Framework for development of Primary Health Care Organisations in Australia Australian General Practice Network Boundary Modelling Project. Parts 1 and 2: Introduction and State and Territory Modelling
Prepared by Carla Cranny and Dr Gary Eckstein Carla Cranny & Associates Pty Ltd
May, 2010
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PHCO Boundary Modelling Project
Contents Contents ...... i
1 Introduction ...... 1
1.1 Purpose and scope of the PHCO modelling project...... 2
1.2 Modelling project methodology ...... 3
1.2.1 Policy analysis and design criteria...... 3
1.2.2 Technical modelling ...... 3
1.2.3 Limitations...... 4
1.3 Report format ...... 4
2 Part 1: PHCO modelling and design criteria...... 5
2.1 Policy Context ...... 5
2.1.1 Need for national health system reform ...... 5
2.1.2 International trends and the role of primary health care...... 5
2.2 Primary Health Care Organisations in Australia - definitions and policy settings ...... 6
2.2.1 National Health and Hospitals Reform Commission...... 6
2.2.2 National Primary Health Care Strategy...... 7
2.2.3 Nation Health and Hospitals Network Reform Directions ...... 8
2.2.4 COAG National Health and Hospitals Agreement...... 8
2.3 PHCO Planning Principles and Design Criteria ...... 10
2.3.1 Planning principles and assumptions underpinning the modelling...... 10
2.3.2 Planning Principle 1: Form should follow function...... 10
2.3.3 Planning principle 2: PHCO Participants, Local Primary Care Networks and Partners ...... 11
2.3.4 Planning Principle 3: Plan for communities using population planning principles...... 13
2.4 Design Criteria...... 14
2.4.1 Design Criteria 1: Align PHCOs with Local Government Areas ...... 14
2.4.2 Design Criteria 2: Align PHCOs with state and territory borders...... 15
2.4.3 Design Criteria 3: Alignment with State Health Services and Hospital Networks...... 17
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2.4.4 Design Criteria 4: Primary Health Care Service Delivery Environments ...... 19
2.4.5 Design Criteria 5: Capability and critical mass ...... 21
2.4.6 Local Primary Health Care Service Provider Networks and Branch Offices...... 22
2.4.7 Teaching and training implications ...... 22
2.5 Results of the National Modelling Project ...... 23
2.5.1 Preferred Options ...... 23
2.5.2 Implementation issues and fine tuning ...... 24
3 New South Wales...... 26
3.1 Overview ...... 26
3.2 Demographic Features...... 26
3.2.1 Current population...... 26
3.2.2 Indigenous population ...... 26
3.2.3 Projected population and patterns of growth ...... 27
3.3 Structure of Health Services...... 27
3.3.1 General Practice...... 27
3.3.2 Workforce and GP distribution ...... 30
3.3.3 Area Health Services ...... 30
3.3.4 Aboriginal community controlled health services ...... 32
3.4 PHCO Design Issues in NSW ...... 32
3.4.1 Size and scale ...... 33
3.4.2 Cross border flows and communities of interest...... 33
3.5 Configuration Options for PHCOs in NSW...... 33
3.5.1 Option 1: 15 PHCOS with 8 metropolitan, Hunter and Illawarra major regional, 5 rural and flows from south west NSW to Victoria...... 33
3.5.2 Cross border flows to Victoria...... 40
3.5.3 Strengths and weaknesses...... 41
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3.5.4 Option 2: 16 PHCOS with 9 metropolitan, 2 regional, 5 rural and flows from south west NSW to Victoria...... 42
3.5.5 Strengths and weaknesses...... 42
3.5.6 Option 3: Cross border flows to Queensland, the ACT and Victoria...... 43
3.5.7 NSW/ACT Cross Border Options ...... 43
3.5.8 Option 3a: Cross border PHCO with contiguous NSW LGAs flowing to ACT...... 44
3.5.9 Strengths and weaknesses...... 44
3.5.10 Option 3b: 14 NSW PHCOs with all of Southern NSW in the ACT PHCO ...... 45
3.5.11 Strengths and weaknesses...... 46
3.5.12 Suggested approach...... 47
3.5.13 NSW/Queensland Cross Border Option...... 47
3.5.14 Strengths and weaknesses...... 48
3.5.15 Suggested approach...... 48
3.5.16 Other cross border options considered and rejected...... 48
3.5.17 Variations in the number and size of rural PHCOs in NSW...... 49
3.5.18 Option 4: 15 PHCOS with 9 metropolitan, 2 major regional, 4 rural plus flows to ACT, Victoria and Queensland...... 49
3.5.19 Strengths and weaknesses of 4 rural PHCOs ...... 52
3.5.20 Option 5:16 PHCOS 9 metropolitan, 2 major regional and 5 rural ...... 53
3.5.21 Option 6: 17 PHCOS with 9 metropolitan, 2 major regional and 6 rural PHCOs ...... 54
3.5.22 Strengths and weaknesses...... 55
3.6 Preferred NSW Option ...... 55
4 Australian Capital Territory...... 57
4.1 Overview ...... 57
4.2 Demographic Features...... 57
4.2.1 Current population...... 57
4.2.2 Indigenous population ...... 57
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4.2.3 Projected population and patterns of growth ...... 57
4.3 Structure of Health Services...... 57
4.3.1 General Practice...... 57
4.3.2 ACT Health Services...... 58
4.3.3 Aboriginal community controlled health services ...... 59
4.4 PHCO Design Issues...... 59
4.5 Configuration Options...... 59
4.5.1 Option 1: ACT as a self contained PHCO ...... 59
4.5.2 Strengths and weaknesses...... 60
4.5.3 Option 2: Single PHCO for ACT and contiguous NSW LGAs ...... 60
4.5.4 Strengths and weaknesses...... 61
4.5.5 Option 3: Single regional PHCO covering ACT and Southern NSW...... 61
4.5.6 Strengths and Weaknesses ...... 63
4.6 Preferred Option...... 64
5 Victoria...... 65
5.1 Overview ...... 65
5.2 Demographic Features...... 65
5.2.1 Current population...... 65
5.2.2 Indigenous population ...... 65
5.2.3 Patterns of growth and projected population ...... 66
5.3 Structure of Health Services...... 66
5.3.1 General Practice...... 66
5.3.2 GP Workforce Distribution...... 68
5.3.3 Trends in GP Numbers ...... 69
5.3.4 State Health Services...... 69
5.3.5 Aboriginal community controlled health services ...... 72
5.4 PHCO Design Issues...... 72
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5.4.1 Metropolitan and rural design considerations ...... 72
5.4.2 Alignment with Primary Care Partnerships and Regions ...... 73
5.4.3 Cross border flows ...... 74
5.5 PHCO Configuration Options in Greater Melbourne ...... 74
5.5.1 Metropolitan Option 1: 8 Metropolitan PHCOs...... 74
5.5.2 Strengths and weaknesses...... 77
5.5.3 Metropolitan Option 2: 7 Metropolitan PHCOs...... 78
5.5.4 Strengths and weaknesses...... 79
5.5.5 Option 3: 6 Metropolitan PHCOs ...... 80
5.5.6 Strengths and weaknesses...... 81
5.6 PHCO Configuration Options in Rural Victoria...... 81
5.6.1 Rural Victoria Option 1: 5 Rural PHCOs aligned with Regions & 2 NSW cross border...... 82
5.6.2 Strengths and weaknesses...... 86
5.6.3 Rural Option 2: 6 Rural PHCOs with 2 bi-state & 1tri-state PHCO...... 87
5.6.4 Strengths and weaknesses...... 88
5.6.5 Rural Option 3: 7 Rural PHCOs with 2 cross border services in South Australia...... 89
5.6.6 Strengths and weaknesses...... 90
5.7 Preferred Option/s...... 90
6 Queensland ...... 92
6.1 Overview ...... 92
6.2 Demographic features...... 92
6.2.1 Current population...... 92
6.2.2 Indigenous population ...... 92
6.2.3 Projected population and patterns of growth ...... 93
6.3 Structure of Health Services...... 94
6.3.1 General Practice...... 94
6.3.2 GP Workforce Distribution...... 95
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6.3.3 Trends in GP Numbers ...... 97
6.4 State Health Services...... 97
6.4.2 Aboriginal community controlled health services ...... 99
6.5 PHCO Design Issues...... 100
6.5.1 Keeping pace with growth in South East Queensland ...... 100
6.5.2 Regional, rural and remote community needs ...... 100
6.5.3 Partnerships with Aboriginal and Islander Health Services ...... 101
6.5.4 Cross border issues ...... 102
6.5.5 Alignment with hospital and health service boundaries ...... 102
6.5.6 Post 2006 Changes in Queensland LGAs and SLAs...... 102
6.6 Configuration Options...... 103
6.6.1 Option 1: Nine PHCOs - 3 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote ...... 103
6.6.2 Strengths and weaknesses...... 112
6.6.3 Option 2: 10 PHCOs – 4 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote ...... 114
6.6.4 Strengths and weaknesses...... 117
6.6.5 Option 3: 8 PHCOs – 2 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote ...... 117
6.6.6 Strengths and weaknesses...... 120
6.6.7 Option 4: 9 PHCOs – 3 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote ...... 121
6.6.8 Strengths and weaknesses...... 121
6.7 Preferred Option...... 122
7 South Australia...... 124
7.1 Overview ...... 124
7.2 Demographic Features...... 124
7.2.1 Current population...... 124
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7.2.2 Indigenous population ...... 124
7.2.3 Patterns of growth and projected population ...... 125
7.3 Structure of Health Services...... 125
7.3.1 General Practice...... 125
7.3.2 GP Workforce Distribution...... 127
7.3.3 State Health Services...... 127
7.3.4 GP Plus Initiative ...... 129
7.3.5 Aboriginal community controlled health services ...... 129
7.4 PHCO Design Issues...... 129
7.4.1 Urban and growing outer urban communities ...... 129
7.4.2 Rural and remote health services ...... 129
7.4.3 Cross border flows ...... 130
7.4.4 Alignment with SA Health Services ...... 130
7.5 Configuration Options...... 131
7.5.1 Option 1: 4 PHCOs with 3 metropolitan and1 rural PHCO aligned with health service catchments and Central Desert flows to Northern Territory...... 131
7.5.2 Strengths and weaknesses...... 134
7.5.3 Option 2: 4 PHCOs - 3 Metro configured with primary care catchments plus 1 Rural...... 135
7.5.4 Strengths and weaknesses...... 137
7.5.5 Option 3: 4 PHCOs - 3 Metro, 1 Rural PHCO & cross border flows to Victoria/NSW...... 138
7.5.6 Strengths and weaknesses...... 139
7.5.7 Option 4: 5 PHCOs – 3 Metro and 2 Rural...... 139
7.5.8 Strengths and weaknesses...... 141
7.5.9 Option 5: 5 PHCOs– 3 metro, 1 rural, 1 cross border based in SA and 1 cross border based in Victoria ...... 141
7.5.10 Strengths and weaknesses...... 143
7.6 Preferred Option/s...... 143
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8 Western Australia ...... 144
8.1 Overview ...... 144
8.2 Demographic Features...... 144
8.2.1 Current population...... 144
8.2.2 Indigenous population ...... 144
8.2.3 Projected population and patterns of growth ...... 145
8.3 Structure of Health Services...... 145
8.3.1 General Practice...... 145
8.3.2 State Government Health Services ...... 147
8.3.3 Aboriginal community controlled health services ...... 148
8.4 PHCO Design Issues in Western Australia...... 148
8.4.1 Balancing demand due to urban growth and the need to strengthen primary care capacity in rural and remote communities ...... 148
8.4.2 Central desert peoples cross border issues ...... 148
8.5 Configuration Options for PHCOs in Western Australia ...... 149
8.5.1 Option 1: 4 PHCOs with 2 metropolitan and 2 rural PHCOs and no interstate flows...... 149
8.5.2 Strengths and weaknesses...... 150
8.5.3 Option 2: 6 PHCOs with 4 metropolitan and 2 rural PHCOs ...... 151
8.5.4 Strengths and weaknesses...... 153
8.5.5 Option 3: 5 PHCOs with 3 metropolitan and two rural PHCOs...... 153
8.5.6 Strengths and weaknesses...... 156
8.6 Preferred Option...... 156
8.6.1 Transfer Jurien Bay/Dandaragan Shire to Rural South West PHCO...... 157
9 Tasmania ...... 158
9.1 Overview ...... 158
9.2 Demographic Features...... 158
9.2.1 Current population...... 158
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9.2.2 Indigenous population ...... 158
9.2.3 Projected population and patterns of growth ...... 158
9.3 Structure of Health Services...... 158
9.3.1 General Practice...... 158
9.3.2 State Health Services...... 160
9.3.3 Aboriginal community controlled health services ...... 160
9.4 PHCO Design Issues...... 161
9.5 Options considered...... 161
9.6 Preferred PHCO configuration ...... 161
10 Northern Territory ...... 163
10.1 Overview ...... 163
10.2 Demographic Features...... 163
10.2.1 Current population...... 163
10.2.2 Indigenous population ...... 163
10.2.3 Population distribution, patterns of growth and projected population...... 164
10.3 Structure of Health Services...... 165
10.3.1 State Health Services...... 166
10.3.2 General Practice...... 166
10.3.3 Aboriginal community controlled health services ...... 167
10.3.4 Regional Health Services...... 168
10.4 PHCO Design Issues...... 168
10.5 Preferred approach...... 168
