CURRENT PROGRAMS AND PROJECTS

Clinic SMART

Bendigo Division of General Practice in June of 1999 initiated an innovative practice support program named Clinic SMART. Clinic SMART focuses on delivering support to GPs in the practical aspects involved in running a practice.

During the first year of the program support was offered in four areas: accreditation, business management, information technology and customer service. This highly successful program has been accessed by all the practices in the Division and has significantly raised the practice performance within the Division area. This program has also developed strong links between the Division and local practices, which allows for targeting of valuable information and resources on a wide range of topics.

The success of this aspect of the program is evidenced by the enthusiasm with which practices in this Division have registered for accreditation and by the fact that the thirty- percent of practices, which have now received full accreditation, did so on the first visit.

Support for practice staff has been another focus of Clinic SMART and has included much of the customer service aspect of the program through working with practice staff. Regular practice staff meetings have addressed issues such as improving communication skills, updates on accreditation, developing policy and procedure manuals and wellbeing for practice staff. First Aid and Triage courses have been organised using the staff from the Regional

Ambulance Service; a four session personal development course and a full day course on sterilisation and infection control have provided practice staff with an opportunity to improve their skills.

As Clinic SMART moves into the second year of operation the focus is shifting from accreditation to Business Planning. The Bendigo and District Division will be able to provide General Practice Business Advantage (GPBA) to members in the second half of the year. Further models are being planned on medical/legal implications for practices. The Division plans to support GPs in the implementation of this program by offering ongoing support and advice to practices that elect to undertake this program.

Immunisation

The employment of an immunisation nurse has enabled practices in the Division to have access to timely and appropriate information about all aspects of immunisation. It has provided an opportunity for a Division -initiated local community immunisation reference group which has been working together on a range of projects.

The Division instigated successful immunisation sessions at the local Koori cooperative that has led to sustainable continuing sessions by the City of Greater Bendigo. The work in the area of immunisation has resulted in an increase of over 10% in the Division's immunisation coverage during the funding period.

Enhanced Primary Care - MBS Items

The Division responded very promptly to the introduction of the new MBS items. A small working party was formed from local GPs to build on the expertise of the research unit, which is attached to the local health care group, and the aged care branch of the Bendigo Health Care Group. An assessment tool was developed to enable GPs to perform a Health Assessment which complies fully with all the requirements. Proformas and information sheets have been developed, and Division staff have spent time with GPs explaining the new items and the use of the relevant proformas.

Additionally, the Division has been able to offer to doctors, the services of nursing staff to perform the home visit component of the Health Assessment. This service has been enthusiastically taken up by several practices, which is supplied on a cost recovery basis. Division-run training sessions for GPs and their own practice nurses means that a consistent best practice approach can be used across the whole of the Division region.

The Division has also been instrumental in bringing together other primary care providers to provide information and to discuss the opportunities for working together which these new items present. Already there has been some work done on streamlining assessment processes for accessing a range of services.

Adolescent Health

The Division has been innovative in developing strategies to link adolescents into the health system and to forge greater communication between GPs, the youth population and youth agencies.

The original goals of the program were to: educate and resource young people in accessing GPs, resource support and educate GPs in their work with young people, and to facilitate better links between GPs and the broader youth sector.

Extensive consultation occurred with the youth sector to identify the goals of the program and continues in the form of an Adolescent Health Reference group for the program. The program will run over three years with the aim of establishing systemic and sustainable change which will enhance the access of young people to GPs and the value of such for all stakeholders.

The Program has had from the outset a model that has strived to enhance the links between GPs the youth sector and young people; therefore the goals of the program reflect a multi-disciplinary sustainable approach. The Division funded the reprinting of a local resource card called a CAV card. This is a pocket-sized card listing all local resources with specific emphasis on health services. The Division highlighted the GP element with a message encouraging young people to have their own GP.

Health Access Workshops are now integrated into the curriculum of all year ten students at local secondary colleges, both public and private. Through these, students learn about how and why to access GPs. A brochure for young people on accessing GPs has been designed and produced. The current focus is on implementing the National Health and Medical Research Council (NHMRC) youth depression guidelines into all practices. This will be implemented in collaboration with our local Division of Psychiatry.

Koori Health

The program area of Koori Health has developed since 1998 when the Division formalised links with the local cooperative and built on the initial contact made through the Needs Assessment. The Division has been a significant contributor to the Health Outcome Agreement with Dja Dja Wrung (DDW). This has resulted in three General Practitioners being part of a weekly medical session offered at the cooperative, targeting Kooris who do not have their own GP.

Other outcomes of this contact have included a positive working relationship with DDW staff, and collaboration in cultural awareness Continuing Medical Education (CME) activities. Other initiatives include representation by the Division's GP Portfolio Manager on the Koori Hospital Advisory group, inclusion in their immunisation reference group and other possibilities to collaborate in the area of the diabetes program.

Information Technology

The appointment of a full-time Information Technology (IT) Officer to the Division has resulted in the provision of a range of much needed services to the practices within the Division. The officer is able to visit practices to offer advice in relation to data and system security and management, capacity planning and negotiation with commercial IT providers. The overall objective being to maximise the ability of IT to support clinical and business processes.

Another IT function is the organisation and delivery of IT and business-related educational programs to large and small groups of GPs. Within the Division, IT has become integrated across, and contributes to all, Division program areas.

At the close of the 1999/2000 financial year, in excess of 80% of practices within the Division are computerised - doubling over the previous 12 months. Future IT initiatives will focus on the Information Management needs of GPs and practices in order that the benefits of IT adoption are fully realised.

Drug, Alcohol and Mental Health Initiatives

The limited number of mental health specialists in rural areas has impacted significantly on GPs in this Division. The Division has undertaken the development of a Methadone Prescibers reference group to support and train local GPs and to act as a resource to other GPs in the area. This initiative has seen an increase in the number of local prescribers and has attracted additional funding to develop a regional training program and to trial new accredited training related to dual diagnosis developed by Monash University.

The new position of Chair of Rural Mental Health, Monash University has just been set up in Bendigo. The Division is working very closely with the major players to optimize the relationships between its members and this faculty.

This strengthens the already strong links between the Division and the Bendigo Division of Psychiatry.

Continuing Medical Education

In the last year the Division has run 39 Continuing Medical Education (CME) events using a range of methodologies and venues. The topics have been developed from the Division Needs Survey and, where possible, incorporate other allied health agencies and pharmacists so that cross referral systems can be in place. Families of GPs are included where possible. Satellites and pizza, IT workshops, pharmaceutical company sessions, all day workshops, clinical audits, lunchtime seminars, case presentations, practice based training - all contribute to a range of modalities to suit all GPs. The Division aims to evaluate all its presentations and to maximize adult learning strategies.

Through the RWAV initiative of Rural Training Networks, the Division is building on links between undergraduate medical students and registrars to GPs undergoing their Fellowship to deliver appropriate vertical training as demonstrated by our recent Skins 'N Things training initiative.

Postnatal Care

Links with Melbourne University have seen the Division develop an involvement in the PRISM program looking at postnatal support and care. Sixteen per cent of local GPs have been trained in the "GAPP" (Guidelines for assessing postnatal problems) and enhanced communication mechanisms established between GPs and Maternal and Child Healthcare Network which, until now, were minimal. This program aims to minimize the risks to newborn babies and mothers postnatally.