About Divisions of General Practice

Divisions of General Practice are local networks of GPs formed with the aim of enhancing General Practice and improving health outcomes for patients. The establishment of the Divisions was endorsed in July, 1992 by the General Practice Consultative Committee, (AMA, RACGP and Commonwealth Government).

Divisions of General Practice aim to improve health care by increasing interaction among General Practitioners and encouraging their collective contribution to the development of health policy, and to improve the quality and access of health service delivery. Divisions provide the focal point for communication between GPs, the Community and other Health Providers.

This liaison minimises professional isolation for GPs and ensures better integration of General Practice with other areas of the health care system. It assists GPs to provide quality, flexible services, addressing the current health needs of all community groups. Divisions also provide access to GP education programs.

About the Central Queensland Rural Division of General Practice

Management Committee
The Management Committee is elected annually from the membership of General Practitioners. The Management Committee meets 8 times per year, 1 face to face and 7 by teleconference with an option to extend the number of teleconference meetings from 3 to 6 as required to conduct the business of the Division.

Funding
The Central Queensland Rural Division of General Practice is funded by the Divisions and Projects Grants Program of the Commonwealth Department of Health and Ageing on a population basis.

Area
The Central Queensland Rural Division of General Practice covers an area from Moranbah in the North to Theodore in the South and West to the Gemfields. This covers an area of 163,919 square kilometres, servicing a population of 65,957 residents and 38 General Practitioners. The Division has a membership of 61 General Practitioners.

A brief profile of General Practice in the Division catchment

Local Workforce:
There are 56 GPs who are Division members, 47% are not vocationally registered. Workforce Queensland has identified this Division as having the most mobile workforce in Queensland. Many of the positions are in solo practices and in situations where the GPs are the only doctor for the community. Many of the positions are also with Qld Health and Right to Private practice that in turn carries all the additional complications of negotiating with Qld health to attempt to ensure the GP’s leave obligations are met. (The current situation is in crisis where many GPs are forced to work extremely long hours for extended periods with no relief).

The workforce required to manage an efficient, quality provision of primary health care through general practice is also an issue for many of the Division’s members. Practice management becomes the role of the GP or their spouse with little or no training and support. Qualified receptions and practice nurses are not available and each new staff member must be individually orientated and supported by members of the practice.

The Allied Health workforce has increased significantly since the introduction of the MAHS program and the BOIMHC Allied Health grants. Although services have improved there is still potential for the introduction of additional services. The introduction of integrated models of employment and the availability of access to private services has also significantly increased the level of access to allied health services. There is still opportunity for further integration within general practice and models of primary health care service delivery.

Areas of Growth
The key area of growth is in support provided to General Practice, specifically the newer practices and GPs who have recently begun rural practice. There is a huge expectation on an individual’s ability to manage the role of General Practitioner, to manage a business and attain vocational registration. There is also a role for support to the other members of the General Practice team who share in this process.

Specialist and Allied Health service provision continue to be growth areas. The Divisions role in health promotion and preventative health within the communities continues to grow, an area of interest for the next twelve months will be palliative care services throughout the communities within the Division.

Distance
The Division covers an area of 164,000 square kilometres and eight hours travelling from one end of the Division to the other. Travel within the Division is only possible by road or charter flight. This has a profound impact on the costs of service delivery, and the models used to implement Divisional programs. The roles of the local co-ordinators in each community within the Division are integral to providing support for General Practice and enabling the local implementation of many of the Divisions programs.

Other Health Services
There are 11 hospitals within the Division over 4 Health Districts. Each community has some non-government providers but the majority of these are very limited. There are three community health services, each very different in the level of services they provide.

A brief profile of the population in the Division catchment area

The Division covers a large area and includes the Statistical Local Areas (SLA) of Banana, Bauhinia, Broadsound, Belyando, Duaringa, Emerald, Monto, Mt Morgan, Nebo and Peak Downs. There are also now members who are resident in the Taroom, Jericho, Sarina and Proserpine Shires. Only those SLA's that are in the currently funded Divisional area have been used to gather demographic information. The total population in the Division is 69,560 (Australian Bureau Statistics, 2001 census).

Age Distribution
The age distribution of the population is very similar across the Division, with concentrations falling within the ages 0 to 15 and 25 to 40. As with most rural populations there is a sharp fall in the populations above the age of 60. In some of the mining communities the aged population is an extremely low percentage of the population.

