2013 - 2014
ANNUAL REPORT
NEW ENGLAND
NEW ENGLAND
new england Medicare local limited
2013 - 14 Annual Report ABn 75 152 868 669 www.neml.org.au Suite 3, 180 Peel Street PO Box 1916 TAMWORTH NSW 2340
t 02 6766 1394 f 02 6766 1372
new england Medicare local limited
2013 - 14 Annual Report
Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health.
ABn 75 152 868 669
www.neml.org.au Suite 3, 180 Peel Street PO Box 1916 TAMWORTH NSW 2340
t 02 6766 1394 f 02 6766 1372
Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health.
Annual Report 2013 - 2014 About Us ..................................................................................Page 4 Our Region...............................................................................Page 5 Meet our Board.........................................................................Page 6 Chair’s Report..........................................................................Page 7 CEO’s Report............................................................................Page 8 Clinical Services.......................................................................Page 10 Aboriginal Health......................................................................Page 13 Finance & Operations..............................................................Page 15 Primary Health Care & Partnerships......................................Page 16 Financial Statements...............................................................Page 22
New England Medicare Local Annual Report 2013-14
About us New England Medicare Local assists people around the New England North West area of NSW to access the health care services they need at the right time, and in the right locations. We are a not-for-profit, public company, that aims to create “healthier people and communities” by helping to coordinate primary health care delivery, and tackling local health care needs and service gaps to “keep people well and out of hospital”
OUR VISION Partnerships, programs and practices that make a difference
OUR PURPOSE Improving health in local communities
OUR VALUES Respect Compassion Support Integrity Innovation Page | 4
New England Medicare Local Annual Report 2013-14
Our Region The New England Medicare Local region covers an area of more than 93,000 kilometres – a space roughly 1.3 times the size of Tasmania Mungindi spanning from Quirindi in the south, to Tenterfield and Mungindi in the north, east to Armidale, and west to Moree Wee Waa. More than 175,000 people live in the towns, cities, villages and remote communities dispersed throughout our region.
Boggabilla Tenterfield Ashford
Deepwater Emmaville
Warialda Inverell Bingara
Wee Waa New England Medicare Local Narrabri provides services in: Moree, Barraba Narrabri, Gunnedah, Quirindi, Tamworth, Walcha, Armidale, Inverell, Glen Innes and Boggabri Manilla Tenterfield, as well as smaller, outlying townships such as: Boggabilla, Gunnedah Mungindi, Ashford, Deepwater, Emmaville, Warialda, Bingara, Tingha, Guyra, Boggabri, Barraba, Manilla, Uralla , Kootingal, Werris Werris Creek Creek, Caroona and Nundle. Caroona Quirindi
Males 49.3%
Glen Innes
Tingha Guyra Armidale Kootingal Tamworth
Uralla Walcha
Nundle
females 50.7%
Median Age is 40 years
Population
176,194
Population density is 1.9 people per Km2
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New England Medicare Local Annual Report 2013-14
Meet our Board of Directors Dr. David Briggs (Chair) -
BHA (NSW), MHM(1st class Hons) PhD (UNE) FCHSM, FHKCHSE
Mr. Roger Munday -
Dr. Briggs is a health academic and consultant based in Tamworth. He was appointed as a Director in 2011 and elected inaugural Chair. He also chairs the Innovation and Research Advisory Committee.
Dr. Grahame Deane -
MBBS, DACOG, FRACGP, FACRRM, DRANZCOG (Advanced)
Mr. Munday is a lawyer based in Armidale. He was appointed as a Director in 2011 and accepted the role of Deputy Chair in 2012. He chairs the Finance, Audit and Risk Committee.
Ms. Debbie McCowen - BSocSc (Applied);Â
DRANZCOG (Advanced),DipPaed,DipDerm
Dr. McIntyre is a GP Obstetrician based in Inverell. She was appointed as a Director in 2011 and represents the Board on the Service Development and Clinical Governance Committee.
Dr. Stephen Howle - MBBS, FRACGP Dip.Phys.Med. Dr. Howle is a GP based in Tamworth. He was appointed as a Director in 2011 and chairs the Service Development and Clinical Governance Committee.
Ms. Sally Urquhart - BAppSci (Speech Pathology); MBA Ms. Urquhart is a Speech Pathologist in private practice in Narrabri. She was appointed as a Director in 2013 and is a Director on the Community and Partnerships Sub Committee.
AvdDip Community Services Management
Ms. McCowen is the Chief Executive of Armajun Aboriginal Health Service in Inverell. She was appointed as a Director in 2012 and is a Director on the Innovation and Research Committee.
Dr. Deane is a GP Obstetrician based in Gunnedah. He was appointed as a Director in 2011 and is a Director on the Community and Partnerships Committee.
Dr. Cheryl McIntyre - MBBS,BSc(Med),FACRRM,FRACGP,
B Bis, LLB; Grad Dip L Prac (Coll Law)
Ms. Jackie Kruger - B.Sc Forestry;
M.Ed in Environmental Education
Ms. Kruger is the Director of Planning and Community Services for Tamworth Regional Council. She was appointed as a Director in 2013 and is a Director on the Finance, Audit and Risk Committee.
Ms. Lyn Rickard - B.Sc; Grad Dip Ed Ms. Rickard is the Faculty Director for Human and Personal Services at TAFE New England. She was appointed as a Director in 2013 and chairs the Community and Partnerships Committee.
New England Medicare Local Annual Report 2013-14
Chair’s Report Dr. David Briggs Chair of the Board Dr. Briggs is a health academic and consultant based in Tamworth. He was appointed as a Director in 2011 and elected inaugural Chair. He also chairs the Innovation and Research Advisory Committee.
