SOMETIMES the best approach to solving a problem is to think outside the square, and many divisions have found that this approach is crucial if programs are to reach the community and support GPs effectively. One of the four finalists in the Innovation category, the Brisbane South Division of General Practice, had to employ lateral thinking to find a way to increase its low immunisation rates.

With 27% of its community  born overseas the division faced a raft of challenges including a lack of education about the importance of vaccination, varying perceptions about health, and other cultural barriers. In addition, children who migrate to Australia or enter as refugees don't receive the patient-held vaccination health record, which is issued by state and Territory health departments to children born in Australia at birth.

Bureaucratic restraints prevented the division from accessing state-produced immunisation books for local GPs to use for their culturally diverse patients, so it created its own Immunisation Health Record Book for children born overseas.The record is endorsed by the RACGP.

"The regulations say that if you are not born [in Australia],you don't get one of the books," division chief executive David Gardner says. "Within the constraints [Queensland Health] operated in, they couldn't doanything. But once we moved outside those constraints they were more than happy to help."It was a matter of saying what can we do, and it wasn't just our GPs that were searching for something of that nature.

"The division has distributed more than 2000 free copies of its immunisation record to local GPs for free, and provides it to other divisions and health providers for $1 per book.Anecdotal evidence suggests GPs are now finding it easier to keep track of their patients' vaccination history.

According to the Northern Rivers Division of General Practice in NSW, providing information that is both useful and time-efficient, is one of its biggest issues. The solution? Disseminating information regularly by CD-ROM. The use of CDs allows the division not only to get its own information to doctors and practices, but also to provide information from other organisations closely involved with general practice, such as the Health Insurance Commission, the National Prescribing Service,and the health department. It also allows the division to filter information to guarantee thedelivery of relevant data. Since distributing the browsable CD, the division's website hits have risen considerably.

"It started off because one of the [events] we sponsored had a wealth of information to go out,and we realised that each GP would be taking home half a ream to a ream of paper," project manager John Gable says."We thought, this is ridiculous - let's just stick it on a CD". It seemed like the obvious, practical solution. Then we decided to make it browsable and interactive, so it has evolved. It's a stepping stone between doctors and the Internet.

"Feedback has been positive, and some practices have downloaded the CD onto a hard drive, so they can use it as a reference tool, Mr Gable says.

The Riverina Division of General Practice, also in rural NSW, established the Primary Health Care Nurse program in 2002, appointing three full-time nurses to cover 12 small rural communities with populations of less than 1000 people.GPs previously weren't servicing the 12 communities regularly because of the lack of continuity of care, but that's changing, division CEO Nancye Piercy says."Now when they go out once a week to a small community, if there is any follow-up needed, there is the opportunity for another health worker to care for patients and be a point of contact for the doctor as well.

"The service provides a balance of clinical support and delivery, coupled with community capacity using the 'healthy communities' model. This model is an evidence-based approach which allows residents to have a major say in the provision of their needs and required support. The project is just 12 months into its three-year funding period, but it is drawing praise from local councils and communities.

"When we first went out to c onsult the community on their needs, the feeling was that "we keep getting asked what we want but we never see any results". The communities now feel that, for once, we said this is what we wanted, and we got it."

The Whitehorse Division of General Practice in outer Melbourne has taken an innovative approach to asthma management. Building on a 2001 federal health department plan to improve health outcomes for people with asthma through general practice, the division designed an Asthma Clinics in General Practice Program.The program aims to help GPs implement the evidence based Six Step Asthma Management Plan, and more recently the Asthma 3+ Visit Plan, as recommended by the National Asthma Council and the health department.

The division employs an asthma educator and contracts services to individual practices for four hours a fortnight. Patients from participating practices are referred by their GPs to the clinics, where they are seen for free.There are now six practices running clinics with qualified and experienced asthma educators, with more joining. The model has been highly effective, and both GPs and patients have been very satisfied, division executive manager Marianne Shearer says.

"This model ... is practical and relevant to how general practice runs, and ... many patients are coming in saying "my friend told me about this service", so there is positive word of mouth about it."  MO

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