Cental Goldfields - Grampians Medicare Local

Contents
Acronyms: .................................................................................................................................................... 2
Community Overview ...................................................................................................................................... 3
Population Profile (3) ................................................................................................................................... 3
Central Goldfields Health and Wellbeing Indicators (1) .............................................................................. 3
Tourism ........................................................................................................................................................ 4
Transport ..................................................................................................................................................... 5
Health Services ................................................................................................................................................ 5
Maryborough District Health Service (MDHS) (4) ........................................................................................ 5
General Practice ........................................................................................................................................... 6
Clarendon Medical Centre (CMC) ............................................................................................................ 7
Nightingale Clinic (NC) ............................................................................................................................. 7
Dunolly Medical Practice ......................................................................................................................... 7
Residential Aged Care Facilities (RACF) ....................................................................................................... 7
HACC Services .............................................................................................................................................. 7
Ambulance Victoria (AV) Services ................................................................................................................ 7
Pharmacy Services ....................................................................................................................................... 7
Diagnostic Services ...................................................................................................................................... 7
Pathology Services ....................................................................................................................................... 8
After Hours Health Care ................................................................................................................................... 8
Maryborough District Health Service (MDHS) Urgent Care Centre (UCC) ................................................... 8
Dunolly Urgent Care Centre ......................................................................................................................... 9
District Nursing/Palliative Care Nursing ...................................................................................................... 9
General Practice ........................................................................................................................................... 9
Residential Aged Care Facilities (RACF) ..................................................................................................... 11
Travel for Health Care - Ambulance Victoria (AV) Services and Other Transport Options ....................... 11
Pharmacy Services ..................................................................................................................................... 12
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Diagnostic Services .................................................................................................................................... 12
Pathology Services ..................................................................................................................................... 12
Community Use of Telephone Triage Services After Hours ...................................................................... 12
After Hours GP Helpline Data (8)............................................................................................................... 14
Nurse On Call (Victoria) ............................................................................................................................. 15
Westvic After Hours Health Advice Service (WAHS).................................................................................. 15
Community Views - After Hours Health Care ............................................................................................ 16
Works Cited ................................................................................................................................................... 19
Acronyms:
AGPH – After Hours GP Helpline
BHS – Ballarat Health Service
CMC – Clarendon Medical Centre
ED – Emergency Department
GP – General Practitioner
HACC – Home and Community Care
HARP – Hospital Admissions Risk Program
MDHS – Maryborough District Health Services
NC – Nightingale Clinic
NOC – Nurse On Call
RACF – Residential Aged Care Facility
TAFE – Technical And Further Education
UCC – Urgent Care Centre
WAHS – Westvic After Hours Service
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Community Overview
Central Goldfields Shire is a Local Government Area (LGA) in Victoria. Central Goldfields Shire is located in
central Victoria, one hour’s drive from the regional cities of Ballarat and Bendigo and two hour’s drive
north west of Melbourne. Originally a gold mining area, the shire has developed on the back of
agricultural industry.
The main activities are cropping and sheep farming. Maryborough, the principal town in the shire, is a
manufacturing centre. The main industries include meat and meat product manufacturing, other food
manufacturing, printing & services to printing, agriculture.
The municipality includes the localities of Adelaide Lead, Alma, Amherst, Archdale, Archdale Junction,
Bealiba, Bet Bet, Betley, Bowenvale, Bromley, Bung Bong, Campbelltown, Caralulup, Carisbrook,
Cotswold, Craigie, Daisy Hill, Dunach, Dunluce, Dunolly, Eddington, Flagstaff, Glengower, Golden Point,
Goldsborough, Havelock, Inkerman, Joyces Creek, Lillicur, Majorca, Maryborough, Moliagul, Moolort,
Moonlight Flat, Mount Cameron, Mount Glasgow, Mount Hooghly, Natte Yallock, Primrose Hill, Rathscar,
Rodborough, Simson, Stony Creek, Strathlea, Talbot, Timor and Wareek (1)
It has an area of 1,536 square kilometres. In 2011 it had a population of 12,498. (2)
Population Profile (3)
Male Female Total
Total Residents 6202 6296 12498
Indigenous persons:
Aboriginal 67 55 122
Torres Strait Islander 4 11 15
Both Aboriginal and Torres Strait Islander(a) 3 4 7
Total 74 70 144
Birthplace:
Australia 5,349 5,458 10,807
Elsewhere(b) 522 535 1,057
Language spoken at home:
English only 5,835 5,974 11,809
Other language(c) 114 117 231
Central Goldfields Health and Wellbeing Indicators (1)
Self-Reported Health was measured in the 2007 CIV Survey. Respondents were asked to rate their health
as excellent, very good, good, fair or poor. 45.9% of persons living within Central Goldfields reported that
their health was either excellent or very good as compared to 55% in the Loddon Mallee Region and the
Victorian State average of 54.3%.