10.5.1 Approach to cross border issues...... 168
10.5.2 Single PHCO with Branch Offices for Northern Territory...... 169
11 References and Appendices...... 171
11.1 Acronyms ...... 171
11.2 References...... 172
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11.3 Appendix 1 - PHCO Options by Service Delivery Environment ...... 174
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1 Introduction Australia is generally regarded as having one of the best health systems in the world with government guaranteed universal access to public health care, mid range spending on health as a percentage of GDP compared to other OECD countries, efficient health care delivery through a mixed public and private system and generally good health outcomes. However the chronic disease burden associated with an ageing population, the need to close the gap in health outcomes for indigenous Australians and perceptions of increasing demand pressures and fragmentation between health services due to differences in national and state and territory funding and governance arrangements resulted in calls for reform and renewal of the Australian health care system.
In 2007 the Australian Government appointed the National Health and Hospitals Reform Commission to undertake a wide ranging review and ” to provide advice on … practical reforms to the Australian health system which could be implemented in both the short and long term to address ... the challenges in Australia’s health system.”
The Commission’s Final Report - A Healthier Future for All Australians 1 - made 123 recommendations for long term reform to address access and equity issues, system redesign and reforms to governance, structure and stewardship to achieve ‘one national health system’.
Putting primary health care at the centre of the system ‘to create stronger primary health care services for everyone’ was a key reform proposed by the Commission. This included Commonwealth assumption of responsibility for all primary health care funding and policy and reform to the structures, linkages and performance of primary health care services.
The establishment of Primary Health Care Organisations (PHCOs) responsible for service coordination and population health planning at the local level and ‘evolving from or replacing Divisions of General Practice’ was one of the key structural recommendations about primary health care made by the Commission.
The Commission’s Final Report recommended that the Department of Health and Ageing should work with the Australian General Practice Network (AGPN) ‘to develop and establish a network of Primary Health Care Organisations that incorporate GPs and non-medical primary health care providers working in government services and private practice.’
In November last year, AGPN released Connecting Care – A Blueprint for improving the health and wellbeing of the Australian population – the role and function of Primary Health Care Organisations 2 which outlines the Network vision for the role, functions, membership and governance of Primary Health Care Organisations in Australia. AGPN has also been in dialogue about future directions with the General Practice Network and a range of key stakeholders and has commissioned research and technical studies
1 A Healthier Future for All Australians: Final Report of the National Health and Hospital Reform Commission June 2009 2 AGPN: Connecting Care – A Blueprint for improving the health and wellbeing of the Australian population – the role and function of Primary Health Care Organisations November 2009
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to inform the transitional arrangements needed to establish PHCOs nationally by 2012. This has included review of PHCO boundaries.
1.1 Purpose and scope of the PHCO modelling project The Australian General Practice Network (AGPN) commissioned Carla Cranny & Associates to undertake an independent assessment and model future requirements for Primary Health Care Organisations in Australia as part of AGPN’s response to the National Health Reform Agenda.
The brief was to make recommendations on the number, size and geographic boundaries of PHCOs using objective, nationally consistent planning criteria.
The consultation process and design and technical modelling was undertaken between January and March 2010 by Carla Cranny and Dr Gary Eckstein and drew on a range of policy directions including the Final Report of the National Health and Hospitals Reform Commission, the National Primary Care Strategy, and the Australian Government National Health Reform Plan.
The project was undertaken in a rapidly changing policy environment.
In March 2010 the Australian Government released A National Health and Hospitals Network for Australia’s Future 3 which set out the National Health Reform Plan - the Australian Government response to the Commission roadmap. In accepting 94 of the NHHRC recommendations, the Government has committed to far reaching reform of the Australian health system.
The National Health Reform Plan confirmed the Australian Government’s intention to assume funding and policy responsibility for all primary health care services and for aged care. The Australian Government also committed to become the majority funder of public hospital services including 60% of the efficient price of public hospital services for public patients; 60% of recurrent expenditure on research and training in public hospitals; 60% of hospital capital expenditure and up to 100% over time of primary care equivalent outpatient services.
The National Health Reform Plan also included commitment to structural reforms including Local Hospital Networks with local boards and local community involvement and Primary Health Care Organisations that would coordinate care for people requiring integrated acute and primary health care and link with one or more Local Hospital Networks.
In April 2010, the Government released the second part of the National Health Reform Plan - A National Health and Hospital Network: Further Investments in Australia’s Health 4 which spelt out more detail on the proposed development of primary health care including the role and functions of PHCOs and outlined additional investments in coordinated diabetes disease management, GP workforce expansion and targeted elements of hospital care.
3 Commonwealth of Australia: A National Health and Hospitals Network for Australia’s Future 2010 4 Commonwealth of Australia: A National Health and Hospital Network: Further Investments in Australia’s Health 2010
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With some refinements, the National Health and Hospitals Reform Plan was adopted by the Council of Australian Governments (COAG) 5 as the framework for national health reform to be implemented progressively from July 2010.
The COAG Agreement indicates a range of further work will be undertaken by the Australian Government and the states and territories in relation to primary health care including further work on mental health, maternal and child health and community palliative care.
1.2 Modelling project methodology The methodology used for this boundary mapping exercise involved policy review and development of design criteria for PHCOs, technical modelling incorporating analyses of demographic and population trends and alignment with health service architecture and development and testing of configuration options in each jurisdiction.
1.2.1 Policy analysis and design criteria The key elements included:
• Review of the policy context and role and function of PHCOs defined progressively by the Australian Government and the National Health and Hospitals Reform Commission;
• Assessment of the available international evidence on the size and catchment populations for primary care organisations with similar roles and functions; and
• Development of a planning framework and design and service development criteria to inform the PHCO modelling.
1.2.2 Technical modelling This included:
• Review of socio-demographic data and population trends for each state and territory and their planning regions using Australian Bureau of Statistics regional population data, state based population projections and analysis of current urban and regional development strategies;
• Analysis of 2006 Census data on socio-economic disadvantage, indigenous status, cultural diversity and English language competence; and,
• Analysis of the current health services offered in each state and territory and relevant Health Plans to provide the context for primary health care and primary/secondary partnerships and integrated service development. This included review and mapping of the distribution and population coverage of current GP Networks and the GP workforce, the number and locations of Aboriginal community controlled health services and the structure of state government run hospital and community health services.
5 Agreement has been reached with all states and territories other than Western Australia
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1.2.3 Limitations The timeframe for the modelling project meant that direct consultation on PHCO boundaries was limited to the national General Practice Network. This has meant that consultation with the wider primary health care sector, including Aboriginal community controlled health services and their peak bodies, state and territory government community health services and major non government organisations could not be undertaken.
We have used population planning principles and service delivery environments rather than the needs of any professional or provider group as the basis for PHCO boundary modelling and design. This is a robust approach given the level of diversity evident in the current structure of the primary health care sector and public and private provider mix across Australia.
However the need to better integrate service provision suggests that consultation with the states and territories and the wider stakeholder networks will need to be addressed as part of the next phase of PHCO development.
1.3 Report format The Report is structured in three parts.
Part 1 contains the policy analysis, planning assumptions and design criteria used to model PHCOs and summarises the available evidence on catchment populations for primary health care services. It also provides a national snapshot and summarises the options considered and preferred configuration/s of PHCOs in each State and Territory. Implementation issues and any fine tuning that may be required to ensure the final boundaries are robust are also discussed.
Part 2 contains the detailed description of the current and projected population and patterns of urban development in each State and Territory together with an overview of the current health service architecture and GP workforce distribution. Options for configuring PHCOs in urban and rural settings in each state and territory are then described together with an assessment of strengths and weaknesses of each option. The preferred PHCO configuration option for each State and Territory is described together with relevant implementation issues such as the need to formally negotiate cross border arrangements.
Part 3 includes Technical Appendices that provide a range of additional information. Appendices 3 – 10 in Part 3 summarise the PHCOs options in each state and territory and show the LGAs they cover, current and projected populations, current service alignments and selected socio-demographic information.
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2 Part 1: PHCO modelling and design criteria
Primary Health Care Organisations are a new entity with no current precedents in the Australian health care system. While PHCOs are expected to evolve from Divisions of General Practice they will have a wider remit to plan for the needs of local populations and communities and to work with the full range of primary health services and service providers to deliver better coordinated and less fragmented care, especially for people with chronic health problems.
In this section we look at the available international models and the policy objectives and expectations set out for PHCOs in the Australian context that define the role, functions and scope and scale of PHCOs. We then set out the planning assumptions and the national design criteria used to inform the modelling.
