Planning & Report Summary for the year 2004 - 2005
|Division Details | Listed Programs|
"The Bendigo and District Division of General Practice is committed to improving the health care for the people of Bendigo and District by making effective use of the skills, knowledge, experience and commitment of GPs. The BDDGP supports a team approach to health care through the Development of partnerships, more integrated services, identification of needs and enhancements of the skills of health professionals."
Evidenced Based Best Practice Education
The prime aim for this Strategic Plan is the promotion of evidence based best practice. Data collection both within practices and the Division will be a major objective of this coming year. A Division developed data extraction tool will be available to all practices, with the ability for all GPs and practice staff to access their own information. It is anticipated that this information will form the basis of the educational needs of the small practice based learning hubs.
The Division will resource all hubs and where possible assist with the access to best practice information and key professional presenters. Information will be attuned to local needs. General practices will be informed by both government and the broader community and the Division will act as a conduit for this information.
The Division will continue to promote, EPC, Chronic Disease initiatives and Home Medicine Reviews.
The key to practice engagement in these initiatives will be supported through out practice manager, staff and nurse networks. The Division will continue to on the executives of two PCPs and the HARP working groups which will complement Division activities especially around the Chronic Disease program. Key local data will be collected as part of these working groups and comparison with hospital admissions will allow the Division to target with practices quality improvement in medication management.
The Board of the Division has chosen the areas of Youth, Aged Care and the Indigenous Community as the population subgroups that will be supported in this coming period. With the areas of nutrition especially childhood obesity being a focus of activities. The Division will continue to disseminate resources within the SNAP framework.
The Division has a long history of working with the aged care industry in the region and the designated funding for this area will be utilised to expand the pilot programs that are currently in place. The expansion of medical software into the majority of Aged Care Homes is a primary aim of the coming year. Castlemaine with some 180 nursing home beds will be new to the Division and we hope to consolidate our knowledge of the Aged Care Facilities in this area.
The Divisions strong linkages to Pharmacists in the region will continue to be entrenched in joint initiatives over the coming years.
The Division has been fortunate to receive funding for linking specialists to GPs electronically through Argus software with particular awareness of privacy guidelines. This will build on the specialist database in the Division and the joint work with specialist practice staff in some of our staff training days. Members of the staff have also been involved in the statewide service directory, which although only in draft at present will assist in networking between GPs and other health agencies in this state.
We have increased our IT/IM staff in this period primarily as a business unit to undertake fee for service support to practices and this has been well received by the members.
Our practice support program will continue to be of prime importance to practices in the continuing role out of new initiative as well as assistance with practice staff, and a help desk which in the annual survey was seen to be one of the most used areas of the Division. The Division will also act as an advocate for GP members recognising their place as a major entry point into the healthcare system. Immunization will be enhance with the Regional Data-Cleaning project. We will continue to work closely with local government as well as tertiary organisations and indigenous communities to improve immunization across a range of ages and cultural barriers.
Recruitment of GPs to the area remains a high priority; as the local GP workforce continues to age, with locally lower than the National average numbers of young GPs to take their place living in Bendigo. Locum and family support of GPs and Registrars is considered pivotal to the retention of GPs in the Divisions catchment. The Division will also support the Clinical School with education of undergraduates, and the Regional Training Network in the recruitment and support of registrars.
The Division will continue to support OTDs towards their fellowship and in the development of their practices in the catchment.
Best Practice in Medication Management
NPS, HMR and EDQUM will support practices to review their prescribing habits in line with best practice. The Division will undertake training and peer GP support to maximize the outcomes from these programs. An active interagency QUM working group will set key areas to develop and resource over the period of this plan.
Drug, Alcohol and Mental Health
The Division has an active practice based training program "Training on Wheels" which support both Pharmacists and GPs in their treatment of patients with alcohol and drugs of addiction. This is further supported with a Special Interest group that meets regularly.
As one of the first to receive BOiMH funding the Division has consolidated an active program that is strongly supported by local GPs. Practice Based Psychiatric Nurses will continue to be employed backed up by a secondary consult in the form of a clinical psychologist.
Strong governance of the Division, with ongoing training and attendance at State and National forums has resulted in a strong board. The board is committed to consumer involvement in the Division and as such support the consumer reference group and the elected representative from that group on the Board. This continues to expand the Divisions outlook and is represented in this strategic plan.
