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Mission Statement General Practitioners working together at a local level to assert the value and the role of GP's within the local community and its health services and promote better health and quality of life outcomes for GPs and their patients Executive Summary The Adelaide Central & Eastern Division of General Practice (ACEDGP) established a Programs & Finance Committee (OBF) to undertake a detailed review of its activities and structures in preparation for the move to outcomes based funding (OBF). This Committee has been meeting monthly and comprises the Division Chairman, Treasurer, Vice-Chairman, Medical Director, Executive Officer and Programs Manager. The Board of the Division also requires that a copy of each draft be sent to it for its input / information.
The key components to the successful uptake of OBF were considered to be:
1. sound management base
2. strong existing program of activities
3. good membership participation &
4. sound links with other organisations
It was determined that, whilst points 1 – 3 were well covered by the Division, point 4 continued to be an on-going issue despite advances made over the years. It was felt that this difficulty was one based more on historical precedence within the other organisations than any inability on the part of the Division. It was clear that this issue would have to be a key matter to be addressed over the coming years and, as such features as a specific outcome in the Infrastructure Strategic Plan.
Initially it was important to highlight the strengths of the organisation; these were felt to be (in no particular order):
ø commitment of staff and Board
ø good working relationships with all the major health care stake holders
ø history of successful project funding and management
ø strong track record of developing innovative, valid projects
ø ambitious Transition Plan that maintained a very comprehensive range of programs despite the funding cuts
ø high level of ongoing membership participation (160 out of 320 in 1997/8)
ø high level corporate knowledge based on retention of quality staff
ø recognition that the Division is ‘all about GPs’ foremost
ø stable physical presence in collaboration with the Royal Adelaide Hospital
ø strong representation of other GP organisations amongst Division Directors (including President of AMA (SA) and current Chairman of AMACGP (SA)) and, lastly
ø plenty of scope for improvement!
The weaknesses were highlighted (again in no particular order) as:
ø the major hospital is also a State teaching hospital and had a long background of offering little leverage for general practitioners to influence developments
ø ambitious Transition Plan that maintained a very comprehensive range of programs despite the funding cuts
ø highly competitive nature of urban general practice
ø perception that Division was merely an arm of the government
ø physical co-location with major hospital strengthened the above view
ø limited funds to facilitate even greater GP participation
ø lack of integrated IT within general practice
ø need to develop stronger links with the non-GP organisations eg Universities & RDNS
ø difficulty in motivating GPs to act collectively
ø potential implications of the Australian Competition and Consumer Commission
ø plenty of scope for improvement!
As a result of the review of the Division it became apparent that several of the changes identified as necessary for OBF could not be fully implemented before 1.7.99. One of the identified steps to cement the Division's development is the establishing of formal business relationships with the key health-care stakeholders within this Division ie the Royal Adelaide Hospital and the Women's and Children's Hospital. This is likely to take some time and forms part of the 3-year strategic plan.
Nonetheless a rolling process of implementation was commenced based on the Transition Plan and its subsequent reviews. Progress against the Plan was reported at each Board meeting and the Division can take some satisfaction in the almost certain completion of all identified tasks by 1.7.99. Background The ACEDGP was established in August 1993 and formally incorporated as a company limited by guarantee in October 1994. It maintains 2 offices and 2 wholly owned clinics. Its principle office and registered address is 226 Fullarton Road, Eastwood SA 5063.
The management structure takes the following form:
Board > Exec Committee > Medical Director (Programs / Clinical Management) & Executive Officer (Administration / Finance) > Programs Manager > Administrative Staff.
The Division employs a total of 21 staff with a further 6 GPs contracted to provide support services eg GP Advisors and clinical support.
The Division's primary forms of communication with the membership are via a bi-monthly newsletter (The ACE) and a bi-monthly CME newsletter (which is printed on alternate months to the newsletter). In addition any issues of a timely nature are sent out via the Division's ACEFax. This latter mechanism has proven extremely successful in obtaining responses to surveys / questionnaires etc. with approximately a 65% response rate. The extensive redevelopment of the Division's web-page will hopefully further enhance the Division's communication.
Key areas of liaison between the Division and other stakeholders are – as indicated earlier – under review however at this point in time they include:
ø Memorandum of Understanding with Adelaide Central & Community Health Service
ø Shareholder in General Practice Information Management Company Inc.
ø AMA Council of General Practice (SA)
ø Representation on Board of South Australian Divisions of General Practice Inc.
ø Active partner in SA HealthPlus Co-ordinated Care trials
ø Royal Adelaide Hospital
ø Women's & Children's Hospital
ø Eastern Community Mental Health Services
ø Majority of private hospitals in the Division area (via Medical Advisory Committees) Postcodes 5000, 5001, 5006, 5034, 5035, 5037, 5038, 5061, 5062, 5063, 5064, 5065, 5066, 5067, 5068, 5069, 5070, 5071, 5072, 5073, 5074, 5075, 5076, 5081, 5134, 5140. Geographic Spread ACEDGP covers an area of 9000 hectares and has a population of approx. 202,000. The boundary includes the City of Adelaide (which has its own health characteristics by nature of its transitory population), the immediate southern suburbs and the eastern suburbs up into the foothills. Demography The Division is unique amongst other SA Divisions in that it comprises a fairly standard cross – section of urban GP / demographic issues along with the unique characteristics of the central business district (CBD) of Adelaide eg the CBD population is very high during normal business hours but contracts rapidly outside of those hours leaving relatively good access to health-care for the permanent residents of the CBD.