Community Connection was measured in the 2011 VicHealth Survey. Respondents were asked to rate
their satisfaction with feeling part of their community and answers are presented according to a 0-100
range. Normative data from the AUWBI indicates that the average Community Connection score for
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Australians is approximately 70. In comparison, the average Community Connection score for persons
living in Central Goldfields was 78.5 in 2011, while the Loddon Mallee Region average was 77 and the
Victorian State average was 72.3.
The employment rate has been calculated from the 2006 Australian Bureau of Statistics. This employment
to population ratio describes the percentage of persons aged 15 years or older who are employed. Of
those aged 15 years or older and living in Central Goldfields, 43.1% were employed, compared to 58.3% in
the Loddon Mallee Region and the Victorian State average of 60.9%.
Median Equivalised Household Income has been calculated from the 2011 Australian Bureau of Statistics.
Equivalising income adjusts the total income of the household according to the number of persons and
household type. Median Equivalised Gross Weekly Household Income for Central Goldfields was $476,
compared to $613 in the Loddon Mallee Region and the Victorian State average of $749.
Food Security was measured in the 2007 CIV Survey. Respondents were asked if there had been any times
in the previous 12 months when they had run out of food and could not afford to buy more. 10.4% of
persons living in Central Goldfields had experienced food insecurity, compared to 7.3% in the Loddon
Mallee Region and the Victorian State average of 6%.
Educational qualifications are an important resource enabling individuals and their communities an
opportunity to engage in the knowledge economy. The percentage of people living in Central Goldfields
who had Tertiary or TAFE qualifications has been calculated from the 2006 Australian Bureau of Statistics.
Of those living in Central Goldfields, 35.9% of persons aged 25 years and over had tertiary or TAFE
qualifications, compared to 43.1% in the Loddon Mallee Region and the Victorian State average of 50.7%.
One measure of Housing Affordability has been calculated through the 2011 Australian Bureau of
Statistics. The data show the percentage of households spending 30% or more of their gross household
income on rent or mortgage payments. 13.8% of households in Central Goldfields were spending 30% or
more of gross household income on rent or mortgage payments, compared to 15.9% in the Loddon
Mallee Region and the Victorian State average of 20.4%.
Tourism
Whilst not a major tourist destination, the Maryborough region has several key events during the year
that attract a large influx of visitors, such as the Highland festival, Maryborough Gift and the RACV
“Breakthrough” event. The RACV event is a human powered vehicle race for school students and results in
an increase in trauma cases presenting at the UCC. Local GPs report an increase in demand for after hour
services during these periods.
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Transport
Bus services connect between Maryborough, Ballarat, Bendigo, Clunes and Avoca. Maryborough Town
Bus Service, operates a limited local service
Monday-Friday - Between 7:15am and 3:00pm, and also between 5:00pm and 6:15pm
Saturday - Between 7:00am and 1:00pm, and also between 5:00pm and 6:15pm
These services do not run on Sundays or Public Holidays.
An hourly loop of four routes departs and finishes at the main bus terminus in Napier Street Maryborough
There is a single taxi company that operates 24/7. There is a limited train service to Melbourne operating
in the daytime only.
There are two healthcare specific transport services – Red Cross, which can take residents to specialist
appointments, and the Cancer Care car, for patients requiring transport to (usually) Ballarat for oncology
treatment.
Health Services
Maryborough health services are co-located in a central health precinct, with the hospital and urgent care
centre, community health centre and general practices all in the same block.
Maryborough District Health Service (MDHS) (4)
MDHS is the only health service in the Central Goldfields LGA. It has 35 beds, operating theatre, imaging
department and pathology, as well as a co-located 45 bed nursing home. MDHS provides a wide variety of
hospital services, from Acute and Urgent Care to Antenatal and Surgical services, enabling a
comprehensive health service delivery to the community. Local General Practitioners provide support for
the Urgent Care Centre, Anaesthetics, Obstetric Services and "in-house" medical treatment. MDHS has
consultant visiting surgeons from Bendigo and Ballarat providing general surgical services
and specialist surgical services in Ear, Nose and Throat, Orthopaedics, Gynaecology and Urology. A Renal
Dialysis unit provides dialysis three days a week and can also provide dialysis for visiting clients. The
Antenatal Clinic provides care to all women from 13 weeks of pregnancy to full term. The majority of
shire residents use MDHS services unless specialist of complex obstetric treatment is needed, then a
referral is made to the larger hospitals such as Bendigo Health Care Group, Ballarat Health Services or
Melbourne hospitals with whom MDHS have close affiliations.