It is my privilege on behalf of the Board to present our third annual report since the establishment of the New England Medicare Local. It has been a year of tremendous development as an organisation as well described in the Chief Executive’s report. We have demonstrated through accreditation of the organisation and services that the organisation has exceeded the expectations of that process and demonstrated high levels of quality service. We have also been diligent and innovative in our analysis of available data to describe our demographics, our communities and the extent of need for health care across our region. This effort was mostly achieved by the capability of our staff who worked on this achievement throughout the year. This profile of the region should be of value to many agencies throughout the area into the future. Given the sometimes poor and, at least variable socio-economic status of some areas of our regional population, we have also continued our strategic emphasis on prevention and promotion. We have also been working closely with local government in some parts of the region to see how
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we can effectively collaborate in meeting the health needs of local communities and improving health outcomes generally. All of this is, of course, a work in progress and again is a strategy that needs to be continued into the future. Through our staff directly we have delivered a range of services into both small and regional communities that otherwise would not have been provided and demonstrated improved access to health care to those communities. Importantly, we have also delivered a significant part of our services through the use of contracted health professionals in private practice throughout the region. This initiative not only improves access to services but underpins the economic viability of many small and solo primary health care practices, particularly in our rural communities. Importantly, we have continued and improved local access to practice support and continuing professional development across the region. All of this has been achieved in the past year through the efforts of our professional senior staff and the commitment of all staff, generally. It has been supported by a cohesive and effectively functioning Board of Directors.
This Report is also written in the knowledge that Medicare Locals (MLs) will cease to exist as at the 30th June 2015. This means that our efforts and achievements in the financial year being reported have been even more significant given the complete lack of information and continued uncertainty about the closure of the MLs and the establishment of Primary Health Networks (PHNs). Our Board supported the move from MLs to PHNs but would have preferred a more localised entity that was focussed on the needs of local regional, rural and remote communities and that understood the differences in clinical services in these contexts compared to more urban centres. Unfortunately this is not to be the case and time will determine if the health needs of rural communities are further advantaged and remain comparable to the level of achievement of NEML. The Board is determined to participate in a future bid for a PHN entity to ensure that our local and regional interests are adequately served.
Dr. David Briggs CHAIR
New England Medicare Local Annual Report 2013-14
Chief Executive Officer’s Report Mr. Graeme Kershaw Chief Executive Officer Graeme was previously the CEO of the North West Slopes Division of General Practice and has been involved in healthcare for over 30 years. He is responsible for the overall operation of the organisation and implementing the strategic directions of the Board
It’s only at times like these when annual reports are due that you have the opportunity to pause and reflect on what has been done and what has changed during the space of 12 months. This past year has been our second full year as New England Medicare Local. It’s been a year of consolidating the changes that came from merging the previous organisations and achieving many of the goals that we set back at the beginning of the new organisation. We have aimed to play our part in the regional primary health sector, delivering healthcare services and programs and supporting GPs and primary health practitioners. I’m very pleased to be able to share some of these accomplishments with you through this report. • In acknowledgment of the robust governance, financial management and program systems that commenced in 2012, we submitted to external evaluation and, after an exhaustive preparation, achieved full 3 year accreditation in April 2014. Apart from meeting all of the required industry standards, we received significant commendations from the surveyors which recognised the foundations that we had laid for continuing quality and achievement. • In addition to our general accreditation, we also undertook a separate evaluation of our mental health services against the national standards. At the time of this report we are awaiting the results, but are confident this will be another achievement that confirms the clinical services that NEML provides meet ‘best practice’ standards.
• Our Clinical Services section expanded during the year with the appointment of Rural Primary Health Nurses who have a roaming brief to connect people in small villages and communities to health care. With a preventative health approach these nurses conducted health screenings with locations as diverse as Yetman, Weabonga, Boomi and Coolatai. • Through employed and contracted health professionals we increased the provision of allied health services across the New England and North West in the disciplines of dietetics, podiatry, physiotherapy and speech pathology to name only a few. Through our contracts with the NSW Rural Doctors Network we also provided support and administration to bring visiting medical and allied health specialists to the New England/North West area so that local people could access services closer to where they live. From skin conditions to kidney diseases, eye conditions to diabetes education, NEML arranged for over 5,000 specialist consultations in the region. Over a quarter of the consultations were for Aboriginal people. • Throughout the year we’ve worked closely with other organisations in our local area. The largest of these is Hunter New England Local Health District (HNEH). From the service delivery level to the executive level our work with HNEH aims to create healthier futures for our communities. We work closely on having one of the highest childhood immunisation rates in Australia, we collaborate on one of the commonest long term
diseases in Australia – diabetes, and we work together to recruit health practitioners to provide care within the region. Our combined work helped to bring 19 new GPs and 9 medical specialists to live and work in the area. This work on health workforce succession planning was recently recognised as a finalist in the NSW Health 2014 Excellence Awards. • In each of our Network Areas – North, South and West, we have established community/ consumer and clinical advisory committees, bringing together local people - health consumers and health practitioners. Apart from advising the Medicare Local on the services that it provides, the committees highlight problems and potential solutions to the health concerns of their communities. The committees help to direct some of our work to these concerns ranging from tooth decay to early childhood development, healthy weight to health literacy. • Health literacy has been a particular focus for our Primary Health Care and Partnerships section this year. People cannot make healthy decisions and care for their own health if they don’t understand the language of health or if health professionals use terms and speak in a way which their patients can’t understand. We’ve made a start on this, training our staff and local practitioners in the area of health literacy. This is just a small sample of some of the work that the Medicare Local has been involved with. Further detail follows in the rest of this report. The importance of this work and the prominence it deserves can only go a small way towards being conveyed in a brief report by a Chief Executive. I haven’t even mentioned the 125 health professional education events we have conducted or the 20,000 episodes of care for Aboriginal people we have delivered, let alone the development of an on-line regional health directory, our ground breaking work in memory assessment or our alliance with Alzheimer’s Australia to deliver support and education to carers of people with dementia.
