Executive Summary - Gold Coast Primary Health Network · PDF fileExecutive Summary . The Gold Coast Health and Wellbeing Plan is on e of ... support people to make healthy choices

Executive Summary

The Gold Coast Health and Wellbeing Plan is one of the most comprehensive and

ambitious reports ever developed on the Coast to provide a shared vision to improve

health and wellbeing services across the region. It is a base for GCML and its partners to

work together into the future.

The plan is ambitious given the depth and breadth of strategies and priorities however in

only the first twelve months significant progress has been made, particularly to improve

access to services, support the primary care workforce and improve coordination of

service delivery. While it may take time to see long term behavioural change, particularly

to prevent illness and chronic disease, a huge amount of work has been undertaken to

lay the groundwork for sustained and long term success.

Since the plan has been developed, during the last year in 2012/13, some of the key

outcomes have included:

• Building and sustaining effective relationships across the sector including the

establishment of the Health and Wellbeing Council and the development of the

Community Reference Panel who have an integral role in progressing key priorities

across a range of stakeholder groups.

• The continuation and expansion of the gr8 START initiative which has been significant

in implementing the internationally validated developmental screening tool (PEDS) in

35 Gold Coast childcare centres, resulting in the screening of 1800 children, and

referring more than 600 children for further support, who were identified as being at

risk of developmental issues. New partnerships have also been formed between Gold

Coast Health, Child Health and the gr8 START Alliance.

• The establishment of one of most comprehensive online health and community

service directories, at healthygc.com.au, to help Gold Coast residents find the services

they need, when they need them, day or night. This directory features more than

1000 listings including medical practitioners, pharmacists, mental health providers,

hospital and aged care services, family services, allied health professionals,

community and wellbeing services.

• Development of an integrated health promotion and prevention initiative to help

support people to make healthy choices including partnering with the National Heart

Foundation and Griffith University, to establish community based walking groups for

the community and in workplaces, brief motivational interviewing training of 80

health and community service staff and exploring ways to assist allied health and

community service staff in making appropriate referrals into community-based

physical activity programs. These strategies are inter-linked and each acts as a value-

add to the others.

• With mental health a regional priority, developing training opportunities for front line

staff from a wide cross section of the primary health care, community service and

government organisations.

• Supporting clinicians and service providers through innovative initiatives including the

patient experience project, which surveyed 462 patients about their experiences when

dealing with local primary healthcare providers including general practice, exercise

physiology, dietetics, physiotherapy and podiatry.

• Hospital admission rates for selected patients with Chronic Obstructive Pulmonary

Disease has dropped by 25% on the year before, through an innovative winter

wellness project, which focuses on improved management of patients and increased

collaboration between primary and acute care.

• Updating referral templates to formalise referral pathways for general practitioners

and the Gold Coast University Hospital, to improve coordination, integration and

service delivery.

With the Gold Coast Health and Wellbeing Plan guiding the way forward, Gold Coast

regional health and community service providers will continue to work collaboratively to

make a difference to the health and wellbeing of residents in our region. Gold Coast

Medicare Local will continue to work its partners, stakeholders and the community to

progress the plan’s priorities and continue to achieve tangible, life changing results.

Gold Coast Health And Wellbeing Plan First Annual Report - 2012-13

Introduction

The Gold Coast Health and Wellbeing Plan (the Plan) was launched in October 2012, as a

shared vision for improved health and wellbeing across the Gold Coast. The Plan was

developed by Gold Coast Medicare Local (GCML) and its partners to guide and inform

service development and investment across health and community services based on

sound evidence and identified need.

To access a copy of the Plan please go to http://www.gcml.com.au/cmsItem.aspx?CK=139

The area covered by the Plan aligns with the boundaries of the Gold Coast Medicare

Local region which includes the City of Gold Coast (COGC) local government area and a

small part of the Scenic Rim Council area including Tamborine, Mount Tamborine,

Canungra and Beechmont.

Identification of the Plan’s six overarching strategic priorities and associated

activities

The Plan contains six overarching strategic priorities which are based on a

comprehensive understanding of the health and wellbeing needs of the residents in the

GCML region as well as the strategies and opportunities available to respond to those

needs.

An extensive community engagement program and comprehensive analysis of data and

statistics allowed identification of a number of key issues requiring attention. This

culminated in a Health and Wellbeing Summit attended by 120 key decision makers

across the broad spectrum of the health and wellbeing sector as well as members of the

community. The attendees developed 18 priority strategies, which together with other

strategies identified in the period leading up to the Summit, were developed into the six

http://www.gcml.com.au/cmsItem.aspx?CK=139

overarching strategic priorities with a range of activities. As not all activities can be

resourced immediately they are listed in the Plan under the three headings:

- We will – actions that have been committed to

- We are going to explore – actions that require further investigation

- How can you help? – actions that may not be able to be progressed in the short

term but other organisations may be able to assist with

Reporting on the Plan

In the Plan, it is stated that GCML, together with its partners, will provide an annual

report to Gold Coast service providers and the community that will outline:

- new and emerging data or trends relevant to the Plan

- outcomes of a rolling program of engagement and partnering

- actions and work undertaken in the previous 12 months by GCML and others that

aligns with the objectives of the Plan

- progress against relevant performance indicators

- challenges in progressing the plan, if any

- a recommendation as to whether sufficient changes have occurred that require

the Plan to be revised in conjunction with the community and partners.

This information is presented below.

New and emerging data or trends relevant to the Plan

In the 12 months since the issue of the Plan a number of key data sources have changed

including the release of 2011 Census data, the Queensland Department of Health, Self-

Reported Health Status Survey, 2011-12 and the release of a number of Healthy

Community Reports by the National Health Performance Authority. This data together

with other recent information obtained from key GCML advisory committees and

stakeholders has been incorporated into the 2013, GCML Needs Assessment prepared for

the Commonwealth Department of Health. This is attached as Appendix A and provides a

comprehensive update of all relevant data and information underpinning health and

wellbeing needs in the GCML region.

Outcomes of community engagement and partnering 2012-13

The innovative and inclusive community engagement process undertaken to prepare the

Plan, including the Health and Wellbeing Summit and over 2,000 responses received

from the Taking the Pulse engagement process, have led to the strengthening of existing

and development of new community relationships in the GCML region. These have

formed the basis of ongoing connection to the community including some more

“marginalised” communities and this is leading to more effective collaboration.

The partnering and community engagement that has taken place over the last 12

months has reaffirmed the priorities that emerged from the initial engagement that

underpinned the six strategic priorities of the Plan.

Engagement and partnering with the community in 2012/13 took place in many different

forms including a community reference panel, surveys, forums, and face to face

engagement. Some key examples are provided below.

A Community Reference Panel of approximately 120 members was established in

February 2013. The panel aims to mirror the make-up of the GCML region community

according to age, gender and ethnicity. The panel is primarily an on-line forum with two

face to face meetings per annum. Eighty-five members attended the inaugural meeting

in February 2013. A second meeting took place in September 2013, with a detailed focus

on review and redirection of the panel. While there has been some drop off from the

original cohort, reporting has identified that those that are currently participating are

highly engaged. The feedback obtained both online and from the September review

meeting is informing the operation of the panel over the next 12 months. Continual

review and improvements will be undertaken regularly to ensure success.

A Disability Forum was held on 5th February 2013. The event was organised with three

key disability sector partners. Sixty individuals participated including services, families,

carers and consumers. They discussed ways of working better together to understand

consumer needs and to coordinate responsive primary health care services to create

person centred care for people with a disability and their families. Over 100 issues were

raised under five key themes and six priorities or action areas were identified with the

aim of improving person centred care for people with a physical and/or intellectual

disability and their families on the Gold Coast.

Some of the emerging activities which are prioritised for progression include:

• Health & Disability Community Expo - lead action group to plan, develop and deliver

• Access Friendly (AF) rating (survey) and AF missed business booklet to promote AF

Services

• Disability services integrated into practice through service access directory, promotion

AF checklist, professional development for carers on Comprehensive Health

Assessment Program (CHAP) tool and eHealth

• Work in partnership with Culturally and Linguistically Diverse (CALD) communities and

stakeholders to develop an action plan for working together.

A Multicultural Health & Wellbeing Forum was held in March 2012 to gather information

about the health and wellbeing needs of multicultural communities on the Gold Coast.

The forum was delivered in partnership with key multicultural leaders and service

providers. Since this time Medicare Local has been working with the key networks to

facilitate the development of a single point of contact for improving the health and

wellbeing of the multicultural community. These processes have contributed to

significant capacity building and the development of strong partnerships across a

diversity of multicultural services and agencies. The formation of a Multicultural Network

will be formally established in November 2013. Gold Coast Medicare Local will then

progress a collaborative action plan with the Multicultural Network to address the

identified needs.

Face to face engagement around mental health issues. In addition to regular Heads Up

meetings, specific workshops and meetings have been held to continue to share

information about Partners in Recovery (PIR), to engage quality applicants for program

recruitment drive and to seek further input and commitment to the Gold Coast PIR

program establishment. The PIR initiative is the collaborative effort of the Gold Coast

Medicare Local in partnership with FSG Australia, Aftercare, Mental Fellowship

Queensland, Mental Health Association Australia and Ozcare. The initiative aims to

improve the system response to and outcomes for people living with severe and

persistent mental illness. PIR engagement processes have involved all key stakeholders in

the planning for the Gold Coast PIR program.

Further examples of community engagement and partnering are provided in Table 2,

Priority 2 (page 19).

Progress against relevant performance indicators

The six overarching strategic priorities are listed in Table 1 below together with data on

the performance measures chosen to assist in monitoring progress towards them. Where

data is available, an indicator of positive, neutral or negative change is also provided.

Activities undertaken towards strategic priorities – 2012-2013

Table 2 below shows the activities listed under each strategic priority in the Plan under

the headings We will, and We are going to explore, together with a summary of the

actual projects undertaken in 2012-2013.

Challenges in progressing the plan

The GCHWP is very ambitious and many of the priorities and strategies cannot be

addressed overnight and may even require generational change. A number of the

projects have already led to service system or service delivery improvement and for other

projects, a huge amount of work has been undertaken to lay the groundwork:

developing partnerships; establishing baseline data; identifying and gathering resources.

This will provide the foundation for the future however meaningful results may take time

and require significant behavioural change which may not be seen for a number of years.

The sheer enormity and diversity of the plan has also presented a challenge. However,

through our well established local networks and active collaboration with key partners

this has been ameliorated. The GCML and its partners have always understood that we

may not be able to achieve all the goals, or make significant progress quickly. However,

it has certainly provided a strong platform to understand and improve health and

wellbeing of people in the Gold Coast region.

Review of the current strategic priorities of the Gold Coast Health and

Wellbeing Plan (Volume 1, 2012)

In the 12 months since the issue of the Plan a number of key data sources have

changed. This information, together with other recent information obtained through

community engagement and partnering, has been incorporated into the 2013, GCML

Needs Assessment prepared for the Commonwealth Department of Health which is

attached as Appendix A.

The data in the needs assessment supports the current strategic priorities in the Plan and

therefore it is recommended that a review of the priorities not be formally conducted

this year. However, the performance indicators may need to be reviewed in the near

future.

Future implementation, monitoring and review

GCML and its partners will continue to work together with the community towards the

agreed priorities in the Plan to deliver the best possible health and wellbeing for people

in our region. Future monitoring and review will be overseen by the recently established

Health and Wellbeing Council which has representation from Gold Coast Health, City of

Gold Coast and Gold Coast Medical.

Table 1: Progress towards Strategic Priorities

Strategic Priorities

Performance measures

Indicator Data source Data Change Comments

1. Support people to make healthy choices and take an active role in preventing illness and maintaining good health and wellbeing

Increase in levels of exercise

% adults meeting the national physical activity guidelines

Self- reported health status survey1

• 2011/12 - 60.5% • 2009/10 – 57.8%

It is pleasing to see a trend of an increase in physical activity however, it is a relatively small increase and should be treated with caution. While a lot of activity is being undertaken by a range of partners across Gold Coast Region to support healthier choices, unfortunately recent data indicates rate of overweight/obesity continue to climb but at a national and local regional level (NHPA figures).