There are two public hospitals in the Division: Royal Adelaide Hospital (RAH; also the main teaching hospital for the State) and Women's and Children's Hospital (WCH). The ability of any Division to influence a large public hospital is limited; this is further compounded between the RAH and this Division which has inherited an acknowledged history of difficult relationships between General Practice and the hospital. This is a key issue for the Division and one that requires long term planning and development.
Public transport whilst perceived as declining, still provides a relatively good service to the population with significant recent improvements in access for the aged and people with disabilities.
16.1% of population are over 65 compared with the state average of 13.8%.
8.4% (7900) of the Division's eligible workforce (93731) are unemployed.
There are over 30 different NESB groups within the Division representing 22.4% of all NESB population within the state. They comprise 17% of the total Division population with the primary groups being Italian (5% of total population), Greek (1.5% of total population and Malaysian (1% of total population).
The ABS SEIFA index categorises the Division (via the Urban Index of Advantage) as above average in its population's access to education, healthcare, income etc. The key implications to the Division in its program development are:
consumers are well informed
have resources to access the services they need and
have high expectations from their healthcare providers.
These implications are reflected in the Division's program development ie in education, upskilling, shared care need for better linkages and co-operation with key stakeholders.
Practices are structured as below:
80 solo practices
40 2-3 GP practices
27 4+ GP practices
The large number of solo practices (with their particular support needs most notably a lack of peer support for out-of-practice activities) strongly influences Division activities in areas such as IT development and shared care.
The immunisation rate for the Division currently places it 57th out of 116 Divisions nationally however there is a definite improving trend.
ATSI – ABS data reveals that 0.44% of the population (ie 924 or approx, only 11% of total metropolitan aboriginal population in SA) are Aboriginal or Torres Strait Islanders (ATSI). The ATSI population is spread fairly evenly throughout the Division with the exception of the CBD, which has over twice the average compared with the other postcodes (30% of ATSI population). Aboriginal people in Adelaide … have considerable choice in using either mainstream or Aboriginal Community Controlled Health services*. The median age for aboriginal people compared with the regional average is significantly lower with 46% of the aboriginal population being under 20. (Fit in homeless project also)
Given the low ATSI population combined with the Division’s current programs and HealthWIZ data the Division believes it to be inappropriate / uneconomic to target resources directly at the ATSI population (at this point in time). This is further supported by the Aboriginal Health Council which is currently developing the Strategic Plan for health services with RAH based on assessed need.
*1998 SA Aboriginal Health Regional Plans (Aboriginal Health Council) Membership There are currently 320 GPs* identified within the Division and a population of approximately 202,000 (1 GP: 631 Residents).
The Division maintains two categories of membership:
Primary Member – any person whose principle place of practice lies within the Division’s boundaries as defined by the Management Committee from time to time, and any person so accepted by virtue of a Special Resolution of the Board. (To date 2 GPs have been accepted as primary members by this latter mechanism).
A primary member shall have all the rights conferred on a member by the Articles of the Company including the right to vote at Annual General Meetings and general meetings of the Company.
Associate Member – any person wishing to support the aims and objects of the Company (whether being a General Practitioner or not) may apply in writing to the Company for admission as an Associate Member of the Company.
An Associate Member shall have all the rights conferred on a member by the Articles of the Company including the right to attend but not to vote at Annual General Meetings and general meetings of the Company.
The Division operates an inclusive policy for membership; any GP meeting the above criteria for primary membership is registered as a member unless they have requested they not to be included.
*GP means a medical practitioner as defined in Section 3 of the Health Insurance Act 1973(Cth) including any amendment of re-enactment of the same or any legislation passed in substitution and whose practice involves the provision of primary, continuing and comprehensive whole-patient care to individuals, families and their community. Issues The recent re-alignment of community health services has drawn substantial resources away from the Division's community. Whilst the Division was invited and participated in the planning phases for some of this re-alignment, such input was largely tokenism on the part of the hosting organisation - this has made the co-ordination of activities with other health services difficult at times. The situation now appears to have stabilised (at least for the short-term) enabling the Division to develop programs based on fairly good understanding of the services available to support the Division Needs The Board of the Division reviewed the requirements for needs assessment planning and decided to establish a Programs Committee consisting of the Chairman, Treasurer, another Board member, Medical Director, Executive Officer and Programs Manager. This committee was asked to undertake supervision of the needs analysis, liaise with other Division committees and then develop the programs of the Division for final review by the Board.
Four GP needs analyses were reviewed; they looked at project prioritisation, National goals and targets, GP focus groups and a Dept of Community Medicine members survey on health issues. In summary the top 8 areas recognised as being very important for GPs were diabetes, palliative care, GP clinical attachments, cardiology, obstetric shared care, mental health, discharge planning and GP practice support issues. Report Summary Final Report for the period 1999 - 30 June 2004.
The Division in 2004 in comparison to the needs analysis in 1999.
An extensive needs analysis was undertaken by the Division in 1999 which reviewed the needs of GPs in relation to the National Goals and targets; in addition, seven focus groups were undertaken with GPs to assess their needs and an extensive consultation was also undertaken with community groups.
As a result of this extensive needs assessment, the Division developed programs around the areas of: infrastructure ( including community liaison), Diabetes, shared care programs ( obstetric shared care, discharge planning, care and prevention); GP education programs; Information Technology; Immunisation and a Developmental Project area ( including mental health and injury prevention).
The GP workforce profile within the Division now has fewer solo GP practices (40 % change) with an increase in the percentage of practices of size two or three person practice (increase 20 %). The total number of GPs within the Division has increased to an annual average of 353 GPs (although within any one year it tends to fluctuate). The socio-economic profile of the Division has remained much the same with the population ageing and this has implications for the types of health conditions that GPs have to consider.