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New England Medicare Local Annual Report 2013-14
It’s been busy and it’s been richly satisfying knowing that we are providing genuine services to people across our region and that we are supporting GPs, nurses, general practice staff and allied health providers to provide the quality healthcare that they deliver every day. In order to do this we need a band of terrific staff members who approach the challenges of their work with an attitude that can overcome any barrier. To them, a special thank you for all of your efforts. Their work is overseen and directed by a very conscientious and committed Board of Directors that provides excellent support to me and my hard working and truly talented executive staff. I hope that you’ll read beyond my opening remarks and dip into the brief outlines of our other initiatives – projects and programs, services and support - that have only one objective, to improve the health of our local communities.
Mr. Graeme Kershaw Chief Executive New England Medicare Local
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New England Medicare Local Annual Report 2013-14
Clinical Services Ms. Therese Greenlees (Acting) Director of Clinical Services Therese previously worked as the Clinical Services Coordinator – Northern Network, stepping into the Acting Director role in 2014. She oversees clinical services across our region, including the Mental Health, Rural Primary Health Services, and Healthy Ageing programs. The Allied Health Practitioners and Visiting Medical Specialists who are employed or contracted by New England Medicare Local are an important part of the region’s health workforce.
The Clinical Services stream provides medical specialist and allied health services to communities across the region that have limited or no access to services, and to community members who could not otherwise access services due to cost or cultural considerations. The 2013-2014 year was one of increasing occasions of care across all programs, with a total of 20,947 individual sessions and 571 group sessions provided by twenty employed and seventy-eight subcontracted health professionals, and five University of New England (UNE) Psychology interns. The model of care provided within the stream is responsive to the local needs of communities and is conducted in consultation with other service providers, such as Hunter New England Local Health District (HNELHD), and is reflective of the challenges of both distance and ongoing health workforce shortages. This results in flexible service delivery ranging from local subcontracted clinicians working within the community where they live, through to employed clinicians providing outreach services through a hub and spoke model, and fly-in outreach medical specialists.
Mental Health The NEML Mental Health Services are funded by the Federal
Government under the Access to Allied Psychological Services (ATAPS) and Mental Health Services in Rural and Remote Areas (MHSRRA) programs. While the MHSRRA program targets those rural and remote communities that have little or no access to mental health services, the ATAPS program targets hard to reach groups, such as those who are financially disadvantaged, Aboriginal and/or Torres Strait Islander clients, women with perinatal depression, children with mental disorders and/or behavioural problems, and those at risk of self-harm. All our services aim to improve access to primary mental health care for people living within our region who have mild to moderate mental disorders, such as anxiety and depression, and who will benefit from short term intervention. These early interventions prevent a worsening of conditions and potential hospitalisation. In 2013-2014, our services received a total of 2,279 new referrals and provided 10,615 individual sessions across nineteen locations, resulting in an overall increase of 9% when compared to the previous year.
In 2013-2014, the NEML Early Years Outreach Clinic (Tamworth) supported the development of the Narrabri Perinatal* Mental Health Working Party, which includes members from government and non-government organisations. The Working Party is tasked with investigating the coordination of services in Narrabri and surrounds, improving service access, and building local workforce capacity to manage perinatal clients. The success of the Early Years Outreach Clinic was rewarded when the program received a NSW Mental Health Association Achievement Award for early intervention and prevention. * Perinatal refers to the period leading up to and immediately after the birth of a child. Perinatal depression alone is estimated to cost the Australian health system $535 million per year.
Rural Primary Health The RPHS program aims to improve the health of people living in rural and remote towns through the provision of, and improved access to, allied health services. There were 8,149 individual sessions (54% increase from the previous year) and 360 group (75% increase) sessions provided in 2013-2014, with a breakdown of services as follows: • Dietetics: 913 individual and 41 group sessions provided in
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New England Medicare Local Annual Report 2013-14
Barraba, Bingara, Glen Innes, Gunnedah, Manilla, Moree, Quirindi, Tenterfield, Walcha, and Warialda; • Exercise Physiology: 450 individual and 51 group sessions in Gunnedah, Moree, Mungindi, and Warialda; • Occupational Therapy: 81 individual sessions in Boggabri, Boomi, Gunnedah, Manilla, Moree, Mungindi, Narrabri, and Wee Waa; • Physiotherapy: 4,270 individual and 180 group sessions in Armidale, Boggabri, Glen Innes, Gunnedah, Guyra, Inverell, Kootingal, Moonbi, Narrabri, Nundle, Quirindi, Walcha, and Wee Waa; • Podiatry: 2045 individual and 2 group sessions in Armidale,
Barraba, Bingara, Boggabri, Glen Innes, Gunnedah, Guyra, Inverell, Kootingal, Manilla, Moonbi, Moree, Mungindi, Narrabri, Quirindi, Warialda, Wee Waa; and • Speech Pathology: 390 individual and 5 group sessions in Boggabri, Manilla, and Wee Waa.
Rural Primary Health Nurses One of the success stories of 2013-14 was the establishment of four Primary Health Care Nurse (PHCN) roles across 40 of our small communities, to identify and address local health care and social needs, and to build community capacity. In 2013-2014, the first year this program has been run within NEML, there were 1,294 individual preventative health screenings provided at community events across the region and health education was delivered to 111 groups, involving 1,754 participants. Health education events were aimed at addressing community identified needs including: drought assistance; mental health and wellbeing; diabetes and heart health; dementia risk reduction; healthy hearing; oral health; healthy feet; Closing the Gap (on Aboriginal health disadvantage) and eHealth. The PHCNs have been involved in Community Garden initiatives, redesigning a healthy food box for our volunteer firefighters, and improving health in our community schools. The PHCNs work closely with each other and other employed staff, such as our dietitians and mental health clinicians, NEML sub-contractors, and other organisations, such as Hunter New England Local Health District (HNELHD), Heart
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Foundation, Country Women’s Association and the Rural Fire Service.