Increase in rates of cancer screening

% people in target range undertaking cancer screening

Cancer Screening rates2 Cervical cancer • 2005/6 – 55.1% • 2007/8- 55.3% • 2009/10 – 54.8% Breast cancer • 2005/6 - 54.6% • 2007/8 - 53.9% • 2009/10-55.8% Bowel cancer • 2010 - 35.2%

Results here are mixed and the changes in statistics quite minor. Even for the areas where there is a slight increase the figures are still well below targets.

Increase in child immunisation

% children fully immunised between at 5 years of age

Australian Childhood Immunisation Register (as reported in National Health Performance Authority Healthy Communities Report: Immunisation rates for children in 2011-2012 report)

2011/2012 - 89% Rates remain relatively steady however, this figure is slightly lower than the target and national average of 90%. GCML is actively partnering with Queensland Health and vaccine providers to provide education and support to primary care and broader community.

2. Better access to services, programs and information, particularly for those most at risk

Providers report that online service directory has improved access for themselves and users

Feedback from health care providers

Qualitative data sourced from meetings and forums and/or survey

No data collected in 2013 Not yet measured

The new platform for the GCML service directory, HealthyGC, went live in November 2013. Website analytics will be used to measure visitations to the site. Qualitative feedback will be sourced as outlined.

Number of services listed in service access directory

Increase in number of services – target of 50-60%

Count from GCML desktop Baseline of 1545 services as at November 2013 (NB: may include some duplications)

Baseline.

Baseline established for number of services.




3. Strengthen the role of non-government service providers, and consumer, carer and community groups to support people to look after their own health and wellbeing and positively influence health outcomes.

Community based support groups report they are better resourced and supported

Feedback from community groups

Qualitative data sourced from meetings and forums and/or survey

From March to May in 2013, 108 people attended 4 capacity building workshops held in different locations throughout Gold Coast City, run by GCML and funded by Regional Development Australia. Participants developed a self-help kit as an on-line resource.

Baseline.

In 2014, groups will be asked whether workshops and resources assisted them to be better resourced and supported.

Increase in the number and geographic spread of community based support groups

Manual count Number of self- help and social support groups listed on GCML on-line directory

As at Sept 2013: • 19 - Southport,

Bundall, Ashmore, Labrador area

• 19 - Burleigh, Robina, Broadbeach area

• 15 - Nerang, Helensvale, Arundel

• 3 - Tugun. Coolangatta • 1 - Coomera

Baseline.

Baseline established for number of support groups.

4. Inspired, skilled work force and flexible work places

Delivery of shared mental health training

Number of people/employees participating in shared mental health training

Count of participants 2012/2013 – • approximately 130

participants attended Mental Health Awareness Training (MHAT).

• 106 people attended training on bereavement, suicide intervention and safe TALK provided by Australian College of Community Services.

• A further 17 people attended a Mental Health First Aid Instructors Course.

Baseline.

85% participants completing evaluation of MHAT stated they had since used skills/knowledge acquired and 92% would recommend training to others

Workforce plan initiatives are progressed

Workforce Advisory and Action Group (WAAG) report that actions on work plan are progressing

Information from progress reports

Part time project officer recruited to support ongoing implementation.

Not applicable. WAAG has prioritised and work is progressing on projects under the 6 workforce plan priorities: Education and training pathways into primary care & community services on the Gold Coast; Quality training and development for existing and emerging workers in primary care and community services on the Gold Coast; Workforce knowledge and data to inform ongoing, evidence based planning and development; and Promote the profile and value of careers in primary care and community services on the Gold Coast. Details of related projects can be found below.




5. Focusing on high quality ‘people-centred’ services and providing support to clinicians and service providers to achieve this

Service providers develop and implement policies/guidelines around person centred care

Feedback from service providers

Audit or survey No audit or survey conducted in 2013. However, eight (8) services participated in patient experience evaluation project (see below).

Not yet measured.

Will need to establish clear understanding of “person centred care” as part of the Partnership Development Framework. GCML will finalise by March 2014 prior to audit/survey being conducted.

Patient experience

Measures of patient experience for GCML region

National Health Performance Authority (NHPA), Healthy communities survey, Australians Experiences with Primary Health Care 2010/113

• 10% waited too long to see a General Practitioner (GP)

• 89% GPs listened carefully

• 13% experienced cost barrier to seeing GP

Baseline.

Baseline established through NHPA data. However, there have been some questions raised as to value of measures NHPA have settled on to measure local

initiatives effectively. Average rates for similar metropolitan Medicare Locals: • 13% waited too long to see GP • 89% GPs listened carefully • 9% experienced cost barriers

National Health Performance Authority, Healthy communities survey Australians Experience with Access to Health Care 2011/124

• 8% delayed or did not see a GP because of cost

• 24% delayed or did not see a Dentist because of cost

• 14% delayed or did not see a medical specialist because of cost

• 15% delayed or did not fill a prescription because of cost

Baseline.

Average rates for similar metropolitan MLs: • 7% delayed or did not see a GP because of

cost • 20% delayed or did not see a Dentist because

of cost • 7% delayed or did not see a medical

specialist because of cost • 10% delayed or did not fill a prescription

because of cost

GCML sponsored survey of patient experiences- April 2013 by Press Ganey

97.2% of 462 patients rated their experience as good or very good

No trend data

Initial focused exploration of patient experience across broader primary health to be used as base to inform ongoing work to understand and support people-centred services.

Gold Coast Hospital (GCH) Patient Opinion Survey

GCHHS General Inpatient Satisfaction Survey – Gold Coast Hospital • would recommend care

to others – 2012: 97.7%; 2009: 94%

• overall care rating - good, very good or excellent: 2012: 94.6%; 2009: 98%

• overall friendliness of staff - good, very good or excellent: 2012: 96.8%; 2009: 91%

• staff involved you in decisions about your care - good, very good

Increased satisfaction rate for most indicators compared to previous years with some being very high. A number of recent operational changes are thought to have contributed to this.




Patient experience (cont) Measures of patient experience for GCML region (cont)

Gold Coast Hospital (GCH) Patient Opinion Survey (cont)

or excellent: 2012: 87.5%; 2009: 89.7%

• given information on how to manage condition/recovery at home - good, very good or excellent: 2012: 87.6%; 2009: 78.1%

GCHHS General Inpatient Satisfaction Survey – Robina Hospital • would recommend

care to others – 2012: 96%, 2009: N/A

• good, very good or excellent overall care rating: 2012: 98.1%; 2009: 96%

• overall friendliness of staff - good, very good or excellent 2012: 99%; 2009: 97%

• did staff involve you in decisions about your care? - good, very good or excellent 2012: 95%; 2009: N/A

• given information on how to manage condition/recovery at home - good, very good or excellent: 2012: 87.4%; 2009: 54%

6. Improved coordination, integration, communication in service delivery

Service providers are satisfied with the timeliness and quality of referrals from other service providers

Feedback from service providers

Annual survey of GPs by GCML - Level of satisfaction with process/content of feedback/shared care:

2012 survey -37% public hospital -41% private hospital -56% allied health -50% community services -47% after hours care Issues include improving timeliness of feedback, more detailed information and requirement for feedback to be provided electronically.

Baseline. 2014 - extend to broader primary care sector

Consumers report being able to move easily between services

Feedback from consumers

GCML on-line survey No data collected in 2013 Not yet measured.

Survey to be developed and trialled in 2014 with Community Panel, with intention of broader implementation through key partnerships.

Table 2: Actions towards Strategic priorities – GCML and other organisations Health & Wellbeing Strategic Priorities Relevant projects Progress

Priority One Support people to make healthy choices and take an active role in preventing illness and maintaining good health and wellbeing

We will… • GCPHU (Gold Coast Public Health Unit),

GCML and a range of partners aim to reduce obesity and increase physical activity by:

o Promoting healthier choices through strategies targeting schools, workplaces, existing services and other places where people connect (including support for delivery of preventative health in general practice)

City of Gold Coast Healthy Communities Initiative City of Gold Coast received funding under the Healthy Communities Initiative to increase the number of Northern Gold Coast adults, predominately not in the paid workforce, involved in healthy lifestyle activities. From the 16 July 2012 to 15 June 2013, a total of 81,389 Northern Gold Coast participants* have taken part in Active & Healthy Program activities and consultation events (this equates to 33.37% of the total Citywide Active & Healthy program and consultation participation.) *Note a participant is not a unique program user - participants may choose to take part in more than one Active & Healthy Program activity. Tai Chi (14.36%), Walking (13.97%), Aqua Fit (12.39%) Group Fitness (12.3%), Yoga (7.8%), Healthy Eating (7.46%) and Nifty over Fifty (7.43%) drew the greatest participation within the NGC for this time period. These were followed by parkrun and stroller groups at 6% each.

The HCI project commenced Dec 2011 and will be completed in June 2014 As a result of Active & Healthy Program participation, participants report:

• an increase in awareness and knowledge of healthy eating (89%) • an increase in skills in preparing healthy food and confidence to prepare

demonstrated items (94%) • being inspired to cook demonstrated items (98%) • an increase in awareness and knowledge of being active (95%) • an increase in skills / confidence in being active (95%) • being inspired to be more active (98%)

The top 5 benefits of participation in the Active & Healthy Program as reported by participants:

• Enjoyment fun - 81% • Improved health /fitness - 73% • Gaining new skills - 67% • Meeting new people / friends - 63% • Feel connected to my local community - 53%

Supporting people to make healthy choices capacity building initiative • Capacity at an individual level for staff will be enhanced through

knowledge and skills developed through a brief motivational interviewing training and ongoing peer support (to engage clients in healthy lifestyle discussions and referrals).

• Capacity of organisations will be developed to implement healthy lifestyle strategies, to help both management and staff in ‘walking the talk’.

Project underway - Bond and Griffith Universities involved in training, data collection and evaluation. Participants in the training and potential workplace pilots included - Kalwun Development Corporation, Uniting Care Communities, Wesley Mission, ACT for Kids, Ozcare, Job Centre Australia. Blair Athol. Organisations whose staff have been through the brief motivational interviewing are being supported to pilot healthy workplace activities, to provide staff with opportunities to ‘walk the talk’ with respect to physical activity and healthy eating and management their health and wellbeing in the workplace so that they can better support clients/patients. To date, three organisations have taken up a minimum of three strategies, with four others currently considering their needs and capacity to participate.

Health & Wellbeing Strategic Priorities Relevant projects Progress

City of Gold Coast (COGC) Active Transport Plan The plan will identify and prioritise routes across the city for walkers and cyclists and refine concepts for community boulevards and pedestrian priority zones. Specifically, it will guide the delivery of five signature projects: • completion of coastal cycle and pedestrian routes • construction of ‘green’ bridges for cyclists and pedestrians in key

locations • creation of ‘community boulevards’ and pedestrian priority

zones in key areas • development and implementation of a cycle plan for the city, • development and implementation of a pedestrian plan for the

city.

The Plan began in 2012/13. A ‘green bridge’ was constructed in Burleigh Waters to provide safer and more convenient access to a school and community facilities. A trial of walking, cycling and public transport as alternatives to car travel has shown the potential of active travel in delivering health benefits for the community as well as the environment. During 2012, students at Norfolk Village State School and Mudgeeraba State School trialled active travel options as alternatives to being driven to school. This resulted in a reduction of 50,000 car trips, equivalent to more than 123,000 kilometres. During this time, the students walked an additional 15,000 kilometres and cycled an additional 18,000 kilometres. Students unable to walk or cycle to school contributed to reducing their carbon footprint through 8000 car-pooling trips and an additional 13,000 public transport trips. Promoting a cycling culture Overcoming barriers to participation in cycling was a key focus of the Asia Pacific Cycle Congress 2013. Some 200 delegates from 10 countries attended the four-day event, which showcased COGC sustainable transport initiatives. It was held at the Gold Coast Convention and Exhibition Centre in March. Construction of new bikeways is creating vital links in the COGC transport network. COGC Major Bikeways Program is helping to reduce traffic congestion and road costs by providing a transport option which has flow-on health benefits for the community and environment.

• Promoting healthier choices through strategies targeting schools, workplaces, existing services and other places where people connect (including support for delivery of preventative health in general practice)

Gold Coast University Hospital project Queensland Health input to design of staff and retail facilities.

Food providers in retail precinct of the GCUH complex have complied with State government healthy food policy ‘traffic light’ system. Staff gym expected to open later in 2013 and bike facilities provided.