In terms of progression, by 2004, the Division has radically changed its focus. In the strategic plan for 2004-08, there is a significant shift in the overall concept of the Strategic Plan. There are now five clearly defined core values including : Innovation, Partnerships, Professionalism, Responsiveness and Sustainability. There are 4 defined key result areas: Corporate, GP Clinical Systems, GP Business Systems and Professional Services.
The concept of Health Intelligence™ as a strategic framework within the Division is central to the Strategic Plan and links the areas of Data Management, GP Workforce, General Practice Education, and GP Systems. Since September 03 there has been a formal recognition that the Division is 'about general practice' and not just GPs. This is consistent with the Division's Review and the Commonwealth's Response.
Within the Division, there has been an evolution of many of the programs that were in existence in 1999. For example, Community Liaison has now expanded into a separate program area, General Practice education includes education of all staff within general practice, and Information Technology has expanded into a number of separate projects including cmebookings (a nationally recognised product) and DocshopServices.
The influence of the Division, in terms of programs such as cmebookings, extends throughout Australia and this must be considered a very significant achievement for a single Division.
Major changes in local conditions, directions and staffing over the past 5 years.
The socio-economic and health circumstances of the region have been relatively stable. The key factors have included:
ø The significant changes in the socio-economic profile of the City of Adelaide and the increasing residential profile of the City; over 20% of the Division's GPs practice in the square mile.
ø The ageing profile of the region, with implications for associated chronic diseases and aged health related illnesses.
ø The asset increase in the housing sector in most areas of the East, with implications for urban infill, increase in housing density and a squeezing out of older residents in the North east of the region who are becoming asset rich but disposable income poor.
Key staffing of the Division has been very stable. The Executive Officer, GP Services Manager, Office Manager and Program Administrator provide reliable and effective management of the Division. There has been a minor turnover of positions at the Board level as part of the move to enable non-GP Directors to hold positions on the Board (expected to be completed by October 04).
The direction of the Division has evolved. In 1999, the Division was just coming to terms with the concept of OBF contracts and the new template reporting requirements. Even in 1999, the Division was examining GP issues from a broad issue perspective, such as services to members, GP Education, HIV medicine, collaborative shared care projects with the RAH such as Diabetes.
By 2004, services to members have firmly established (and expanded) themselves within key areas such as Health Promotion - Early Intervention (formerly Community Liaison), Docshop Services, cmebookings.com and General Practice (formerly GP) Education. Newly emerging areas include Aged Care, where the Commonwealth has provided new funds to facilitate this project. Non OBF areas of the Division are increasingly important funding sources if the Division is to maintain its responsive capacity, ensure sustainability and provide opportunities and services to its members that might not be consistent with the requirements of the OBF contract eg DocShop Services which is funded using non-OBF resources.
The extensive web-based needs analysis conducted by the Division in October 2003, provided a solid basis for identifying priorities to the membership for the next planning period (04-08). Nevertheless, the Division has to position itself so that it has the capability to respond to the issues arising from the implications of the State Generational Health Review, the implications of a federal election and how these quite disparate ideological perspectives on primary health care impact of the role of the Division as a potential significant stakeholder in the primary health care arena. This difficulty is further emphasised by the lack of a consistent national primary care policy.
Major strengths.
A key strength is the level of involvement by GPs and their staff within the activities of the Division. Our figures show that at least 75% of GPs have actively participated in one or more Division events involving at least 35 minutes of active engagement. From a qualitative perspective, there is a general recognition of the key staff within the Division and an acceptance that they are provide a friendly service to the membership.
The management structure of the Division is relatively stable with a clear understanding of the relationship of the role of the Board and the role of management. A series of checks and balances have added strength to the governance structure as has the ongoing education program to upskill the Board with regard to its responsibilities.
The policy of engaging GPs as Advisors within the projects and services of the Division helps to engage the membership and bring specific skills to the projects; this has added to the overall depth and strength of the project teams and contributed to successful outcomes of relevance to general practice.
Significant successful outcomes / what has worked and possible reasons why
Significant successful outcomes include:
ø the development of cmebookings.com which is an electronic booking system for GPs and a management tool for Divisions and now used by 26 Divisions throughout Australia.
ø the development of DocshopServices as a collaborative development with Adelaide Hills Division and which involves the provision of online purchasing of IT/IM services and on site IT/IM support services in a one stop-shop web-based environment (turnover $200,000 in 03/4). This is significant because it represents GPs paying a commercial fee for a service offered by a Division.
Other successful outcomes include:
ø The provision of a GP Education program and clinical attachment program which has been evaluated externally by the University of Adelaide and found to be of a high standard
ø Presentation of the Division's achievements in poster and paper form at a number of National Forums, with positive feedback.
ø Increase in recorded immunisation coverage rates to almost 90% for the entire Division; an increase of over 10% in five years.
ø Development of an integrated community liaison program, running for over seven years, with respect in the local community for services such as Family Doctor Week, Doctor in the Classroom and Community Mental Health Network.
ø Facilitation of the Data Aggregation Group (DAG) which is a formal alliance of 5 Divisions in SA seeking to share resources so as to enhance of the data management capacity within Divisions and general practice via an enlarged research network within SA.
A significant reason for the success of these activities relates to the small team project structure within the Division where each member of the team has a clearly defined role, lines of communication are effective and there are agreed outcomes, with sufficient resources to achieve the outcomes.