2.1 Policy Context
2.1.1 Need for national health system reform Australia is generally regarded as having one of the best health systems in the world. However the need to renew and reform parts of the system to reduce fragmentation in service delivery between the acute, primary and aged care sectors has been a recurring issue for almost a decade as demand for medical care, pharmaceuticals and the use of hospital care has continued to rise exponentially.
The need for structural and funding changes to strengthen primary health care coordination, the need to target resources more effectively to address the rapid growth in chronic illness associated with an ageing population, and, the need to prevent avoidable hospital admissions have been common themes.
Population ageing over the next 40 years will exacerbate all these concerns.
The 2010 Intergenerational Report Australia to 2050: future challenges 6 found that total government spending is projected to increase to 27.1% of GDP in 2049/50 with around two thirds of the projected increase expected to be on health. Spending on health will rise from 4% of GDP in 2009/10 to 7.1% in 2049/50 and the bulk of the increase will be on MBS, hospital services and the Pharmaceutical Benefits Scheme. Aged care expenditure is also projected to rise significantly from 0.8% of GDP in 2009/10 to 1.8% by 2049/50 with residential aged care recording the highest growth.
2.1.2 International trends and the role of primary health care The WHO World Health Report 2008 Primary Health Care: Now More than Ever 7found that countries at similar stages of economic development with health care systems organised around the tenants of primary health care produce the better health outcomes for their populations. This includes countries with high expenditure western style health systems as well as developing countries.
It is therefore not surprising that strengthening primary health care and care in the community has been a centre piece of health reform in many western countries grappling with similar demand pressures to Australia including the United Kingdom, Canada and New Zealand. Despite the differences in the funding
6 Commonwealth of Australia: Australia to 2050: future challenges . Treasury January 2010 7 WHO: The world health report 2008: primary health care now more than ever . 2008
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and service delivery arrangements in these countries the literature suggests that several common models and service design principles are used or recommended 8 including:
• Planning around the needs of populations and communities and across the life span;
• Focusing on improving population health outcomes through prevention and addressing the causes as well as the consequences of ill health and disability including the social determinants of health;
• Putting the ‘person or the patient’ and carers at the centre of the service system and providing support for people to ‘take control of their own health’;
• Increasing capacity to provide a wider range of care in the community by expanding the range of services available through general practice, in ambulatory care ‘one stop shops’ and community health centres and in peoples’ homes. This includes increasing access to multidisciplinary and team based models of care for people with complex and chronic illness and high long term care needs;
• Linking different service providers (and where relevant social care agencies) through local networks and partnerships that work together to assess and address local needs and that use common tools to support integrated and coordinated service provision for their clients. These can include referral systems that use common eligibility criteria, common care plans and electronic health records, evidence based service protocols and a range of flexible and fit for purpose funding models ;
• Adopting workforce structures that use the skills and competencies of the medical, nursing and allied health workforce effectively to provide integrated care for people and to address gaps in access and workforce shortages;
• Using commissioning and ‘purchasing’ approaches to address gaps in service delivery and market failures and to test innovation and new models of care; and,
• Focusing on improving quality and measuring performance in primary health care.
2.2 Primary Health Care Organisations in Australia - definitions and policy settings The National Health Reform Plan (March 2010), the National Health and Hospitals Reform Commission Final Report and the National Primary Health Care Strategy each identify Primary Health Care Organisations as a key component of the new revitalised primary care system and describe different features of PHCOs. Information drawn from these sources on the scale, roles and functions and required capabilities of PHCOs that has been used to inform the technical modelling process is summarised below.
2.2.1 National Health and Hospitals Reform Commission The National Health and Hospitals Reform Commission Final Report described PHCOs as vehicles for local coordination and planning in the following terms - “service coordination and population health planning priorities should be enhanced at the local level through the establishment of Primary Health Care
8 This is an aggregate list drawn from several international reviews and policy documents. Key references are listed in Appendix 2.
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Organisations, evolving from or replacing the existing Divisions of General Practice. These organisations will need to:
• Have appropriate governance to reflect the diversity of clinicians and services forming comprehensive primary health care;
• Be of an appropriate size to provide efficient and effective coordination approximately 250,000 to 500,000 population depending on health need, geography and natural catchment; and
• Meet required criteria and goals to receive ongoing Commonwealth funding support”
Recommendations in other sections of the Commission’s Final Report also outline strategies that are relevant to the role and operation of primary health services, family and child health services, Aboriginal community controlled health services and specialist community based mental health, rehabilitation and palliative care services. The directions proposed for these services all have implications for the wider primary care service system and the potential functions of PHCOs.
The major design guidance available was the NHHRC suggestion that PHCOs would cover geographic catchments with populations of between 250,000 and 500,000.
2.2.2 National Primary Health Care Strategy
The Australian Government identified regional integration through the establishment of PHCOs – Medicare Locals as the first building block in its National Primary Health Care Strategy.
The Strategy identifies that, to improve integration of services at the regional level, the Australian Government will build on its funding and policy responsibility for general practice and primary health care, by committing $290.5 million over four years for the establishment of a network of primary health care organisations (Medicare Locals) across Australia. Medicare Locals will be created as independent legal entities (not government bodies) with strong links to local communities, health professionals and service providers, including GPs, allied health professionals and Aboriginal Medical Services. Strong clinical leadership will be a key feature. They will work closely with local GPs and Local Hospital Networks to identify and address local needs, improve patient care and the quality and safety of health services.
The Strategy notes that Medicare Locals will be responsible for a range of functions aimed at making it easier for patients to navigate the local health care system and to provide more integrated care. They will:
a) work with local health care professionals to ensure services cooperate and collaborate with each other
b) facilitate allied health care and other support for people with chronic conditions, starting with diabetes, as identified in personalised care plans prepared by GPs;
c) identify groups of people missing out on GP and primary health care, or services that a local area needs, and better target services to respond to these gaps;
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d) work with Local Hospital Networks to identify the best pathways between services, and to assist with patients’ transitions out of hospital and, where relevant, into aged care;
e) work with aged care services to ensure that the primary health care needs of older Australians are being met at the local level;
f) deliver health promotion and preventive health programs targeted at risk factors in communities, in cooperation with the Australian National Preventive Health Agency, once it is established; and
g) as needed in the execution of other functions, undertake population level planning and potential fund-holding roles in areas of market failure.
2.2.3 Nation Health and Hospitals Network Reform Directions The National Health and Hospitals Network: Further Investment in Australia’s Health (April 2010) described PHCOs as independent legal entities with strong links to local health professionals, communities and service providers including GPs, allied health and Aboriginal Medical Services.
PHCOs will be separate from Local Hospital Networks to embed the focus on primary health care as the core of the health system. However there will be strong linkages between Local Hospital Networks and PHCOs and they will be expected to work closely to coordinate care across settings and support local service integration.
The range of functions PHCOs are expected to perform will have a strong focus on collaboration, co- operation and integration to make it easier for patients to navigate the health system and receive integrated and comprehensive health care, health promotion and prevention and local level gap analysis and targeted service development.
2.2.4 COAG National Health and Hospitals Agreement The COAG National Health and Hospitals Agreement (signed by all jurisdictions other than Western Australia in April 2010) defined the key function of PHCOs as improving patient navigation and health system integration. As part of their specific responsibilities PHCOs will:
• Work with local health professionals to ensures services cooperate and collaborate with each other so that patients can easily and conveniently access the full range of services they need;
• Facilitate allied health care and support for people with chronic conditions as identified in personalised care plans prepared by GPs;
• Identify groups of people missing out on GP and primary health care, or services that local areas need, and better target services to respond to these gaps;
• Work with Local Hospital Networks to identify the best pathways for services and to assist with patients’ transition out of hospital, and where relevant into aged care;
• Deliver health promotion and preventive health programs targeted to risk factors in communities in cooperation with the National Preventive Health Agency; and,
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• As needed in the executions of other functions undertake population level planning and potential fund-holding roles in areas of market failure and where patient needs are not being met.
The Commonwealth and States also agreed to undertake further work in relation to either transfer to the Commonwealth or strong national reform in relation to community health promotion and population health programs; drug and alcohol treatment services; child and maternal health services; and community palliative care by December 2010 and report back on specialist community mental health services for people with severe mental illness in 2011.
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2.3 PHCO Planning Principles and Design Criteria PHCOs will be independent incorporated entities that will operate in a mixed private, not for profit and public sector service delivery environment where funding arrangements and care have been fragmented and where access and differential health outcomes for some communities and some population groups remains a major issue.
This section outlines the service planning principles, assumptions and national design criteria that been used to inform the review of the PHCO configurations and to propose specific options for each state and territory.
2.3.1 Planning principles and assumptions underpinning the modelling The geographic area and service catchment covered by each PHCO will need to reflect:
• Their role and agreed range of functions;
• The range and type of primary health services and health professionals that come under the PHCO umbrella for planning, coordination and service development;
• The wider health system and community partnerships that PHCOs will need to foster and maintain to support improved health outcomes, better coordinated care and efficient and effective health system performance;
• The needs of the diverse communities and population groups they serve; and
• The needs of the health workforce they will be expected to support.
2.3.2 Planning Principle 1: Form should follow function Role and function are key considerations that underpin the structure and operation of most organisations and determine their size and scale and the type of support structures they require.
We have used the concept of ‘form following function’ as our first planning principle.
The National Health and Hospitals Reform Commission, the Australian Government, COAG and the AGPN and the General Practice Network have each outlined a vision of the role and functions of PHCOs. They are generally consistent but some differences in scope and emphasis have emerged that will no doubt be resolved or clarified during implementation.
We have taken a comprehensive view and used the PHCO roles and functions listed below to inform the modelling:
• Needs assessment, population health planning and delivery of targeted prevention and health promotion programs to address risk factors and improve the health of local communities;
• Health service development to support integrated primary health care, improved access to allied health and multidisciplinary care for people with chronic disease and address gaps in services;
• Fostering practical partnerships between general practice, the wider primary health care sector, Local Hospital Networks and aged care services. This will assist patients to navigate the health system more effectively, improve transitions between acute, primary care and aged care settings and improve access to allied health services and community based services;
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• Innovation including funds holding and commissioning for communities with gaps in service architecture;
• Capacity to provide multidisciplinary services where required to address local needs and gaps, especially in rural and remote communities; and,
• Business and system development and workforce planning, development and support as required by primary health care providers and partner services.
This suggests that PHCOs will need to be appropriately sized to engage with local communities and local service providers and networks while also having the critical mass required to undertake high quality needs assessment, planning and service development, commissioning and where required service delivery on an efficient and cost effective basis.
2.3.3 Planning principle 2: PHCO Participants, Local Primary Care Networks and Partners The primary health care architecture in Australia is complex with multiple service providers operating under different funding and governance models.
General practitioners and state government Community Health Services and specialist programs are the largest provider groups. There are also increasing numbers of allied health professionals in private practice receiving funds under Medicare and other Australian government programs such as More Allied Health Services and the non government and not for profit sector is also growing strongly.
