Mission Statement
The mission of the Southern Highlands Division of General Practice is to work with and assist local general practitioners to provide optimum standards of primary health care, health education and health promotion to health consumers in the Wingecarribee Shire.
Report from the Chair
It is easy for GPs to be caught up in a spiral of depression about the state of general practice – the paperwork, exponential multiplication of new EPC items in the HIC schedule, medico-legal fear, workforce issues and tsunamis of aged and obese patients requiring chronic and complex care, sub-specialties like skin and cardiac screening clinics picking the lucrative eyes out of the general practice carcass, to name a few.
However, on the other hand, there is a real wind of change about us. At federal, state and local levels, there is a new recognition of the key role of GPs in Australia in managing these changing areas of healthcare. Integrated Primary Care is happening, with real financial support from government and new enthusiasm from the Health Service. Practice nurses are fast becoming a integral part of most of our practices. And our new rural oriented Graduate School of Medicine is full of keen and enthusiastic folk who for the first time in decades have a genuine possibility of future practice in rural and regional Australia. A growing band of GP registrars is learning our trade from us in our area. And average GP incomes have risen significantly over the last couple of years.
I must congratulate the Division of General Practice for standing alongside us, assisting us in these times of change and helping us cope with new patterns of practice, new methods of delivering healthcare and all those other changing and developing facets of our practices – such as IT, immunisation, practice nurses, practice managers and accreditation. On behalf of all our members, I therefore thank Warwick, Sally and all of our Division staff for all their cheerful achievement and endeavor on our behalf, as well as our Board members and the many members who have contributed to our efforts.
I wish you all the best for the Christmas season and the New Year, and recommend the Division’s annual report to you.
Dr Vince Roche
We gratefully acknowledge support from the
Commonwealth Department of Health and Ageing
Management Report
The Division's operations in the period were generally the same as in the previous year since the needs have not significantly changed.
Governance standards continued at the same high standard.
The Division Board has been chaired since December last by Dr Vince Roche, supported by Deputy Chair Dr Ann Parker, Treasurer Dr Richard Hanbury, Education Officer Dr Geoff Sparkes and Director Dr Clive Cawthorne. The Board has continued to perform in an exemplary manner, including an appraisal examination based on a protocol from the Institute of Chartered Secretaries in July. This revealed the need for refresher training in the governance responsibility related to the Commonwealth contract issues and the interpretation of the monthly Board financial reports. The Treasurer is to also play a more active role in the financial reporting procedure.
The Board also expressed the view that they would welcome some new blood in the Board Room following the elections in November 2007.
Our Community Representative, ex Wingecarribee Shire Mayor Phil Yeo, attends and participates in all Division Board meetings and the AGM. Mr Yeo is ideally suited to the position of Community Adviser and is making an increasingly important contribution to Division life.
Staff appraisals were conducted in July–August 2006. These revealed a high degree of professionalism and competence on the part of the staff, which in turn is a major contribution to the high level of productivity of our staff and the generation of a 'happy workplace'. The latter is evidenced by an extraordinarily low staff turnover.
The Division collaborates with other Divisions including in particular our neighbouring Division (Macarthur), and the other five Sydney South West Divisions. The Division continued to collaborate with our State Based Organisation, known as the Alliance of NSW Divisions, and the Federal body, the Australian GP Network.
The Subsidiary Company continued to operate the After Hours Service which is popular with members and consumers. This service had a 90% approval rating in the recent GP satisfaction survey. The recent change in the operating hours of the clinic seems to have been well received by consumers and GPs. The patient numbers fell in the months around last Christmas, but most pleasingly they had returned to previous numbers by year end. The numbers for 2006–2007 were 1176 as against 1438 in 2005–2006.
Immunisation activity has continued to be popular with the practices under the management of our part time nurse. Despite her hard work, results have not been as good as we would wish. This is mainly due to our smaller Division size, combined with the presence of two practices with numbers of conscientious objectors. It is disappointing that the objectors continue to be counted in the denominator. At year end our overall result was 88.5% coverage of the target group. However most practices are over 90%, with some in the high 90s.
Aged care activity has always been a strong point in our area, with 16 of 18 practices supporting the Residential Aged Care Facilities. The two not supporting the RACFs comprise one which is a 'specialised' practice and the other a new practice in the area. GPs have welcomed the Aged Care Panels Program which has further strengthened our previous excellent record in aged care. The RACFs have reported a high level of satisfaction on their part with the support of GPs for RACF residents. Other aged care activities include our Health Care Directives Program and the Falls Prevention Program.
The one problem we still appear to have in aged care relates to the supply of the plethora of related service information to GPs in a ‘GP friendly’ form. Much has been done in this area by our expert Aged Care Officer and the remaining problem will be addressed in early 2007–2008.
More Allied Health Services (MAHS) funding was used for services in Diabetes Education, Group Psychology CBT, certain clinical Aged Care Nurse services and Exercise Physiology services. The previous shortage of dietetic services had improved during the year. However, unfortunately the situation looks as though it will deteriorate again in the near future.
Our Diabetes Program has continued on its successful path. This has included complimentary reports from the University of NSW and the ANU. Notable achievements in these reports are worth repeating, including that our HbA1C ‘plateau effect’ is at a lower level than that of the ‘gold standard’ UK Provisional Diabetes Study and that our coverage of the estimated numbers of persons with diabetes in our area is a very high 94%.