• GCPHU, GCML and a range of partners aim to reduce obesity and increase physical activity by:

o Promoting healthier choices through strategies targeting schools, workplaces, existing services and other places where people connect (including support for delivery of preventative health in general practice)

COGC Gold Coast Suns Shine program The Gold Coast Suns Shine program aims to promote an active and healthy lifestyle, as well as surf safety, to Year 4 students in state and non-government schools. The Suns’ home, Metricon Stadium, provides the venue for the program, where students can learn AFL skills and how to enjoy the Gold Coast’s beach culture safely.


• Supporting local physical activity programs (e.g. COGC Active & Healthy program and Fitness Industry programs) and promote within health, community and workplace settings

Walk It (and other physical activity) Project • Establishment of, coordination and support for walking groups

including specific targeting of health service and providers already working with disadvantaged groups

• Increased uptake, access and awareness of walking groups by community.

• Engage local A&TSI children in physical activity and healthy eating through role modelling and mentoring and increase school retention with Gold Coast Suns

Project underway and ongoing – target of 40 walking groups by June 2014

Exercise Intensity Grading tool for group-based physical activity programs Provide a mechanism for both health professionals and the community to ascertain appropriate community-based physical activity programs for self or other referrals and promote uptake/increase of physical activity. Deliverables: • A validated tool for measuring the intensity of a group-based

physical activity program • Enhancements to the Gold Coast Active and Healthy website to

enable searches based on intensity gradings • Awareness-raising activities to promote use of the tool and

website

Project underway – website and promotion expected by March 2014

Gold Coast University Hospital (GCUH) - staff cycle centre and gym. • Staff cycle centre with end of trip" facilities such as showers. • A gym to be provided, with a private operator, and option to

salary sacrifice fees

Secure bike parking etc has been established adjacent to Gold Coast University Hospital car park. This will support staff who choose to cycle to work. Gym expected to open later in 2013.

• Using multiple channels and points of delivery for local, consistent health messages, including social marketing techniques

GCUH Retail precinct healthy food project As part of lease agreements with food retailers, they must all comply with state government healthy food policy comprising a traffic light system: green are healthy food choices, orange are food to eat in moderation and red for food that should only be eaten occasionally. Womens Health and Wellbeing Expo and Children’s Health and Wellbeing Expo Focus on cancer screening.

Final lease negotiations with preferred providers underway and all have submitted compliant menus and none have raised issues. Documented increase in number of screenings at the mobile breast screen service.


• GCML working with GCPHU and others will ensure access to information on services and supports available for prevention early intervention through the development of a web based portal including a service directory, linked to the Get Active Gold Coast website

See Priority 2, GCML Service Access Project

• Support screening for early childhood development issues through gr8 START Alliance

gr8start Project • Continue to foster effective cross sector collaboration in early

years • Early identification of developmental issues and connection to

appropriate services • Increase 3-4 years old health checks • Improve knowledge and understanding of early childhood

development issues in general practice

Gr8 Start initiative includes the development/review of resources designed to increase parental/carer health literacy around early childhood development, potential red flags and key local services. Gr8 Start Service Model – GCML contracted two providers to deliver place-based roll out of Parental Evaluation of Developmental Status (PEDS) tool, embedding it in Early Childhood Education and Care centres including; • Training • Capacity development • Mentoring • Systems support for general implementation and follow up of referral

recommendations • over 500 occasions of mentoring/follow up have been provided to centres. Feedback has been generally positive indicating it supported the parent in their approach to the GP or Allied Health Professional. Results include 118 childcare and community staffed trained in use of PEDS, 1800 Children screened, 616 referrals made to services and 29 children and families with complex needs supported with brokerage. Gr8 Start was the Winner of the Collaborative Practices Award for 2012 Health and Community Services Workforce Council Innovation Awards. Significant change in Early Childhood Education and Care centres specifically; there is a greater awareness of local support services, strengthened referral pathways and a hotline to PEDS Child Development Mentors for additional support when required. This includes the printing and distribution of approximately 8,000 booklets in 2012-2013 through general Practices, Early Childhood Education and Care Services and other Child and Family Service Providers. Printing has just been completed for the updated booklet for 2013-2014 year. New partnership formed between Gold Coast Health and Hospital System (GCHHS), Child Health and gr8 START leading to development of new collaborative business model (documented in formal Working Together Agreement) with GCHHS CHILDS team, to provide clinical assessment for children flagged through the PEDS process with particular focus on timely appropriate referral of children with confirmed issues.


We will explore… • Developing preventative health

strategies that specifically target people of low Socioeconomic Status (SES) and ATSI people

See ‘Walk it” Project above.

Close the Gap project • Support people to make healthy choices and take an active role

in preventing illness and maintaining good health and wellbeing • Better access to services, programs and information for those

most at risk • Improve the capacity of mainstream primary care services to

deliver culturally sensitive services • Increase the uptake of ATSI specific Medical Benefits Services

(MBS) items, including health assessments for ATSI people and follow up

• Support mainstream primary care services to encourage ATSI people to self-identify

• Increase awareness and understanding of Closing the Gap measures relevant to mainstream primary care

Delivery of Cultural safety training to primary care by June 2014 The Karulbo Partnership operational meetings occur monthly with quarterly meeting with broader community. Annual action plan developed and funded includes: • Elders Advisory Group • ATSI Mental Health Facilitator Training – 13 community workers completed

, 7 more training dates 2013-14 • Community Workers Workshops (two) • Two World Work Resources – 8 key areas of resources completed – 240

resources kits distributed and placed on website

Joint Initiatives Across the Sector Mungulli. GCHHS funded by Queensland Health (QH) to develop model for chronic disease self-management. In partnership with ATSI community developed Mungulli which provide both a screening and assessment, treatment model run either in the community, at ATSI providers or GCHHS facilities. Preliminary results indicate screening model “gathering” very good for identifying those at risk issues with improved engagement in “clinics” Developing model of Pulmonary Rehabilitation in conjunction with Lung Foundation more appropriate for ATSI Jallum Jarum “Fish Kids” Surfing Program. Krurungal have partnered with QLD Government, COGC, Gold Coast (GC) Suns, Westpac & Surfing Queensland to offer a surfing program to 10 – 17 year olds. GC Suns No Boundaries Program Kalwun Health in collaboration with GCSuns, Education Queenslandld, Yuganbeh Museum, City of Gold Coast, Queensland National Parks, Recreation, Sport & Racing and Queensland Health to provide a program utilising Australian Football (AFL) to encourage children to stay engaged in school and promote an active healthy lifestyle. ATSI DRASTIC PROGRAM. GCHHS Indigenous Health Service, Creative Inclusion, Gold Coast Drug Council, Clinical Liasion Aboriginal & Islander Service delivered the DRASTIC program in April with Art and bush tucker. Also joining the UNITED by STYLZ Hip Hop theatre program in April 2013.


OTAGO Program The purpose of this project initiative was to increase older people’s awareness of, and access to evidence based falls prevention programs in RACFs and Community Care Programs.

The key outcomes from the activities under this section were: • Fifty service providers from aged care, allied health and general practice

undertook the OTAGO Program • April No Falls Day was convened on the 30 April 2013. GCML provided small

grants to a range of organisations across the Gold Coast. Over 20 events were held across the Gold Coast with participating organisations including:

o General practice -7 practices o Aged Care -10 organisations o Allied Health Practices -2 practices o GCHHS 1 service

• April No Falls Day Posters and Flyers were distributed to 50 general practices across the Gold Coast.

• Working with partners to find more

effective ways to inform the community of the benefits of immunisation and facilitate access to immunisation programs

Supporting the uptake of 0-7 immunisation schedule project: deliver Immunisation support, resources and training to general practices, to maintain and improve vaccination rates to 90% • Practice Support

o Telephone o Face to face o Resources

• Collaboration with Gold Coast Public Health Immunisation group • Quarterly feedback to practices • four Back to Basics workshops • Linkages with local Immunisation activities including school

based programs, Close the Gap and community activities

• Back to basics being held between Aug 2013 and June 2014 • AMLA Qld Immunisation network and strategic planning meetings to be

held in Aug 2013 and Mar 2014

• Working with partners to find more effective ways to inform the community of the benefits of immunisation and facilitate access to immunisation programs, cont,d.

Improving school-based immunisation in secondary school – Phase 2 Project • Increase the return rate of consent forms for the School Based

Vaccination Program for Year 8 and Year 10 students in the participating schools

• Increase in the vaccination completion rates of students in participating schools for Phase 1 in 2012/13 (data available until October 2010)

Planning underway – estimated completion by June 2014

• Gaps in services for young children See ATAPS Tier 2 – Priority six.

Speech pathology services A trial is currently underway between GCML and Griffith University for delivery of Speech Language Pathology Services through a student led clinic (an identified area of market failure).

If successful GCML will consider clinics with Griffith and Southern Cross University next year


• Assisting service providers to undertake more screening services for chronic disease and cancer services in a range of locations, targeting population with poor access

GCML Health Assessment Plus (Screening) Project. • Design a screening model suitable for widespread use in General

Practice • Increase the uptake and completion of a patient screening

questionnaire in General Practice • Increase the uptake and completion of Time Based Health

Assessments in General Practice

5 General Practices recruited to participate in development of model in April 2013. Expert panel recruited and decided to focus on screenings for 40-49 year olds. Report and evaluation on this project currently being prepared.

• GCML and Primary Care Partnership Council Members will advocate for the built environment and land use planning which supports healthy lifestyle choices such as physical activity, especially in areas of disadvantage

Ongoing monitoring of opportunities for comment on relevant local and State government land use planning policies, plans and strategies.

Input to COGC Transport Strategy.

Priority Two Better access to services, programs and information, particularly for those most at risk

We will… • GCML and partners are going to develop,

market and maintain a web-based portal as a single point of service access for information sharing, linking to other key sites and communication, including a service directory

GCML Service Access Project GCML will host, market and maintain a web portal featuring a service directory and on-line network for key communities of interest to increase awareness of services available and improve collaboration between services. More than a service directory, health professionals and the general public will be able to become members of the new site to publish listings, promote events, connect with other members, subscribe to newsletters and participate in online group networks.

Web portal established (continuation from General Practice Gold Coast (GPGC) service directory). Scoping of the web portal and commissioning of an appropriately qualified web development company has been undertaken and development is currently underway.

• GCML with support of key stakeholders will maintain up to date population health information to inform pro-active planning for service delivery and investment

As part of the GCML ongoing needs assessment and planning process the following documents have been developed: • Gold Coast Medicare Local Population Profile – a summary

document containing relevant socio-economic and health related information.

• GCML Summary Statistics – contains summary statistics for GCML region, Queensland and Australia on population numbers, demographics, socio-economic factors, health status, behaviours affecting health (eg. cancer screening, exercise, smoking), and health programs and services.

• GCML Detailed Statistics – Contains detailed population, demographic, socio-economic and health status data at the SA2, SA4 (GCML region), Queensland and Australia levels where available.

These documents are currently available on-line and are regularly updated - last updated September 2013.


• Maintain partnerships, advisory groups, networks and communities of practice across the Gold Coast to improve information sharing, service access and coordination of services

• GCML and Gold Coast Health and Hospital Service (GCHHS) Annual Partnership Agreement

• Executive Steering Group established and meeting monthly.

• The Connecting Leaders In the Community (CLIC) groups

• Leadership & Partnership Community of Practice programme ran for 12 months, concluding in December 2012 with 33 emerging leaders from across the GC Community and Health Sector. The programme involved monthly meetings, skillset workshops, guest speakers/mentors and collaborative community projects.

• ATSI MHFA

• Following the local data and high suicide rates in this community, the 5 day ATSI MHFA programme developed by University of Melbourne & MHFA was identified as an appropriate capacity building tool. Local partnership network Karulbo encouraged a diverse range of participants who would be trained to provide a rolling engagement across targeted communities over a 12 month period.

• LGBTIQ - The local Sexual Health Network identified the need for

local dialogue following the restructure of Queensland Health and consequent primary health care services being affected.

• GCML brought a diverse group together to plan a forum to plan collaboratively with this community of interest.

• Community Development Network - the local network leadership role was dissolved in Statewide funding decisions.

• Existing members were brought together to explore alternate resourcing and to develop a strategic plan.