Socio-economic Status
There is a wide range of difference in the socio-economic status of the population; the majority however are equivalent to or above the state average. This mainly occurs because of the high level of industry (particularly mining) within the Division. There are however some particular areas of need, where the community has a totally rural base, the extended effects of the drought have been significant. There are also members of each community who have a low socio-economic status, and will require access to free or low cost health services. The economic downturn and its impact on mining will be significant for many communities.

Aboriginal Torres Strait Islander population
The Division population includes 2866 people of ATSI origin. This is 4.12% of the population, compared to 2.85% for the whole of Queensland. The population however, is concentrated in two communities of Woorabinda and Mt Morgan, in the remainder of the Division the ATSI populations are below 2%. These two communities are the focus of the Aboriginal Health strategies identified within the Strategic Plan, although some education strategies that relate to ATSI populations will be delivered throughout the Division.

Other Cultural and Ethnic Groups
There are 1664 (2.52%) people who are classified as being from Non English Speaking Background. This is well below the Queensland percentage of 6.4%. People from Non English speaking backgrounds are concentrated around the mining communities, where most of these populations speak English as their second language. Mt Morgan, located close to the major centre of Rockhampton, has a population that is largely comprised of the lower socio-economic groups and a significant proportion who do not speak English.

Geographic Spread
The majority of the population is based around small communities or on properties outside these centres. There are two major population centres, Emerald being the largest with a population of approximately 8,500 and Biloela just over 5,000. The majority of the communities line the major transport corridors with only the basic services located in the smaller communities.

Key issues for the Division in relation to primary health care needs and delivery

General Practice workforce is the key issue and priority within the Division. This includes all levels, GP, Practice manager, receptionist and other staff. Within the Division General practice provides the majority of primary health care services and in some cases is the only primary health care provider within a community. The capacity of General Practice to respond to this level of demand has not been developed and General Practice is under immense pressure to stay abreast of the changing service provision role.

There is an acute lack of service providers across all primary care disciplines. The continuation of the Divisional CPD program provides some professional support and education for GPs and an opportunity for the development of informal and formal mentorship relationships. The Division has an extensive practice support program that involves the delivery of education, support and resources to individuals within the practice and the practice as a whole.

The extended primary health care team is also supported by the Divisions Allied Health programs which support service provision but also the development of a team approach and the upskilling of staff working within General Practice. The Division is also involved in a broader approach to community and population health programs. These services have significantly increased the levels of access to primary health care services but do not meet the current level of need or provide an equitable level of access to all communities or all groups within the community.

Key issues for this Division in relation to integration with hospital based services

The majority of hospitals within the Division have a Medical Superintendent who is also in Private Practice. The main issue for this Division is not one of integration as the majority of communities enjoy a strong collegiate relationship between Queensland Health staff and those working in the Division and within General Practice. In some cases the Division is able to contract to supply primary health care services to Queensland health.

The current issue within Queensland Health is one of policy. The current lack of support for doctors employed as medical superintendents and the way in which they are treated, with leave often withheld and exceptional demands placed on them. The services provided by Queensland Health to rural communities in the provision of primary and secondary services is rapidly declining with many positions remaining vacant for long periods or never filled and the level of services provided rapidly decreasing, eg maternity services. Without these services the demands on private practice increase to try and meet the needs of the community.

Key directions for the Division in engaging General Practice at the local level

Workforce – Recruitment and Retention
The Division has one of the most mobile GP populations in Queensland. There are a number of senior GPs who have practiced in their communities for over 10 years, many of these will retire within the next 5 years. The remainder of the GP population has been in the Division area less than 5 years and the majority of these less than 2 years. They are mostly overseas trained doctors who have not sat a Vocational registration exam. The Division is able to provide support to them as they learn the Australian Medical System and adapt to the Australian culture. In the last 12 months we have developed additional programs to support non-VR GPs into training programs and in their studies as the move towards vocational registration.

Professional development, mentoring and locum support assist to reduce professional isolation, as do family support programs. The Division has an extensive practice support program and allocates a staff member to each practice, in addition to support from the Division office and in relation to specific program areas.

Engagement
The Division has 100% membership within the Division and membership from outside the Division area. Registrars and students are also able to become Division members while they are in the area. There are practice manager and practice nurse networks, as well as networks between practice staff and practice support and project staff. Each community has a Division appointed position who works with the GPs and Division staff and community groups.