Community based programs are provided by MDHS. These include health promotion, ill-health
prevention and community connectedness programs, community dental, district and palliative care
nursing. The Rural Involvement Towards Communities Health (RITCH) program services the smaller and
more isolated areas within the catchment, with populations of less than 5000 people. Other major
programs include:
Alcohol & Other Drugs (including Needle Syringe) Program
Counselling, Withdrawal, Drink-Drive and Drug Drive Assessment and Education. The Needle
Syringe Program is a harm reduction program aimed at providing sterile needles and syringes to
people who inject prescription or other drugs. There is a drop off point for used needles outside
our building.
Asthma Education
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Assists those with Asthma to better manage their condition and associated issues.
Cardiac Rehabilitation
A rehabilitation program for people who have angina, or have had a heart attack or heart surgery.
Chronic Conditions Self Management Program (Breath of Fresh Air)
A group self-management program for people with cardiac, or respiratory conditions or Type 2
Diabetes. Diabetes Education
Assists those with diabetes to better manage their condition and associated issues.
HARP (Hospital Admissions Risk Program)
A self-management program for people over 65 years with complex needs associated with a heart
or lung condition.
Strength Training
Prevents functional decline that can lead to falls. Improves balance and overall health and wellbeing.
Supervised by qualified staff. Programs held at Avoca, Dunolly and Talbot.
Other Regular Health Education Programs
- Lifestyle Challenge
- Men’s Health
MDHS has campuses at Dunolly and Avoca (Pyrenees Shire). The Dunolly and Avoca campuses are
primarily residential aged care. Dunolly has an Urgent Care Centre (UCC), however it is a very limited
access site. The staff in the ward open the UCC on demand, but as there is only one GP providing services,
the demand is around 20 presentations per month – and these calls tend to be post minor surgery
dressing reviews rather than urgent care.
District Nursing/Palliative Care Nursing
Operating out of the MDHS Community Health Centre, which is also located in the main MDHS health
precinct, these nursing services are provided in Maryborough between the hours of 8am and 8pm, and to
the broader region from 8am to 4.30pm. This is a home visiting nursing service provided on referral to
registered palliative care clients, and HACC-funded clients.
General Practice
There are two General Practices operating in the township of Maryborough – Clarendon Medical Centre
and Nightingale Clinic. These clinics are co-located to each other and also to Maryborough District Health
Service. Nightingale Clinic also has a consulting suite in Avoca in the neighbouring Pyrenees Shire. There is
one other solo GP practice operating in Dunolly.
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Clarendon Medical Centre (CMC)
Staffed by 5 GPs and one Registrar, CMC operates Monday to Friday 9am to 5.30pm, with weekend clinics
operating on a collaborative roster with Nightingale Clinic. Due to high demand, this clinic is now no
longer taking new patients.
Nightingale Clinic (NC)
Staffed by 5 GPs, NC operates Monday to Friday 9am to 5.30pm. Due to high demand this clinic is now
also no longer taking new patients.
Both practices charge a consultation fee for service, however will bulk bill vulnerable groups, such as
Health Care Card holders and youth under 16 years.
Dunolly Medical Practice
There is one other General Practice operating in the Central Goldfields – a solo GP Practice - Dunolly
Medical Practice in Dunolly (population 969). This practice operates Monday to Friday only. This solo GP is
nearing retirement. Staff at Dunolly campus are concerned about the maintenance of GP services in
Dunolly, as there does not appear to be any GP succession planning for when the solo GP retires. This
Practice declined consultation for the needs assessment.
Residential Aged Care Facilities (RACF)
There are two RACF providers in Maryborough, with a total of 196 beds, which includes 20 secure
dementia and 45 high care beds. MDHS also has RACF services based in Avoca (Pyrenees Shire) and
Dunolly.
Maryborough Nursing Home is a high care facility located on-site at MDHS. Most of the residents are
managed by two of the Maryborough GPs. Havilah Hostel is a private not-for-profit nursing home with a
mix of60% high and 40% low care beds. They currently have 97 residents. They are also extending the
facility, with a new building to house another 30 low care beds due to open in March 2013.
HACC Services
Central Goldfields Shire manages the majority of HACC funded services. These services include home care,
personal care, respite, home maintenance, social activities and meals on wheels. Depending on the type
of service, HACC services are available from 7am to 9pm weekdays.