• Partnership Capacity Training • 2 x 2 day training was held, led by expert trainers

• Inter Medicare Local engagements

• A variety of engagements have been undertaken with; bordering Medicare Locals, Interstate enquiries regarding ‘Taking the Pulse’ community engagement process, presentations at national forums

• Advisory Groups; • Formal Advisory groups were developed in collaboration with existing

networks or created from stakeholder engagement. Each one is unique but all have Terms of reference developed jointly and undertake regular meetings/activities to action a strategic plan and provide a conduit to GCML exchanging local data & information/opinion.


We will explore… • Taking more services to the community,

facilitating access for people who need them most, through:

o multiple access points to receive coordinated and facilitated care through e-health conferences, linking services and groups

o opportunities for virtual hubs for multidisciplinary teams

o building on existing places and facilities where the community already frequent as access points for service information, providing training for the staff to assist

Palliative Specialist Community Nurse Position. Funded by Primary Care Partnership Council (PCPC) to support Non-government organisations (NGO’s) with education and support of palliative patient living in the community. Position linked with GCHHS Palliative Services.

Improved access for palliative patients in the community. Providing better integrated service provision across the hospital and NGO services. Regular joint case conferencing.

Stanford Chronic Disease Self-Management Course. Funded by PCPC evidence based model of peer lead education and training sessions held run by Anglicare.

99 participants. Improved integration and coordinated referral from GCHHS to the program. Positive outcomes and feedback from participants re changes in lifestyle patterns ie diet, exercise etc.

Specialist Community Chronic and Complex Wound Clinic. Funded by PCPC provision of access to GP and nurse practitioner with specialist expertise in wound care.

Provides individual service delivery to patients referred to them for assistance with chronic and complex wounds. Provides education and advice to GP’s and practice nurses on the ongoing management of wounds.

CACP Capacity Building The purpose of this initiative was to increase awareness across the Primary Health Care Sector, in particular General Practice of Community Aged Care Packages (CACP). The key goal was to assist community aged care providers to build capacity and reduce the number of vacant CACP packages across the Gold Coast. At the end of January there were up to 150 vacant CACP packages. As a result GCML convened a 'Think Tank' with 18 providers including ACAT.

The following outcomes were achieved: • Promotional articles on the community aged care program were put into

GPGC newsletters and available on both GPGC and GCML websites. • Linkages with the GPGC Community Nurse project assisted in creating a

broader awareness of CACP availability. • A Service Integration Forum was convened involving community aged

care, HACC, primary health care and acute sector representatives to explore strategies on how the sectors could work more closely together. Over 50 practitioners participated in this event.

• By the end of June vacant CACP packages had significantly reduced to under 60 vacant packages. Providers were continuing to work with the integrated sector to fill the packages. It should be noted that there is no one data source at this point in time to collect the total number of vacant packages, which was considered a gap in the sector.

• The S2S eWaitlist management system currently utilised in NSW was considered by the sector as a positive step forward. GCML will explore utilising this product in the sector in 2013/14.

• Maintaining access to appropriate service levels for GP and pharmacy services after hours. Develop specialised services for aged, mental health and palliative care patients after hours

After Hours Program Stage 2 Plan – Improving Care Coordination with Electronic Communication Increase the number of patient feedback reports being sent electronically to patients’ usual treating GPs the morning following the patient consultation about the care provided after hours by the medical deputizing services (MDS)

Service agreement with Medcall underway.


After Hours Program Stage 2 Plan – After Hours General Practice Services • To support the expansion of general practice after hours services

in areas of identified need in the north and west of the region where there is low access to such services after hours.

• To support the maintenance of general practice after hours services in all areas, other than the identified needs areas of the north and west, that meets community needs.

Service agreements with Medcall and Chevron underway. Will be reviewed to ensure continuation of services in 2014/15

After Hours Program Stage 2 Plan – Increasing Awareness of After Hours Services

Commencement of the combined Service Directory and After Hours marketing campaign in June 2013. Review of initial plan in December 2013.

After Hours Program Stage 2 Plan – Improving Access to Medications After Hours

Service agreements with Medcall and Chevron underway. Will be reviewed to ensure continuation of services in 2014/15

• Developing more specialised after hours services for aged, mental health and palliative care patients

After Hours Program Stage 2 Plan – Enhancing Access to Palliative Care After Hours

Funded service commenced April 2013. Review in June 2014

Integrating Quality Aged Care Services in Residential Care Facilities and the Community • Promote communication strategies to all parties • Collect and analyse GCHHS data in relation to ED presentations

and admissions related to the elderly • Develop pathways • Develop joint integration activities • Review existing activity programs available for the aged

population in RACFs and the community • Increase older persons awareness of and access to evidence

based falls prevention programs • Implement a communication platform linking ACAT &

community service providers

Project underway – completion in June 2014

• Development and delivery of training and education for more culturally appropriate services

2013 Multi-cultural Forum and subsequent engagement with key partners

The formation of a Multicultural Network will be formally established in November 2013. GCML will then progress a collaborative action plan with the Multicultural Network to address the identified needs.

• GCH&HS to include consideration of medical detoxification beds in facility planning

See Gold Coast University Hospital Project below.

Additional services for mental health from September 2013

Planning for detox services Gold Coast Health and Hospital Service (GCHHS) service planning has been concluded for dedicated dual diagnosis medical detoxification capacity in the mental health services footprint of Gold Coast health and hospital services. This will be put forward for future budget consideration with funding to be considered as part of Gold Coast Health's full spectrum of health care priorities.

Other funding alternatives have been pursued including an application this year to Queensland Health Clinical Innovation Fund. However, the application was unsuccessful.


• Opportunities for partners to inform development of GCH&HS facility planning

Consumer representatives were embedded into the project delivery of Robina Hospital Expansion and GCUH to ensure representation of the local community on key project committees and reference groups. This engagement strategy has ensured the capital works projects are better informed by the community - Consumer Advisory Group [CAG]. The GCHHS Stakeholder Advisory Group [SAG] included representatives from the CAG and key stakeholders and partners representing the health and knowledge precinct approach to project development. Stakeholders included GCML, education; private health services; cross border public health; Gold Coast City Council and Economic Development Qld. Engagement with other government departments with project dependencies is also a major part of the engagement plan. Steering Committee membership includes Queensland Treasury, Premiers and Cabinet etc.

• Linking the service directory database with telephone support services

Yet to be explored.

• Collaborative development of a local dementia strategy which considers issues such as avoidable admissions, increase staff training / skills, improved specialist support

GCHHS Dementia strategy Coordinated dementia care pathways and services has been prioritised as part of internal business planning within GCHHS for 2013-2014. Memory Clinics. QH has supported the GCHHS to develop community based multi-disciplinary team (MDT) CLINICS for people with memory problems. Can be referred from GP or Hospital Emergency Department or on discharge from hospital. Located in GCHHS Community precincts as opposed to outpatient services. Provision of assessment and treatment by geriatricians for those with memory problems and access to specialist MDT team including neuropsychology, social work, nurse practitioner, occupational therapy etc.

Dementia related services and mental health services within GCHHS will work closely with primary care to streamline care and provide coordinated support dementia patients. There have been a total of 514 patients reviewed in the clinic. In the time frame, Oct 1st 2012 - September 30 2013, a total of 290 patients were assessed or reviewed at the clinic. Some of these patients had multiple appointments according to their needs.


Other projects contributing to achievement of this strategic priority………. • Better access to City of Gold Coast

services, infrastructure, employment and information

City of Gold Coast (COGC) Draft Accessible and Inclusive City Action Plan 2013-2018 The draft plan provides a framework for COGC to address accessibility for the diverse needs of residents and visitors. It contains 7 priority areas: • City Services and Information • Customer contact and community engagement • City buildings, community facilities and recreational facilities • Pedestrian environments, public transport infrastructure and car

parking • Planning and development • Tourism and events • Employment and training

The draft plan has been released for public consultation from 28 October 2013 until 25 November 2013.

• Better access to oral health Gold Coast Oral Health Service - Decrease wait times for General dental examination - recommended State wide – less than 2 years

June 2012 – 7 years August 2013 – 15 months

• Better access to hospital services Gold Coast University Hospital Project The new Gold Coast University Hospital will have 750 beds – an increase of over 60% of beds over existing hospital. New capabilities: • Cancer Centre • neuro-science • neonatal intensive care • trauma response including helicopter landing site • cardiac surgery

Expanded services: • significant expansion of emergency department including a

dedicated area for children • additional birthing suites and birth centre • extended mental health services • more special care nursery cots • increased surgical capacity to 20 operating theatres • expanded support services including intensive care, pharmacy,

medical imaging and pathology

Hospital opened September 2013

• Improved approach to palliative care Palliative Care project • To increase the workforce skills and develop strategies to

encourage RACF and community aged care providers to work with the primary health care and acute sector.

• To deliver person-centred palliative approaches.

In partnership with Leading Aged Service Australia (LASA), Aged Care Queensland (ACQ) Education Institute, Palliative Approach and Advanced Care Planning Training was delivered to both Community and Aged Care Providers on separate days. 60 community and residential staff were trained over the 4 days representing 18 organisations across the Gold Coast


• Better access to services for people with disabilities and people from CALD backgrounds

Improving equity for people with disabilities project • Increase service access through development of access friendly

(AF) approach to GCML service directory • Develop an ‘equity’ checklist for GCML program areas • Work in partnership with Disability sector stakeholders and

communities and to develop an action plan for working together.inc the delivery of a Health & Disability Expo with a focus on increasing access to information and services.

• Work in partnership with CALD communities and stakeholders to develop an action plan for working together.

• Technical issues have delayed operation of expanded service directory

including access friendly approach. • Checklist expected to be developed by Dec 2013 • Health and disability expo – expected to be held in Dec 2013. Disability

Action plan to be completed by June 2014 • Action Plan for CALD community expected to be completed by June 2014

Partnering with Schools project - aimed at improving the social inclusion in targeted schools and the health and wellbeing of children.

To be implemented with Gold Coast Suns in 2013

• Better access to services for people with disabilities and people from CALD backgrounds, cont’d.

Phone App for disability car parking access RDA Gold Coast in collaboration with Griffith University, City of Gold Coast and the Perry Cross Foundation, have developed the "Access GC" iPhone app. This app provides a visualisation of car parking available for people with a disability in the Gold Coast region overlaid on a map, as well as directions to those areas. Griffith University worked with City of Gold Coast to provide their car park locations through their Open Data Initiative. This work with City of Gold Coast is their first collaboration in their newly launched Open Data Initiative. They provided on street and off street parking data for the Gold Coast region in Google Earth KML format.

Following the successful trial of the iPhone app, the RDA Gold Coast Committee met and agreed to contribute funds towards the immediate development of an Android version of this app. Further, it will continue to be developed to include special access toilets, ramps, etc and other information that will be of assistance. This app is now available via iTunes.

• Improved employment outcomes for people with disabilities

COGC Advantaging the disadvantaged (Ethical outsourcing) In what is believed to be a national first, COGC during 2012-13 offered tender opportunities to organisations whose operations provide a direct social benefit. Under the contract, Endeavour Foundation workers will recover waste which can be resold or recycled. The contract is also generating further social value as all profits go back into the organisation to continue supporting people with disabilities on the Gold Coast. The second tender was for recycling at the Molendinar Waste and Recycling Centre, awarded to Endeavour Foundation Industries for an initial 12-month term from 1 July, 2013.

The first tender was a $2.8 million, two-year contract for cleaning public buildings and facilities, including Council chambers, Councillors’ offices and libraries and community and youth centres. This provides employment for 28 people, including those with intellectual disabilities, teenagers, older persons and people from culturally and linguistically diverse backgrounds with limited English. Four contracts, commencing 1 June 2013, have provided jobs for around 30 individuals with low employment prospects, equating to 13 full-time equivalent positions created for the disadvantaged.


Priority Three Strengthen the role of non-government service providers, and consumer, carer and community groups to support people to look after their own health and wellbeing and positively influence health outcomes We will… • Work in partnership to build on links to

community organisations through GCML on-line service access directory through referral pathways

Gr8 Start early years information and referral pathways. Other appropriate community facing referral pathways will be identified for transition to online publication.

Following consultation with gr8 Start Alliance, updated materials to inform and support parents and service providers in relation to early childhood development have been uploaded to HealthyGC website. Linkages between this information and service directory (including parenting programs) are currently being finalised.