The mix of primary health care professionals in private practice, salaried health workers and those employed in non government organisations is also changing and varies between the states and territories and in urban, rural and remote settings. For the purposes of the modelling we have assumed PHCOs will undertake planning and service development activities for and with a wide range of primary health care services and related service providers including:
• General practice;
• State community health services however managed;
• Aboriginal community controlled health services;
• Non government organisations providing care in the community and contracting to provide health and welfare services;
• Allied health professionals in private practice;
• Specialist services and programs run by state health services or Local Hospital Networks including mental health, drug and alcohol, palliative care, rehabilitation and specialist aged care and integrated chronic disease management programs;
• Local Hospital Network; and,
• Royal Flying Doctor Service and similar agencies providing remote health care.
Public health units, statutory health protection services and cancer screening programs tend to be managed as separate professional streams or as statewide services in most jurisdictions and we assume
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that this will continue pending decisions from COAG. However PHCOs are likely to collaborate in service planning and development in these areas on behalf of their members and affiliates where required.
We also expect there will be strong links with non government and not for profit providers of community based aged care, disability support and social care and family support services and agencies engaged in community development activities.
2.3.3.1 Local primary care networks In most communities we would expect PHCOs to support and maintain or facilitate the development of ‘joined up’ primary health care service provider networks to meet specific needs in local communities.
Local primary health care service provider networks will bring together local GP practices, community health staff, allied health professionals in private practice, pharmacies, specialist teams and NGOs working in a Local Government Area, a town or a specific community or region to provide multidisciplinary care and ‘joined up’ services for people and families most likely to benefit from this approach.
These local networks are more than referral systems. The services and practices involved agree to commit their resources to deliver joined up services for specific client or groups with complex health needs and agree to use common tools and multidisciplinary approaches to deliver integrated care.
Local primary health care service provider networks aim to improve functional integration between local service providers by using common assessment, referral and case management tools. They also work together to expand the services that can be offered to individuals and families by tapping into a range of available funding sources and personnel (e.g., Medicare fee for service payments, GP practice staff, special programs and state or territory funded health services) to provide the range of services required. This can include joined up early intervention services and programs for parents and families at risk and coordinated care and support services for people with complex or chronic health problems. They are also expected to bring together provider networks for interdisciplinary education and clinical networking such as the local groups developing with the support of the Mental Health Professionals Network (MHPN).
The concept of local primary health care service provider networks is evolving across Australia and there is no single model or ‘one size fits all’ approach. Several states and territories have implemented initiatives aimed at building joined up primary health care services in specific localities. These include HealthOne initiatives in NSW, Primary Care Partnerships in Victoria, Regional Health Services in the Northern Territory and Connecting Healthcare in Communities initiatives in Queensland.
The majority of primary health care service provider networks in Australia are likely to be ‘virtual networks’ that link GP practices and other primary care services working in established practices and a range of locations. In some communities, including urban and rural growth areas with workforce shortages, GP Super Clinics and community health hubs or precincts are being developed as ‘one stop shops’ offering a range of multidisciplinary primary health care services under one roof.
PHCOs are likely to play a major support role for primary health care service provider networks by providing planning and service development skills, access to practical tools and systems to support joined
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up care and assistance with workforce recruitment, development and retention. PHCOs that are regional services providers may also allocate staff time to meet gaps in the local service architecture.
Interacting with these local primary health care service provider networks will ensure that PHCOs remain connected with local communities and primary care professionals on the ground.
2.3.3.2 Other partners PHCOs will also need to collaborate with a range of human service agencies and partners around prevention, health promotion, community development, workforce development and support and research and evaluation. They include:
• Local government;
• Schools and colleges;
• Universities;
• Workforce agencies and training providers;
• Community groups and voluntary organisations;
• Aboriginal and Torres Strait Islander Councils and similar organisations; and,
• National organisations such as the National Preventive Health Agency.
2.3.4 Planning Principle 3: Plan for communities using population planning principles The National Health and Hospitals Plan indicates that population health planning and needs assessment and provision of health promotion and prevention programs to improve the health of local communities will be core business for PHCOs.
This suggests that PHCOs need to be designed around the needs of defined communities and populations and not just the current users of health services or health professional networks and communities of interest. This represents a shift in focus for GPs and other health professionals who have traditionally been concerned about the needs of their individual patients and practice users and have had limited ability to address equity and access issues within the wider community or specific population groups.
We have assumed that PHCOs will be responsible for communities and populations living in defined geographic areas or catchments made up of Local Government Areas or Statistical Local Areas. The model also includes selected socio-demographic variables and available workforce information to describe the PHCO catchments. These include:
• Current population size based on the ABS Estimated Resident Population by Region at June 2008 plus projected population in 2021 to pick up population trends in urban and regional areas that are relevant to changing primary health care requirements, especially in high growth states or regions;
• Age structure with a focus on the populations aged 0-4 years, 65 years and above and 85 years and above;
• Diversity including the size and distribution of the Indigenous population, the portion of people from non English speaking backgrounds and the percentage that speak English poorly;
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• Measures of socio-economic status – primarily the Index of Socio-economic Disadvantage as a proxy for high health care need; and,
• Workforce data for GPs derived from Division of General Practice 2007/08 annual returns. No accurate state community health staff or private allied health workforce data was available to include in the modelling.
In the future we expect that PHCOs will use a range of data to determine health need and health status including Health Survey information on risk factors and self reported health status, information on the social determinants of health and data on primary care utilisation data derived from the MBS, PBS and surveys such as BEACH and population health surveys.
2.4 Design Criteria As well as these planning principles we have also used a series of design criteria to review the initial proposals and inform the PHCO configuration options presented in Part 2.
2.4.1 Design Criteria 1: Align PHCOs with Local Government Areas PHCOs have been designed around contiguous Local Government Areas that where possible are clustered into geographic catchments with similar socio-demographic characteristics and/or similar service delivery environments.
Local Government Areas are our preferred PHCO building blocks because they provide a nationally consistent tool used by the Australian Bureau of Statistics to report socio-demographic information from the Census and other sources. They are the most commonly used geographic platform for health and human service planning.
Using LGAs will regularise the population catchments for all primary care services and will also assist with the alignment with Local Hospital Networks. State health services and most Commonwealth funded programs operate or fund services on an LGA basis.
Divisions of General Practice are currently an exception, especially in parts of Victoria, NSW, South Australia and Queensland. In many cases the original Divisions of General Practice established their boundaries based on professional networks and communities of interest rather than catchment populations. Many Divisions boundaries are still based on postcodes and cross LGA boundaries as shown in the maps in Part 2.
These populations are generally too small to provide statistically valid information on health status or service utilisation. Using LGAs as a common platform will regularise the catchments for all primary health services and provide a more reliable basis to measure the impact of health promotion initiatives.
While LGAs are the preferred building block they are not uniform in size or scale across Australia. In rural Australia LGAs tend to cover very large geographic areas that are often sparsely populated. In these cases PHCOs may consist of a large number of LGAs with a modest overall population. Queensland currently has the largest LGAs in Australia in terms of population size. Brisbane LGA covers a catchment population of over 1 million people that is socioeconomically diverse and growing rapidly.
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We split LGAs into SLAs as the basis for PHCO design in cases such as Brisbane where the size of the LGA would make the PHCO too large relative to other states or where local geography (mixed urban and rural areas) or built infrastructure (e.g. major highways segmenting LGAs) creates distinct communities with differing needs. There are PHCOs options that include SLA splits in all the mainland states. They are summarised in Appendix 2 in Part 3.
2.4.2 Design Criteria 2: Align PHCOs with state and territory borders This criterion suggests that PHCOs would generally be aligned with state and territory borders and form part of a single state or territory’s health infrastructure.
While this approach will be the norm for the vast majority of the PHCOs in Australia there are situations where more regional communities of interest, professional networks and patient flows suggest that cross border PHCOs would be viable and desirable.
Aligning PHCOs within state or territory boundaries would mean that all PHCOs were consistent with the local health service architecture and could align with one or more Local Hospital Networks established under state or territory legislation (as foreshadowed in the COAG Agreement) in each jurisdiction.
PHCOs and their members would be covered by one suite of local public health legislation and other state or territory legislation or regulation impacting on primary care professionals such as child protection policies and procedures.
It would also enable the health status and health need profile of each PHCO to be compared with the state and territory average and facilitate intra state/territory and national benchmarking and performance review.
2.4.2.1 Cross border issues and considerations Despite the apparent advantages of configuring PHCOs within jurisdictional boundaries there are examples in each mainland state and territory where strong cross border communities of interest and clinical networks exist that would warrant consideration of cross border PHCOs.
Divisions of General Practice that cross state boundaries already function successfully in several locations across Australia. They include:
• The North East Victoria, Murray Plains and Mallee Divisions of General Practice and the Albury Wodonga Region GP Network cover populations on both sides of the Murray River in south western NSW and northern Victoria. These communities have similar rural demographic profiles, common local health service architecture and clinical networks and hospital patient referrals already flow across state borders for treatment in the local regional hospital or in Melbourne for tertiary care.
• General Practice Network Northern Territory covers remote LGAs in the north west of South Australia. The arrangement enables the Central Australian Aboriginal communities that relate to the APY lands that stretch between the Northern Territory and South Australia to be covered by a single Division.
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Consultations with the State Based Organisations (SBOs) and Division feedback about regional communities of interest and patient flows across state and territory borders suggest that cross border PHCOs need to be considered.
We have developed options for cross border PHCOs where populations and services have one or more of the following characteristics:
• Remote locations where traditional ‘cultural communities of interest’ operate that cross state borders such as the APY lands in Central Australia;
• Rural communities near state borders that have similar agricultural and socio-demographic features and where distances mean residents use the service centre and health services closest to where they live;
• Locations where a regional service centre in one state or territory acts as the hub for a large rural region with dispersed local populations. The regional hub is generally the major population centre and is the location of the major secondary hospital or tertiary referral centre. It supports the network of medical specialists that serve the region, acts as the base for clinical education and training, and, is the major site for employment and other regional services; and,
• Coast growth areas where urban development plans and road and transport networks link populations across state borders. Specialist referrals and hospital patient flows operate across state borders and GPs and other primary care services are often part of a larger regional network.
We have developed cross border PHCOs as part of one or more configuration options in all the mainland states and territories using these criteria. The Options and their respective strengths and weaknesses are described in Part 2. Their merits need to be assessed on a case by case.
2.4.2.2 Implementation Issues The COAG Agreement has confirmed that the Australian Government will be responsible for primary health care policy and funding. However the operational arrangements for specialist services such as mental health and community palliative care and the ongoing management arrangements for state and territory Community Health Services are not yet clear.
General practice, private allied health providers and many NGOs services that receive Australian Government funding (including MBS and program funding) already operate across state and territory boundaries and affiliation with a cross border PHCO will not result in major change.
