Name Knox Division of General Practice Division Number 314 Classification Urban Number of Member GPs 203 State Victoria Year Established 1993 Number of Member Practices 57 Postcodes Covered 3136, 3137, 3152, 3153, 3154, 3155, 3156, 3158, 3178, 3179, 3180, 3785, 3786 Population 196,458 (2001 Census) Area Covered Approximately 200 square kilometres including the cities of Knox, Maroondah and the Shire of Yarra Ranges. CEO Ms Melanie Virtue Chair Dr Igor Jakubowicz Physical Address: First Floor 664 Mountain Highway BAYSWATER VIC 3153 Australia Postal Address: First Floor 664 Mountain Highway BAYSWATER VIC 3153 Australia Email: admin@knoxdiv.com.au Phone: 03 9720 2044 Fax: 03 9720 2066 Website: http://www.knoxdiv.com.au

Geographically, the Knox Division of General Practice is an urban fringe division.  Although not classified as rural under the RMMA coding, Knox Division is located at the foot of the Dandenong ranges with six postcode areas located in a high risk bushfire zone (e.g. steep blocks located on the side of Mount Dandenong, along dirt roads).

There are 50 general practice clinics, including 13 solo practices, 34 group practices, and three corporate owned.  Eight Knox GPs practice as GP Obstetricians and 11 GPs have Visiting Medical Officer rights at the Angliss Hospital.

GP/Population Ratio: “Based on the Estimated Resident Population (June 2003 & June 2004), the rates of population per GP in Knox DGP were higher than those for Victoria and Australia, indicating a lower level of provision of GP services in the Division (Population health profile of the Knox Division of General Practice, Population Profile Series: No. 50 , PHIDU, November 2005).

DIVISION OVERVIEW/INTRODUCTION:
Knox Division's mission is "to support the diversity of General Practice models in delivery of quality health outcomes to Knox community"

Knox Division of General Practice has ISO Quality Endorsed Company certification.

PRIORITIES & RATIONALE:
Our Clinical Management Unit will address the following priority areas:

• Clinical education focusing on quality use of medicines and mental health, particularly depression and anxiety disorders (36% of GPs using Knox Division’s Referral Links service are seeking mental health services for patients).
• Immunisation upskilling focusing on clinics with lower overall childhood immunisation rates and education for maternal and child health nurses (particularly targeting 18-48 month under-immunised children).

Our Patient Linkage Unit will address the following health service priorities:

• Patient referral and waiting list advice - through the GP Referral Links service (dial-in access/referral to specialist and allied health services).
• Knox Division’s Resi-Care Improvement service works with local GPs and residential care facilities to increase GP-access and promote use of comprehensive medical assessments and residential medication management reviews.
• GP inclusion in management of their patients at hospital – through a Hospital Liaison service (developing GP-patient referral, discharge & feedback systems).

Our Business Support Unit will assist clinics in the following priority areas:

• Information management – focusing on data management, particularly patient register and recall systems;
• Workforce recruitment and retention is a major issue in the Knox catchment area which has lower GP to population ratios than both the Victorian and National average.  The Division will focus on GP principals, particularly increasing business acumen and developing workforce recruitment strategies tailored to individual clinic needs.
• Business systems development - assisting clinics in cyclical strategic and business planning at an individual clinic level;

Our Health Promotion Unit aims to address local health needs through health promotion focusing on the following locally identified priority areas:

• Smoking Cessation Campaign - media promotion of General Practice as first point of call and series of community education activities including local billboards and posters.
• Immunisation rates – media campaign promoting age-appropriate immunisation for children, particularly the 18-month to 48-month target group.
• Lifescripts promoting use of Lifescripts to assist patients in smoking cessation as part of the Smoke Free Knox campaign.

MAJOR ACHIEVEMENTS:
Major Achievements during the previous 12 months include:

• 205 quality audits conducted in Knox clinics by the Business Improvement team;
• Development of GP hospital communication tools through regional GP Hospital Liaison project, including:
  • Rejected auto-faxes report & protocol for GP database rectification,
  • Auto-faxed Medication summaries from Eastern Health to GPs
  • Eastern Health – electronic referral letter template (45% GP uptake in first year)
  • GP trial of the electronic discharge summary
  • New process whereby discharge summary is faxed to the Aged Care Facility for all patients from an Aged Care Facility;
• Knox Division achieved the highest Broadband-for-Health adoption rate of all Victorian metropolitan Divisions;
• Development of GP Practice Map for display in hospital emergency departments across the region;
• 80% of Resi-Care Facility DONs attended the Knox Division’s Director of Nursing Network;
• 88% of Residential Care Facilities within Knox area actively engaged in the Knox Division’s Aged Care Panel;
• 200% increase in the number of Comprehensive Medical Assessment items claimed within the Knox area (compared with 2004-5 data);
• Childhood immunisation ranking increased 7 places to 9th highest overall immunisation rate in Victoria which was the highest ranked metropolitan Division;
• Establishment of Smoke-free Knox Campaign steering committee, including local and state government, secondary colleges, youth services and associated activities
  • Whole of school smoking cessation activities including GP education sessions for students, staff and parent resources
  • General Practice smoking cessation health promotion displays
  • Smoking cessation articles in local newspapers;
• Achieving an overall GP participation rate (across all Division activities) of 97%;
• Highest ever engagement of clinics with 94% utilising at least one business improvement service;
• Excellent impact indicators for clinics undertaking clinic system audits with 100% of participating clinics reaching accreditation standard in the audit area;

CHALLENGES:
Again the major challenge will be meeting the expectations of local GPs and those of all stakeholders at local, regional, State and Commonwealth level with decreased funding.  Knox Division will continue our work with neighbouring Divisions to develop cost-efficient activities and funding submissions for shared projects.

Retaining and attracting highly skilled staff will continue to be a challenge without additional funds for even modest annual wage increases of 3% (comparable to public service award).  The increasing discrepancy between Division pay rates and public service pay rates, not to mention job security and other public service entitlements, makes staff retention more difficult.  In the past 18 months, Knox Division has lost four staff to State Government positions (all paying substantially higher wages).