Ambulance Victoria (AV) Services
Maryborough has an ambulance station with multiple crew with Advanced Life Support (ALS)
qualifications on day shift and 24 hour on-call night service. Maryborough ambulance response times for
2011 averaged 14.2 minutes (5) which meets the State-wide target of 15 minutes.
Pharmacy Services
Two pharmacies are available in Maryborough – Monday to Friday 9am to 6pm. Pharmacy supplies to
outlying towns are on a dispensary model.
Diagnostic Services
Radiology Department in MDHS operates Monday to Friday 8.30am to 5pm. There are two local
radiologists providing this service.
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Pathology Services
There is one pathology provider based at MDHS which operates Monday to Friday 8am to 5pm and
Saturday 8.30am to 12 midday.
After Hours Health Care
Maryborough District Health Service (MDHS) Urgent Care Centre (UCC)
This is a 24 hour centre staffed by Registered Nurses with medical care attended to by the local GPs on an
on-call after hours roster. Residents presenting to the UCC are bulk billed.
MDHS UCC reports an after hours throughput of 7000 patients per annum (average 136 patients per
week). This figure does not include the number of residents who bypass the UCC to attend care at other
health services. Ballarat is the closest regional city centre to Maryborough. Ballarat Health Services (BHS)
Emergency Department (ED) reports that in 2010-11 over 120 ATS Category 4 & 5 (non-urgent)
presentations in the after hours period to Ballarat Heath Services ED were from Maryborough. (6) We are
unable to ascertain if this has been on referral from a Maryborough GP or from the Urgent Care Centre in
Maryborough, or through self-referral/presentation. The trend for presentations to BHS ED for all hours is
quite steady which probably reflects the difficulty the local community has with accessing a GP during the
day.
On 12 July 2012, representatives from Westvic After Hours Service (WAHS) met with Maryborough
District Health Service staff and doctors to discuss some of the issues around the high demand for after
hours services in Maryborough. The key issues identified at this meeting included:
high number of phone calls direct to the UCC nursing staff (no IVR or receptionist after hours)
no fee for service after hours at UCC encourages walk-ins (appointments at General Practices are
not bulk billed)
no appointments available during the day with popular GPs, but patients can get seen by these
doctors when they are on-call
some people do not get out of bed until later in the day
“nice doctors” – do not like to refuse to see people presenting to the UCC if they are already there
number of calls received by the GP after hours directly relates to the nursing staff competency –
which can vary
on call doctors only want one person contacting them after hours (eg getting a call at 1 a.m. that
someone is going to go to the hospital but then the person does not present until several hours
later results in a broader period of broken sleep for the GP than warranted).
The efficiency and effectiveness of care at the UCC, combined with the no fee-for-service model continues
to make the MDHS UCC an attractive after hours option to seek health care. In the community survey,
eighteen people reported the time it took to be seen by a health professional at the UCC. Most had a first
assessment attended to in a very short time frame (less than one hour). Only one person reported waiting
more than two hours to be seen by a doctor. Sixty three percent of respondents were bulk billed, with no
out-of-pocket expenses. Out-of-pocket expenses were usually for additional services such as pathology
and radiology.
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One UCC staff member reported that when popular GPs are on-call, and these are usually the GPs that are
not taking new patients or have a 3 week wait for an appointment in business hours, the “word” spreads
quickly in the community resulting in a higher number of walk-ins. There is no doubt that the access block
to Maryborough GPs is a significant influence on presentations to the UCC.
There is also a tendency for people to use MDHS UCC as a default pharmacy supplier. The UCC is trying to
discourage this practice, requesting GPs provide starter packs of medication, and sending patients with
prescriptions to late opening pharmacies in Ballarat.
In an attempt to control presentations, the UCC has tried directing patients to return at a single time to be
seen by the GP at a “mini-clinic”. On several occasions this has not worked due to emergency
presentations – which have resulted in a waiting room full of people unable to be seen by the on-call GP
for many hours.
One GP interviewed, who has been providing after hours services for decades, has observed that nursing
staff are becoming reluctant to do the face to face assessment and management of people presenting to
the UCC without calling the GP. He believed that this was less about competency, but more about nurses
being constrained by risk-averse policy. Another GP thought that better training in initial patient
assessment and a review of hospital policy regarding GP call-outs would be helpful. Advanced nurse
practitioners in the UCC could also reduce GP workloads.
Dunolly Urgent Care Centre
Dunolly UCC is a 24 hour service attached to the Dunolly campus of MDHS. It’s operation is maintained by
ward staff and a solo GP. The population of Dunolly is generally managed by the solo GP and he will
answer calls 24/7. Due to his intimate knowledge of the Dunolly population there is limited demand for
after hours services, as most queries are managed by phone. Acutely unwell residents are generally
transferred directly to Bendigo. Most of the activity in the Dunolly UCC is non-urgent care, as it functions
as a default outpatients department.