It is possible that each jurisdiction will continue to manage a range of Community Health Services and that cross border PHCOs will need to interact with Community Health Services that are managed by more than one jurisdiction.
Transparent interstate agreements and local service level agreements are likely to be required for state and territory managed Community Health Services that come under the umbrella of a cross border PHCO and for cross border PHCO linked with Local Hospital Networks in different jurisdictions.
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The current cross border arrangements under the Australian Health Care Agreements that cover transfer payments for public hospital patient flows between jurisdictions offer one possible prototype for cross border PHCOs. However developing targeted service level agreements that aim to ensure consistency in service provision and coordinated care arrangements irrespective of the management of the service in question may be a more desirable approach.
These issues will need to be resolved as part of PHCO implementation.
2.4.3 Design Criteria 3: Alignment with State Health Services and Hospital Networks PHCOs are designed to strengthen the primary health care focus of the Australian health system and to strengthen coordinated and integrated care in the community, especially for people with chronic and complex health problems and the elderly.
Criterion 3 suggests that PHCOs will need to have effective links with hospitals to plan better systems of care and to support patients to transition seamlessly from hospital to community settings and vice versa when needed.
Integration is also required with a range of specialist health services, including mental health, palliative care, drug and alcohol and rehabilitation services that are often managed as programs made up of a mix of inpatient care, outpatient or ambulatory and community based services. Involvement in planning the best mix of these services across the continuum and building effective links between primary care and specialist providers will be an important focus for PHCOs.
Our consultations with SBOs and Divisions of General Practice (undertaken before the release of the National Health and Hospitals Reform Plans which outlined the role and scope of Local Hospital Networks) identified a range of other reasons why appropriate alignments and partnerships between PHCOs and hospital services or networks were desirable:
• The importance of an integrated approach to referral, admission and discharge and post acute care arrangements between hospitals, GPs and primary care services;
• Teaching and training linkages;
• The need to plan together to manage demand and improve service design in urban growth areas where there are workforce shortages that impact on general practice and the hospital sector; and,
• Clarity for rural general practitioners who provide medical services as VMOs or on salary in rural community hospitals and Multi-Purpose Services or are part of the emergency and primary care services provided in remote communities. These rural GPs need to interact with local management and Local Hospital Networks as well as providing primary care.
2.4.3.1 Alignment issues While alignment with a range of state health services including hospital networks is desirable there are a number of challenges in designing a nationally consistent approach. They include:
• There are significant differences in the size and scale of Districts, Regions, Area Health Services and Hospital Networks operating across Australia. Some Areas and Regions have catchment populations
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of 1.2 million people or more and cover several distinct communities with different service and access needs while others serve much smaller populations.
• Hospital role delineation can impact on local relationships. Some Areas and Networks cover a tiered network of hospitals with different roles, areas of specialisation and capacity while others have one or more acute general hospitals or several smaller community hospitals or Multi-Purpose Services with strong links to primary care and local GPs. Where there is strong role delineation between hospitals within the local catchment, GPs will need relationships across the wider network to facilitate appropriate referrals and discharge planning.
• The catchment populations of some of the larger Areas or Hospital Network are designed around the population needed to support major trauma services or low volume high cost tertiary sub specialties (1 million to 2 million people depending on the specialty) and the critical mass needed for major teaching hospital functions.
• Some states and territories have integrated hospital, community health and specialist services that serve a common population base or catchment whereas others such as Victoria have slightly different planning templates for Hospital Networks, Primary Care Partnerships and Human Service Regions.
• In states with large sparsely populated rural areas specialist care is often highly centralised with rural people travelling to metropolitan or large regional centres for acute hospital care.
• Community Health type services are not delivered by the same agency in every jurisdiction. Child and family health services are aligned with Health in some jurisdictions and provided by other Human Services Agencies in others. Community nursing is provided by NGOs or Local Government in some jurisdictions and by Areas or Districts in others.
2.4.3.2 Mapping the service system The following approach has been used to assess the current and potential links between PHCOs and state health services.
Primary health care design criteria (populations and service delivery environments) were used to establish baseline catchments for PHCOs and then mapped to the most relevant state and territory health service structures (Regions, Area Health Services, Districts, Hospital Networks, Primary Care Partnerships etc) and to the current Divisions of General Practice to shown the current alignment of services. These alignments are shown in overview in Part 2 and in detail in Part 3.
In some PHCO Options the proposed boundaries align with current state health services but in many cases they differ. Several PHCOs have a primary health care catchment rather than a hospital catchment (for example we have used the Primary Care Partnerships catchments in Victoria as one of our building blocks rather than Hospital Network catchments) and we have used a regional approach in large rural areas where there are many small community hospitals with very localised catchments and fly-in or mobile primary care services.
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Our modelling was undertaken before the release of The National Health and Hospitals Reform Plans which described Local Hospital Networks that are now being developed by each State and Territory under the COAG National Health and Hospitals Reform Agreement.
We expect there will be similarities between the PHCO boundaries and Local Hospital Networks in some urban areas where the proposed PHCO boundaries coincide with hospital catchments that would support a logical Local Hospital Network. However there are other cases where we have opted for large scale PHCOs that will need to relate to more than one Local Hospital Network when their boundaries are confirmed.
2.4.4 Design Criteria 4: Primary Health Care Service Delivery Environments This Criterion suggests that the design of PHCOs should also reflect the primary health care service delivery environment in which the PHCO will operate and factors such as access to services and workforce availability that will shape the range of functions the PHCO will need to perform.
We have identified 6 primary health care zones with distinct service development needs and service delivery challenges.
Established urban areas in the inner and central ring of most of the capital cities have relatively high population densities and ethnically diverse communities but fewer humanitarian arrivals. These areas generally have a relatively large primary health care workforce with large established GP practices as well as medium sized practices and partnerships. These areas also have good access to private allied health services including sub specialty services and to Community Health Services.
Many of the GPs and private allied practices in urban areas have a mobile patient population and serve commuters who work in the city centre as well as local residents. Many of these areas have been gentrified or are targeted for high density urban infill development so the socio-demographic profile is changing.
PHCOs operating in this environment could be expected to play a major role in health planning and development of coordinated systems of care with a wide network of established providers and with local hospitals. They may also focus on addressing gaps in the local service architecture, health improvement and health promotion initiatives and providing workforce and practice support.
Outer urban growth areas include new and emerging communities where major population growth is planned on the urban fringes of all our capital cities. These communities have a higher proportion of young families accessing affordable housing and include public housing estates or other forms of low cost housing being developed under national housing initiatives. Some families in these communities experience economic pressures and other forms of disadvantage including higher levels of unemployment and intergenerational poverty. These areas also tend to attract more recent arrivals and humanitarian refugees.
In some states including South Australia, Victoria, Queensland and Western Australia outer urban growth areas take in semi rural or coastal communities that are growing because of migration by tree changers and retirees.
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Outer urban growth areas often face major issues in terms of access to comprehensive primary care services. They experience GP shortages relative to population need and have significant gaps in private allied health services and community health services. Large corporate practices operate in some of these locations but small GP practices are also common.
Health service supply (GPs, Community Health and hospitals) has struggled to keep pace with rapid population growth in many of these communities which results in short and medium term workforce catch-up needs.
PHCOs operating in these environments may commission services to fill gaps and target population groups with high health needs, support capacity building with other agencies and provide high levels of practice and workforce support to help recruit a stable local workforce. They are also likely to need to work closely with local hospital services to develop integrated systems to manage emergency and after hours demand and chronic health problems and to provide shared care programs.
Rural regional centres in inland areas or on the coast (populations ranging from 30,000 to 50,000 with a regional catchment of 100,000 to 250,000 people) exist in most states and territories and act as the major service hubs for the surrounding rural communities. The Centres tend to have stable or growing populations and relatively stable health service architecture.
As well as a regional or base hospital offering specialist acute care, these centres also host the specialist community health teams for the region including mental health, drug and alcohol, allied health, dental and family support services and also provide the majority of private allied health services. There are regional centres in all the mainland states and in Tasmania and the ACT functions as the region hub for southern NSW.
PHCOs in this environment may need to act as a regional auspicing body or regional service provider supplying services locally and on an outreach basis to surrounding small communities. They will also provide workforce development and practice support.
Rural towns (typically ranging in size from 5,000 to 15,000 population) will typically have a district or community hospital with GP involvement and some visiting specialists, a community health service offering generalist services and salaried allied health professionals working across hospital and community settings. Larger towns may also have private allied professionals in some disciplines. Recruiting and retaining sufficient health professionals is a challenge and many of these communities rely on international medical graduates and some visiting services.
PHCOs in these areas are likely to be local or regional service providers and act as a support hub for GPs and other primary health care staff working in smaller towns.
Small rural communities (populations under 5,000 but typically under 2,000) are likely to have a small community hospital or Multi-Purpose Service with integrated and visiting Community Health Services and one or more small GP practices. Recruitment and retention is a major issue and many of these areas rely on international medical graduates who can have high professional and practice support needs.
PHCOs covering these communities are likely to be service providers employing allied health and other providers as well as providing a range of support including locum services for GPs in smaller towns.
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Remote rural communities with low density populations dispersed over vast distances are found in Far North Queensland, the Northern Territory, the Kimberley, Pilbara and Goldfields Regions in Western Australia, rural South Australia and Far Western NSW. Many of these communities have large Indigenous populations with significant health needs and a younger age profile than the state or territory average.
Primary health care is the main form of service delivery in many of these communities and the population needs to travel to cities or regional centres for most hospital care. These communities rely on skilled rural generalist GPs and rural health nurses who are often salaried and Aboriginal Community Controlled Health Services. Fly-in services provide specialised primary care, mental health and drug and alcohol services and multidisciplinary chronic disease teams. These communities face major workforce challenges and require skilled and well supported rural health staff.
PHCOs operating in these environments will need to be service providers as well as providing practice and workforce support for the established local workforce. Many are likely to be in a consortium or a formal partnership with Aboriginal Community Controlled Health Services, rural health services and fly-in service providers. They will use funds pooling models and other arrangements to commission effective service for local communities.
Appendix 2 in Part 2 shows each of the PHCO options proposed in each jurisdiction and the service delivery environment or settings in which they will operate.
2.4.5 Design Criteria 5: Capability and critical mass PHCOs represent a new entity in the Australian health system landscape with a wider range of functions than current GP Divisions or other primary care or community health services. They are expected to play a major role in working with networks of local service providers to improve coordination and quality of care; to implement health promotion and prevention programs; and, to provide or commission services to address the needs of specific high risk populations or where there have been market failures.
The NHHRC Final Report suggested that PHCOs would cover catchments ranging in size from 250,000 to 500,000 people. However the diverse service delivery environments in which PHCOs will operate and the differences in the densities of population in urban, rural and remote areas in Australia suggest a wider population range is needed.
In review and modelling of PHCO configuration options we have tried to balance the issue of local connectedness with the size and scale required to have capable organisations with the critical mass and skills required to hold budgets and manage the risks associated with commissioning and with service provision in high need communities. We have opted for large scale PHCOs in many areas to ensure they have the critical mass they need to fulfil the required range of functions and to lead change and reform in the sector.
