 2 holding GP quality meetings
ø 2 participating on working parties
ø 2 Attending information sessions.
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