District Nursing/Palliative Care Nursing
Registered clients can contact the nurse and access a home visit up until 8pm on weeknights, and up to
6pm on weekends. The Hospital Admission Risk Program (HARP) and palliative care services both provide
detailed home care plans. Westvic After Hours Service (WAHS) is promoted as the first contact point for
advice, although it is known that the community preference is still to present at the MDHS UCC. Palliative
care patients are more likely to get a home visit by a GP at the end-of-life stage, if the patient has
expressed a wish to die at home.
General Practice
All GPs working in Maryborough are on the after hours roster. CMC and NC share the on-call after hours
roster that provides service to their own patients, walk-in presentations to MDHS UCC and also to the
Residential Aged Care Facilities (RACF). Dunolly Medical Practice will take calls from patients in the after
hours period, but rarely provide face to face after hours services. These patients are referred to other
centres, such as Maryborough, Ballarat, Castlemaine or Bendigo.
There is also a collaborative agreement in Maryborough to run weekend clinics that operate on Saturday
from 9am to 12 midday and Sundays and Public Holidays from 10am to 11am Whichever practice is oncall
opens the clinic during these hours, which is staffed by a nurse and a receptionist. These clinics do not
have appointments, but operate on a walk-in basis. Attendance at these clinics attracts the usual
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consultation fee, in contrast with presentations at the UCC, which are bulk-billed. This provides no
incentive for patients to go to the usual clinics.
CMC do not provide home visits, but NC will for special circumstances, although this is discouraged. GPs
believe that patients who are too sick to get out of bed should be in hospital, and also that it takes a lot of
time to see someone in their home, due to travel.
Both practices report a heavy after hours workload for their GPs. On average, the on-call GP will see 10 to
12 patients on a weeknight, Saturdays 15-20, Sundays 10-20 at the morning clinic, plus another 10 later in
the day. The GP is also required to do ward rounds for the inpatients. One GP estimated that 60-70% of
after hours calls were more for convenient care. There are 7 GPs on the after hours roster, but only 3 GPs
can do obstetrics and anaesthetics. These 3 GPs are also senior clinicians and are required to be available
to supervise or attend if a Registrar is on call and requires assistance or advice. Due to the day time
practice workloads, these GPs may not get any time off after being on-call overnight – a significant issue if
it has been a busy night. At interview, one practice manager reported that a GP had consulted all day and
then had been so busy overnight that he had only had 2 hours sleep. He had a fully booked consulting day
the next morning. The manager had no choice but to cancel all the morning appointments due to the risk
of the GP seeing patients when exhausted.
When asked to identify the key issues in after hours, one manager believed that during the sociable hours
the demand was too high and in the unsociable hours there was frustration at inappropriate use by the
community. This manager felt that the remuneration for after hours work did not offset the stressors on
the GP providing that service, and the current demand made it difficult to recruit and retain GPs:
“The after hours demand of country GPs is excessive and makes the task of recruiting doctors to our town
extremely difficult.”
One GP commented that many after hours phone calls in the unsociable periods were from isolated frail
elderly patients living independently in the community.
Remuneration for after hours services is a particular issue for Maryborough GPs. The retainer for being
on-call to RACF is minimal. A great deal of work is telephone calls from patients, health services and
RACFs – all of which attracts no payment. One GP estimated that he earns $14 per hour for a 24 hour oncall
period.
These GPs feel they are providing the same level of practice as an Emergency Department salaried doctor
without the associated remuneration. There has previously been a co-payment model at the UCC, but this
no longer exists, mainly due to the high number of bad debtors, and the fact that the usual clients
presenting to the UCC are those that get bulk-billed anyway. The GPs are hoping that MDHS implements a
facility fee payment for non-urgent after hours, so the onus no longer lies with the GPs, or the practice.
The GPs see this as the only way to discourage people turning up for convenient versus urgent care.
After Hours Practice Incentive Payments (PIP) are viewed by Maryborough GPs as inequitable across the
region, as Ballarat GPs have access to two Emergency Departments.
Maryborough GPs trialled an extended hours clinic based at MDHS over a period of years under grant
funding. The decision was made to discontinue this clinic due to the majority of the presentations being
convenient care, not urgent care. There was no discernible impact on daytime demand nor presentations
to the UCC.