This approach reflects the views that PHCOs need to be large enough to operate as equal partners in the design and delivery of integrated models of care and to have real bargaining power in their relationships with Local Hospital Networks.
The configuration options that have been developed include PHCOs ranging in size from 100,000 to over a million people. The size of the catchment population varies according to the service delivery environment
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in which the PHCO operates and the density of the population in the geographical areas they cover. They include:
• Remote and rural populations ranging in size from 102,000 to 260,000;
• Rural and regional communities with populations ranging in size from 136,000 to 490,000;
• Large mixed urban and rural populations ranging in size from 380,000 to 600,000;
• Medium sized metropolitan communities with relatively homogenous population and discrete geography ranging in size from 300,000 to 500,000; and,
• Large metropolitan and urban growth areas with populations ranging in size from 560,000 to more than 1 million.
2.4.6 Local Primary Health Care Service Provider Networks and Branch Offices Whatever their size and scale PHCOs will need to work effectively with local primary health care service provider networks and services to address gaps or to target specific health problems or needs in their local communities. We expect that the development of primary health care service provider networks will be encouraged in all settings and their scale and focus will be locally determined.
While medium to large scale PHCOs are the preferred model overall the distances between communities in rural and remote Australia mean large scale PHCOs may face challenges in terms of effective communication and local community connectedness. As well as working with local service provider networks in all settings, PHCOs covering dispersed populations are also likely to need local Branch Offices to ensure they are locally engaged, can build effective relationships and practical partnerships and provide cost effective support services, especially in high need or isolated communities.
Each PHCO will need to determine the number and location of Branch Offices required during the next stage of planning. Consultation with SBOs and some Divisions suggests that Branch Offices are likely to be required where PHCOs need to:
• Function as a local service provider in parts of their service catchment to address gaps in the available primary care services;
• Target the needs of rural communities where a large PHCO has a regional focus that includes distinct urban and rural catchments with different service architecture and workforce; and,
• As part of the structure and governance arrangements required for PHCOs operating across state and territory borders.
Using these criteria the modelling suggests that over 20 Branch Offices could be required nationally.
2.4.7 Teaching and training implications The need to align PHCO boundaries with existing GP teaching and training networks was identified by some Divisions as an important variable that should be considered in the PHCO modelling. While we acknowledge their importance, we have not used current teaching and training networks to define PHCO boundaries for a range of reasons.
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Many of the existing GP training networks are based on professional networks and collaborating practices that cover supra regional catchments that were not designed around the needs of local populations and do not cover contiguous LGAs. The communities of interest that underpin these networks are based around individual clinical leaders and practices and may change over time.
Undergraduate and post graduate training in all health disciplines is expanding rapidly and changes such as national registration and rural placements in many disciplines impact on training requirements. Universities and other training organisations are developing affiliations with a broad range of service providers to meet demand for supervised clinical placements. Training providers often work with hospitals and practices in several states and these arrangements are likely to continue in the foreseeable future.
The educational models used are also changing as more training programs are delivered using distance and online learning and more clinical placements are planned outside hospital settings.
PHCOs need to support teaching and training activities for the entire primary health care workforce including general practice, allied health professionals, community nurses and Aboriginal Health Workers. This means PHCOs will need to work closely with a wide range of teaching and training organisations and have the flexibility to negotiate partnerships that suit their local needs and that may need to change over time. These partnerships will not be dependent on nor should they determine PHCO boundaries.
2.5 Results of the National Modelling Project The results of the PHCO modelling project are summarised in Table A and the detail by jurisdiction is contained in Part 2.
Options for between 44 and 60 PHCOs across Australia have been modelled in this report and the strengths and weaknesses of each configuration are discussed in Part 2.
The number of PHCOs proposed in each state and territory is generally consistent with the size and distribution of their population with the largest numbers of PHCOs in NSW, Victoria and Queensland and one large PHCO proposed in Tasmania, the ACT and the Northern Territory. In states such as Western Australian and South Australia and in the Northern Territory that have vast sparsely populated rural and remote regions a smaller number of large PHCOs are proposed supplemented by Branch Offices to maintain connectedness with local communities. The same approach has been adopted in Tasmania.
Seven of the recommended PHCOs cross state and territory boundaries and the rationale to establish cross border PHCOs is discussed on a case by case basis in Part 2.
2.5.1 Preferred Options In line with the project brief we have nominated a preferred option in each state and territory based on best fit with the design criteria described above.
However in some instances more than one configuration option would be equally valid. This is especially true for some of the rural PHCOs where a trade off between PHCO critical mass and local connectedness for high need rural or remote communities may be appropriate. The National Summary includes two core Options to address this concern.
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Option 1 suggests that 52 large and capable PHCOs would form the national core with one each in the Australian Capital Territory, the Northern Territory and in Tasmania, five in both South Australia and Western Australia, nine in Queensland and fifteen in both NSW and Victoria.
Option 2 suggests 53 PHCO would form the national core with sixteen PHCOs in NSW including 5 rural. Option 2 also suggests that approximately 22 branch offices could be needed to maintain both local connectedness and the benefits of scale in some of the large regional, rural and remote and cross border PHCOs.
Both these Options assume that 7 cross border PHCOS are established to address significant communities of interest between the mainland states and territories.
Table A: National Options Summary State Lower Upper Option 1 – Large and capable Option 2 – Expand number of Cross border PHCOs rural PHCOs and add rural implications branch offices
NT 1 1 1 PHCO 1 PHCO with 2 branch offices Central desert communities flow from WA and SA TAS 1 1 1 PHCO 1 PHCO with 3 branch offices
ACT 1 2 1 - large regional with Southern 1 - large regional with Southern Potential for 1 PHCO NSW and 1 branch office NSW and 1 or 2 branch offices with part or all of Southern NSW WA 4 7 5 PHCOs - 3 metro & 2 rural and 5 PHCOs - 3 metro & 2 rural & Flows to NT remote remote with 3 or more branch offices SA 4 5 5 PHCOs - 3 metro and 2 rural and 5 PHCOs - 3 metro & 1 SA rural Lower Murray (Vic, SA remote and remote plus 2 cross border (1 NSW) & Otway/ in SA, 1 in Vic) with 2 to 4 branch Limestone (Vic/SA) offices VIC 11 15 15 PHCOs - 8 metro & 7 rural 15 PHCOs - 8 metro & 7 rural Potential for three with cross border with cross border PHCOs with NSW and 2 with SA NSW 17 17 15 PHCOs - 9 metro, 2 large 16 PHCOs - 9 metro, 2 large Potential for 1 PHCO regional & 4 rural and remote regional with branch offices & 5 with ACT, 3 with rural and remote Victoria, 1 with SA and 1 with Queensland QLD 8 12 9 PHCOs - 3 metro Brisbane, Gold 9 PHCOs - 3 metro, Gold Coast, Potential for 1 PHCO Coast, Sunshine Coast/Wide Bay Sunshine Coast/Wide Bay & 4 between Tweed A and and 4 rural and remote with rural and remote with 6 or more the Gold Coast branch offices branch offices Total 44 60 52 core 53 core plus approximately 22 7 cross border PHCOs branch offices
2.5.2 Implementation issues and fine tuning Most of the PHCO boundary issues that will need to be addressed as part of the next phase of planning are identified in Part 2 and relate to selection of the Options that are most appropriate in each state and territory and decisions in relation to cross border PHCOs.
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If cross border arrangements do not proceed on policy grounds then the populations concerned can generally be absorbed by the adjoining PHCO in their state or territory of origin without increasing the number of PHCOs. NSW will need at least 17 PHCOs if Southern NSW does not form part of a cross border PHCO with the ACT and review of the proposed boundaries in south western NSW may also be required to establish a larger PHCO in the Riverina /Murrumbidgee area.
In some instances we have made arbitrary decisions about the allocation of Statistical Local Areas and our choices and other options are discussed in Appendix 2 in Part 3. These and similar issues highlighted in the state and territory profiles are part of the fine tuning that should occur as part of the next phase of planning.
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3 New South Wales 3.1 Overview NSW is the most populous state in Australia and is bounded by Queensland in the north, South Australia in the west and Victoria in the south. NSW covers an area of 809,400 square kilometres and the population is concentrated in Sydney, the Hunter and Illawarra regions and large coastal cities to the north and south of Sydney. The rural and regional areas west of the Great Dividing Range are more sparsely populated with substantial regional cities on the western slopes and in the south west that act as hubs for agriculture and human services.
3.2 Demographic Features
3.2.1 Current population New South Wales had an estimated resident population of 6,984,172 people at June 2008 and this grew by 1.7% to 7.1 million by June 2009. The annual growth rate for 2008-09 was higher than the previous five years. While NSW remains the most populous state in Australia it has been growing more slowly than the national average of 2.1% and ranked behind Western Australia (3%), Queensland (2.6%), the Northern Territory (2.3%) and Victoria (2.1%) in terms of annual growth in 2007/08.
At June 2008 9 4.4 million people or 63% of the NSW population resided in Sydney and 2.58 million or 37% of the NSW population lived in regional and rural areas.
The 9 LGAs recording the largest population growth were in Sydney and included Blacktown, Parramatta and Baulkham Hills LGAs in the north west, Liverpool in the south west and inner city LGA of Sydney. Fast growth is occurring in western, inner western and south western LGAs including Auburn, Parramatta, Sydney, Strathfield, Canada Bay, Camden and Holroyd.
The fastest growing Statistical Districts outside Sydney were Richmond-Tweed (1.6%), Mid North Coast (1.1%), Hunter and South Eastern (1.1%) which recorded above state average growth while Central West, North Western and Northern Statistical Districts all recorded growth rates under 0.5%. Far West experienced population decline.
Growth remained strong in the 21 coastal LGAs in NSW (including Sydney) and one third of the coastal areas outside Sydney including Tweed, Illawarra, Lake Macquarie and Newcastle, Port Macquarie, Coffs Harbour, Shellharbour, Byron and Ballina all recorded growth rates above the state average.
The inland population of 1.2 million people grew by 0.7% in 2007/08 with the main increases occurring in Maitland and Cessnock in the Hunter region, regional centres including Wagga Wagga and in Queanbeyan, Palerang (A) and Yass Valley which share borders with the ACT.
3.2.2 Indigenous population There were estimated to be 138,507 Aboriginal and Torres Strait Islander people in New South Wales in 2006 and indigenous people made up 2.1% of the NSW population compared to 2.5% for Australia. NSW
9 Regional population growth data was only available Australia wide for 2007/08 when this report was compiled.
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had 28.3% of the Australian indigenous population. This is likely to be an underestimate due to the high rates of under reporting in many communities.
Approximately 42,000 indigenous people or 30% of the population lived in Sydney, 42% live in major cities and 5% of the indigenous population live in remote or very remote areas as shown in Table 1. The Indigenous Regions with the highest indigenous population include Sydney, Coffs Harbour, Wagga Wagga, Tamworth, Dubbo and North Western NSW and Queanbeyan.