Healthy Ageing The Healthy Ageing program aims to improve access to allied health services for older people living in the community and in Residential Aged Care Facilities (RACF). The Healthy Ageing program reported a 53% increase in individual services, with 527 sessions delivered, and a 10% increase in the number of group sessions, which equated to 92 group sessions with 672 participants (34% increase in number of participants). These services were provided by Dental Oral Hygienists, Exercise Physiologists, Physiotherapists, Podiatrists, Dietitian and Registered Nurses within the community and across 22 RACFs. The Southern Network’s successful history of falls prevention programs, with positively assessed outcomes for participants, supported the rollout of strength and balance programs across the region in 2013-2014. The Memory Assessment Program (MAP) continued in the Northern Network, providing 163 individual sessions to people within the community experiencing mild to moderate cognitive impairment (memory loss). The model of care and support provided by MAP has been recognised in The NSW Dementia Services Framework 2010-2015 as an “Example of existing good practice” in integrated care The Alzheimer’s Australia NSW (AANSW) funded Dementia Education and Carer Support (DECS) program received 55 new referrals, provided 362 individual sessions and 120 referrals to external dementia support
New England Medicare Local Annual Report 2013-14
services. The DECS program also provided dementia awareness and risk reduction education at eight group sessions and ten community events in the Northern and Southern Networks, as well as supporting AANSW workshops for health professionals, carers and the community. Both the MAP and DECS programs work closely with the HNELHD Cognition and Memory Services to ensure an integrated approach to memory assessment and dementia support across the region.
Medical Outreach The aim of the Rural Health Outreach Fund, Medical Outreach Indigenous Chronic Disease Program, and Indigenous Specialist Outreach Assistance Program is to improve health outcomes for people living in our communities, primarily through supporting the delivery of outreach health activities. These programs are funded by the Rural Doctor’s Network of NSW, and provided 5,445 occasions of care in 2013-2014, with 1,269 occasions provided to patients identifying as Aboriginal. A breakdown of the services is as follows: • Dermatology (Armidale) 688 occasions of service; • Endocrinology (Armidale and Moree) 482; • Gynaecology (Moree) 185; • Nephrology (Armidale) 159, (Inverell) 160, (Moree) 138; • Neurology (Tamworth) 404; • Ophthalmology (Moree) 482; • Psychiatry (Armidale) 534 and (Tamworth) 555;
• Rheumatology (Narrabri) 84 and (Tamworth) 478 ;
information on primary care issues between the NEML and primary health practitioners;
• Aboriginal Health Worker (Gunnedah and Moree) 110;
• Help promote the goals of the NEML;
• Diabetes Educator (Gunnedah and Moree) 92;
• Improve the design and effectiveness of NEML communication strategies;
• Dietitian (Gunnedah and Moree) 96; • Exercise Physiology (Gunnedah and Mungindi) 126; and • Podiatry (Armidale, Glen Innes, Gunnedah, Guyra, Inverell, Mungindi, Tenterfield, Tingha) 672;
• Assist in identifying gaps in services; • Facilitate provider feedback on specific issues, services and programs; and • Provide advice on how best to reach health service providers with information about services.
Clinical Advisory Committees The purpose of the New England Medicare Local (NEML) Clinical Advisory Committees is to provide advice, from a clinical perspective, to the NEML Board and staff on primary care issues that impact on the health and wellbeing of the people in our region. There are three committees, with each committee having a focus on the local towns within their Network, and the committees are made up of both General Practitioners and Allied Health Professionals. The aim of the committees is to: • Enhance the capacity of New England Medicare Local to work more effectively and efficiently to meet the identified needs of primary health practitioners; • Identify provider issues relevant to NEML services or activities; • Achieve improvements in transparency of decision making processes; • Provide two-way exchange of
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New England Medicare Local Annual Report 2013-14
Aboriginal Health Report Ms. Natalie Green Director of Aboriginal Health Natalie previously guided the development of the New England Division’s Aboriginal Health services and is now bringing that expertise to a range of Aboriginal Health programs and services across the region. Over 30% of the Medicare Local’s staff work in Aboriginal Health and this is a vitally important role for the new organisation to continue.
It has been another busy year for the Aboriginal Health Stream across the New England North West region. During 2013-2014, we delivered 19,925 episodes of care to 4,383 registered clients across the region. There were 25,903 client contacts, which gives an indication of the shared visits and work load that many of our team are a part of in delivering support and care to our clients. Of this total around 11,600 were directly related to the 780 clients who are registered in our Care Coordination and Supplementary Services (CCSS) program, supporting and working with people living with a complex chronic disease. This one particular program is making specialist and allied health access achievable for Aboriginal people living with chronic diseases who are otherwise unable to access the care and follow-up. It is not only improving health outcomes, but improving quality of life and this is tremendously rewarding to see. In January 2014 we saw this service commence in Goondiwindi, which has given us the ability to support clients from both Boggabilla and Toomelah. By far, our biggest achievement has been and continues to be, the way that we deliver the programs differently in each community, responsive of what each particular community identifies as their challenges. For many the challenge can be transport. The NEML Aboriginal Health
Stream provided and in some cases, purchased a total of 6,241 transports to improve the access of our clients to health care services across the region and beyond.
