Members of the Hippicractics pictured at Learning Workshop 2 in Melbourne.









“If you always do what you have always done, then you’ll always get what you’ve always got.”

The 1st wave practices involved in the National Primary Care Collaboratives (NPCC) have embraced this awareness. It was the impetus for them to lead the way bravely towards improved primary health care.

Change is the only constant in life
It is easy to feel bogged down and ill equipped to deal with the constant changes that seem to be thrust upon us by outside forces. This can lead to a sense that one is existing (not living) in survival mode and to a feeling of not being in control. Medical literature and the media abound with stories of dire predictions for the future of primary care in the face of a diminishing GP workforce, aging population, increase in chronic diseases, increasing need to demonstrate systems and information management efficiency, and the importance of involving patients in care planning. You all know the impact of all this on GPs’ and practice staff’s lives.

“We have gone from being technophobes to technophiles!”

Kingsley Pearson, Prema House, Lismore

Problem not change itself but how you deal with it
Good chronic disease management may seem like a daunting task, for doctors in general practice who already feel stretched. That people are living longer is a given. That this has contributed to an increased need to manage chronic disease is no surprise. Nor is the knowledge that lifestyle factors such as exercise, smoking and diet have such an impact on health.

Traditional general practice was a place that people visited when they were sick. In today’s practices, GPs care for people with acute and chronic diseases, and are being encouraged to take a systematic proactive approach to health promotion and prevention of secondary risk factors.

Looking to the future, GPs need not only the requisite skills in diagnosis, treatment, and performance of procedures, they must also demonstrate competencies in managing relationships, information and processes (Kahn et al, 2004, p.14).

I represented the Nimbin Medical centre at the recent 2nd learning workshop of the collaboratives in Melbourne. We currently have two doctors at our practice and we decided to take it in turns to attend the workshops. It was a good time for me to see what everyone was so excited about. It certainly was a great few days and it was a very rewarding time for me to share with other GPs from around Australia about what are really common problems.

The main take home message for me regarding the collaboratives process was the three Rs - Register, Recall, Review

So basically if you want some way of being able to review at risk populations you need to have some way of recalling them, and to do that you have to start with a register. Sounds simple but it is amazing that we ‘get by’ as GPs with often no true way of knowing what is going on in our ‘populations’. This is where the beauty of the collaboratives process lies in that it is insightful and thus empowering.

Oscar Sellarech, Nimbin Medical Centre

Maps show the way
Participating in the collaborative (NPCC) has been an enriching experience for the wave 1 practices. Lured by the NPCC promise that the process and methodology, along with support and resources, would provide clear signposts and ‘group think’ solutions, they were willing to trust and have a go. Their progress to date has been phenomenal. Each practice has been working on the change principles and initial tasks involved setting up and validating CHD and diabetes registers and beginning to measure demand for access. This resulted in numerous PSDAs as it required improving patient data entry, upgrading clinical data management skills and, in essence, moving from an individual patient view to one that embraces a population health perspective.

Knowing exactly how many diabetic patients, for example, the practice had, enabled them to begin to plan proactive management and care planning. Most practices in the collaborative have started GP and nurse run diabetic clinics and one solo GP practice has realised the benefit of a practice nurse and is currently employing one to manage chronic disease.

Current and future planned activities include involving patients in self managed care planning, reevaluating practice systems and choosing the best person for the job which increases multidisciplinary collaboration in care.

“I used to be a bit slack about coding. We have signs on our computers to remind us to code. I found it didn’t take long to change my behaviour and now it’s automatic!”

Michael Pelmore, Meadows Medical Centre, Mullumbimby

When two of our practices presented some of their achievements at the national workshop in Melbourne in June, they were the two most highly rated sessions! Naturally we are immensely proud of them.

Sandi Hille is the Collaboratives program manager at the division. shill@nrdgp.org.au