CHALLENGES FOR THE FUTURE
Maximise use of current income and attract income from new sources.
Continue to attract more GPs to Bendigo to decrease ratio of GPs to patients below current level of 1:2000.
Continue to reinforce the benefits of utilising the NHMRC guidelines around Depression in Adolescents.
Assist in further integration and collaboration of mental health services and indigenous communities and agencies.
Work with Pharmaceutical companies to make training appropriate to the needs of local GPs.
Through the NPS program, to introduce best practice prescribing information to local GPs to enable them to review current prescribing practices.
Continue to increase the numbers of active Methadone Prescribers in the region.
Continue to improve reporting from local hospitals to GPs and to improve electronic discharge summaries.
To support secure electronic communication between GPs and all other health agencies and medical specialists.
Continue to work with Aged Care Facilities to improve systems to encourage GPs, especially younger GPs, to remain involved in the care of their aged patients.
Strengthen links with Bendigo/Loddon Primary Care Partnership and Central Victorian Health Alliance. Improve co operation between GPs and all other health agencies in region.
Working towards accreditation of the Division.
The Bendigo and District Division is a small but robust entity situated in the fast growing regional centre of Bendigo, Victoria.
Bendigo and district is home of Bendigo Bank, ADI, Empire Rubber, three prisons and many other large employers. With both a public and a private hospital in Bendigo, a wide range of medical services is offered. It boasts excellent educational facilities with Girton Grammar, Bendigo Senior Secondary School and Castlemaine Secondary College and the Castlemaine Steiner School in the district as well as La Trobe University.
Bendigo is the main centre for a much larger rural population who shop, access health services and work within its boundaries. As such, the Division's catchment is much larger than the set boundaries of its grant.
The Division works towards strengthening General Practitioner's capacity to be the gatekeepers to the rest of the primary healthcare sector through collaborative, innovative and sustainable initiatives and whole of practice support.
* 99% of local GPs are active members of the Division and use Clinic SMART in-practice accreditation and business support service.
* 74% of practices in Division have gained accreditation.
* Collaborative work with the State Health organisations and Local Government to provide regular immunisation sessions for the Koori community and student population at La Trobe University. Regional Immunisation Reference Group chaired by Division. Responsible for regional immunisation data cleaning across five shires, roll out of Q fever vaccination program and organization of local government immunisation programs.
* Active Practice Managers and Nurses networks that enhances uptake of new Govt initiatives. Data base of practice nurses and medical receptionists seeking employment
* Involved in development and distribution of service directory to assist people with diabetes and their health care team in diabetes management. National guidelines distributed to GPs as flip chart. This project involved collaboration with broader health sector, GPs, endocrinologists and consumers.
* Collaboration with HARP team to improve management of people with asthma, COPD and CHF. Division was member of working party to develop communication strategies and promote best practice management guidelines. Emphasis on team approach and patient self management of these chronic diseases.
* Active Consumer Reference Group. Consumers include a carer, Koori elder, teenager, aged pensioner. Strong links through this group to other Consumer Reference Groups.
* Consumer representative on the Division Board of Management.
* GP Registrar on the Division Board of Management.
* Resources folders around SNAP framework (smoking, nutrition, alcohol and physical activity) developed and distributed to all GP practices via managers staff and nurse networks.
* 97 % of GP members and practices are now computerised and using electronic prescribing.
* Business Unit offers a range of fee for service IT and business services to members. This service was established in 2002.
* Strong links with other Primary Care Providers and pivotal player with Bendigo Primary Care Partnerships, CVHA and forty other health organisations.
* 95% improvement in the 24 hour notification of admissions and deaths to local GPs by Bendigo Health Care Group.
* Strong aboriginal liaison - initiatives include diabetes education, immunisation, strength training, GP service assistance with management development skills, staffing support, OATSIH funded integration. Business and accounting services provided.
* Improved medication management in Aged Care facilities due to widespread usage of Medical Director and streamlined system of prescription supply. GP Aged Care Panel established. Member of development committee of Bendigo/Loddon Aged Care Strategy, the first in regional Victoria.
* Division emphasis on education program based on principles of adult learning and best practice medicine, incorporating a range of delivery modalities and sites.