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Residential Aged Care Facilities (RACF)
The co-located Maryborough Nursing Home has several advantages in the after hours period – principally
access to medication via the hospital’s imprest pharmacy, Registered Nurse (RN) support and the ability
to transfer directly residents who need acute care without the need for ambulance services.
Havilah Hostel is unable to access medications out of hours, unless a visiting GP can provide supply via his
or her Doctor’s bag. There have been occasions when a resident has been transferred via ambulance to
the UCC for medication. There is also no nursing support overnight, requiring the staff RN to be available
by phone for consultation and occasionally to come in to assess a resident. The addition of another 30 low
care beds in March 2013 will increase the demand for access to after hours care.
Both facilities reported that they try and limit after hours call to GPs – using care plans and accessing GPs
during business hours to ensure residents who may be deteriorating are assessed.
However, at interview, GPs reported that RACF calls are often inappropriate, and a result of inexperienced
nursing staff. Many of these calls are for reassurance and do not need a face to face assessment. GPs are
not remunerated for phone calls. One GP estimated that 30% of calls from the RACFs were inappropriate.
Travel for Health Care - Ambulance Victoria (AV) Services and Other Transport
Options
The single ambulance crew is on-call only in the after hours period. In 2012, there were 614 ambulance
calls to Maryborough private residences, and 53 calls to RACFs. Although the data does not specify level
of urgency, it can be assumed that a percentage of these calls would be low acuity (7). Maryborough GP
comments around ambulance services after hours included:
GPs get left with sick people in UCC as the ambulance is busy doing non-urgent calls
Local ambulance reluctant to take ill patients to Ballarat or Melbourne due to the loss of local
vehicle. Have to wait for metropolitan ambulance or air ambulance to be dispatched. Average
wait is 3-4 hours and GP has to remain with critically ill patients.
Community perception is that AV is a medical taxi service
Ambulance service used due to lack of other transport options
Community perception that ambulance membership entitles use of ambulance for transport
There is a need for many in the community to access transport after hours for healthcare. Our community
survey identified home visiting by healthcare professionals does occur in this region, with two
respondents reporting a home visit, however the remainder had to travel to be seen. Only one General
Practice provides home visits, and usually this is for specific needs patients, such as palliative care
patients. Most travelled by car to be seen, although one respondent used a taxi. Four people travelled
over 50 kilometres to health care – the longest distance being 67 kilometres. Eight people travelled more
than 5 kilometres, with six of these travelling more than 25 kilometres
There is very limited public transport options in the after hours period, although the local taxi service is
available 24 hours a day, 7 days per week. MDHS will occasionally provide a taxi voucher for residents
who have no other transport options to get home. MDHS reports that patients have been admitted
overnight due to the lack of transport options overnight. Sometimes the local police will assist with
transporting patients home.
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The Red Cross car will occasionally travel in the sociable after hours period, but this is for planned
appointments, not urgent care.
Pharmacy Services
One pharmacy has extended hours to support the GP weekend clinics, opening Saturday 9am to 12.30pm
and Sundays and Public Holidays 10am to 12midday..
Diagnostic Services
Radiologists can be called in for emergencies only, but the GPs report they are reluctant to do this, for
fear of “driving away” these radiologists with after hours demands. The usual practice is to stabilise until
the next day, although this can be a difficult decision. If there is doubt, the GPs tend to send the patient to
Ballarat rather than bother the radiologist.
Pathology Services
The UCC has equipment that allows nursing staff to perform a range of basic pathology testing required
for urgent assessment, such as cardiac enzymes and glucose. Access to pathology after hours is not seen
to be an issue. Pathology providers worked on an on-call system for many years, although this has
become too costly for the private provider to sustain, so it is now actively discouraged.
Community Use of Telephone Triage Services After Hours
Lee Duffin, the Community Development Worker at MDHS Community Services, reported that consumers
are confused about the range of telephone advice options which are promoted in Maryborough by
different health service providers:
Westvic After Hours Health Service - brochure obtained from the hospital 1800 641 395
After hours GP Helpline – recommendation and brochure obtained from local chemist 1800 022 222
Nurse On Call – Advertised on TV and received in a mail out. 1300 60 60 24
Illness specific services such as the Cancer Nurses on call from the Cancer Council Vic on 13 11 20.
Lee believes that there needs to be consistency and clarity in promotions.
The consumer survey asked which services residents accessed for advice. The result reflects the diversity
in approaches taken by residents and reinforces Lee’s observation. Of interest is the predominance to
contact the local health service (40.9%) which identifies that MDHS UCC remains the preferred point of
call. No respondent used the After Hours GP Helpline and only five respondents used Nurse On Call.