• GCML will develop a framework of support for consumer, carer and community networks across the region, using a community development approach, delivered in mobile and accessible ways using existing venues, technology and roles

‘Linking you locally’ project A series of Linking you locally events were held at Gold Coast City Libraries to boost their capacity to act as community information hubs and to provide information directly to the community about health and wellbeing services and the on-line directory. Developed and delivered by Gold Coast Libraries in partnership with Gold Coast Medicare Local, the program aimed to connect individuals with local community groups, services, support agencies and each other. Participating groups and organisations showcased their activities and services at their local library on a Saturday between March and May 2013. A typical ‘linking you locally day’ included: • ‘Neighbourhood fun day’ look and feel • Full diversity of groups – knitting, walking, sporting, school, health

support • Food provided by local service clubs • Activities by local groups – demonstrating or workshopping their

activities • Activities by Libraries – computer classes, story time, Local Studies

sessions • Attractions (depending on location) – jumping castle, climbing

wall, face painting, petting zoo • Speakers topics - Importance and value of social connections,

branching out projects, community groups, health, environment, getting involved.

• Activities by Active and Healthy • A ‘What’s Missing’ or ‘Start a group’ stall • Partner with local businesses to provide activities • Measuring device to determine perceived levels of community

connectedness. • Meet and greet with local Councillor/Mayor

10 Linking You Locally events were held with Gold Coast City Council Libraries. 5000 attended, including community members and services to improve knowledge and access to support groups relevant to local areas needs and demographics.


• Support the establishment and maintenance of self-help and self-management groups, particularly including groups focussed on chronic disease self-management

Social support and self-help groups project. A detailed mapping of support groups across the Gold Coast was undertaken and collated. Funding from the Regional Development Authority was obtained through a grant and 4 support group forums were held across 4 geographical areas of the Gold Coast. These forums provided support groups with a vehicle to build their capacity, strengthen their own networks and celebrate the very meaningful community service that they provide.

A total of 108 people attended workshops from various social, support and self-help groups. As a result of these workshops, a total of 58 groups registered to be involved on the GCML online directory. This website is also the platform for the online tool kit that was discussed at the four workshops, including the groups own ‘words of wisdom’ that have been shared electronically.

COGC Community development program

• In 2012/13, COGC worked with residents to build community networks to further strengthen the social fabric of the city

• In 2013/14 COGC will invest $314,000 in the Community Development Officer program to strengthen communities by improving connections between individuals and not-for-profit groups and other essential services

We will explore… • Promotion of active consideration of

broader social determinants of health in all policies and planning to create environments and circumstances which foster better health outcomes

Partnership with GCML and Gold Coast Suns: No Boundaries Project - Targeting children in grade 6 and 7 from Aboriginal and Torres Strait Islander backgrounds through both group and one- on- one activities with Gold Coast Suns players and staff. Messages include: healthy eating and the importance of an active lifestyle (increase awareness and knowledge and provide positive role models) and the value of education and remaining engaged with school (addressing a key social determinant of health). Multicultural Schools project - the primary objective to provide Culturally and Linguistically Diverse (CALD) students with a positive means of social inclusion. Targeting local schools with high enrolments of multicultural students to ensure that we not only deliver to students with a culturally and linguistically diverse background but students of all backgrounds. In addition to the physical AFL related skills development, messages include harmony, respect and healthy eating and the importance of an active lifestyle

No Boundaries Project – partners Gold Coast Suns, Kalwun Development Corporation and Education Queensland to deliver key messages to up to 80 Aboriginal and Torres Strait Islander children across 10 primary schools. Nearly 1,000 from across 12 schools have participated in Multicultural Schools Project so far this school year. Will review and evaluate content and delivery at end of school year.

• Web based functions to support self-management for people with health conditions

GC Health and Community Services Directory Arising from the priorities of the After Hours and Service Access projects a marketing campaign was developed to make it easier for individuals to navigate the local health and wellbeing system to find the appropriate services and supports they need, when they are needed, day or night. The aim was also to create smoother and more-timely transitions between service providers and greater coordination of services.

A multi-channel advertising campaign commenced on the 24th of June to increase community, service sector and partner stakeholder awareness of the Gold Coast Health and Community Services Directory at www.healthygc.com.au. In the 2012-13 reporting year preparation for this campaign was the major focus and at this time it is too early to report on its results. Visitation to the healthygc.com.au website will be monitored to measure the number of unique browsers, total visits, average duration of visit, referral source (online only) and a comparison of new and returning visitors. An annual report will be collated with month by month analysis of these metrics.

http://www.healthygc.com.au/


• Resources required to assist community consumer and carer groups to be sustainable

See Social support and self-help groups project above

Other projects contributing to achievement of this strategic priority………. • Construction of community facilities and

development of community hubs COGC libraries and community centres In 2012-13 the Helensvale Branch Library and Community and Cultural Centre and the Upper Coomera Centre, which incorporates a branch library opened. Community hubs Development of Paradise Country Parklands at Nerang.

The $22m Upper Coomera Centre has given the Gold Coast its first fully integrated community facility. The centre incorporates a branch library, community and youth centre, aquatic centre, City customer service centre and Councillor’s office within a park setting that includes a playground, picnic area, outdoor events space and ANZAC memorial. Located at the corner of Reserve and Abraham Roads, the four-hectare site is close to schools, a shopping and commercial precinct and public transport routes. Another program of works to renew and upgrade the city’s youth centres and create new community facilities continued during 2012-13, with $19.4 million allocated to key projects. Bringing the country to the Coast Groups and individuals are helping to make the Paradise Country Parklands at Nerang a focal point for the hinterland community. Since the site on the Beaudesert-Nerang Road was purchased by the City in 2011, it has become home to a number of community organisations and the setting for successful events including Jamie Oliver’s Ministry of Food demonstrations and the Nerang Folk and Bluegrass Festival. Members of the community have been involved in planting trees, creating a community garden and helping the City and the State Government to restore the creek and natural areas surrounding the site.


Priority Four Inspired, skilled work force and flexible work places

We will… • GCML and partners will foster a

workforce that has the skills and capacity to deliver the health and wellbeing services the Gold Coast region needs through:

o Working with the education sector to ensure courses align to industry needs

o Partnering between organisations and tertiary education sector for work placement opportunities, internships and traineeships

o Mentoring and succession planning and knowledge sharing

Workforce Advisory and Action Group (WAAG) Project • Promote, support and collaborate in the recruitment and

retention of an appropriately skilled workforce • Make the Gold Coast a preferred destination for people wanting

to work in a dynamic, innovative and outcome focused service system

Griffith University and GCHHS commenced inter-professional training within Adult Community Health Services Partnership between Griffith University, GCML and service providers • GCML provides placement experiences for Griffith University

students and assists the university to organise placements with local service providers. This helps to ensure that future health professionals are trained to the highest standard based on their direct experience of practice in their chosen profession and to develop the necessary competencies that employers are looking for.

• Through the leadership role that Griffith University is undertaking in the Gold Coast Health Precinct, a number of strategic research projects are being developed with local stakeholders addressing issues of importance to the local community.

Project underway – estimated completion June 2014 Inter-professional placements commence mid 2012 including nursing, doctors, pharmacists, social workers • Griffith University provides advice and expertise on a range of taskforce

and advisory groups established by the GCML including the Engagement and Planning Stakeholders Committee.

• A major project under development seeks to secure funding to address the needs of people with chronic obstructive pulmonary disease (COPD) in the community to improve their quality of life by developing stronger links between primary care providers and hospitals to offer alternative option to hospital admission by providing services in the community, once people are discharged. Partners on the research collaboration include GCML, GCHHS, the Australian Lung Foundation, the University of New South Wales, the University of Queensland and the University of Copenhagen.

• It is anticipated that the connection with Griffith relating to placements, advice, expertise and research collaboration will continue.

• Deliver shared mental health training,

open to service providers across health and community services

GCML and Australian College of Community Services delivered mental health awareness training in February 2013.

Approximately 70 participants attended • 85% participants completing evaluation stated they had since used

skills/knowledge acquired • 92% would recommend training to others

Australian College of Community Services has run training on bereavement, suicide intervention and safe TALK

• 106 people attended


• Continue to implement the Workforce Advisory and Action Group “Workforce Plan”

WAAG (Workforce Advisory Group) Through the WAAG, initiatives which align with the “Workforce Plan” were reviewed and discussed with certain strategies prioritised. Work is progressing on the prioritised projects under the 6 workforce plan priorities: Education and training pathways into primary care & community services on the Gold Coast; Quality training and development for existing and emerging workers in primary care and community services on the Gold Coast; Workforce knowledge and data to inform ongoing, evidence based planning and development; and Promote the profile and value of careers in primary care and community services on the Gold Coast. Details of related projects can be found below.

Shared Mental Health training and Cultural Competency training as outlined above. High School Careers Forum– see below. “Regional Orientation” has been explored in detail, work was postponed, and is currently being reviewed.

We will explore… • Shared training across sectors to further

build capability (such as working with people from multicultural backgrounds and Aboriginal and Torres Strait Islanders)

Flinders Closing the Gap training Chronic Condition Management – facilitated by Gold Coast Health and Hospital Services.

Eight participants with 100% participants felt their attendance was relevant to working needs. All participants gained “ Certificate of Competence”

• Inspiring young people into the health and community sector

Careers forum held, 48 staff and health professionals, 100 students WAAG reviewed outcomes and forum to be expanded in late 2013 to reach more students.

Students • 75% increased confidence in selecting education and training options • 80% more confident in planning career • 82% name three or more new occupations in health/community

services. Principal

• students talked about the event in the following weeks and were more confident in selecting a career path in the industry.

• fourfold increase in students applying for the schools Certificate III Allied Health Assistance course..

• Developing a shared approach to

promoting work in the health and community sector to young people

See Careers Forum above

• Making shared training available for staff across sectors in key priority areas to address common issues increasing complexity of clients such as effective coordinated management of chronic illness and disabilities and stronger focus on self-management

Flinders Chronic Condition Management Education and Training – course funded by QH and managed by GCHHS to support cross-sectorial training ie. GCHHS, NGO and GP Practices 2 day workshops Also see mental health training above.

• 85 participants completed workshop with 35 participants receiving “Certificate of Competence”. Participants included GP Practice, GCHHS and NGO nursing, medical and Allied health staff. Participants completed “Accreditation as Trainer”.


• Increasing understanding of roles within health and community services, improving understanding across providers as well as assisting in promoting career pathways

See Inter-professional learning, Priority six.

• Increasing numbers of workers from different cultural backgrounds particularly in promotion, prevention and early intervention and the complex areas such as mental health and drugs and alcohol

Yet to be fully explored

• Coordinating local planning across the different parts of health and community services sector to address workforce capacity issues and gaps and develop a regional orientation and induction program.

GCML is currently working collaboratively with other South East Queensland Medicare locals to support the development of a Whole of Region Primary Health Care Workforce Plan. The desired outcome for this project is to gain an evidence based understanding of the primary health care workforce within each ML region to inform future planning and action. This will be achieved through identifying anticipated gaps, issues and barriers, opportunities and evidence based solutions for consideration.

The Health and Communities Service Workforce Council has been contracted to provide consultancy services for the development of the plan which is scheduled for completion by end March 2014.

Priority Five Focusing on high quality ‘people-centred’ services and providing support to clinicians and service providers to achieve this

We will… • In partnership GCML will build policy to

support high quality and people- centred care and services amongst clinicians and service providers through implementation of a Clinical Governance Framework

See Quality Cluster Project listed under Priority 6

• Make it easier for consumers to take responsibility for their own health and wellbeing by enhancing the proposed service directory (see Priority Two) with user friendly information to improve knowledge and understanding of health and wellbeing strategies, health promotion and self-management

See GCML Service Access Project listed under Priority 2.


• Develop a policy guide in partnership to provide a basis for all health and community services to embed consumer/carer participation as a core component to quality practice

“Partnership Development Framework” to be created which will include principles for consumer /carer participation.

Partnership Development Framework to be finalised by March 2014 as part of GCML accreditation process.

• GCML and partners to conduct a series of forums to improve knowledge and understanding about how to improve health and wellbeing and prevent illness (also called health literacy) across the community

Health Literacy (HL) for Community Wellbeing project • Review evidence base and develop HL framework • Analysis (mapping and audit) of the HL of the GCML environment

and develop an action plan.

• Action Plan expected to be completed by March 2014

We will explore… • The development of a community

reference group that can provide a local evidence base, that is responsive to need and potentially shared across a number of agencies including GCML, GCPHU and GCH&HS.