In partnership with HNELHD, we have continued to work together in the Chronic Disease for Aboriginal People space, supporting their Nurse led clinics and General Physician clinics, as well as conducting community education and screening together. Heartmoves, for people living with a heart condition, has continued as a tremendous success in Tamworth, with 25 regular participants attending each week. NEML also partnered with HNELHD and Hunter Medicare Local in the joint planning, coordination and delivery of the 2013 Aboriginal Chronic Care Forum which saw 220 participants link up across three telehealth sites to listen to innovative approaches to working with Aboriginal people living with chronic disease.
I also applaud the way that the team has worked with other agencies and organisations to partner in the delivery of From a marketing perspective, we health initiatives throughout the saw the commencement of our area. Nine Cultural Awareness Cameron Hammond TV campaign, workshops were delivered explaining that making healthy across the area on our behalf choices in life will lead to a brighter by Widders Consultancy, that is future where you can realise and always successful in opening achieve your dreams. up participant’s minds around being insightful and reflective Making the right when they are choices in life working with can lead to a Aboriginal people. brighter future Additionally, many of our team members have been involved with delivering Cultural Awareness to the Ambulance Service of NSW, University of Newcastle s ecision Good d Department of ack p s y a alw Rural Health, a punch Are you and at GP Synergy Abor or Torre iginal Registrar training s Strait Islande days. r? ond n Hamm Camero pic Boxer ym alian Ol - Austr
Our partnership with Walhallow Aboriginal Corporation continued, which enabled the enhancement of existing services in Walhallow and Quirindi with a Child and Family Nurse position.
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New England Medicare Local Annual Report 2013-14
Cameron is a local Moree lad who achieved the pinnacle of his boxing career when he represented Australia at the 2012 Olympic Games and someone who many across our region either know or are aware of. We also refreshed the “Identify” TV advertisement, encouraging people to selfidentify their Aboriginality with their health care provider. This was accompanied by a suite of posters and again featured local faces. Sadly with the end of the 20132014 year came the notification that Strong Fathers, Strong Families funding would cease within our Southern Network. This program was one of 19 pilot sites across Australia and despite some amazing things being achieved for men across these communities, the funding was discontinued. NEML however has not lost the momentum, choosing to continue Strong Fathers into existing program areas into 2014-2015. This sees the continued success from weekly Soul Bros fitness groups, the Soul Fathers workshops which addressed issues including anger management, debt management, family and relationship issues as well as domestic violence. The workshops also address positives including building self-esteem and self-belief. In December 2013, a camp for participating Dad’s and their kids was held overnight at Lake Keepit. It was a powerful experience for all those involved to witness and share the love and bonding between the fathers and their children. Some of the other highlights for this year from the Aboriginal Health Stream have included: • The commencement of a boxing exercise program in Guyra; • Tai Chi in Tamworth, which sees consistent numbers around 20 each week; • The Gunnedah lifestyle program, which is showing people that simple movement and modification of your
lifestyle can make a big change; • The Wellbeing Drop In Clinic in Tingha which has been a partnership with the NEML Clinical Services Stream, and the offshoot of the Tingha Women’s Sewing and Quilters group;
happen. And finally, the various stakeholders we have worked with during this past year. Both now and into the future we committed to working together toward improved health outcomes for the Aboriginal people across our region.
• The review and modification of the Drug and Alcohol program in Moree to include weekly yarning circles; • Hearing screening for children in many schools across the region, including Tamworth and Narrabri; • Dental and hygiene program in the pre-schools and schools in Gunnedah, providing fun education and support to children; • Jarjums Mothers Group in Coledale and the Goorialla Playgroup in Guyra, both facilitated playgroup sessions which not only improve access to and for previously hard to engage families, but also allows a safe and comfortable environment to share some parenting skills, nutritional awareness and cooking skills; • Chronic disease support groups across the region; • The Men’s groups and Women’s groups in Armidale providing sustained support and education around various health topics; • As well as the numerous one-off opportunities and school based programs that we are invited to deliver across the area. There are a few important acknowledgements that need to be made in the wake of all that I have detailed. Firstly, it is important to say thank you to the communities across the region who continue to embrace the support we are able to provide to them and who help us to shape the services we deliver. The people who work as a part of the NEML Aboriginal Health Stream need to be acknowledged for their commitment, their innovation and their creativity – without them, these programs and activities can’t
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New England Medicare Local Annual Report 2013-14
Finance & Operations Ms. Melissa Hayes Director of Finance & Operations Melissa joined New England Medicare Local in 2012. She manages the NEML budget on behalf of the Board with the primary objective to improve out of hospital healthcare for people in the region. Melissa also oversees the day to day operation and logistics of each office within the New England Medicare Local region.
The primary focus of the Finance and Operations team during 2013/14 continued to be supporting the staff and Board of the New England Medicare Local to improve health in our local communities, by providing high quality back office support functions. The 5 key areas within the Finance and Operations stream are: 1. Finance: from the processing of day-to-day financial transactions, to the development and management of the budgeting and financial reporting processes to ensure the timely provision of accurate financial information to support decision making. 2. Human Resources: developing and overseeing the processes that attract, select, develop and retain competent and skilled staff. 3. Information Management & Technology: oversee and support the NEML’s own computing hardware and software requirements, as well as those of a small number of medical practices in the region. Also enable best practice in the use and management of NEML’s data to aid in the delivery and development of quality services. 4. Quality: delivery and oversight of effective corporate governance systems and benchmarking activities.
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5. Administrative support: provision of day to day administrative support, and ensuring the effective management of the organisation’s resources including facilities and vehicles. In 2013/14 the administration team coordinated the establishment of a new office in Guyra, and the relocation of our Moree office and one of the Tamworth offices.