Table 1: Indigenous population by Remoteness Areas - 2006 Census Major Cities Inner Regional Outer Regional Remote Very Remote Australia Australia Australia Australia % % % % % NSW 42 33 19 4 1 Australia 31 22 23 8 16 Source: Population distribution Aboriginal and Torres Strait Islander Australians ABS 4705. 2006
Indigenous people in NSW have a younger age profile, higher fertility rate and higher premature mortality rate than the population as a whole.
3.2.3 Projected population and patterns of growth NSW Health Population Projections estimate that NSW will have a population of 8.006 million by 2021. The NSW Government Metropolitan Strategy and City of Cities – a Plan for Sydney’s Future 10 and related regional planning strategies indicate that Greater Sydney will continue to absorb the majority of population growth.
New release areas in the south west and north-west of Sydney will continue to provide new housing stock and new communities on the urban fringe but urban consolidation through infill development and higher densities in established inner ring suburbs around transport hubs is also proposed.
In terms of regional trends expansion of major regions including the Hunter and Illawarra is expected together with continuing growth on the north and south coasts and expansion of regional inland centres. Overall inland communities are expected to remain stable.
3.3 Structure of Health Services
3.3.1 General Practice There are 33 Divisions of General Practice in NSW as shown in Figure 1 and Figure 2 including 15 that are classified as rural and remote and entitled to More Allied Health Services program funding. The key characteristics of the NSW Divisions operating in 2007/08 are shown in Table 2 and there have been some restructures and several NSW Divisions have amalgamated since the data in this Table was collected.
The Division catchments range in size from 529,000 residents in Central Sydney to 15,000 in the Outback Division. The boundaries of the Divisions in NSW have evolved differently across the State and in metropolitan Sydney are based on postcodes not LGAs and local communities of interest. The shaded areas in Figure 1 show where the current Division Boundaries cross Local Government Areas.
10 Department of Planning : City of Cities – a Plan for Sydney’s Future, 2009
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Figure 1: Current NSW Divisions of General Practice
Figure 2: Current Metropolitan Sydney Divisions of General Practice
There is a relatively poor alignment between Division catchments and Local Government Areas in NSW and the hatched areas show where Divisions cross LGA boundaries.
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In terms of workforce and practice characteristics in 2007/08 there were:
• 7,388 practising GPs in NSW of whom 2,692 or 36% were female
• 918 people per GP or 1,035 per GP FWE
• Approximately 2,782 general practices including 1,298 solo practices or 46.6% of the practice base
Table 2: New South Wales Divisions of General Practice Key Characteristics 2007/08 Name of Division of General Practice Pop Total Solo Estimated Number FWE GPs GPs: FWE 2007 B number practices number of as at pop GP: of of female 30/06/07 E 2007 pop practices practising GPs ratio 2007 GPs ratio Central Sydney General Practice Network 529763 302 159 635 298 579 834 915 Eastern Sydney Division of General Practice 185563 156 70 479 183 248 387 748 South Eastern Sydney Division of General Practice 190149 83 50 211 88 176 901 1080 Bankstown General Practice Division 174360 98 57 158 47 224 1104 778 WentWest Ltd 489561 206 114 536 165 576 913 850 Northern Sydney General Practice Network 222596 100 29 334 186 215 666 1035 St George Division of General Practice 235638 125 66 282 76 244 836 966 Fairfield Liverpool Interim General Practice Support * 396715 198 120 404 77 427 982 929 GP Network Northside 412579 154 52 503 271 372 820 1109 Manly Warringah Division of General Practice 226230 74 28 211 93 185 1072 1223 Sutherland Division of General Practice 213076 71 24 225 94 195 947 1093 Macarthur Division of General Practice 232660 89 54 208 49 250 1119 931 Illawarra Division of General Practice 279518 88 39 228 71 270 1226 1035 Hunter Urban Division of General Practice 460793 151 66 446 192 394 1033 1170 Hunter Rural Division of General Practice 213522 71 32 224 53 188 953 1136 NSW Central Coast Division of General Practice 302672 94 38 304 91 301 996 1006 Shoalhaven Division of General Practice 92167 37 17 109 24 87 846 1059 Southern General Practice Network 203608 58 15 213 69 130 956 1566 Hastings Macleay General Practice Network 101422 37 15 107 25 109 948 930 Mid North Coast Division of General Practice 134642 47 17 132 42 111 1020 1213 Northern Rivers General Practice Network 169531 76 26 208 63 146 815 1161 Tweed Valley Division of General Practice 88137 33 9 112 33 91 787 969 New England Division of General Practice 65663 29 13 64 24 49 1026 1340 Riverina Division of General Practice & Primary Health 136406 31 9 86 28 109 1586 1251 NSW Central West Division of General Practice 172156 53 23 130 42 142 1324 1212 Dubbo Plains Division of General Practice 100109 34 14 87 25 77 1151 1300 Barwon Division of General Practice 51107 18 6 49 15 41 1043 1247 Murrumbidgee Division of General Practice 60500 22 12 48 10 50 1260 1210 NSW Outback Division of General Practice 15932 9 3 13 3 15 1226 1062 Southern Highlands Division of General Practice 50945 19 6 64 25 44 796 1158 North West Slopes (NSW) Division of General Practice 63233 26 18 49 20 36 1290 1756 Nepean Division of General Practice 178385 79 48 177 52 196 1008 910 Blue Mountains Division of General Practice 76364 23 11 65 31 57 1175 1340 Hawkesbury-Hills Division of General Practice 259984 85 37 263 118 222 989 1171 Barrier Division of General Practice+ N/A 6 1 24 9 N/A N/A N/A Source: Primary Health Care Research & Information Service Division Profiles * Now part of Macarthur + Linked with Riverina
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3.3.2 Workforce and GP distribution The population to FWE 11 GP ratios in 2007/08 suggest that the inland rural areas including North West Slopes (FWE GP to population ratio of 1756), Southern NSW (1566), New England (1340) and Dubbo Plains (1300) are the areas of greatest GP workforce shortage in NSW.
In metropolitan areas the outer urban growth areas such as Hawkesbury Baulkham Hills in Sydney’s north west (FWE GP to 1171 population), Blue Mountains (1340) and Manly Warringah (1223) face shortages or are above the NSW and national ratios.
The established metropolitan communities in the north, west, south west, south and eastern suburbs of Sydney are generally at or below the NSW average and national averages.
Overall there has been a steady increase in the number of GPs in NSW as shown in Figure 3 from a low of 6,917 in 19999/2000 to a high of 7,388 in 2007/08 despite a downward dip to 7,131 in 2004/05.
Figure 3: Trends in NSW GP Workforce
3.3.3 Area Health Services There are currently 8 regionally based Area Health Services in NSW and their boundaries are shown in Figure 4.
They include four regional and rural Areas in Greater Western, Greater Southern, Hunter/New England and North Coast and four Metropolitan Areas including North Sydney and Central Coast, South Eastern Sydney and Illawarra, Sydney South West and Sydney West Area Health Services.
Each of these Areas operates a range of hospitals and community health services and most are organised into geographic clusters or networks. While not contiguous in every case current GP Divisions catchments align more closely with these local networks or clusters than the larger Area boundaries.
11 See PHCRIS website for Full time Workload Equivalent definition used by Department of Health & Ageing
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Figure 4: NSW Area Health Services 2010
3.3.3.1 Hospital Services The hospital configuration varies in line with population density and growth across NSW.
Principal referral or metropolitan teaching hospitals offering tertiary services for their region and the state operate or are being expanded at Westmead, Liverpool and Nepean in the greater West; Camperdown in central Sydney; Potts Point, Randwick and St George in the south east; St Leonards in Northern Sydney and in Newcastle, Wollongong and on the Central Coast.
Major metropolitan hospitals that supply emergency care and high volume secondary services, specialist sub-acute and mental health facilities operate throughout Sydney, Hunter, Illawarra and on the Central Coast.
Rural referral hospitals with specialist staffing operate or are being upgraded in the regional growth centres on the coast and key inland centres including Port Macquarie, Coffs Harbour, Lismore, Tweed Heads, Orange/Bathurst, Dubbo, Wagga Wagga, Albury and Tamworth. There are rural Base Hospitals in other rural centres including Broken Hill and a new regional hospital is being planned at Bega on the South Coast.
The majority of rural hospitals in NSW are small Community Acute and Non Acute Hospitals with less than 30 beds and Multi-Purpose Services that provide general medical, emergency and aged care services for their local community. Many of these hospitals rely on GP VMOs for medical staffing.
3.3.3.2 Community Health Services Community health services are generally integrated with hospital services or serve defined geographic areas in NSW and the operating models vary. Community nursing, child and family health, chronic
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disease, aged care and community rehabilitation, mental health, dental health, health promotion and specialist services are the major programs offered. Metropolitan areas tend to have free standing Community Health Centres used by a range of multidisciplinary and specialist teams and post acute care services linked with major acute hospitals. Rural community health services have specialist teams in the regional centres and generalists offering a range of programs in medium and small rural communities. Staffing is integrated in small rural hospitals and MPSs. 12
3.3.3.3 HealthOne and Other Community Initiatives Innovative service models are being developed. The NSW HealthOne Initiative is being rolled out in rural and more disadvantaged metropolitan areas and aims to integrate general practice, community health and non government services in ‘one stop shop’ facilities or virtual networks.
More Allied Health Services and Rural Health Services are Commonwealth funded programs that are auspiced by Divisions in many parts of NSW. The Royal Flying Doctor Service also provides fly-in fly-out primary care clinics in rural and remote communities and there are nurse led primary health care posts in several small communities.
NSW Health is also contracting community care services including HASI mental health services and CAPC post acute services from non government providers.
3.3.4 Aboriginal community controlled health services The Australian Government Office of Aboriginal and Torres Strait Islander Health currently funds approximately 59 organisations in NSW. This includes 44 Aboriginal Community Controlled Health Services that are members or affiliates of NACCHO and several specialist services and organisations.
There are Community Controlled Health Services in Newcastle, Muswellbrook, Wyong, Inverell, Armidale, Gunnedah, Tamworth, Mungindi, Toomelah, Moree, Caroona, Coonamble, Dubbo, Wellington, Narromine, Gilgandra, Balranald, Dareton, Menindee, Broken Hill, Wollongong, Nowra, Condobolin, Lake Cargelligo, Orange, Parkes, Peak Hill, Forbes, Redfern, Mt Druitt, Campbelltown, Taree, Grafton, Kempsey, Casino, Port Macquarie, Coffs Harbour, Forster, Nambucca, Bourke, Brewarrina, Cobar, Walgett, Brungle, Griffith, Wagga Wagga, Narooma, Queanbeyan and Albury.
The NSW Aboriginal Health and Medical Research Council is the state peak body and has 44 members and 14 associate members.