Community Reference Panel A Community Reference Panel of approximately 120 members was established in February 2013. The panel aims to mirror the make-up of the GCML region community according to age, gender and ethnicity. The panel is primarily an on-line forum with two face to face meetings per annum.

Eighty-five (85) members attended the inaugural meeting in February 2013. A second meeting took place in September 2013, with a detailed focus on review and redirection of the panel. While there has been some drop off from the original cohort, reporting has identified that those that are currently participating are highly engaged. The feedback obtained both online and from the September review meeting is informing the operation of the panel over the next 12 months. Continual review and improvements will be undertaken regularly to ensure success.

Gold Coast Hospital (GCH) Consumer Advisory Group project. The Consumer Advisory Group has been active since 2008. Its purpose is to provide an ongoing mechanism for health consumers, carers and representations from community organisations to participate in health care planning, delivery and assessment to ensure the community is part of the ongoing improvement of health care services in the Gold Coast district.

The group has been ongoing since 2008. The number of members has increased from 8 in 2008 to 48 in 2013.

• Developing tools to measure health literacy

Community reference panel – The community panel was established in February 2013 to provide an opportunity for Gold Coast residents to provide feedback and advice on health and wellbeing issues in our local communities. The Panel provides a voice for the community based on local experiences and knowledge.

Information obtained from the Panel is being used to test new service ideas, concepts and communication, to develop a health literacy strategy for internal and external use.


• Developing a method to gather consumer and carer feedback on services and use the findings to inform improved care delivery, service standards and partnership models

Patient experience project. Commissioned Press Ganey to survey patients through a cohort of 8 Allied Health & General Practices. Orientation & information sessions (April) and Evaluation Post Survey (July) GCML assessing Patient Opinion Australia as a platform to conduct patient experience on all current programs and subcontracted services. Partnership established with Griffith University to conduct longitudinal study to investigate patients' experiences of primary health care services after being diagnosed with type 2 diabetes. Focus will be on the perceived effectiveness and satisfaction of services and health professionals. Although conducted over 2 years, potential for interval insights into episodic patient care from point of referral through patient decisions and attendance at service providers.

Patients reported over 90% satisfaction with: • Friendliness/courtesy of Care Provider • Care Provider spoke using clear language • Overall care received during visit • Patients' confidence in Care Provider • Friendliness/courtesy of nurse/asst

Practices gained an improved understanding, knowledge and resources to conduct patient experience activities in their own practices Practices and patients were provided with evaluation reports/feedback along with recommendations for engaging any future patient satisfaction survey.

Other projects contributing to achievement of this strategic priority………. • Improving health literacy The C.H.I.L.D.S. (Child Health Intervention Liaison and Developmental

Support) Team within Community Child Health Services (a division of Gold Coast Hospital and Health Service) is trialling the use of documentation intended to support parents’ health literacy surrounding their children’s health and wellbeing. C.H.I.L.D.S. Team Nurses are issuing parents with a written summary of the recommendations made during their child’s consultation for a developmental/ behavioural assessment. The summary includes specific details of formal referrals to other service providers, as well as suggestions for attendance at group talks and other relevant avenues of support. The written summary should not only support parents’ recall of recommendations, but may also facilitate their navigation of the healthcare system and enhance their communication with other service providers when following up referrals. With parental consent, the summary of recommendations will also be forwarded to the service providers the child is being referred to, in addition to the agency that originated the child’s referral to the C.H.I.LD.S. Team (such as an Early Childhood Education and Care Centre or school). This is intended to decrease service duplication and promote continuity of client care. The referring agencies will be aware of the range of interventions initiated for children and will be able to provide further support for parents to action these recommendations.

A survey of parents to evaluate usefulness of initiative is to be undertaken.


Priority Six Improved coordination, integration, communication in service delivery

We will ……. • GCML will support care coordination

through ‘e health’ initiatives to assist service providers to adopt effective care coordination processes for people with complex health issues

Diabetes Care Project: Trial project supporting practices to improve management of care through use of the CDM Net tool.

Trial to commence September 2013 and completed March 2014.

Better Health Care Aged Care • Promote a multidisciplinary model of care with RACFs and

facilitate GP video consultations

Video consultations and care to commence from December 2013. Target of 300 video consultations per RACF per year.

Coronary Heart Disease (CHD) Care Project Improve the quality of care and care coordination provided for patients with coronary heart disease in a flexible way that is tailored to the needs of the individual patient. The primary interventions that will be introduced to support the CHD Care Project Model is the introduction and implementation of a new IT tool and consistent review and evaluation of process through continuous quality improvement (CQI) meetings (CDMnet).

Project commenced in Oct 2012 and achieved • 31%increase in CHD Patients with GPMP • 20% increase in CHD Patients with TCA • 34% increase in percentage of CHD patients with BP<130/80 • 26% increase in Number/Percentage of CHD patients with Cholesterol < 4 • 22% increase in the Number/Percentage of CHD Patients with TCA

• GCML will improve coordination and integration by supporting service providers to increase the use of electronic communication to support effective referral, use of service pathways and effective information sharing including via Personally Controlled Electronic Health records (PCEHRS)

GCML ‘E-Health’ Project • Supporting primary care organisations to undertake e-health

readiness assessments and establish and implement goals to increase their readiness

• Using existing GCML primary care interdisciplinary activities to target primary care organisations to register their patients for PCEHRs via assisted registration, either via GCML project staff or via the primary care organisation’s administrative staff

• Establish a trial of up to 25 primary care organisations to have their administrative staff trained and supported to provide assisted registration services to their patients from the priority target groups. Identify and document effective strategies to register patients and use the PCEHR and use these early adopters to encourage their collegues to take up the benefits of e-health

Project commenced July 2013

Improve connectivity in referrals for Allied Health Providers (AHPs).

• GCML connected 81 AHPs to Medical Objects. • 17% increase in AHPs listed in on-line service directory.


We are going to explore…… • GCH&HS, general practice and their

multi-disciplinary teams to further expand their ability to transfer patient information through secure electronic communication

Persistent Pain Project • Establish a GC Chronic Pain Network with key interested primary

health care providers across the spectrum from prevention (GP & Primary Health Care Providers) in community-based services to complex tertiary care.

• Map the continuum of pain management services across the Gold Coast from prevention/early intervention to tertiary intervention.

• Develop an integrated, stepped self-management management model.

• Develop a coordinated primary health care arrangements for pain self-management, with clinical (case conference support), mentoring and educational support.

• Development of education, resources and a service register supported through GCML website.

Project underway – expected completion June 2014

• New integrated models of service provision for example with ATAPS funding

ATAPS is a Commonwealth Government funded, Two Tier program, that addresses service gaps for people in particular geographical areas and population groups, who, due to financial disadvantage, are unable to access services though other subsidised mental health services (such as the Better Access initiative). ATAPS Tier 1 ATAPS provides short term evidenced based “focused psychological strategy” mental health services, to people with mild to moderate mental disorders. Financially disadvantaged and hold Health Care/ Pension cards.

Project underway. Quarterly reviews to be conducted through 2013/14

ATAPS Tier 2 – Aboriginal & Torres Strait Islander Mental Health (MH) Services Special purpose funding to provide focused psychological strategies support for mild to moderate mental health disorders to Aboriginal and Torres Strait Islander People.

Project underway. Quarterly reviews to be conducted through 2013/14 Project underway. Quarterly reviews to be conducted through 2013/14 Project underway. Quarterly reviews to be conducted through 2013/14

ATAPS Tier 2 – Peri-natal Depression Special purpose funding to provide focused psychological strategies support for mild to moderate mental health Perinatal Depression. Financially disadvantaged and hold Health Care/Pension cards. ATAPS Tier 2 – Suicide Prevention Special purpose funding to provide focused psychological strategies support for short term intensive treatment for clients have self- harmed, attempted suicide or who have suicidal ideation and are being managed in the primary health care setting. Financially disadvantaged and hold Health Care/Pension Cards.


• New integrated models of service provision for example with ATAPS funding

ATAPS Tier 2 – Child MH Services Special purpose funding to provide focused psychological strategies support for Children 0-12 years with or at risk of a mental illness that may not otherwise be able to access services. Financially disadvantaged who hold Health Care/Pension cards.

Project underway (commenced March 2013). Quarterly reviews to be conducted through 2013/14 Development of model underway - expected completion by June 2014 GCML Integrated Primary Health Care Project

The aim of the project is to develop an agreed service model for best practice COPD management across the Gold Coast which will then be transferrable across other chronic disease streams. Interventions will cover the whole spectrum of chronic disease management from prevention through to complex end stage management including terminal care. A focal point of model design includes the development of pathways to support cross sectoral communication and clinical advice in relation to “trigger points” for escalating care requirements. Model design will also provide increased capability for persons with COPD to be managed within the community setting reducing unplanned hospital presentations and/or admissions.

• Development and promotion of service pathways where needed

GP Liaison Team Two GPs now funded by GCML and Gold Coast Health and Hospital Service (GCHHS) The second position was recruited to develop strategies to reduce outpatient waiting lists.

Referral template developed; a persistent pain management network developed.

Specialist Nurse support for GPs to increase access to Home and Community Care (HACC) services Involved five General Practices and two Community Nursing services

73% of 92 referred patients identified as eligible for HACC services and referred on to relevant service

Winter Wellness Strategy – Joint project GCHHS acute and community teams & GPGC develop model to target all people with COPD with 2 or more admission previous year. Active contact with all patients, action plans updated, linked with GP and if admitted process to facilitate early discharge.

Improved Electronic transfer between GP & GCHHS • Standardised electronic referral templates • Implementation of electronic discharge summary • GP support to ensure compatible programs

25% reduction on hospital admissions for that cohort of patients between July 2012 – June 2013. Training in COPD provided to NGO nurses and practice nurses & GP sessions by HHS medical specialists and allied health staff. Secure web link between GP and HHS for outpatient and Adult Community Health referrals Secure web transfer for electronic medical discharge letter.


• Closer links after hours between specialist doctors and primary care services

Complex Needs Assessment Panel (CNAPSIS) PCPC has supported Gold Coast Drug Alcohol Council to co-ordinate the panel to support people aged 17 to 29 years all with high and complex needs. It is an “integrated model of specialist treatment to address the complex requirements of those clients who have a coexisting mental health and substance abuse needs”. Agencies from multiple government and non-government services meet monthly to coordinate care and support for referred young adults.

During 2012/13, supported 29 clients with high and complex needs across a number of sectors, housing, health, education, employment. 40% Aboriginal or Torres Strait Islander. CNAPIS Evaluation completed by Bond University identified numerous positives in meeting its stated objectives. Some areas for improvement were identified by a small number of clients and stakeholders. These included the need for periphery stakeholders to be able to contribute in meetings and remain active partners in case planning, and dissemination of information regarding services provided by the agencies involved with CNAPIS. The integration of multiple services is a strength for CNAPIS, though a small number of clients may find this overwhelming, and some stakeholders may find contributing in panel meetings challenging.

• Development of care coordination systems for people with severe and complex mental health conditions

Partners in recovery (PIR) project GCML successfully tendered for PIR funding and has formed a consortia with four other agencies including FSG, Aftercare, MIFQ and, Oz Care. The initiative aims to improve the system response to and outcomes for people living with severe and persistent mental illness. PIR engagement processes have involved all key stakeholders in the planning for the Gold Coast PIR program. The Heads Up Consortia continues to be one of the key networks utilised for the engagement of primary health and social services. Additional advisory groups such as Allied Health, Population Health Planning and Primary Care Partnership Council have been engaged in PIR planning to maximise potentials for collaboration, promoting regional access strategies and enhancing referral pathways. Ongoing engagement with the PIR group has occurred on a weekly basis for planning and service development. The Program aim & objectives are to better support people with severe and persistent mental illness with complex needs, and their carers and families by: • facilitating better coordination of clinical and other supports

and services to deliver 'wrap around' care individually tailored to the individual's needs;

• strengthening partnerships • improving referral pathways • promoting a community based recovery model to underpin all

clinical and community support services

The Gold Coast Partners IN Recovery secured the contract for the Gold Coast region and will commence service delivery in November 2013. It has being agreed that the GCML will be the lead organisation with all other organisation working in partnership to provide a comprehensive model of service delivery. The funding is to support 589 clients over a 3 year period.

