DIVISION OVERVIEW/ INTRODUCTION
The Central Highlands Division of General Practice is one of 122 Divisions around Australia, funded by the Commonwealth Department of Health & Aged Care. We commenced operations in November 1993 and established our offices in January 1994. The Division is a company limited by guarantee, which consists of a Board of Directors, a staff team (including Chief Executive Officer) and a general membership.

The Division is located immediately to the North of greater Melbourne and, while it is mostly rural, contains an increasing proportion of 'urban fringe' areas. The Division contains a number of sizeable towns but no major regional centres. The largest hospital is located at Kyneton but most of the population would access Melbourne for tertiary care needs and a substantial proportion access accident and emergency services at Northern Health, Western Health and Royal Melbourne Hospital.

Many of the towns in the Division have an increasing proportion of people who commute to Melbourne for work, having purchased homes out of the city for lifestyle or affordability reasons. This is the case even for some of the distant parts of the Division such as Daylesford and Castlemaine.

The size of the Division presents challenges in providing services particularly to outlying areas and numerous member consultations have indicated that members near the edge of the Division feel less well served by the Division, particularly in relation to their ability to access professional development activities. Historically the Division was superimposed upon local informal affiliations of GPs focused on local hospitals. With the demise of a number of local hospitals and the reduction of the GP role in others these informal networks have become less strong and members are more likely to look to the Division as their primary means of affiliation with other GPs.

On the other hand the fact that the Division is mostly made up of small to medium sized towns also brings opportunities. It means that there is often a strong sense of a community identity and that practices have a relatively definable population to which they relate.

The Division contains great socio-economic diversity as reflected in scores for the SEIFA index of socio-economic disadvantage and also estimated burden of disease. For example the post codes of Macedon and Mt Macedon have amongst the highest SEIFA scores in the state (high equals less disadvantage) and lowest age standardised burden of disease whereas Seymour has amongst the lowest SEIFA scores (most disadvantage) and highest burden of disease. As is generally the case in Australia, access to GPs in this Division is generally inversely proportional to need.

MAJOR ACHEIVEMENTS

• Commencement of the Central Highlands After Hours Medical Service at Kyneton District Health Service in December 2003.
• The Division's Better Outcomes in Mental Health Care Allied Health Project is now providing additional counselling services in 3 locations through the Division.
• 3 Division practices have been involved in the RACGP Smoking Cessation and Practice Nurse project, facilitated by Dr John Litt.
• 93% of practices are now using patient registers and recall and reminder systems to some extent.
• 65% of eligible practices have employed one or more practice nurses using the Practice Nurse Incentive payments.
• 4 practices with 22 GPs are now signed up for PKI.
• 92% of eligible practices are now at the 90+% fully immunised level required for GPII outcomes.
• 135 GPs (68.5%) attended one or more Division-facilitated educational events;
• 6 practices were involved in the CALM alternative dispute resolution project, with 90GPs, staff and nurses attending 5 training sessions.
• All practices (except new and non-vocational) are now accredited.
• The Division provided a study program for Overseas Trained GPs, Registrars and non-vocationally registered GPs, with 29 doctors involved to varying degrees.
• 10 new GPs were recruited to the Division area, and 8 registrars have agreed to stay in the Division for their subsequent term.
• 20 GPs, 10 partners and 16 children participated in a Division-facilitated GP Health weekend.

CHALLENGES FOR THE FUTURE

Issues and directions for Central Highlands Division
The Board of the Central Highlands Division of General Practice has decided that this Division has a number of strengths that make it appropriate to adopt a major focus on population health over the next three years. These strengths include:

• High support from  the membership for the concept of the GP and Division role in population health
• Geographical setting that makes it relatively easy for GPs and practices to identify themselves with a particular population (ie scattered small to medium sized towns)
• Very high uptake of clinical computerisation, with a high level of use of the more advanced applications of such systems
• Large proportion of practices with practice nurses
• Relationships with tertiary and public health organisations that will facilitate the development of population health capacity and the Division's ability to use population health data.

In order to build upon these strengths the Division has recognised the need to increase its ability to relate to GPs and practices IN SITU, that is, within the local practice and community. This is considered to be the greatest organisational challenge facing the Division over the next three years. In response the Division is looking to:

• Establish a regional substructure based on five Divisional regions
• Alter the way in which the Division works with practices such that:
  • Practices relate primarily to one person in the first instance
  • Practices are offered the opportunity to  participate in a 'Development and Support Needs Assessment'
  • The Division will hold more systematic data about needs and progress within practices.