* 60% of GP members involved in regular small self directed learning groups (CPD hubs) which are accredited through the RACGP.
* Division co-ordinates local education programs with a range of providers including Pharmaceutical companies, health related organisations, hospitals and educational institutions.
* A local perspective is provided in all education through "value adding" with locally relevant/resources, using local GPs and Specialists as facilitators/ presenters and incorporating topic specific input from Division.
* Active participation in Better Outcomes in Mental Health. Our unique model incorporates the use of practice based mental health nurses in the delivery of therapy whilst in consultation with referring GP.
* Training on Wheels. Three specific rounds of funding to deliver Alcohol and Drug education and training within GP practices whilst focussing on their day to day patients issues. Training on Wheels builds relationships between GPs, pharmacists and Alcohol and Drug workforce resulting in an increased shared care model.
* Special interest groups in "Alcohol and other Drugs" and "Mental Health"
* Quality Use of Medicines program encompasses NPS, HMR and EDQUM
* Strong links with local pharmacy industry.
* Strong links with RWAV and RMFN.
* Regular GP family events held.
* Support given to GP registrars and their families. Social and educational support groups established through WSRGP program.
* Meet and Greet visits to all new GPs and families.
* Involvement in RTN Fellowship Exam Preparation program for overseas trained doctors. Regular study groups hosted by Division.
* MAHS providing a range of allied health services by local rural allied health practitioners
The Bendigo and District Division is based in the postcode areas: 3450, 3453, 3462, 3463, 3472, 3475, 3515, 3523, 3539, 3550, 3551, 3555, 3556, 3557.
This area encompasses the heart of Victoria, and the City of Greater Bendigo and the Shires of Mt Alexander, Central Goldfields, and Loddon.
The Bendigo and District Division is based in the heart of Victoria, of rectangular shape. The area encompasses Healthcote to the East the southern boundary includes Heathcote, Castlemaine, Newstead, and approaches Maryborough. The western boundary includes Bealiba and towns west of Dunolly. The Northern boundary approaches the towns of Inglewood, Bridgewater and Elmore. The regional centre is to the east of the Division - Bendigo.
The majority of the catchment is some 2-3 hours from Melbourne, the western half of the catchment however has very poor transport systems.
The whole of the Division is within the State Regional area of Loddon Mallee.
From the 2001 census data.
Population of the Division is 98,664 persons, this represents a 9% increase since 1996.
* 0-4: 6123 this is equal to the state average of 6.5%
* Over 65: 13,240 this represents 14.1% of the population (State average 12.6%)
Socioeconomic status: The Greater City of Bendigo - Eaglehawk has the highest rural SEIFA index (3rd in Victoria) indicating the highest measure of disadvantage in rural Victoria. In 15th position is Central Bendigo and 23rd is Castlemaine out of 194 SLAs in the state
Aboriginal and Torres Strait Islander population: 958 for the catchment, the Aboriginal Co-operative indicates this figure is closer to 1500.
Marital Status: married 40.4%, separated, divorced or widowed 22.3%, never married 37.3%.
5.9% of the population in the Division were not born in Australia. This figure is made up of 3.2% from UK or New Zealand and with 0.4% from the Netherlands. The remaining 1.3% are from 27 countries.
The majority of the population is based in Bendigo with the other centres in Castlemaine, Maldon, Newstead, Heathcote, Dunolly, Harcourt.
Number of practices in the Division area: 40 with 19 being solo General Practitioners. Practices range in size from solo to a practice with 15 GPs.
The number of GPs eligible for membership:97 this includes all local registrars.
Number of eligible GPs who are members: 96 this includes all local registrars.
Distribution: Bendigo a GP/population ratio of 1:2000 and an FTE of 48.1 with 20% of GPs expected to retire in the next 7 years, the emergency department of the base hospital is currently run by GPs. There is currently about 1000 nursing home and hostel beds in Bendigo whose catchment extends to the border. Local GPs are expected to take on nursing home patients who come from outside the catchment.
* Castlemaine: GP/population ratio of 1:1200 but runs a large hospital with 180 nursing home beds and obstetrics and surgery.