Gold Coast University Hospital Project Expansion of Mental Health Service – increase from 42 to 70 beds for mental health services

New hospital opens in September 2013


GCHHS MHS (GCHHHS Mental Health Call line) The 1300 number appropriately links the geographical coverage of the GCHHS MHS to a single point of contact. The estimated benefits to consumers, carers, families and the community at large include: • A single point of entry to public mental health services • Improved ease of access and transition into the mental health

service. • Clear and consistent pathways for the for the community and

other services • Continuity and consistency of care for consumers outside of

standard business hours requiring a service response • Improved access for consumers who may be at risk of

deterioration and need crisis intervention

• 1300 MHCALL number was successfully implemented on 1/8/2013. Data is indicating a steady increase in calls since this time from approximately 750 calls in June up to nearly 1000 calls in September.

• a tentative day has been set for a formal launch in February 2014- this will result in increase in calls

• Some of the additional expected outcomes from the 1300 MHCALL number launch for the GCHHS are :

o Increase capacity for a pro-active response to community based treatment by reducing the need for consumers to present to the Emergency Departments.

o Increased capacity for co-joint clinical interventions with emergency services through improved access.

o Meet benchmark, state wide strategic and public value expectations of service delivery

Other projects contributing to achievement of this strategic priority………. Improving Performance Project

• Develop Primary Health Care Improvement Committee (PHCIC) to act as a quality forum informing on and reviewing GCML projects and activities

• Conduct 10 inter-professional Continuing Professional Development (CPD) meetings in 2013/14

• Develop a relevant CPD program that encourages use of best practice and evidence based principles in primary health care

• Develop Education subcommittee to inform on development of CPD calendar and provide quality review of CPD activities

• Develop General Practice Nurse, Practice Manager and GP email list serves with moderators

Activities underway and will be completed by Jun 2014.. During 2012/13 GCML hosted 11 continuing professional development sessions hosted. 667 participants attended at least one session. Learning outcomes set and participant evaluation completed after each session. Sessions promoted inter-professional learning discussion.

Quality Cluster Project The aim of this project is the implementation of a quality improvement model to facilitate improved system and clinical outcomes through engagement with Primary Health Care service providers. The Quality Cluster project is aimed at assisting General Practices and Allied Health Providers to develop practice capability to deliver rapid, sustainable and systematic improvements in the care they provide to patients and their communities, through a sound understanding and effective application of quality improvement methods and skills. It is expected the Health Assessment Plus project will be incorporated into the Quality Cluster framework following the 2014/15 project activity.

Project underway – expected completion June 2014

ACQ Aged Care Queensland AF Access Friendly AFL Australian Football AHPs Allied Health Providers ALM Accredited Learning Module ATAPS is a Commonwealth Government funded, Two Tier program, that addresses service gaps

for people in particular geographical areas and population groups, who, due to financial disadvantage, are unable to access services though other subsidised mental health services

ATSI Aboriginal and Torres Strait Islander C.H.I.L.D.S. Child Health Intervention Liaison and Developmental Support CACP Community Aged Care Packages CALD Culturally and Linguistically Diverse CHAP Comprehensive Health Assessment Program CHD Coronary Heart Disease CLIC Connecting Leaders In the Community CNAPSIS Complex Needs Assessment Panel COGC City of Gold Coast COPD Chronic obstructive pulmonary disease CPD Continuing Professional Development GC Gold Coast GCH Gold Coast Hospital GCHHS Gold Coast Health and Hospital Service GCML Gold Coast Medicare Local GCPHU (Gold Coast Public Health Unit) GCUH Gold Coast University Hospital GP General Practitioner GPGC General Practice Gold Coast HACC Home and Community Care LASA Leading Aged Service Australia MBS Medical Benefits Services MDT multi-disciplinary team MH Mental Health MHAT Mental Health Awareness Training MHFA Mental Health First Aid NGO’s Non -government organisations NHPA National Health Performance Authority PEDS as a screening tool for detection of developmental delay in children PIR Partners in Recovery QH Queensland Health SA3 Statistical Area 3 – Australian Bureau of Statistics reporting region SES Socioeconomic Status WAAG Workforce Advisory and Action Group

Appendix A

2012/13 GCML NEEDS ASSESSMENT

Medicare Locals Needs Assessment Report Template 2013 Medicare Locals must complete this template. The information provided in the template should reflect a concise summary of the information requested. Where appropriate, further information, tables, evidence, graphics etc. that you wish to provide, should form an attachment to this template.

Medicare Local information Needs Assessment Report of:

Gold Coast Medicare Local (Name of Medicare Local) Contact Person

Kellie Trigger – Planning and Population Health Program Manager (Name of contact person at the Medicare Local) Contact Details

07 5635 2451 (How can we contact you if we require additional information?)

CERTIFICATION I, the undersigned, certify that the information provided in this Needs Assessment Report is correct and has been approved by the Medicare Local’s Board of Directors. I acknowledge that it is an offence under Section 137 of the Criminal Code Act 1995 to provide false or misleading information or documents to the Commonwealth. Signed:……………………………….. Date:……………………………….. Name:……………………………….... Position:……………………………

1. How have you progressed your understanding of the health care needs of your population?

Your response should demonstrate that you have performed activities to obtain a better understanding of your population and that you are working collaboratively with local stakeholders.

This template should be completed with reference to the Guide for completing the Template for Medicare Locals Needs Assessment Report (the Guide).

1.1 Describe how you have progressed your understanding of the health care needs of your population?

(Please refer to items 2.1, 2.2, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 4.1 and 4.2 of the Guide)

o Outline the activities you have undertaken to understand the heath care needs of your population. For example, include details here of any formal processes you have implemented, focus groups held and specific data accessed.

o What challenges have you have faced?

Response:

Work undertaken prior to submission of first interim needs assessment (2013) The process for the development of this plan resulted from our intention to create a shared Health and Wellbeing Plan for the Gold Coast Region. By gathering and analysing a broad range of data, reports and information from service providers and the community to identify local health and wellbeing priorities, we have the basis of building sustainable partnerships as well as determining priorities. This will provide a shared platform for us and our partners to understand and improve the health and wellbeing of the people in the Gold Coast region. A key mechanism to support the entire planning process was the creation of the engagement and planning stakeholders working group. Initially targeting a group of people with expertise and responsibility for planning, key players were brought together to discuss the process and scope of planning which would be required to develop both a comprehensive understanding of health and wellbeing needs in the Gold Coast Region and to have good foundations for the implementation of initiatives to address them. This group continued to meet and progress these ideas and people with expertise and responsibility for engagement and/or partnering were also included. Active members of the group include Gold Coast Health Service District (GCHSD) (both from the planning and the corporate office, Population Health (Division of the Chief Health Officer), GCCC (both from Social Planning and Development and the corporate office), Department of Communities, FaCHSIA, Griffith University and the Gold Coast Primary Care Partnership Council. The Engagement and Planning Stakeholders Group is more than a sounding board for the GCML. The guidance and direction of this group of partners has been sought throughout the community engagement and planning processes and will continue into the future. In particular the group has contributed by: • providing advice on the development and implementation of engagement tools • providing information regarding data available • providing particular data or data in requested formats (eg maps, hospital data) • advising of and providing relevant reports and plans • identifying potential opportunities for engaging with service providers/community • reviewing documents developed, ensuring accuracy and full context included • informing the topics and processes for forums and related engagement events • providing feedback and advice on format of the Health and Wellbeing Plan. This group was also the main mechanism by which sign off/endorsement of the shared Health and Wellbeing Plan was progressed. To understand the health and wellbeing needs of the Gold Coast region, it was necessary to gather information from diverse sources: research and policy; data and statistics; and robust local intelligence. Research and policy – national and state policy, local research and analysis of issues across health and wellbeing. Key policy drivers were identified including: • National Health and Hospitals Reform Commission Recommendations • COAG agreement

• Medicare Local strategic objectives • ANPHA • Strategic Planning from key organisations including Queensland Health, Department of Communities and

Gold Coast City Council. We also identified and reviewed local reports, plans and initiatives which have been produced in the last few

years including: • Northern Gold Coast Coordinated Social Infrastructure Strategy • Role of NGOs in chronic disease management • Gold Coast City Housing Stress Analysis • Social Connections: A Gold Coast Primary Care Partnership Council Project • Gold Coast Homelessness Community Action Plan • ........and many others Key issues and recommendations were identified from each of these and mapped against the Australian Institute of Health and Welfare (AIHW) Health performance Framework (this information is available on the GCML website). Data and statistics – The information covered both the social determinants of health (such as income, vulnerable population groups) as well as disease prevalence/health outcome information. While producing information in summary format for broad distribution, we have also created a set of tables of regional data, concorded to the GCML boundary and where possible broken down across SLAs. While this is not possible for all data sets, having such information easily available has and will continue to enable us to easily drill down to specifics when necessary. This will be useful for both GCML and for our partners when designing services so they can be best targeted to areas of highest need and greatest potential impact. This information is now available through the GCML website. Robust local intelligence – from service providers, services users and the general community to: • provide context and detail to the data and research • understand where there is potential for projects or initiatives to be well received or supported, and

where people and organisations are willing to put their energies, resources and time.

Firstly the community engagement tool we developed and implemented was called “Taking the Pulse” (TTP). It was designed as the opening conversation with the community; the first stage of an ongoing partnership and engagement strategy in the Gold Coast region. The initial draft was tested with input from community members, GCML staff, key stakeholders and as a result some changes were made. An online version using a Survey Monkey format was developed with Gold Coast City Council administrative support and placed online to seek a wider input. This was later converted to an Interspire format as it allowed more consistency. An EOI was sent out through networks, inviting people to assist with the distribution of TTP and become an “Ambassador for Health and Wellbeing” and to participate in information / training sessions. Around 100 people from diverse sectors and demographic backgrounds were trained in four sessions which covered information about GCML; TTP and its purpose; the process and skills to host conversations using the tool and gather the feedback. Ambassadors for the project were provided with collateral kits including business size cards (to encourage community members to complete the engagement tool online); hardcopy TTP tools, hat, tee-shirt, post its, pens and a tote bag. A total of 2,005 responses to TTP were received with respondents ranging from 4 to 94 and there was a relatively good geographic spread across the GCML region. A number of topic specific forums were planned and designed in partnership with key stakeholders. The aim of the forums was to bring together diverse participants across government, non-government, private practice, primary health, community services, community, consumers and carers to review the current understanding of key priority issues and identify priorities for action as part of the needs assessment to inform the development of the plan.

Each forum was designed to build on the level of needs assessment and planning previously undertaken. Up-to-date data and previous planning information about the topic were presented. Relevant services also set up an expo style presentation prior to the start of each forum and in the lunch breaks. The forum participants were facilitated to describe a preferred vision for the future. Data, work done to-date and previously identified priorities were reality tested and mapping of current situation undertaken. The groups used a nominal group process to identify priorities for action and then designed strategies to address the agreed priorities. A write up of key themes emerging for priority action from the forums was developed to analyse common themes and priorities and to inform feedback to the wider community, key stakeholders and summit participants. GCML were also opportunistic in working with groups and service providers at events such as strategic planning days to identify emerging issues: • Gr8 START- early years, childhood development(50 participants) • Persistent Pain forum (35 participants) • Workforce Strategic Planning day (40 participants) • Housing and Homelessness Services Best Practice showcase (40 participants) • Mental health and drug and alcohol forum (106 participants) • Karulbo- Aboriginal & Torres Strait Islander partnership (60 participants) • Allied Health Forum (79 participants) • Multicultural Forum (31 participants) • Physical Activity Alliance Strategic Planning day (50 participants) • Social Connections Forum (59 participants) • Healthy Ageing Forum2012 (73 participants) • After Hours Stakeholder Meetings (12 participants) • Mt Tamborine Community meeting (around 20 participants) • Promotion, Prevention, Early Intervention Forum (86 participants) Additional input was gained through attendance at community events and other meetings, including: Kirra Hill community event; Tugun Nippers; Griffith University open day; Dept of Communities NGO forum; Bleach festival; HACC forum; Greek respite program

After analysing the research and policy, and data and statistics, a general population profile with key information and statistics was developed and distributed at each forum, strategic planning days, meetings and other events. Topic specific addendums with key information and statistics were also developed for each of the forums and more general distribution. At forums there was a brief overview of information and at each event, attendees were invited to advise of any other data, reports or plans of which they were aware that may be relevant to inform the planning processes. As a result of this, a number of data sets and reports were identified, reviewed and included as part of the needs analysis. The Population Profile and Addendums (which are now available on the GCML website) have clear references indicating the source of any information used for transparency, to maximise the accuracy and validity of the data and to allow people are able to seek additional information easily,