Barriers and challenges - what did not work and possible reasons why
From a practical perspective, the development of a health contract with the Commonwealth, using the template of the OBF format, has posed challenges in that a strategic plan should be a simple concise document. The template format has made it difficult to communicate a concise message to GPs and therefore engage DoHA in the development of programs as well as we would have liked (notwithstanding that the STO staff have been supportive and flexible enough to meet to discuss our plans as and when needed).
A challenge for ACE (and probably most Divisions ) has been to provide the infrastructure required to collect evidence based information to measure the effectiveness of programs. Some evidence can only be assessed in terms of change over a minimal period of four years or more. Such timeframes have often been beyond the timeframe of the OBF contract. Despite the standardised Divisions Database, this has been much more problematic than we had anticipated and, is therefore indicative of the issues that would no doubt also exist within general practice.
Some programs have been introduced to the Division without adequate baseline data being established. The funding for the Chronic Disease Management program is a classic example of funds being provided for a retrospective period with the Division then being expected to measure change!
A lack of clear support for Divisions with regards to GP IMIT is an ongoing frustration; given the increased emphasis on data management placed at almost every level of service delivery by state and commonwealth bodies. Whilst ACE has allocated its limited resources to reflect this priority we await additional support from both the State and Commonwealth.
How will these learning / opportunities, guide the future business of the Division.
These barriers have been turned into opportunities by the Division and hence the significant investment in Health Intelligence™ in ACE's 2004-08 Strategic Plan. A copy of the diagram outlining the relationship of Health Intelligence to the major areas of the Division is shown on the following page.
In addition, the Division is in year 3 of its 10 year financial plan which is aimed at capitalising on opportunities to enhance the sustainability of the Division and improve its services to the membership and their practices.
The Division is confident that the inclusion of 2 non-GP Directors will help to further enhance the overall capacity of the organisation and continues to invest in the training of the Board members to improve the overall governance of the Division. There is a continuing plan to encourage GPs to take up positions within the programs of the Division as GP Advisors and to provide opportunities for GPs to engage in research on general practice.
There is also recognition that collaboration between Divisions is important where there is commonality in goals. For example, the Division has been instrumental in establishing the DAG (see above), we have a joint Home Medication Review project and we are currently exploring a tri-partite arrangement for the Aged Care Panel initiative.
In summary, the Division has embarked upon a revolutionary new Strategic Plan in response to the issues identified over the past five years and in order to position more strategically to meet the challenges associated with changes in the health system at the state and national level.
12 Monthly Report 1/7/2003 - 30/6/2004.
Div 504: Adelaide Central & Eastern Division
Report Date: 1/7/04
Street Address 226 Fullarton Rd Fullarton SA 5063 Postal Address PO Box 17 Fullarton SA 5063
Phone: 0882715455
Fax: 0882711055
Email: acedgp@healthon-net.com
Homepage: acedgp.healthon-net.com
Executive Summary
In terms of progression, the fifth year of the three year OBF plan has enabled the Division to develop its 04/8 strategic plan as well as consolidate its existing activities. As outlined previously, the Strategic Plan for 2004-08 represents a significant strategic change in that it takes a central position on the issue of data management and uses this as the hub for its activities. The following summary of activities during the year illustrates the progression of programs and how the Health Intelligence™ emerged.
Infrastructure / Administration
The Division is now in its 11th year. Infrastructure operates very consistently with high levels of staff continuity. We have renewed our office lease at Glenside for a further 2 years and in January we appointed Dr Rob Pegram as our Medical Director - this appointment will significantly enhance our network and capacity.
Our new Business Manager has quickly become an integral part of the infrastructure team and provides a valuable role in managing the increasing complexities of multiple contracts and an increasing turnover. We are rightly proud of our ability to manage our projects and services on-time and within budget and of our ability to generate a genuine asset base (non-OBF sourced) that will enable ACE to move forward with confidence over the coming years.
The Board undertook comprehensive governance training facilitated by the Australian Institute of Company Directors and also implemented a thorough annual performance evaluation process (inc. peer review). The Board has achieved the necessary changes to its constitution to allow non-GP Directors onto the ACE Board.
With regards the Division review the Division has taken a decision to actively position itself as a 'partner of choice' in anticipation of amalgamation / collaboration opportunities. This position is further strengthened by our financial security.
In summary our strategic plan has been completed and our Business plan is now being implemented. It represents a revolutionary development in response to detailed assessments of future direction / needs of the membership, DoHA, DoH and the community. We are confident that our Health Intelligence™ framework will position us well in terms of both membership support and population health management. and we look forward to the next 3 years
Program 1 : CMEBookings.com
CMEbookings.com continues to grow. Between January 2003 and December 2003, the number of Divisions subscribing to cmebookings increased from 14 to 26. This number has stabilised in the period of January to June 2004. Some Divisions chose not to renew their subscription, but overall numbers remain steady. Significant success has been achieved with enrolments in:
ø All of SA
ø Sydney
ø NT and
ø Tasmania.
The website is now achieving 100,000 hits per month. (from 32,000 in January 2003).
The service's Business Plan for 2004/5 has been finetuned and a key area of focus will be to target urban Divisions in the capital cities. Improvements to the service such as better report formats continue to be made.
Program 2 : Community Liaison (now Health Promotion - Early Intervention)
During the year, the Community Liaison program has been a real strength in the Division. As a result, the program has been renamed and expanded under the heading of Health Promotion and Early Intervention. This will enable the Program the freedom to expand and cater for new opportunities as they arise. Significant achievements during the year are outlined below:
Doctor in Classroom Activity.
The poster presentation on Doctor in the Classroom at the National Divisions Forum in November 2003 was well received. Also, Rotary have emerged as a strong supporter of the Program and have donated $300 to our project to advance the teaching. Dr Lloyd accepted the cheque on behalf of the Division.