* Healthcote: GP/population ratio of 1:1400 but many patients attend these clinics who are not part of this catchment - support a small hospital and nursing home
* Dunolly: GP/population ratio of 1:1500 and small hospital with nursing home beds (30)
* Maldon: GP/population ratio of 1:2000 and small hospital with acute (5) and nursing home beds (12) and hostel (12)
The Division covers both RRMA 3 and 5 areas. The RRMA3 area has the worst GP to population ratio this is further exacerbated by the RRMA3 limitations of only a quota of 11 Overseas Trained Doctors eligible to work in the area through the RLRP and who receive only A2 level payment. This makes moving to Bendigo a relatively unattractive option where places closer to Melbourne receive the full rebate and outer metropolitan areas can receive add incentive payments to start up a new practice. With 87% of new GPs in rural areas being OTDs in the last year (RWAV figures 2003) it is not surprising that few are attracted to Bendigo.
The Division despite having an SLA area with the highest growth rate in rural Victoria, and one GP was not eligible under the Areas of Consideration initiative.
The workforce situation is currently critical as even registrars who are under the rural stream are ineligible to apply for positions in the RRMA 3 area. The local Regional Training Provider, Victoria Felix has only 7 General Registrar positions. These position are required to fill positions over one quarter of the state. Despite these disadvantages the Division has an active recruitment and support program.
VACANCIES, REGISTRARS AND UNDERGRADUATES
The prime shortage is in GPs, currently with a GP to population ratio of 1:2000 which does not include the number of people outside the Division area that use Bendigo as their source of healthcare. There is currently a 48% bulk billing rate which has remained relatively stable over the last few years (ACOSS statistics). There are only two completely bulkbilling practices one of which is Bendigo Community Health and the costs associated with this are subsidized through the community health service. Currently of the 40 practices in the Division only 6 are taking new patients. There is a progressive diminution of available GPs to attend Nursing Home patients - bulk billing clinics currently do not have nursing home patients.
There are at present 15 GP vacancies in the Division catchment with 4 practices eligible for registrar placement who are unable to attract a registrar. 10 of the local practices are hosting undergraduate medical students most of whom are in the rural stream. The Division hosts the undergraduate students several times a year. On average the Division provides 400 sessions of locum placements per year to GP members.
24 or one quarter of GP members are female,and the majority work part-time, however 60% of registrars are female.
The Division has a proactive approach to GP education with the 2003 Division survey indicating it was the most popular program with members.
OTD education: ongoing workshops to assist with the fellowship exam.
Registrar support groups.
Undergraduate involvement in Division activities.
Special Interest groups on mental health and drug and alcohol.
Hub based learning, with currently 8 practice hubs functioning.
A range of collaborative functions with local agencies to build improved networking and referral pathways.
DIVISION WIDE STAKEHOLDERS
Major stakeholders that the Division has formed alliances with.
Bendigo Healthcare Group
Mt Alvernia Hospital
Mt Alexander Hospital
McIvor Health and Community Services
Community Health Centres
Bendigo Community Health
McIvor Health and Community Services
Cobaw Community Health
Loddon Mallee Women's Health Services
Maryborough and District Community Health
Other Local Agencies
Bendigo and District Aboriginal Co-operative
Loddon Mallee Housing
DHS Regional Office
Area Mental Health Authority
Police (Bendigo region)
St Lukes (disability support)
Victoria Felix (Regional Training Network)
Nursing Homes:23 in this Division with 1180 beds
Currently 100 specialists are involved within the Divisions catchment and receive ongoing communication.
Pharmacy practices: All local pharmacies
City of Greater Bendigo
Mt Alexander Shire
Pharmaceutical Society of Australia
Latrobe University Bendigo
Monash Rural Clinical School
Primary Care Partnerships: on the executive and multiple working groups
Central Victorian Health Alliance
Bendigo Loddon PCP
Major Health Services that are lacking
Mt Alexander Shire has the highest rate of Hepatitis C infection in the whole of the Loddon Mallee (DHS catchment). This is exacerbated by 3 prisons in the area, but also by a local alternative lifestyle culture (2004 DHS survey). Loddon Mallee is the only Victorian region not to have a liver clinic - to address Hep C and HIV clients in the catchment. Currently clients have to travel to Melbourne for treatment.
Half of the Divisions catchment do not have access to Broadband technology.
There is a lack of Psychiatrists and mental health services across the whole Loddon Mallee Region.