An exhibition of information obtained in the planning and engagement process was set up from 7.30am - 7.30pm March 27, 2012. The aim of the exhibition was to provide an opportunity to feedback to the Gold Coast community all the information gathered in the needs assessment - themes from forums, TTP responses and data and reports, and to invite community to indicate their priorities for action. A 9 minute documentary made from forums and Taking the Pulse was shown along with a film about the importance of physical activity. (film can be viewed at http://www.youtube.com/watch?v=rrwLJyd94SQ&context=C4ac3cb1ADvjVQa1PpcFNA2Ahlrzgcxso6PKuWniV704ZuSvvUEHc) A user friendly display was set up comprising a welcome booth and 10 topic booths each with key data, TTP responses, issues from previous reports, evidence and the forums, all presented in poster display and slide shows. The 10 topic booths were: Aboriginal & Torres Strait Islander community; children and families; youth; new arrivals; ageing; social connections; support to live in the community when unwell; mental health and

http://www.youtube.com/watch?v=rrwLJyd94SQ&context=C4ac3cb1ADvjVQa1PpcFNA2Ahlrzgcxso6PKuWniV704ZuSvvUEHc

http://www.youtube.com/watch?v=rrwLJyd94SQ&context=C4ac3cb1ADvjVQa1PpcFNA2Ahlrzgcxso6PKuWniV704ZuSvvUEHc

drug and alcohol; workforce; promotion, prevention and early intervention. The final two booths summarised the key themes emerging from the analysis of needs identified and provided participants with the opportunity to prioritise themes and/ or strategies for action. Over 100 people attended the exhibition. The aim of the Gold Coast Health and Wellbeing Summit held March 28, 2012 was to bring together a selected group of people representing leaders in health and community services along with community members, consumers and carers to review all of the information gathered in the needs assessment process. 120 key stakeholders were invited to attend the summit. The event was by invitation only to ensure key decision makers and across sector involvement. However, nominations were also called for from the community, with nominations being selected against criteria (geographic spread and ensuring all stakeholders represented) as well as 10 drawn randomly. GCHSD, GCCC, Dept of Communities, Community members, consumers/ carers, Aboriginal & Torres Strait Islander community, multicultural community, private practice (allied health and General Practice), education, NGO providers were all represented. Pre-reading was made available to all summit participants comprising a write up of forums and events conducted, a summit pre - reading discussion paper combining data, previous reports, TTP responses, and forums under key themes. A live briefing using the exhibition (which was displayed around the room) highlighted some of the key emerging information to both demonstrate the breadth of health and wellbeing issues in the region and to focus participants for the prioritisation process to be undertaken. Participants were facilitated in 12 small groups of 10 participants, with each group having a representative from each of the various sectors identified to ensure diversity. All groups worked on all themes to identify three priorities for action across all groups. Using a framework to support the prioritisation process including an “equity lens” voting was undertaken by the whole group using electronic voting pads. Results were immediately displayed for all participants to see.

As a result 18 priority strategies emerged from the summit. This and all the supporting information was used to inform GCML”s 2012 – 2013 priorities.

Work undertaken since submission of first interim needs assessment. With the support and active involvement of the Engagement and Planning Stakeholders Group the 18 priorities together with other strategies identified through the work leading up to the summit and the summit itself were incorporated under 6 priority areas with a number of strategies under each. Using the research and policy, data and statistics and the robust local intelligence gathered (as noted above) each priority areas outlines:

- The reason it is a priority - What we know - What is being done - What more do we need to do – identified strategies split into 3 groups:

o “We will” for actions that have been committed to (by GCML or others) o “We are going to explore” for strategies that health and wellbeing providers believe require

further investigation o “How can you help?” for strategies that may not be able to be progressed in the short term

or that organisations and the community in the GCML region can assist with progressing The plan was given a level of endorsement and/or approval by key stakeholders in health and community services in the GCML region namely:

• Gold Coast Health and Hospital Service • Queensland Health Gold Coast Public Health Unit • Queensland Department of Communities, Child Safety and Disability Services, South East Region • Department of Health and Ageing • Australian Government Department of Families, Housing, Community Services and Indigenous Affairs • Griffith University, Urban Research Program • General Practice Gold Coast • Gold Coast City Council

• Scenic Rim Regional Council The resulting Gold Coast Health and Wellbeing Plan is not only a plan for GCML but is designed to guide and inform service development and investment decisions across health and community service providers. The Plan was launched October 2012 with its supporting documents (Population Profile and Community Engagement Report). The full Gold Coast health and Wellbeing Plan, Population Profile and Community Engagement Report can be found at http://www.gcml.com.au/cmsItem.aspx?CK=139. The plan and supporting documents have been used by many stakeholders, advisory groups, interagency and consortia to inform their own planning, service development and investment decisions. The information considered as part of the planning process was also made available through the GCML website http://www.gcml.com.au/cmsItem.aspx?CK=96 so that it could be used as a repository of locally specific data by local health and community service providers. The 'Detailed Statistics' document, detailed demographic and health status information at the Statistical Local Area level where available. The 'Summary Statistics' document provides a full range of key health and wellbeing statistics comparing GCML to other areas at a glance. As new data has been released (eg ABS census releases, Office of the Chief Health Officer self-reported health status report etc) we have been updating the data in both the population profile to inform both the 2013-2013 Needs Analysis and the online repository of data. This process has been supported by the Engagement and Planning Stakeholders Group. See Attachment 1 updated Population Profile. A number of detailed program specific scoping papers have been produced over the last 6-8 months to inform activities for some of the priorities which were more broadly defined in the Regionally tailored flexible fund, namely primary health promotion and aged care. Challenges

• GCML had been awaiting the release of the first National Health Performance Authority Healthy Communities Report as a main input into our 2013-2014 planning. However the reports are being released in a series of very small discreet data sets concentrating on single issues rather than as an annual summary across all data sets available and the information to date has generally not been particularly “new” data

• Data which could inform work around preventative health / health promotion is still not being captured systemically in sufficient detail in general practice. In particular we are not able to get a break down across the different types of health checks (although we can get a breakdown across general population and Aboriginal and Torres Strait Islander patients).

• new data and new ways to interrogate it are emerging all the time, making it difficult to know when to draw a line in the sand stop gathering information and start to analyse and plan

• getting the balance between data and other sources of information right to ensure both objective rigour and localised context

• working with a broad range of stakeholders and the community is resource intensive and the more thorough your engagement is the more diverse and numerous your emerging identified health needs are.

1.2 Provide details of your relationships with stakeholders in your catchment area

(Please refer to items 4.2 and 4.3 of the Guide)

o Detail the stakeholders you have worked with to develop your understanding of health care needs?

o Which stakeholders do you need to build relationships with?

o What barriers or issues have you encountered in working with stakeholders?

Response:

See Attachment 2 Stakeholder matrix

http://www.gcml.com.au/cmsItem.aspx?CK=96

2. What are the health care needs of your population?

Provide a snapshot of the health care needs of your population. Your response should demonstrate that you understand differences in health care needs across your population and that you have identified and considered a range of opportunities to improve health outcomes through primary health care initiatives/services.

NOTE: If you have identified other health care initiatives/services to improve health outcomes which you intend to pursue please provide details of these here.

2.1 Provide a snap shot of the health care needs of your catchment population

(Please refer to items 4.3 and 4.4 of the Guide)

Your snapshot should:

o Describe the health care needs of your population.

o Describe the health service system in your catchment area, identifying what works well, what doesn’t work well and what gaps exist.

o Discuss opportunities to improve the health outcomes of your population through primary health care services/interventions.

o Discuss the levers available to your Medicare Local to implement primary health care initiatives or services changes.

NOTE: You are not required to provide comprehensive details on the health care needs of your population. You should highlight what you consider to be the major (primary) health care needs in your catchment.

Response:

See Attachment 3 Health Care Needs

3. What priority activities will you pursue in 2013-14?

Provide details of how you identified your priorities for 2013-14. Your response should illustrate the processes you used to determine priorities and provide details on each priority.

NOTE: The information on priorities provided here should align with the priorities detailed in your Annual Plan

3.1 Provide details of the process you used to identify priorities for 2013-14

(Please refer to items 5.1 of the Guide)

o Outline any processes you used to identify your priorities for 2013-14. Include details of the information considered to identify priorities and who was involved in making decisions.

Response:

In addition to the GCML Strategic Plan (attachment 1), GCML staff will be reviewing the following documents to inform planning and prioritising for activities in 2013-2014 financial year (copies are attached for your convenience as refreshers if you wish to seek more detail). From January to April 2013 GCML conducted

• Review of 6 month Report 31 December 2012 (attachment 2) • Review of Gold Coast Health and Wellbeing Plan (attachment 3) • Review of Population profile (attachment 4) • Review of Taking The Pulse report (attachment 5) • an organisational review • a high level environmental scan • a review of newly emerging data (in the updated population profile) • engagement with key advisory groups

During February, March and April GCML staff lead strategic discussions with key Advisory Groups. The discussions generally covered the following questions:

• Advisory group strategic goals • Projects/activities currently underway • New regionally specific data or reports (not already reflected in planning to date) • New/emerging trends (not already reflected in planning to date) • Priorities for 2013-2014

Advisory groups consulted in this way included: • Practice Improvement Committee • Gr8 Start Early Years Alliance • Workforce Advisory and Action Group • Engagement and Planning Stakeholders Group • Allied Health Advisory Committee • Primary Care Partnership Council • Karulbo (Aboriginal and Torres Strait Islander Partnership) • Gold Coast Health and Hospital Service and Gold Coast Medicare Local Executive Steering Group

Meeting. All this work informed the development of a range of potential projects, both continuations of existing work and new proposals. But it also highlighted that there were potentially too many small projects and insufficient resourcing to achieve optimal results. Subsequently the board approved the following Principles for Planning and Prioritising Activity in 2013-14 financial year:

1. There is a stronger focus on programs that deliver greatest visible benefit and tangible outcomes to the community in the shorter term.

2. There is greater emphasis and investment in fewer activities, closely aligned to priority objectives (rather than developing discrete activities to meet every identified need)

3. Prioritise activities contribute to a coherent strategy of integrated and comprehensive primary care, recognising the key role of general practice as care coordinators.

4. Support well established and successful projects that have momentum 5. Where separately funded projects exist to meet high priority needs funding can be directed into

other areas. 6. GCML undertakes a flagship activity/ies, highly visible, evidences patient outcomes and best defines

the role and value of the ML to the greatest number of stakeholders Both continuations of existing work and new proposals were considered in accordance with the above principles and a shorter revised list of projects was determined by senior staff. As GCML is currently in negotiations to transition work which had previously been outsourced to General Practice Gold Coast, the planning meetings were held with key general Practice Gold Coast staff in attendance. Once the revised list was finalised it was cross checked ML strategic objectives, RTFF key reporting areas and Health and Wellbeing Plan priorities. This resulted in some minor amendments and the finalisation of proposed priority projects.

3.2 Provide details of your priorities

(Please refer to item 5.1 of the Guide)

See Attachment 4 Priorities

END OF TEMPLATE

Appendix B

GOVERNANCE STRUCTURE – GOLD COAST MEDICARE LOCAL

References

1 Self Reported Health Status 2011-12 and 2009/10, Hospital and health services and Medicare Locals summary report, Queensland Government, Division of the Chief Health Officer. 2 Queensland Department of Health and BreastScreen Queensland Gold Coast Service, 2013 3 National Health Performance Authority, 2013 http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Healthy-communities 4 National Health Performance Authority, 2013 http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Healthy-Communities-Australians-experiences-with-primary-health-care-2010-11/$file/HC-PatientExperience-2010-2011-Report.pdf

http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Healthy-communities

http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Healthy-Communities-Australians-experiences-with-primary-health-care-2010-11/$file/HC-PatientExperience-2010-2011-Report.pdf

http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Healthy-Communities-Australians-experiences-with-primary-health-care-2010-11/$file/HC-PatientExperience-2010-2011-Report.pdf

Documents

Executive Summary - Gold Coast Primary Health Network · PDF fileExecutive Summary . The Gold Coast Health and Wellbeing Plan is on e of ... support people to make healthy choices