The Division has recently been made a partner in a community based Diabetes Prevention Program to cost some three million dollars over three years. This is Commonwealth money via NSW Health and will be rolled out across three divisional areas in SSWAHS, namely Central Sydney, Macarthur and ourselves. This will greatly amplify our existing Pre-diabetes Program. We also hope that this program will ultimately lead to a resolution of our chronic shortage of dietetic services. GP support for our existing pre-diabetes program has been strong and expanding.
The Diabetes Program currently has 89% practice support and continues to have excellent control figures. The reduction from 100% practice participation is due to the existence of one new practice and one specialised general practice which does not provide general care.
There were 1,011 consults by our Diabetes Educator in the year.
The other success story in the year has been the funding for the Primary School based 'Bluearth' Activity Program targetting childhood obesity. This has been well received at Colo Vale and Moss Vale Primary Schools this year. We acknowledge the assistance of the Mittagong RSL and Moss Vale Services Clubs in assisting with a grant of $5000 towards the cost of the Program this year. During the year, we received another $5000 grant from Wingecarribee Shire Council to continue the promotion of activity amongst the children who are participating in the Bluearth Program this year as well as assisting us to raise more community funding for the Program in the next school year.
The number of GP VMOs serving our local hospital has regrettably fallen to nine, covering general medicine, paediatrics, obstetrics, surgery and anaesthetics. There is little shared care with the hospital but full involvement by GPs in the Ambulatory Care Service and the Palliative Care Program operated by Community Health. The Division works closely with the Hospital, including holding monthly meetings. This includes advising the Hospital on ways in which the GP VMO numbers may be increased.
The Division continued its strong support for the REO Activity Program during the year. This particularly applied to patients from our now three year old Pre-diabetes Program. Due to increased funding availability, we were able to subsidise 66 Healthcare Card holders into the Program in the year. This Program is the subject of a UNSW evaluation process.
While we have had a change in Mental Health Nurses in the year, our Mental Health Program has continued strongly. The position is shared with the Health Service. The changes to the Better Outcomes in Mental Health (BOMH) access arrangements for GPs have resulted in a major increase in its utilisation. The Group CBT Program was closed in the light of the new Mental Health initiatives. During the year, there were 899 GP Mental Health Plans against an estimated number of 4,900 persons who could benefit from Plans. By year end it became apparent that the demand for the BOMH Program was such as to exhaust our funds for this Program early in 2007–2008 and consequently it is anticipated that some form of rationing of this free service will be essential. Members should be aware that the funding of the BOMH Program is finite, although it is hoped that there will be additional funding provided by the Commonwealth.
At year end, new initiatives in Division mental health services were being developed including a GP practice mental health nurse initiative and a psychology adjunct to the Diabetes Program.
One major event in the year was our success in receiving a 'Round the Clock' Medicare grant to help support the After Hours Service. This enabled the Division to free up the long standing application to the AHS of our Workforce Support for Rural GPs funds. In accordance with the decisions of the General Meeting on this issue earlier in the year, these funds have been redirected to assisting the University of Wollongong to place students in our area; assisting GPs by providing practice management support; encouraging and fostering more use of practice nurses; providing promotional material for prospective new GPs; encouraging four GP registrars to the area; and encouraging more practices to become registrar training practices.
We achieved three new fulltime GPs in the year and four new part time GPs in the year.
On the other side, Dr John Barnett retired from his 19 years of general practice to become a staff specialist Gerontologist at the Hospital at year end.
Practice quality support has included nine GP CPD sessions with an average attendance of 16 (28%) of GPs; and a well utilised Home Medicine Review Program with 104 reviews in the year. The second arm of the Division’s Quality Use of Medicine Program was the National Prescriber Service’s project directed at providing GPs with accurate information in relation to targetted medications. There were 64 P sessions under this Program in the year.
Our QUM worker also operated the UNSW project on Practice Nurse based smoking cessation. This NH&MRC funded project is studying the feasibility of providing a Medicare Benefit for this activity. The project spans our Division as well as Macarthur Division. The work has been completed in our area, but the project will not conclude until June 2008. The preliminary results are encouraging.
Consumer focus is obtained through consumer input into the Diabetes, Mental Health and Aged Care programs, the After Hours Service and the presence of our Community Adviser at Board meetings.
Division staff as at 30 June 2007:
Executive Director – Dr Warwick Ruscoe – three days per week
Deputy CEO and Admin Officer – Sally Pfahl – full-time
Diabetes Program Officer – Jill Snow – full-time
Diabetes Admin Assistant – Anne Rogers – part-time
Aged Care Program Officer – Margaret Mogg – full-time
Mental Health Program Officer – Astrid Toscan – full-time shared with the Health Service
Mental Health Admin Assistant – Catherine Amos – part-time
Immunisation Officer – Cheryl Jones – part-time
Quality Use of Medicine and Smoking Cessation programs – Gail Forlonge – part-time
Manager, After Hours Service and Admin Assistant – Julie Huntington – part time
After Hours Service Receptionists – Raelene Daley, Nicola Lindsay, Jennifer Menzies.
Dr Warwick Ruscoe
Other Reports
2007-2008 Annual Report
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