Human Resources The Human Resources team support a diverse workforce across the region and partner with the business to ensure our staff are engaged and responsive in achieving our organisational objectives and the primary healthcare needs of our footprint. We have grown rapidly since 2012-13 and our organisational structure has now stabilised to reflect the services we offer throughout the New England/ Northwest region. The HR team support the business in recruitment, credentialing, performance management, professional development, employee and industrial relations, remuneration and capability frameworks, performance reviews, organisational development, work health and safety, and workers
compensation & rehabilitation. Highlights for the year included working with the business to develop a workforce plan and human resources strategy to enable strategic decision making for developing a workforce reflective of our community needs. We have also focussed on re-credentialing, accreditation, recruitment growth, staff collaboration, gender equality, role clarity and linking it to overall business planning. We are proud to offer career progression and on the job staff development with many of our key roles being from internal promotions. Moving into 2015 the focus will be on maintaining the legacy we would like to leave in winding down the organisation, supporting managers in the uncertain times to motivate, develop and retain their staff to the best of their ability to achieve our deliverables and supporting the organisation in planning for the future.
New England Medicare Local Annual Report 2013-14
Primary Health Care & Partnerships Ms. Fiona Strang
Director of Primary Health Care & Partnerships Fiona was the former CEO of the Barwon Division of General Practice. Her teams provide support services for local health practitioners, work on health workforce recruitment and engage with local communities to assist them to meet their health needs.
2013-14 has been an exciting year in the area of Primary Health Care and Partnerships with a number of new and innovative projects and initiatives under implementation, and the overall work of the Stream consolidating and maturing to attain some excellent results. Work has centred on the support and engagement of our primary health care providers through the provision of a comprehensive provider support model. Through this model 100% of general practices have been engaged at various levels, as well as allied health providers, aged care facilities, pharmacies and medical specialists. Services have ranged from the provision of a comprehensive continuing professional development program, network meetings and education for practice managers and primary care nurses, assistance to qualify and meet eHealth criteria, to assistance with the management of people with chronic disease, the uptake of new technology such as telehealth, the maintenance and improvement of immunisation rates and the training of practice staff and providers in the assisted registration of patients for the Personally Controlled Electronic Health Record. A dedicated team of Provider Support Officers and Program Managers oversee these activities as well as the management of a number of large clinical and chronic disease
programs for the general and veteran community. Engagement with our stakeholders has always been a priority for the New England Medicare Local (NEML) and strong relationships with community, our members, local Government, the Hunter New England Local Health District and other health care providers, has underpinned the success of all programs in the PHCP Stream. The development of 3 Consumer Advisory Committees across the NEML footprint has ensured the NEML receives advice and input from local people around health concerns and services provided by the NEML. A number of initiatives have developed from these committees particularly targeting childhood development, obesity and lifestyle issues, mental health and the ageing population. The recruitment and retention of our health workforce, an ongoing issue for rural areas, has been well supported through a collaborative relationship with the NSW Rural Doctors Network, Hunter New England Health recruitment and management team and the regional general practitioner training provider, GP Synergy. Through 3 Succession Planning Committees, 19 new GPs and 9 Medical Specialists have been recruited to the area, a better understanding of the issues surrounding the retention of GP Registrars has been gained, and a model of remote supervision
for GP Registrars to assist rural practices with dwindling numbers of experienced GPs to supervise GP Registrars, has been drafted. It was with great pride that we learnt that the collaborative partnership had been nominated for the HNELHD Excellence in Quality Award for Collaboration; the ACHS Awards under the category: Nonclinical service delivery; and the Premier’s Public Sector Awards. The development of a Regional Recruitment Strategy and a Recruitment Website devoted to workforce support activities and information has further enhanced the NEML’s comprehensive workforce program. Preventative Health has been a priority of the NEML Board since inception and 2013-14 has seen a range of activities developed and implemented across the NEML footprint, including a health coaching program via social media (Shape Up) and health checks at various events including AgQuip. Partnerships with organisations such as the Heart Foundation have been particularly important in the roll out of programs such as Healthy Oils, Mums United, and walking groups. A key focus area has been the promotion of healthy workplaces, commencing with the development of a NEML Staff Health and Wellbeing Program. A developing area of work for the organisation has been around the Social Determinants of Health (SDoH). A partnership with four local Councils and Hunter New England Local Health District to discuss the SDoH is in its infancy, but aims to increase the knowledge and awareness in community of the SDoH. Internally the NEML has identified poor health literacy as a major barrier to good health and commenced an education program for its staff and health care providers. Additional SDoH activities include participation in the Market Basket
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New England Medicare Local Annual Report 2013-14
Survey, a review of food security, quality and cost across Western NSW, and the development of an educational program for early childhood educators to address school readiness and ability to learn, a key social determinant to good health. All this work is underpinned by a range of information systems, and 2013-14 has seen the NEML undertake significant work to ensure its program management, planning and reporting activities are supported by a comprehensive and accurate information management system. Late 2014 saw the launch of the NEML on line regional Health Service Directory which provides health providers with quick access to details of all local and visiting general practice, allied health, medical specialist and health care providers. The depth and breadth of work undertaken during 2013-14 would not be possible without a dedicated and talented team of staff. To all PHCP staff, thank you for your hard work and commitment and ability to rise to the challenges we face daily in our desire to provide a service of excellence to our providers and patients. A special thank you to the PHCP Network Coordinators, whose abilities and talents never cease to amaze me, and who have provided me and the Stream with exceptional support and dedication. Everyday, a member of the PHCP Stream is providing a local health care provider with the support they need to provide better care to their patients.
Provider Support Program The New England Medicare Local (NEML) provider support
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program aims to coordinate effective support services for health professionals and other people working in primary health care. In 2013-14 the NEML provider support program provided numerous support activities to health care providers including upto-date information and resources, professional development, training and networking opportunities and advice and support and training in the use of clinical practice software and data extraction tools. Dedicated Provider Support Officers were located throughout the region and over the past 12 months provided the necessary skills and assistance to engage with 100% of general practices located in the region, as well as many allied health, nursing, pharmacies and aged care facilities.