Family Doctor Week.
Family Doctor in July 2003 was very successful. The Division held events at three different locations including the Coordinating Italian Committee's centre, Burnside Community Centre and the Unley Library. There were over 12 GPs willing to participate in the health promotion activities.
Status : The official date for Family Doctor this year from the AMA is 11-17th July 2004. This has also been very successful.
GP presentations.
There have been 8 GP presentations to community groups in addition to Family Doctor Week.
Community Mental Health Network Meetings.
The Community Mental Health Network, in operation now for over 18 months, continues to thrive and the quarterly meetings attract significant numbers of GPs and allied health professionals.
Network Meetings with Secondary Schools
Two early intervention meetings have been held with the 3 state high schools in the region with a number of other health organisations. A key aim of the early intervention meetings has been to look at ways of coordinating services to assist young ( almost ) adults.
Further meetings were scheduled for 2004 and the meetings have significant opportunity for the Division to advocate on behalf of local GPs. Drs Megan Lloyd and Cathy Sanders have been involved as well as Lily Mountain. There are potential funding opportunities here as well as an extension of our work ( i.e building relationships ) that we have started with the Open Access College. However, the Division is awaiting the schools to initiate the activity at this stage.
Program 3 : CPD & GP Attachments
In the period 1 July 2003 - 30 June 2004, cmebookings recorded that there were over 600 ACE GPs who participated in education sessions offered through CMEbookings in 71 activities ( many of these were small group activities, but still recorded, 37 cpd activities ) and there were a total of 620 attendances. The average attendance at seminars was 98%. The main seminars organised by the ACE Division totalled 17 seminars including dermatology, HMRs, immunisation, men's health, IT/IM and eye diseases.
There were 14 Clinical Attachments scheduled for 2003-04, most which are available for Group 1 QA & CPD RACGP points. A copy of our evaluation from the University of Adelaide is on our website and this paper highlights the available evidence, using EBM principles, of the benefit of the education program.
Program 4 : Developmental Activities
The Developmental Activities project provides the opportunity for the Division to provide resources to initiate new activities in response to emerging needs.
Since July 2003, the Division has supported a number of developmental activities including support for the concept of an After Hours Consortium and for a Mental Health initiative involving GPs and school students (Mindmatters Plus, see below).
Mindmatters Plus - GP Initiative
The Mindmatters Plus GP Initiative is a National Divisions Pilot Project, with funding coming out of the Australian Divisions of General Practice and sourced from the Australian Principals Assoc Professional Development Council and the Australian Guidance and Counselling Association. The initiative aims to promote effective, ongoing partnerships between GPs and Mindmatters Plus Schools.
The key initiative has involved development of a new electronic referral form ( suitable for inclusion in computer software such as Medical Director) between the Open Access College and GPs.
Stage 1 is complete. Stage 2 of this project, which has been approved, is expected to involve piloting the Form with GPs.
GP After Hours activity
After Hours is a particular need in the Division. To maintain the momentum of the application submitted to the Commonwealth ( which we have subsequently discovered has not been successful), the developmental activities project has continued to fund the time for Dr Richard Hetzel and Dr Megan Lloyd to work on maintaining the momentum. A very successful symposium was held in November. Papers from the symposium are on the Division's website and a report was included by Australian Doctor.
For the period July 04 - June 2005, After Hours has become a full program of the Division and we anticipate working with a range of partnership to develop a web based on-line booking system. This innovative approach promises to also assist the GP practices in workforce management.
Program 5 : Diabetes and Chronic Diseases
For the new business plan commencing July 2004, Diabetes and other Chronic Diseases have been incorporated into the new Health Promotion and Early Intervention program.
Activities during the July 03 - June 04 period included a GP Diabetes Focus Group, held on 6th November, 7.00 pm -8.00 pm, with representatives of the Diabetes Unit, RAH, and GPs, both Board members and non-Board, was a considerable success. The meeting was ably facilitated by Dr Cathy Sanders. The round table discussion with Dr Mitra Guha and David Torpy, as well as other representatives from Adelaide Central Community Health Services, was pragmatic and realistic about the funding difficulties that confront Divisions. There were several productive suggestions arising from the discussion. One of these, a recommendation to investigate a business model involving the hiring of a diabetes nurse educator by the Division, for short term hire by practices, was agreed at a subsequent Diabetes team meeting, as a recommendation to pursue and present a feasibility report to the Programs Committee by next March.
At the Diabetes meeting, we heard that a recent presentation by Dr Mario Giordano at the Coordinating Italian Committee Centre on Payneham Road, attracted over 30 people; a recent Impaired Glucose Tolerance meeting at Burnside Community Centre attracted over 20 people.
The seminar on Eye Cancers and Macular Degeneration had a very relevant section for Diabetes and evaluations from GPs were very favourable. Our thanks to Drs James Muecke and Jim Runcimon for their excellent presentations.
Other education opportunities for GPs in the Other Chronic Diseases promoted included a range of On-Line education programs in Asthma for GPs ( especially PriMed software).
Program 6 : Business Modelling
Practice Management training
In order to support better business practices, the Division has offered practice staff the opportunity to enrol in Certificate 4, Frontline Management Training. There were initially 24 practice staff enrolled in the program but this has subsequently reduced ( such attrition can be expected). The course is a win-win for everyone; the practice staff person who undertakes the course benefits professionally, the practice benefits, the Division covers its cost whilst facilitating another quality service to practices. The course takes 18 months to complete ( part-time).
Program 8 : GP Hospital Liaison
Division staff have continued to build relationships with the hospitals, including the Royal Adelaide and the Women's and Children's Hospital.