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In the community survey there was support and understanding for the need for telephone advice:
I understand the difficulties of having doctors on call in smaller communities but the nurse practitioners
call line should be promoted a lot more and if possible work towards nurse practitioners in all urgent care
facilities if doctors cannot provide after hours service. Every refrigerator should have a "help line" magnet
with a number to call for worrying symptoms or advice on treating injuries from accidents
Both General Practices utilise the Westvic After Hours Service and report a high level of satisfaction with
this service in assisting the GPs to manage non-urgent demand in the after hours period. One practice
promotes Nurse On Call, but neither practice promotes the use of After Hours GP Helpline (AGPH).
At interview one practice manager had already reported patients turning up at the clinic and demanding
to be seen “because the doctor on the phone said I HAD to be seen”. With no clinical notes or indicators as
to the nature of the issue, and a fully booked clinic with no available GPs, this manager felt it would be
inappropriate to promote AGPH.
The GPs expressed several concerns about Nurse On Call, such as the lack of knowledge of rural services,
a tendency to send people unnecessarily to be seen and believe that these services do not reduce
presentations after hours. No GPs interviewed were aware of the After Hours GP Helpline.
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After Hours GP Helpline Data (8)
For the period January to June 2012, Maryborough (postcode 3465) recorded the following
healthdirect/After Hours GP Helpline data:
Volume Calls handled by hdA during after hours period 7.0
Volume Calls Handled by after hours GP helpline
(AHGPH) 13.9
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Number of Calls by Age
Gender %
Female 64.3%
Male 35.7%
Other 0.0%
Grand Total 100.0%
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25%
Call % by Day and Time
20%
15%
10%
5%
0%
Thur Sun 12:00pm
11:00pm - - 11:00pm
8:00am (Fri)
Mon
11:00pm -
8:00am (Tue)
Tue 6:00pm -
11:00pm
Fri 6:00pm -
11:00pm
Mon 6:00pm
- 11:00pm
Sat 12:00pm
- 11:00pm
Fourteen calls is a small number, and highlights the low uptake of After Hours GP Helpline by
Maryborough residents. Patterns of use also are consistent with usual after hours period of demand, with
female callers more common than male.
Nurse On Call (Victoria)
Nurse On Call is unable to release current data at the time of this report. Historical data from Nurse On
Call for the period May to October 2010 showed that Maryborough residents were the second highest
users of Nurse On Call in the Grampians region (11.93%), with 189 calls to the service over this period. (9)
We are unable to ascertain which of these calls are in the after hours period. Users of Nurse On Call
provided further comment in the survey:
I found Nurse-on-call a very valuable service. Visiting Emergency at hospital was a long wait and not
always successful.
"Nurse on call" is fantastic in between option.
Two comments reflected some concerns about Nurse On Call:
From what I understand of the government's nurse phone service most people merely get referred to a
hospital anyway, so I’m not sure that a call in service is really going to help anyone.
Nurse on call is not an option I feel safe with
Westvic After Hours Health Advice Service (WAHS)
The Westvic After Hours Health Advice Service is a nurse-led telephone triage service that links consumers
in need with General Practitioners (GPs) in the former West Vic Division of General Practice region when
the GP clinics are closed. The advantage of WAHS is that it is a regional service that provides clinical notes
back to the GP and coordinates care with the health service and GP on-call. It has been operating in the
region for over 10 years and has strong support from General Practice in the appropriate management of
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calls. Maryborough has had a history of underutilising the WAHS service. A recent review compared
Maryborough usage with other towns of similar size in the WAHS service region:
40
35
30
25
20
15
10
5
0
Nominated GP Clinic Calls Jan-Mar 2012
MARYBOROUGH
STAWELL
ARARAT
Jan Feb Mar
This identifies a significantly lower than expected use of WAHS in Maryborough compared with other
similar towns. MDHS UCC is currently trialling diverting calls received to WAHS, and on one night 4 out of
the 6 diverted calls were able to be managed by WAHS, without the need for face to face assessment.
MDHS is also exploring an IVR answering machine that will direct callers to WAHS in the first instance,
rather than being answered by UCC staff.
Community Views - After Hours Health Care
There were 39 respondents to our consumer survey who live in the Central Goldfields – Maryborough
region (10). Most had a mobile or landline and all but one had internet access. No respondents were
Aboriginal or Torres Strait Islander nor spoke a language other than English at home.
Twenty nine of the respondents used the Internet to find out about health care options after hours. The
most common method used to find healthcare information was Google, or other internet search engine
(93.5%). Only one user had accessed the National Health Service Directory (NHSD).
More people knew the operating hours of their local pharmacy than their local General Practice (86.8% vs
76.3%).