• Numerous practice visits, meetings with practice managers, face to face support for practice nurses and GPs to provide assistance with registration for telemonitoring to assist the veteran community • Over 80% of practices have received cultural awareness training and support to make their practices more accessible to Aboriginal patients. • Provided 4 practices with 93 quality improvement cycles and assistance with the management of their diabetes patients. • Screened 437 people for diabetes risk factors.
Below are some results from the team of staff working to provide support to our health care providers: • Over 70 networking events and education sessions for nurses and practice staff • 271 practice support visits • 55 education/ training/ consultation meetings with practice staff • Over 1,150 e-mail and phone follow up instances of support • Over 80% of general practices were assisted to qualify and meet eHealth criteria • Over 1,000 consumers were provided a Personally Controlled Electronic Health Record (PCEHR) though assisted registration initiatives • An additional 22 staff were trained across NEML to support staff and clinicians to register patients for the PCEHR.
Continuing Professional Development The New England Medicare Local is proud of its annual Continuing Professional Development (CPD) program. Locally created and locally delivered, the aim of the CPD program is to assist health practitioners in the primary health care sector address issues of behaviour, attitude, skills and knowledge in clinical practice. Our program endeavours to provide innovative and equitable education based on best practice guidelines and evidence based medicine, with strong consultation taking place
New England Medicare Local Annual Report 2013-14
with the health professionals in the region. Our CPD Program offers a range of high quality educational opportunities for primary health care practitioners including: educational evenings, active learning modules, online learning forums, small group learning and procedural workshops and day long events. All education is developed within a multidisciplinary team approach to patient care while recognising general practitioners role as central to patient management. As a result of this strong locally based approach to professional development, 125 RACGP and ACRRM accredited events were held in this 12 month period including a number of education formats provided through small group learning, evidence based medicine journal clubs, and Acute Cardiac Life Support training resulting in over 1,871 individual attendances made up of over 747 GP attendances, over 679 nurse attendances including aged care nurses and acute care nurses, and 391 allied health and other health professionals.
Workforce Recruitment & Retention The workforce support that New England Medicare Local provides to our communities focuses on the recruitment and retention of primary health care providers. In order to provide this support we work closely with a number of stakeholders to plan for the future health workforce needs of our communities. As a result of this over the last 12 months we have seen the establishment of Succession Planning Committees in each Network of the New England Medicare Local (NEML). Under
the Succession Planning model, the NEML works in partnership with the management and recruitment teams from Hunter New England Local Health District (HNELHD), representatives from NSW Rural Doctors Network and the general practice regional training provider – GP Synergy. Together the collaboration work to recruit and retain GPs to the area and investigate innovative ways to make the NEML region an attractive and supportive area for GPs to work in. The results achieved through this collaboration has seen the Succession Planning Teams nominated for a HNELHD Excellence in Quality Award for Partnerships; an ACHS Award under the category: Non-clinical service delivery; and the Premiers Public Sector Awards. A Regional Recruitment Strategy was developed to enhance recruitment activities currently undertaken by the NEML and its partners (HNELHD). This resulted in the NEML developing a website devoted to workforce support activities and information on health care providers as well as information on current vacancies, rural/regional incentive programs, positive testimonials from current service providers and the development of an information pack for new GPs advising them of the services and support that NEML can provide them. NEML, in collaboration with HNELHD, has supported and successfully recruited 19 new GPs and 9 medical specialists to the region and have actively participated in the coordination of 14 Specialist visits to the region. NEML has, in partnership with GP Synergy, hosted 4 Community
welcome evenings for new GPs and GP Registrars as well as general support to assist new and prospective GPs and medical specialists to familiarise themselves and their families with the local community and services provided. In the area of retention, NEML in partnership with NSW Rural Doctors Network and HNELHD have collected and examined data to determine the retention rate of GP Registrars trained through the local regional training provider over the past 10 years - retention being 5 years post completion of Registrar training. This has assisted in identify the future support needs of registrars and practices in the NEML area, in a hope of lifting the retention rate of our GP workforce.
Primary Health Care Nursing The NEML Primary Care Nursing Program aims to build the capacity of the nursing workforce within the primary health care sector, including general practice, allied health providers, pharmacy, and speciality providers. It provides nurses with education and support, supports primary health care to recruit and retain suitably qualified nurses and promotes the role of primary health care nurses to others in the community and within the health professions. In 2013/14 NEML created and implemented a region wide approach to Network Meetings resulting in 43 meetings being held, with an average of
New England Medicare Local Annual Report 2013-14
7 nurses at each meeting. 17 educational events specific to the needs of Primary Care Nurses were held, resulting in 204 participants. In addition NEML collaborated with the Woolcock Institute to train PHCNs to deliver a predominantly behavioural therapy intervention for individuals with insomnia. 6 PHCNs were involved in the pilot program. In 2013/14 NEML created a region-wide media campaign – I’m a Nurse… What’s your superpower via NEML’s communication stream and social media. This campaign featured six of the region’s nurses, all of whom spoke about the benefits of working in General Practice, their love of their jobs and the flexibility it enabled for qualified nurses to meet their personal needs.
Childhood Immunisation General Practice has an important role in immunisation through support of the implementation of government initiatives, including those aimed at limiting childhood vaccine preventable disease transmission in the community. NEML is proud to provide ongoing promotion and support of best practice immunisation processes within the New England North West Region. NEML’s goals are to improve the childhood Immunisation rate of the New England North West Region, promote and assist general practices accessing and transferring data to the Australian Childhood Immunisation Register (ACIR), support GPs and practice staff in their important role in promoting and performing immunisation through education, support in the maintenance of cold chain and vaccine storage and to work closely with the
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Health checks were conducted at major community events such as AgQuip in Gunnedah and the Australian Country Music Festival in Tamworth as well as regional events such as the Caravan and Motorhome show in Narrabri, the Boggabri Drover Campfire, the Healthy Ageing forum in Armidale and Nosh on the Namoi in Narrabri.