Joint Activities with Divisions
The Division runs a DHS sponsored datacleaning project for the Shires of Macedon, Mt Alexander, Loddon, Campaspe, Central Goldfields and the City of Greater Bendigo - these are in the Division areas of Central Highlands, WestVic, Murray Plains, Bendigo and District.
Division continues to be funded by DHS to train GPs and Pharmcists in Central Highlands, Murray Plains and BDDGP on treatment of patients with drug and alcohol problems.
BDDGP represents WestVic on the CVHA executive and working groups and Murray Plains on the BLPCP executive.
Joint initiative with DHS funded program on clinic risk management with Central Highlands and Goulburn Valley.
Division represented on the development committee of the Statewide Service Directory for Victoria.
Annual needs assessment in November 2003 when 86 GP members were surveyed with a 64% return rate. The following were rated as the key needs of the GPs,
* Supporting Practice managers and practice staff (100%)
* Assisting with health promotion /prevention (99%)
* Liaising with local health services about local needs, service co-ordination, access, building the local service network (98%)
* Assisting practices to adapt to and utilise new payment structures (94%)
* Supporting the role of practice nurses (94%)
* Assisting with human resource issues (87%)
* Assisting with business planning (80%)
Considered the most used service in the Division with a preference for Division run events rather that pharmaceutical sponsored events.
Second most popular service
Community Health Centre
Bendigo Community health Service submission to GPs in Community Health Strategy 2004
The proposal seeks to address the following key priorities of the GPs in CHS's strategy:
* Improving access to general practice
* Generating service co-ordination and integration between GPs and CHS's
* Improving workforce capacity for CHS Medical teams
The submission also highlights the lack of GPs in Bendigo, the long waiting time for bulk billed services at CHS.
The Bendigo Loddon Aged Care Strategy 2004 a consortia of local health agencies has indicated the needs of the aged community of Bendigo and Loddon. It has suggested the formation of an aged care precinct as a one stop shop for an ageing community. It also highlights the shortage of GPs available to undertake support of consumers in aged care homes.
DHS regional office forum 2004 with both consumers, GPs, specialists and members of the BHCG and allied agencies has demonstrated the Mt Alexander shire has the highest number of patients with Hep C in the region. With high drug of addiction use in Bendigo. The forum highlighted the need for a Liver Clinic for treatment of these consumers.
The spate of recent tragic accidents of young learner drivers in the catchment (Bendigo Advertiser 2003/ 2004) has prompted the board to consider the role the Division can play in local prevention.
The shortage of water in the Divisions catchment after three years of drought is a major concern of consumers, with GPs being approached for exemptions to the Stage 4 water restrictions. (Coliban Water 2004)
Discussions between Bendigo and District Aboriginal Co-operative, RWAV, OATSIH and the Division 2004 have indicated the difficulty of conducting a bulk-billing clinic in an aboriginal co-op without funding for the GPs as an aboriginal medical service only on a fee for service basis. With 900 aboriginal people in the catchment (2001 census) three sessions per week in insufficient.
As a regional centre with two universities present, a clinical school, pharmacy school and a RTN based in Bendigo, the number of meetings the Division is required to participate in is excessive. This has created the culture of the Division which is one of integration and collaboration. The meetings are often on behalf of other Divisions within the Loddon Mallee region and the Division is interested in the outcomes of the review process which may address the inequalities now experienced by Divisions with RRMA3 catchments.
In line with the changing nature of Divisions, the Bendigo and District Division of General Practice has used this interchange year to undertake in-house PDSA processes. A review by the Board and staff created the goals which whilst taken before the outcome of many of the RIC initiatives at least set a strategy for further development in place and a culture to accept change.
The Division has long had a strategy to develop each practice in line with a range of services both allied health, in practice education, data aggregation and review and strong communication linkages with the rest of the health system. This year has seen further development in this area with in-practice psychiatric nurses as part of the Better Outcomes project, practice nurses who have been supported in a range of extra skills, further development with in-practice educational hubs in which GPs and practice staff design their own educational requirements based on a review of the practice needs.
Building on the CHUMS process the Division has worked with the Bendigo Health Care Group (base hospital) on data sharing with pilot practices. Although this has been a somewhat attenuated process the information is now able to be shared and it is believed this will articulate to discharge strategies at a later time.