We have also met with the Health Promotion Units of the RAH and WCH - they were quite open to further working together in specific areas of collaboration. Dr Lloyd has also met with Meg Lewis, Transitional and Community Service of the RAH as part of this hospital liaison.
Since the appointment of the Medical Director, Dr Rob Pegram, we have focussed more specifically on individual departments in the hospitals as a way of building our relationship from “ the ground up”. In particular, a valuable relationship is being developed with the Emergency Department ( Head : Professor Chris Baggoley) and after July 2004, a clinical attachment for GPs with the Emergency Department is planned.
Program 9 : Mental Health
Level 1 Registration
Still proceeding with training for GPs; we have over 71 GPs who have completed all requirements for registration, which is very good.
Mental Health Committee.
The Committee has assisted the Division in developing its range of activities in Mental Health ( which has been identified as a high area of need in the Division's RACGP needs analysis).
Program 10 : Computers in Practice
The first half of the year was very active and included the following:
Evidence based medicine education program
The Evidence Based Seminar on 5th December was very successful . ( viz Professor Peter Schnatter from Uni of Monash who facilitated the seminar - He also works as a GP in one of the Divisions of GPs in Melbourne. ). There were 11 GPs in attendance.
There were 3 Board members in attendance and they can no doubt provide their own perspectives on the workshop. Peter Schnatter was an excellent facilitator and his own experiences as a GP were invaluable. In terms of the learning environment, we had access to a computer room with 12 computers for practical activity and we also had access to a room containing a group of tables arranged in a square in the middle which facilitated discussion when this was required. So we had the best of both worlds in the learning environment!
It was felt that Professor Schnatter's coverage of Evidence Based Medicine was comprehensive and that he stimulated GPs to consider the different perspectives of “ Theory, Evidence and research” as well as practical experiences in using Critical Appraisal Techniques.
“How much is my data worth” activity:
This project activity was a key research initiative that the Division sought to resolve through the Computers in Practice Project. A focus group of GPs was held in early November to explore the concept in more detail and to invite GPs ( who were remunerated for their time) to explore potential research topics relating to the relevance of their data and its value.
As a result of this research, we now have a clearer idea / answer to this question. Basically, there are about 3 parts:
Evidence Based Medicine Workshop:
We are more confident now that if a GP attends an EBM workshop that they will have a better framework ( both theoretical and practical ) on how to organise their data in valued added and quality framework.
“Uncoded data”
We now recognise that much of the data in GP computer files can be described as “ uncoded” in much the same way that uncoded DNA ( twenty years ago) was thought to be junk. We now recognise that what we need is a framework ( i.e an EBM framework) on how to make sense or meaning of the data as it is constructed by GPs.
Markets for data.
We now recognise that aggregating de-identified data using systems such as Geographical Information Systems ( GIS) can present in a graphical way that data can be meaningful and important to particular organisations, such as Governments or Pharmaceutical Companies. The work we have been doing in collaborating with other Divisions in mapping GP diabetes patients, for example, and filtering the information through a statistical package to look for relationships, will be very interesting to both Pharmaceutical Companies and State Governments because the data is quality data and has high validity and reliability. Similarly, our mapping of After Hours Services and pressure points will be valuable in a market sense for both GPs and Corporates.
In the second half of the project year, ideas were advanced and the Data Aggregation Group emerged as a very important strategic collaboration with other Divisions.
Program 11 : Marketing Plan
With the appointment of the Medical Director has been appointed, the implementation of the activities within the Marketing Plan take place in the period February to June 2004. A number of health promotion activities for GPs were undertaken including the launch of a well being book produced by one of the GPs in the Division.
MORE DETAILED INFORMATION ON CDM.
Diabetes and Chronic Diseases.
The Diabetes Nurse educator and the GP Services Manager met with Dr Mitra Guha on 25th September to outline our proposal for endocrinologists to meet GPs in their practices and how to proceed forward with our relationship wit the RAH - Diabetes Department, given the significant downsizing in our funding from the Chronic Diseases Funding. The meeting started off with some difficulty as Dr Guha expressed her strong disappointment with the Division for the lack of consultation with the RAH regarding the decision to downsize the diabetes project activity. We listened carefully to her concerns and to her issues regarding the possibility of proceeding forward. We concluded and agreed that if a focus group of GPs from the Division could meet with Dr Guha and some of her colleagues, it might be possible to identify ways forward. I will report in more detail to the Programs Committee on this issue as I have already reported to the Diabetes and Other Chronic Diseases project team on this issue.
Other parts of our project are proceeding well including : Patient education courses, held at Burnside Community Centre, the Coordinating Italian Committee venue on Payneham Rd, and Payneham Community Centre. We are also receiving invitations to make presentations at a number of Nursing Hostels & Centres to staff.
We are also exploring education opportunities for GPs in the Other Chronic Diseases and are reviewing a range of On-Line education programs in Asthma for GPs.
The Diabetes Project team worked with the HMR team on a recent seminar, held at the Chifley on 4th February. This was a very well attended seminar (N=10 GPs, N=14 pharmacists) and those present were treated to a very informative and evidenced based cited seminar on the use of the new oral hypoglycaemic agents. Dr Mitra Guha and Ms Debra Rowett, as two of the three key presenters, were very impressive. Dr Flo Mignone did an excellent job as the Chairman.
