As part of its achievement awards, the ADGP is rewarding local divisions for their level of consumer involvement. Dr Kathy Kramer reports on the three finalists in this category.

THE Nepean division, in the foothills of the Blue Mountains, is celebrating more than just the Penrith Panthers' stunning rugby league grand final win. It's been nominated as one of three finalists in the Australian Divisions of General Practice (ADGP) achievement awards for its work in engaging consumers, having decided to enter after reading about the competition in Medical Observer.

CEO Michael Edwards says there's been a change in thinking about consumer involvement, from a certain reticence to frank excitement.The challenge has been to integrate consumer viewpoints at both strategic and operational levels. "The community itself is better educated. So many people go to the Internet or are involved in their own health decisions, so we just had to involve consumers.

It's a natural expansion of the changing relationship between doctors and patients away from a paternalistic model. "Work began in earnest a couple of years ago, when the division created a consumer reference group that meetsquarterly. Their discussions help the division to tailor its programs to the needs of the community. For example, when the division planned its cervical screening promotion strategies,the group contributed by sharing members'experiences of Pap smears.

"In light of those discussions, we readdressed our strategies on how to get the message across to the younger generation about the need for Pap smears. They also helped with aspects of promotion: Which is the best place to promote education?  Posters in shopping centres? Radio interviews? Newspaper ads? These sorts of answers have come through these discussions.

"The group is also able to advise us once we get a strategy. For example, if we make a printed brochure we show it to the group before we publish it and they give us fresh pairs of eyes. "Members are remunerated for their time but Mr Edwards says most were embarrassed by the thought - "they are happy to be involved and feel they are making some difference in community health".

Consumers are also recruited into specific advisory groups. "One of our most exciting projects has been in youth health," Mr Edwards says. Local year 12 student, Jessica Hamilton, is a member of the Youth Health advisory committee."She brought a freshness to the committee.While we think we understand what the youth are saying and thinking, to actually have it from a student opens up a new realm.

"Working out how to engage consumers across 100,000 square kilometres, two states and communities as diverse as Murray River citrus growers and dryland farmers was not too big a challenge for another award finalist, the Mallee division.

Executive officer Robert Mutton knew the answers would have to come from within the area itself, and hired a local consultant who came up with the idea of a division-wide system of community focus groups.The groups vary in size from six to 10 people and meet every second month. The groups then decided to elect a representative to a community reference group, which meets during the other month and, in turn, that group decided to elect a member to the division's board.

"Our division has the view that simply having somebody sitting on the board does little for community participation - it looks good but it doesn't achieve much. We have a structure under that person to support them, and there is a path for community input. So far, it seems to be working fairly well."It took time for members to come to grips with the idea of opening their hearts to consumers - and paying for the privilege. "It was a pretty expensive exercise," Mr Mutton says, but adds,"people were able to see there was good value in it".

"The community groups are more focused on finding solutions for health issues facing their communities and not just finding faults with what they have got." For example, the groups were involved in organising a rural men's health issues program and developing a brochure on patients' rights and responsibilities.

The third finalist, the Southern Tasmania division, covers a mix of rural and urban populations with Hobart as its centre. It began working towards greater consumer engagement several years ago by getting representatives on individual programs. This provided feedback from the ground level but, according to program officer Carolyne Field,did not provide a structured way to get input into strategic planning.  "We wanted a broader, more overall vision."

 So the division created a health consumer network with representatives from 59 consumer and community organisations plus individual members."We didn't want to waste time arguing about who is or is not a consumer - everybody is a consumer of general practice, and if people are interested we don't want to exclude them.

"Examples of members include the Heart Foundation and Asthma Tasmania but also grassroots organisations like the Post Polio Network, which consists of people who have the condition.It's quite a broad spectrum.

"The network holds forums twice a year but also communicates by email. A bi-monthly newsletter plays a dual role of keeping members informed about what's happening in the division and allowing the division to ask for consumer feedback on particular issues.

"For example, there's been a lot of talk about what's a high quality general practice, but we actually asked consumers what they thought were the individual characteristics of a good GP and a good general practice, and they helped make two separate lists."These lists are in our minds when we look at developing new programs: How would it help meet these hallmarks of quality??

Members can also approach the division with ideas. When a national disability body recently called for a national day of action looking at access to surgeries, the local Tasmanian group knew just criticising GPs would not achieve anything. Instead, with the help of the division, they completed a mailout to GPs to let them know the group was available to consult with practices wanting ideas on how to improve access. MO

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