The Divisions own data extraction tool - for de-identified data extraction from practices is easily modified to most parameters. This has been used successfully with Monash University school of Rural Health in a joint research project on osteoporosis currently being published. The knowledge gained from this study has been very useful in identifying future data input and extraction needs from practices and is the forerunner to future research by the Division in collaboration with University Departments.
The Division has run over 130 educational events using a range of methodologies with a high turnout from member GPs. Only some of the events are sponsored this has allowed us to develop a number of topics of key interest to our members, using local and imported knowledge and skills. The Division is also accredited through the RACGP.
Chronic Disease is seen as a major area of interest for the Division. We have seen an increase in the number of Diabetes 3+ plans unfortunately this has not been mirrored in the asthma plan. The increase in diabetes plans is partly due to the development of linking the recalls to the business systems of the practices, this pilot process is expected to make recalls more useful in the future. It is noted that although the figures for asthma appear to have decreased that this is primarily due to patients not completing their full process. This is partly compounded by the GP workforce shortage in Bendigo.
INTEGRATION WITH THE BROADER HEALTH SYSTEM
The Division has also been very active with the local HARP program, working with all stakeholders and GPs to develop care plans for "frequent fliers" those attending the emergency department too frequently. This has resulted in some stunning decreases in attendance in ED and much improved patient morbidity.
The Division has expended many hours in trying to attract more GPs to Bendigo, with some success through the RLRP program. All 11 places have been filled during the year but there is a high turnover of RLRP doctors when they achieve their fellowship. RWAV have been supportive of the Division as there is no specific funding for recruitment in RRMA3 area despite being a "District of Workforce Shortage" we are not an "Area of Workforce Shortage", the somantics of which elude us continually.
The Aged Care Strategy has built on the work that the Division has been undertaking for a number of years since it first realised the extent of problems locally. The strong relationships with the Pharmacy Guild has allowed our pharmacy folder system to involve all local pharmacies contracted to aged care facilities locally. The Division has an excellent number of female GPs undertaking the care of the elderly well in excess of the state average and has been in contact with all ACFs in the catchment and has conducted two forums for their staff. There are currently two GP panels in place with the involvement of the local Geriatrician has well.
MENTAL HEALTH, ALCOHOL AND DRUGS
This is the largest area of Division activity in terms of funding attracted by the Division. The Better Outcomes program which in this Division has been very successful was further enhanced by Youth anxiety and depression funding. Although this was only received in the last couple of months the Division was able to meet the challenge and the referrals were being received within a very short space of time.
The Division was also involved in the Co-morbidity program (Managing the Mix) with Murray Plains Division this is a continuing program into the 2005/06 year looking at dual diagnosis.
Building on the success of the in-practice BOiMH model in Bendigo and District Division the Division was successful in obtaining AERF funding for an in-practice counsellor for patients with an alcohol addiction and support for their families. This program is a first for this area but is too new to elucidate on outcomes at this time.
The Division continues to work with other agencies on local initiatives to address these areas, especially two Primary Care Partnerships, community health and the State Government regional office.
The Division is also involved in the Regional Suicide Strategy.
The Division has, for a number of years, had a Consumer Reference Group (CRG) who elects a consumer board member on a yearly basis. This has been further enhanced by the development of a youth consumer reference group who are supporting the YAD program and looking at various Division initiatives to make sure a youth focus is maintained. The Consumer Reference Group was surveyed this year and a revision of procedure and involvement has been developed following the feedback. The CRG was responsible for improved notification to agencies and the Emergency Department of practice taking new patients; this has helped to alleviate the strain on some practices.
THE BOARD AND FINANCIAL MANAGEMENT
The monthly board meeting is presented with the monthly financial reports, these have been reviewed and the board is happy with the format. The Division has passed its audit review again and with close budgeting achieving a very small surplus of funds raised the Division from non - DoHA sources, which currently make up 40% of Division funding.
All board members have now undergone Star board training with GPDV some at an advanced or specialized level. This will articulate well with the accreditation process the Division has undertaken this year. This is due to be reviewed in 2006.
The Division continues to have a very stable staffing structure with a number of staff now approaching seven year terms, however the Division has continued to expand in staff numbers with two new individuals starting this year. The longevity of staff employment has been allowed for in terms of provisions for long service leave over a number of years.
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