How much is my data worth project:
Not withstanding the conclusions as outlined in the previous November report to the Board about this project, ( and the concepts of un-coded data and markets for data), the recent Computers in Practice Project concluded that we should stop the project activity “ How much is my data worth?”. We concluded that GPs have difficulty in developing research ideas in this area following our workshop in early November. No GPs since the Workshop have approached Grant with a firm idea or proposal. It was clearly a conceptual area of some difficulty. The Executive Officer and the GP Services manager have asked Informatics Administrator to consult the GPs who expressed interest in the activity and advise that we are stopping this activity. Other parts of the Computers in practice are continuing.
Evidence based medicine education program
Following on from the Evidence Based Seminar on 6th December, and from the feedback from the recent Strategic / Business Planning weekend, we are making a deliberate attempt to incorporate the principles of evidenced based medicine more overtly into our CPD seminars. The recent Diabetes and HMR seminar was a good example as to how speakers were able to incorporate EBM principles into their presentations.
INDIGENOUS SPECIFIC HEALTH RELATED ACTIVITIES
During the period, we have maintained ongoing communication with Nunkuwarrin Yunti ( key staff : Dr Penny Silwood and Mr Lindsay Osborne) and maintain the open offer to assist with educational sessions or advice in computer software or data management.
ADDITIONAL INFORMATION .
NON-OBF PROGRAM ACTIVITIES
Insomnia Management Project ( Reducing the Use of Benzodiazepines; funded by the DHS, $15,000 up to December 2004)
The DHS is funding us to promote information packs on Insomnia Management to GPs. Our planned approach is for Debra Rowett's team to introduce the pack to individual GPs as part of their academic detailing. We will also support this approach with the offer of more information from Helen Pecanek, our pharmacist. In addition, Shelley Howe, who also attended the training sessions, will be available to promote the information packs to practice staff through our practice staff networks.
Immunisation ( Dr R Pearce)
Current immunisation coverage rate: 89.3% recalculation - Nov 2003.
We have held two Immunisation - Practice manager network meetings to cater for interest in knowing about changes to the 8th Immunisation Schedule - these were well attended by GPs and practice staff.
Refer to attached 6 month report for more details of extensive involvement with GPs.
HMR - Home Medications Review ( Dr S Gilchrist; consortium with AHDGP)
Note the statistics : HMRs in ACE are the highest in SA.
The first small group of GPs and pharmacists meeting together has been arranged at the Edinburgh Hotel ( Meet and Greet - for GPs in Unley side of the Division) was held on 27th November. It was a lively and active discussion by all participants. Subsequently, a media fax was sent to all practices to highlight the successful outcomes.
A further meeting is planned for early February 2004 on the topic of Diabetes and HMRs.
National Prescribing Service - Quality Use of Medicines ( contract with DATIS, Debra Rowett).
Debra's team will be contacting GPs in the new year on the key topics. Debra will now be coordinating her work more closely with the work of Helen in the HMR project. Debra has a wealth of knowledge and we are pleased that she is able to share this with us as part of the NPS contract. Debra's work is coordinated with the Shoulder Pain Imaging Project being conducted by A/Prof Norm Broadhurst, Flinders Uni, in association with Prof Justin Beilby. Prof Broadhurst has an NHMRC grant to investigate the use of imaging in referral on of shoulder pain.
After Hours Project - Consortium metrowide. ( Dr Richard Hetzel / Dr Megan Lloyd)
The After Hours Symposium on 29th October was very successful with good representation from all Urban Divisions and the Adelaide Hills. There was a quiet level of confidence and willingness to work together whilst recognising the practical realities of progressing an area of health often considered as “ too difficult”.
A media statement was published and we received interest from Australian Doctor and we hope that an article will be published soon.
OSC Statewide ( Dr D Cox)
Dr Cox reports on activities from July to September. It has been a busy time and the challenges of the Statewide program are many, but the running of the OSC at WCH has continued efficiently. Di has held a very successful seminar on Infectious Diseases at WCH on 25/7/03 ( N=81 GPs); a small group discussion of GPs is being organised for 19/11/03 on Gestational Diabetes and Group B Strep. The OSC Reference Group is to meet on 22/10/03 to discuss progress of the Statewide Project with a meeting with DHS to discuss Prof Beilby's proposal for a prospective evaluation of OSC.
GPs Accessing Allied Health Services ( Dr Jon Sporne)
The clinical panel has met and we now have 20 psychologists who have met our high criteria for registration with the program. On the clinical panel, we have A/Professor Helen Winefield from Uni of Adelaide and Dr Jon Sporne as well as Dr Nick Adams, from Eastern Mental Health Service.
We expect GPs to start sending in referrals very soon. On a 12 month average, we can provide services to 19 patients per month with 4 hours of brief focussed psychological service at a psychologist fee of $75 per hour ( the gap to the patient being additional). Whilst this is modest start to the program, we will monitor the statistics carefully to advocate for increases in future. ( Note variations can occur, depending on the number of hours of service accessed by the GP & patient - max of 6 hours).
Program Project OBF/Non OBF funded Key Achievements
GP Clinical Services Diabetes and Other Chronic Diseases OBF Due to shortage of funds the emphasis has been on promoting community education, both to English and non-English speaking groups. These have been overall successful with full attendances and the number of sessions is as follows: 4 x IGT; 4 x Italian; 11 x Italian Diabetes Support Group. Heart Support - Central Branch has also been supported with a full calendar of education programs coordinated by ACE. Linkage to physiotherapy unit of the RAH Hampstead Gardens Unit. ( N=11 sessions, 1 per month) Enquiries by GPs regarding care plans and other clinical advice managed on an as needs basis.
ø Home Medication Review Program Non OBF Pharmacist promotes the use of HMR in at least 3 educational seminars for GPs, and 3 practice staff seminars; ACE Division, on a comparative basis in SA has a high number of HMRs completed; note over 40 % are undertaken by 1 accredited pharmacist; this has caused concern with the project team due to possible inappropriate marketing and lack of access to other community pharmacists. N=146 GPs contacted in the program; N= 35 pharmacists contacted.
