Name Barwon Division of General Practice Division Number 231 Classification Rural Number of Member GPs 37 State New South Wales Year Established 1993 Number of Member Practices 17 Postcodes Covered 2346, 2347, 2356, 2379, 2380, 2381, 2382, 2383, 2385, 2386, 2387, 2388, 2390, 2391, 2394, 2397, 2398, 2399, 2400, 2401, 2402, 2404, 2405, 2406, 2407, 2408, 2409, 2411, 2833. Population 55,619 (2001 Census) Area Covered The Barwon Division covers an area of 44,132 square kilometres, with a distance of 300 kilometres from north to south. The towns included in the Division are Barraba, Bingara, Boggabri, Collarenebri, Gunnedah, Manilla, Moree, Mungindi, Narrabri, Warialda and Wee Waa. CEO Ms Fiona Strang Chair Dr Grahame Deane Physical Address: Shop 5, 96 Balo Street MOREE NSW 2400 Australia Postal Address: PO Box 804 MOREE NSW 2400 Australia Email: admin@barwondgp.org.au Phone: 02 6752 7196 Fax: 02 6752 7397 Website: http://www.barwondgp.org.au

The Barwon Division of General Practice is a small rural Division covering a large geographic area in Northwest NSW. The Division is a Company Limited by guarantee and a Board of 7 Directors oversees the strategic direction of the Division. The Board meets by teleconference every 2 months. The Division has a permanent staff of 10, CEO (1 FTE), Operations Manager (1 FTE), 4 Program Managers (2.8 FTE), Education & Support Officer (.8 FTE), Data Support Officer (.5 FTE) and 2 Dietitians (2 FTE employed under MAHS program). Four casual nursing staff are situated in towns around the Division and provide immunisation advice and assistance with EPC care planning and health assessments. A casual dietitian works from Gunnedah under the MAHS program. The Division office is located in the central business district of Moree. The division contracts 11 private providers to supply Podiatry, Physiotherapy, Occupational Therapy and Clinical Psychology services to patients throughout the Division area.

The FTE GP: Population ratio is 1:1620 and currently higher in some of the towns. The Division activities centre around programs that are based on local need and current guidelines. The Division currently has 39 GPs living and working in the Division area, 38 are registered members, an increase of 7 since 2000-2001. 29 of the 39 GPs are full time, 3 of which are female. 10 GPs are part time, 7 of which are female. The Division currently has 11 GP Registrars working from practices throughout the Division area and 8 Overseas Trained Doctors.  The full time equivalent GP number is currently 32.5 with 8.8 FTE Registrars. There are 17 Medical Practices within the Division varying from solo medical practices in the one-doctor towns through to multi-doctor practices in towns with two or more practices. 

The Division has always enjoyed close to 100% membership with many members active on local, state and national committees such as Area Health Service Board, the Rural Doctors Network, Rural Doctors Association of Australia and the Regional Training Consortium. A wide disparity of services are available within the towns of the Barwon Division of General Practice, with some of the smaller towns providing excellent general practice and non procedural services to their community, and some of the larger towns providing quite significant, surgical, anaesthetic and obstetric services to the patients of their area.  Some of these larger towns also provide a referral service for some of the smaller towns in the local area.

MAJOR ACHEIVEMENTS
In the past 5 years the Division has achieved much for a small rural Division. Funding provided through the Department of Health and Ageing to assist GPs to raise the immunisation rate has seen the Division rate rise from 72.4% in 1999 to a current rate of 93.9%. In 2001 the Division held the highest immunisation rate for the whole of Australia, having held the number 1 position in NSW for some time. This was achieved with an Aboriginal population of 9% and a small number of GPs. The Division employs 4 registered nurses to assist the GP practices with data cleansing, education and cold chain monitoring. Over the past 7 years the Division has produced a comprehensive advertising campaign promoting the immunisation schedule for childhood vaccination and other programs as they were introduced eg. Q Fever, Hepatitis B, Flu.

The Integrated Diabetes Care Program, which was in its infancy in 1999, has developed into a highly successful recall/reminder register based around a HIC accepted care plan. Over 1000 patients are now registered on the database, 17% of which are of Aboriginal and Torres Strait Islander descent. 90% of Division GPs participate in the database. The development of the More Allied Health Services Program around the diabetes program has resulted in an enhanced program well supported by the provision of Podiatry, Dietetics, EPC Nurses and Physiotherapy services. The recent introduction of a lifestyle program coordinated by the Division Dietitians further enhances the program through education and assistance to make lifestyle changes and reduce risk factors. Funding recently awarded to the Division through the National Diabetes Improvement Program will see the development of self management resources.

The More Allied Health Services Program has gone from strength to strength since it's inception 4 years ago. The Division now employs 3 Dietitians (2.1 FTE) and 3 casual EPC nurses. Podiatry, Physiotherapy and Psychology services are contracted through private providers. Over the past 4 years the Division has also provided Speech Pathology and Mental Health services. Services are provided according to need as indicated by a yearly Needs Assessment. Recently the scope of the program has been broadened with the introduction of the Lifestyle Program and the soon to be released Schools Program.

Under the Medical Specialist Outreach Assistance Program the Division currently provides Outreach Surgical Services, a Paediatric Specialist, Ophthalmology Upskilling. Generalist Physician, Haematology and Gynaecology services to numerous towns within the Division area.

The formation of relationships with local Councils, the Area Health Service and Education Departments has seen a more coordinated approach to support for new GPs to the area. The communities of Warialda, Moree, Gunnedah, Narrabri, Boggabri, Manilla, Bingara and Wee Waa (some in partnership with the Division) provide housing for GP Registrars, locums and Overseas Trained Doctors, and some Councils provide locum accommodation and free accommodation to GPs new to the area for a fixed term.

A significant amount of work has been done by the Division in the area of relationship building in the past 4 years. The development of the Combined Senior Executive (CSE), a committee consisting of the Chair and Executive Officer from the Barwon, North West Slopes and New England Divisions that meets quarterly with the CEO and Director of Mental Health and Community Services from the Area Health Service, has created a forum in which to debate a number of cross Divisional issues with the Area Health Service with satisfactory results. The Committee was also the parent body from which the New England Area Training (NEATS) Consortia developed. From this forum various opportunities for shared programs have arisen including the Warialda Primary Care Program, the Regional Health Services Primary Care Project and Clinical Risk Management for Small Rural Hospitals. The three Divisions involved in the partnership are known to have one of the best GP/Area Health Service relationships in NSW.

The quality and outcomes achieved by the Barwon Division programs and the persistent effort to create productive relationships with key health organisations has seen the Division become the recipient of a number of awards:Highest Immunisation Rate in NSW 2002Moree Professional Business of the Year 2003The Inaugural John Aloizos Medal - Dr Grahame Deane 2003

CHALLENGES FOR THE FUTURE

• Retention and recruitment of highly skilled procedural GPs and the provision of support such as locum services and practice management.
• The provision of adequate Allied Health services with current budget constraints.
• The maintenance of the current high standards of service with budget constraints, small staff numbers and the difficulties and constraints of a large geographical area.
• Moving into true practice support through practice management of GP practices throughout the Division area.
• Sourcing of additional revenue to enable the Division to provide comprehensive GP, practice and patient support.