Thirty respondents reported having more than one occasion where they were concerned for the health of
themselves or a loved one in the after hours period.
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Seven of these did not go on to seek health advice, four because they were not sure who to contact or
whether their issue was important. Almost 50% of these concerns arose in the sociable after hours period
(up to 11pm). Thirty percent were on weekends during the day. This is consistent with demand data for
after hours health advice services, such as WAHS, NOC and AGPH.
The age group most commonly needing health care in the after hours was in the 18-74 year age group,
with only one paediatric issue (0-4 years), three child issues (5-17 years) and one elderly (over 74 years).
This result was surprising as paediatric calls are usually the highest demand for after hours health advice
services (11). There were multiple places where people found out where to go for health advice, which
highlights a lack of consistency in information sources. The range of sources included:
“Other” identified that many respondents either went to, or phoned, the local health service, which is
consistent with the MDHS UCC reports that phone calls and walk-in presentations are a significant
burden.
Four local residents attended personal interviews in December 2012. Some issues raised by these
residents included:
* one isolated resident could not get to health care when sick – no home visit offered by GP
* access to GPs in business hours is nearly impossible – 2-3 week waiting list. Some residents go to
practices out of town to be seen
* for one resident the communication of results between Ballarat Health Service and the practice was
non-existent and could not get recommended follow-up appointment locally
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* there is a feeling that the medical clinic staff could be more caring and compassionate when people are
sick
Many respondents chose to leave further comments about after hours care.
...I also wasn't sure if my concern was serious (in spite of intense pain) didn't want to bother the doctors
(they are so overloaded) decided to wait till business hours - and it got better eventually. The good things
about the service is that it exists and if you are really in trouble they are fantastic. The difficult thing is that
the after hours clinic times are not well advertised (I guess they don't want to be inundated) and there is
no option between a) bothering them after hours or b) a very long wait to get an appointment in business
hours. It's either "go now and feel a fool if it's not life-threatening" or wait a week to a fortnight (and
spend hours in the waiting room) for an appointment.
To make a doctor’s appointment to see a doctor in Maryborough requires nearly 2 weeks booking in
advance and seeing a doctor urgently if you are unwell is impossible. In the case of non emergency type of
issues I go to one of the Ballarat clinics such as Eureka, I know you have to wait for 2-3 hours sometimes
but at least you see someone. If I had an emergency situation such as broken bone etc, I would go straight
to Ballarat hospital. Most things I usually go to Ballarat. Maryborough really needs more Doctors.
It is always a concern with having small children who seem to get sick very quickly (and also recover just as
quick often with the right treatment) but it is knowing how urgent their need is that is difficult. Sometimes
it is the way you are treated when you take them or yourself and the practitioner does not seem to think
they are that ill that is the most off-putting about seeking after hours care. I have no complaints about the
treatment once received it is sometimes the time it takes to be seen.
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Works Cited
1. Community Indicators Victoria. Community Indicators Victoria. [Online] [Cited: 31 12 2012.]
http://www.communityindicators.net.au/wellbeing_reports/central_goldfields.
2. Wikipaedia. [Online] 26 12 2012. [Cited: 31 12 2012.]
http://en.wikipedia.org/wiki/Central_Goldfields_Shire.
3. Australian Bureau of Statistics. 2011 Census Community Profiles - Central Goldfields LGA. [Online] 20
11 2012. [Cited: 31 12 2012.]
http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/communityprofile/LGA216
70?opendocument&navpos=230.
4. Maryborough District Health Service. Maryborough District Health Service. [Online] [Cited: 10 January
2013.] http://www.mdhs.vic.gov.au/Services/index.aspx.
5. Ambulance Victoria. Response Times by Station 2011. 2011.
6. Department of Health. Emergency Department Presentations by Medicare Local. [Spreadsheet]
Melbourne : Modelling, GIS and Planning Products, Business Planning and Communications, 2012. VEMD
2008/9-2010/11.
7. Ambulance Victorua. Ambulance Victoria Data for Medicare Locals. [Excel spreadsheet] 2012.
8. NHCCN Health Direct. After Hours GP Helpline Postcode Report Jan to Jun 2012. [Database] 2012.
9. Medibank Health Solutions. Nurse-On-Call 10th November 2010. 2010.
10. Health Consumer Survey: Seeking healthcare in the after hours period in the Grampians Medicare Local
region. [Web Survey] 2012.
11. National Health Call Centre Network. Quarterly Report: Quarter 1 2012. 2012.
12. Australian Bureau of Statistics. 2011 Census QuickStats All people - usual residents. 2012. Code
SSC20853 (SSC).
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