ø NPS Non OBF Over 226 GPs participate in a range of educational programs provided by DATIS to GPs in their surgeries.
ø Mind Matters Plus GP Initiative Non OBF A national demonstration project ( 1 of 17 in Aust, and 1 of 2 fully completed by June 04); Collaboration with Open Access College to improve use of on-line health assessment / referral forms for GPs leading to improved communication with the OAC. Referral form developed using improved computer software to assist GPs; referral now available on-line for GPs to download; A second stage project including roll out of education in metro Adelaide has been developed.
ø GPs Accessing Allied Health Services Non OBF Over 20 psychologists are on register; 16 GPs have referred patients to the service; Over 60 patients have been referred. At least 70 GPs have completed all training requirements for registration at Level 1 Better Outcomes in Mental Health. At least 4 educational seminars have been held; individual training sessions to assist GPs have also been held.
ø Mental Health (Committee/Collaboration with RAH) OBF Regular ( bi-monthly ) meetings of RAH, Eastern Community Mental Health and Division are held; Excellent communication links are maintained and lead to assistance in support for the GPs Accessing Allied Health Services.
ø Immunisation Non OBF Overall immunisation coverage rate hovers around 89%. ACE coordinates immunisation component of Parent -Child expo at the Convention centre in Feb 04; ACE coordinates health promotion / immunisation awareness at 3 University campuses in March 04; ACE promotes use of immunisation policy in SANFL Clubs;
ø After Hours Consortium OBF 1 educational seminar held in Oct 2003 attracts over 20 GPs, including key stakeholders from 3 other Divisions; Media coverage of seminar in Australian Doctor; Collaboration with MSD initiated; MoU to work together in developing an on-line web -based booking service; Consultation with GPs in the Eastern Afters group confirms agreement to proceed.
GP Business Services DocShop Services Non OBF Key sales turn over target for the year exceeded. Total profit = $20,339 ( not net); excluding grant from investment account leaves net profit of $9,339. Gross revenue of $212,471 exceeded the budget income of $140,000. Marketing plan for the future established.
ø Computers in Practice OBF Evidenced based full day workshop held in Dec 2003; over 10 GPs enrolled; Attempts to encourage GPs to engage in research project “ viz : How much is my data worth “ attract only 9 GPs; only 1 is able to propose an idea; Data Aggregation collaboration with 4 other SA Divisions initiated during the year; encouraging response from other Divisions.
ø GP Business Modelling OBF Practice Nurse and Practice Staff education seminars = Evaluations conducted and show high level of satisfaction with program. Certificate in Front Line Management initiated; over 18 practice staff enrolled.
ø Developmental Activities OBF Support for research project : Spiriva Research: over 20 GPs expressed interest in Phase 1 of this trial which compares the use of spiriva in COPD and asthma patients. Research publications published on the Division's website. 2 posters presented at the National Divisions' Forum in Nov 2003. Regular meeting s of the Programs Committee held. Support for developing projects such as After Hours, supported though funding available in the Developmental Activities Project. The Strategic Planning Weekend for the Board coordinated through Developmental Activities; Follow up planning weekend held in Feb 2004.
Advocacy and Representation Community Liaison OBF Doctor in the Classroom project: 10 GPs GP presentations : 10 presentations. Community Mental Health Network. 5 workshops; Number of GPs ranged from 2 to 23 according to topics and themes. Family Doctor week ( July 2003) 9 GPs participated at 3 venues. Support for community groups. Includes Heart Support, Coordinating Italian Community, Rotary. Applications for additional grants. Lily Mountain and Dr Megan Lloyd were successful in obtaining an Asthma Education Grant of $9,600 to promote better GP -Community networks. The application was based on a review of evidence based literature as to how GPs can be most effective in health promotion setting.
ø GP Hospital Liaison OBF Project stopped in Feb 2004; conclusion that the Generational Health Review made the aims of the project obsolete; initiative taken up at Board level to pursue representation on the new Board of Health for Central and Northern Adelaide.
Professional Sector GP Education / GP Clinical Attachments OBF No of Clinical attachments = 12 No of different areas = 6 areas. Needs analysis undertaken to identify reasons for / not uptake of clinical attachments. Refer to key evaluation report on the program undertaken by the Uni of Adelaide ( Dept of General practice) posted on Division website under Research and Development.
ø GP education / CPD program OBF There were 37 CPD seminars held; Average attendance of GPs = 17.9, range from 4 to 59. Total number of GPs = 592 Total number of individual GPs attending = 471 Total number of practices = 85 Average level of satisfaction with CPD seminars ( i.e were objectives met ) => 5 out of 7 rating in all seminars. GPs were able to participate in 2 research projects during the year; The Orthopaedic Musculo-Skeletal Project, coordinated by A/Prof Norm Broadhurst, attracted interest from 51 GPs. The Division undertook a review of its endorsed provider status ( i.e 2 points per hour) and the RACGP was well satisfied with our management. Our progress to gaining Accredited provider status for 5 points per hour edged closer and there are now 2 applications undergoing the final stages of approval. Completion of all post test evaluation criteria is likely to be completed in September 2004.
ø Marketing Plan OBF 12 practice visits by Medical Director; Shiraz and Jazz Social Evening attracts over 50 GPs. Marketing Plan developed with assistance of Impress Media and subsequently presented to the Board.
ø GP Well Being Project Held over to 28/29th August 2004. Two nationally recognised speakers will lead the weekend workshop.
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