Hunter New England Area Health – Public Health Unit to provide up-to-date and relevant information on immunisation issues to GPs and staff. Data from March 2014 indicates the success of this program with NEML’s percentage of fully immunised children currently being 94.4% which is above the national rate of 91.9%.
Preventative Health This year was another successful year for preventative health activities, with health literacy high on the agenda. With approximately 60% of Australians experiencing less than adequate health literacy skills, work began by developing a policy and a plan under which introductory training in Health Literacy was offered to NEML staff in all streams. Training continues with our local health practitioners to increase awareness and help address barriers to accessing health.
Health education and coaching was offered using social media with a 4 week pilot program called Shape Up in July and another 10 week program offered across our entire region from April to June. The program resulted in increased confidence to lose weight and eat healthily. The Shape Up pilot program was presented at the national conference in November. Social Determinants of Health were addressed with a school readiness program to upskill early childhood educators in the area of phonological awareness (pre-literacy) skills. An evidenced based program was compiled and taught to staff from 10 childcare centres. Results will be reported later in 2014 and further training workshops are planned for early in 2015. In partnership with Far Western Medicare Local, over 90% of the supermarkets and grocery stores in the NEML were surveyed as part of the Western NSW market basket survey. The study is looking at access, variety and cost of fresh fruit and vegetables and other food and will report in
New England Medicare Local Annual Report 2013-14
November 2014. Oral health was a further component in the survey. Partnerships with the Heart Foundation, Shape Up Australia and the University of Newcastle have helped to minimise duplication of resource development. Preventative health is of high interest with the NEML’s Consumer Advisory Committees and they have been provided with information and support to implement some of the committees’ ideas. Late in the year the NEML Board signed off on the establishment of a partnership with four Local Government Councils and Hunter New England Local Health District to explore the potential to enhance community capacity to understand and address the Social Determinants of Health. Although in its infancy, a working group has been established and discussions have commenced around short and long term activities that the group could consider to increase community knowledge of the impact of the Social Determinants of Health.
Consumer Advisory Committee During the year three Consumer Advisory Committees have been developed covering the Western, Northern and Southern Networks of the NEML, meeting on a quarterly basis. Each committee consists of members of the community from a range of backgrounds and are convened by an elected chairperson. Seven meetings have been held across the three networks in 2013-14. The Committees report on local needs and consumer concerns, with the reports then passed to the Community and Partnerships Sub-Committee to the Board for further information and action. The three Consumer Advisory Committees have prioritised areas from the NEML needs assessment; the following are examples of the committees’ priorities for 2013-14:
of information targeted at headphones and hearing issues, resources provided to the public at events such as AgQuip and the Cotton Conference and health literacy material for people from CALD backgrounds. Each priority has been researched and appropriate activities have been undertaken by NEML staff to implement the CAC recommendations.
Northern Consumer Advisory Committee - Resources for Culturally and Linguistically Diverse (CALD) community members; preventative health; specialist services and community transport. Southern Consumer Advisory Committee - Healthy workplaces; falls prevention; drug and alcohol; access to services; and ovarian cancer awareness. Western Consumer Advisory Committee - Mental health services awareness; early intervention for children; water fluoridation; violence against women and vision and hearing awareness. Some activities and outcomes from the meetings have included: the creation of sugar and fat awareness posters, discussion with Life Education providers regarding the inclusion
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New England Medicare Local Annual Report 2013-14
National Prescribing Service The National Prescribing Service (NPS) team have had a successful year during July 2013 – June 2014. After entering into a new service agreement at the beginning of January 2014, the team has navigated their way though the challenges and continued to provide an outstanding and valued service to the GP’s, nurses, pharmacists and allied health providers of the NEML area. Once again, NPS facilitators have gone above and beyond conducting a total of 218 GP educational visits that allowed us to achieve 121% of our agreed count in July 13 – Dec 13, and 108% in Jan 14 – June 14. Educational visits were also provided to 63 pharmacists, and community visits provided to 78 other health professions (including nurses, medical students and other allied health professionals).
Comprehensive Needs Assessment & Health Planning 2014 saw another round of Needs Assessment work which built on the previous 2012 / 2013 findings. This work resulted in the successful approval of the Comprehensive Needs Assessment Report from the Department of Health in June this year. This report is available on the NEML website. The Comprehensive Needs Assessment assisted in the development of the NEML Annual Plan and further enhanced our understanding of health across our large region. The extended version of the report, a large document entitled ‘Our
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Region, Our People’, has since been finalised which further demonstrates the complexities and uniqueness of our population. The collections of data used to formulate such reports are strengthened by active community participation and collaborative relationships with like organisations. Community and Health Professional/Provider surveying together with data triangulation and service mapping across all 13 Local Government Areas of the NEML region has highlighted that the vast majority of gaps in health and health service provision/ access are linked to major upstream factors of health workforce (recruitment and retention), the Social Determinants of Health, and infrastructure to support health within regional/rural locations. The major health issues across the region include; • Limited health workforce across all disciplines in a number of locations. • Access to health services. Barriers exist which relate to geographic isolation, limited access to transport, socioeconomic disadvantage, lack of health service navigation resources and education, low levels of health literacy and clearly as previously stated, a limited health workforce. • An ageing population; • Higher Aboriginal and Torres Strait Islander populations; • Service gaps specifically related
to; aged care services, palliative care services, drug and alcohol treatment and rehabilitative services, mental health service navigation (particularly for youth), allied health services, affordable dental/oral health services and as previously mentioned, the infrastructure to support health service delivery and healthy lifestyles.
Financial Statements
Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health.
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