3.4 PHCO Design Issues in NSW The key issues for PHCO design in NSW include:
• The size and critical mass of PHCOs that are needed in NSW to respond to coastal growth and the urban regional hub strategies planned for Sydney, Newcastle and Wollongong as well as the needs of inland regional centres and sparsely populated rural and remote communities with high health needs and persistent workforce shortages.
12 Eagar K, Owen A, Cranny C, Samsa P and Thompson C (2008) Community health: the state of play. A report for the NSW Community Health Review . Centre for Health Service Development, University of Wollongong
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• The issue of cross state border flows and how they are addressed as part of PHCO design given that NSW has more state boundaries than any other jurisdiction.
• Getting the best fit to meet the needs of local communities and the primary health care workforce while also interfacing effectively with hospital networks and local and regional community health services.
3.4.1 Size and scale NSW population projections and the NSW Government Metropolitan Strategy and Regional Strategies suggest that many urban growth areas and coastal regions will have populations in excess of 600,000 by 2021 whereas inland regions will have stable or declining populations.
PHCOs in NSW will need to range in size from 130,000 to over 800,000 people to plan and commission services and support effective service delivery and partnerships in sparsely populated remote and rural communities, regional centres and densely populated urban areas.
3.4.2 Cross border flows and communities of interest NSW shares borders with Queensland, South Australia, Victoria and the ACT and natural flows and communities of interest exist across state borders. These flows determine the communities that individuals identify with, the hospitals and specialist community based services they use and training and professional linkages. There are three main borders where natural cross border flows are significant from NSW to other states and territories that will need to be considered as part of PHCO design. They are:
• Cross border flows from NSW to Victoria in the south west along the Murray River
• Cross border flows from NSW to Queensland primarily from Tweed Shire to the Gold Coast
• Cross border flows from NSW to Canberra and the Australian Capital Territory
These are discussed in detail in Option 1 and Option 3.
3.5 Configuration Options for PHCOs in NSW Six options to configure Primary Health Care Organisations in New South Wales have been developed to address these issues and they are described below.
3.5.1 Option 1: 15 PHCOS with 8 metropolitan, Hunter and Illawarra major regional, 5 rural and flows from south west NSW to Victoria Under this Option there are 15 PHCOs in NSW consisting of 8 metropolitan PHCOs in greater Sydney and the Central Coast, 2 regional PHCOs covering the growth centres of Hunter and Illawarra and 5 PHCOs covering rural and remote NSW. The configuration is shown in Figure 5 and Figure 6.
The proposed PHCOs with their 2008 population and projected 2021 population and alignment with LGA and current Division and NSW Health Area boundaries are shown in Table 3 and Table 4.
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Figure 5: Option 1 – 15 NSW PHCOs
Figure 6: Option 1 - Sydney Metro PHCOs
3.5.1.1 Metropolitan PHCOs Characteristics The 8 metropolitan PHCOS are made up of contiguous LGAs in the Greater Sydney basin that generally align with the ABS Statistical Divisions.
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These PHCOs ranged in size in 2008 from a catchment population of 310,000 people on the Central Coast to 796,000 in Northern Sydney.
The four PHCOs covering the outer urban growth areas in Sydney West and South West Sydney and urban consolidation areas in Northern Sydney and Inner Western Sydney and Canterbury Bankstown are projected to have with populations of between 763,000 and nearly 1 million people by 2021.
The Sydney PHCOs in more established eastern and southern suburbs and in Outer Western Sydney are projected to have population of between 363,000 and 490,000 by 2021.
Sydney South West, Sydney West and Inner and Eastern Sydney have the largest Aboriginal and Torres Strait Islander populations and Sydney South West, Sydney West and St George Sutherland have the largest overseas born populations from non English speaking backgrounds and the largest CALD groups that do not speak English well as shown in Appendix 3.
The metropolitan PHCOs with the highest rate of socioeconomic disadvantage are South West Sydney and Sydney West.
The metropolitan Divisions with the highest population to GP FWE ratios are Blue Mountains (1340), Manly Warringah (1223), Hawkesbury Hills (1171), Hunter Urban (1170) and GP Network Northside (1109).
3.5.1.2 Metropolitan PHCO Profiles Inner Western Sydney and Canterbury Bankstown PHCO covers the inner city LGAs of Ashfield, Bankstown, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Strathfield and part of the City of Sydney. This PHCO had a catchment population of 678,000 in 2008 that is projected to rise to 763,000 through infill development and reclamation of industrial sites. It is a culturally diverse community with 33% of the population born in non English speaking countries and 8.5% who speak English poorly.
This PHCO has a mixed socio-demographic profile with more advantaged communities in Canada Bay (IRSD score of 1077) and Ashfield (1022) in the inner west and relatively disadvantaged LGAS such as Canterbury (927) and Bankstown (945).
Eastern and Inner Sydney PHCO covers the LGAs of Botany Bay, Sydney City, Randwick, Waverley and Woollahra or a catchment population of 418,000 in 2008 that is projected to grow to 482,000 through urban renewal and infill development.
This PHCO has also has a mixed socio-demographic profile with very advantaged communities in Woollahra (IRSD score of 1122), Waverley (1082) and Randwick (1045) and more disadvantage in Botany Bay (962) and parts of Inner Sydney. Twenty four percent of the population were born in non English speaking countries and 3% speak English poorly.
St George Sutherland PHCO covers the multicultural LGAs of Hurstville, Kogarah and Rockdale and the adjoining Sutherland Shire. There is strong growth due to migration in the inner southern suburbs which have between 32% and 36% of local resident born in non English speaking countries and almost 8% who do not speak English well.
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This PHCO had a 2008 population of 450,000 and is projected to grow to 483,000 by 2021. This PHCO catchment also has a mixed socio-demographic profile including high ranking suburbs such as Sutherland Shire (IRSD score of1084) and Kogarah (1045) and more disadvantaged communities such as Rockdale (993).
South Western Sydney PHCO covers the outer urban and urban growth centres of Camden, Campbelltown, Liverpool and Fairfield and the semi rural and rural areas of Wingecarribee and Wollondilly Shires. This is one of the fastest growing corridors in Greater Sydney with a 2008 population of 658,000 that is projected to grow to 857,000 by 2021.
South Western Sydney has a mixed socio-demographic profile with economically disadvantaged communities in Fairfield (LGA IRSD score of 876), Liverpool (966) and Campbelltown (955) and more affluent communities in Camden (1057) and Wollondilly (1044).
Nearly 29% of local residents were born in English speaking countries (48% in Fairfield LGA) and nearly 8% of the population speak English poorly (18% in Fairfield).
Sydney West PHCO covers the middle ring western suburbs of Auburn, Holroyd and Parramatta and the west and north western growth areas of Blacktown and Baulkham Hills LGAs. This catchment is also a major urban growth corridor with a population of 795,000 in 2008 that is projected to grow to 995,000 by 2021.
Sydney West also has a mixed socio-demographic profile with disadvantaged communities in Auburn (922) and Holroyd (972), Parramatta South (893) and Blacktown South West (903). Baulkham Hills (1116) and Parramatta north west (1042) are advantaged LGAs/SLAs. Sydney West has a culturally diverse community with 31% of the population born in non English speaking countries (50% in Auburn) and 5.5% of the population speak English poorly.
Outer Western Sydney PHCO covers the Blue Mountains, Hawkesbury and Penrith growth areas or a catchment population of 320,000 in 2008 that is expected to grow to 363,000 in 2021. This community is more advantaged than the NSW average with an IRSD score of 1022 ranging from 1051 in the Blue Mountains to 988 in East Penrith. Nearly 10% of the population were born in non English speaking countries but less than 1% speak English poorly.
Northern Sydney PHCO covers Hornsby, Ku-ring-gai, Ryde, Hunters hill, Lower North Shore and Northern Beaches Statistical Districts or a catchment population of 814,000 in 2008 that is projected to grow to 904,000 by 2021.
This is a relatively advantaged community with an average IRSD score of 1100 ranging from 1054 in Ryde to 1130 in Mosman. Nearly 20% of the population were born in non English speaking countries and 2.5% speak English poorly and this group is concentrated in Ryde, Willoughby and Hornsby LGAs.
Central Coast PHCO covers the LGAs of Gosford and Wyong or a catchment population of 310,000 that is projected to grow to 355,000 by 2021. The Central Coast has socio-demographic profile that is similar to the NSW average with an over IRSD score of 990 and less than 5% of the population born in non English speaking countries. Nearly 19% of the Central Coast community is aged over 65 years.
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Table 3: Option 1 - 15 NSW PHCOs - 8 metropolitan, Hunter and Illawarra, 5 rural PHCOs and cross border flows to Victoria Name ERP 2021 LGAS/Region 2008 Pop Inner Western Sydney & Canterbury 677778 763164 Ashfield, Bankstown, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Bankstown Strathfield and part Sydney Eastern and Inner Sydney 418463 484274 Botany Bay, Sydney, Randwick, Waverley and Woollahra St George Sutherland 450502 482935 Hurstville, Kogarah, Rockdale and Sutherland South Western Sydney 657840 856799 Camden, Campbelltown, Fairfield, Liverpool, Wingecarribee and Wollondilly Sydney West 795622 995468 Auburn, Baulkham Hills, Blacktown, Holroyd and Parramatta Outer Western Sydney 320313 362727 Blue Mountains, Hawkesbury and Penrith Illawarra Shoalhaven 378069 425136 Kiama, Shellharbour, Shoalhaven and Wollongong Northern Sydney 814076 903644 Hornsby, Ku-ring-gai, Ryde, Hunters Hill, Lower North Shore and Northern Beaches Central Coast 310546 355401 Central Coast and Wyong Hunter and Greater Taree 666847 758616 Greater Newcastle, Upper Hunter and Greater Taree New England 195452 191980 Northern Tablelands, Slopes and Plains LGAs plus rural Upper Hunter North Coast 493903 574258 LGAs in Richmond-Tweed and Mid North Coast Statistical Divisions Central and Far Western NSW 313258 313692 LGAs in North West, Central West and Far West Statistical Divisions including Lithgow Riverina 192217 197788 LGAs in Murrumbidgee Statistical Division plus Young Southern NSW 193665 231287 LGAs in South Eastern Statistical Division excluding Young Albury Murray Darling 105621 111326 LGAs in Murray Statistical Division including Albury but excluding Greater Hume Total 6984172 8008495
Table 4: Option 1 PHCOs mapped to current GP Divisions and State Health Services PHCO NSW Health Division Boundaries Boundaries Inner Western Sydney & Canterbury Part SSWAHS Central Sydney GPN, Bankstown DGP & part St George DGP Bankstown Eastern and Inner Sydney Part ESIAHS Eastern Sydney DGP & South Eastern Sydney DGP St George Sutherland Part ESIAHS St George DGP & Sutherland DGP South Western Sydney Part SSWAHS Macarthur DGP & Southern Highlands DGPs Sydney West Part SWAHS WentWest & part Hawkesbury Hills & part GPN Northside Outer Western Sydney Part SWAHS Nepean DGP, Blue Mountains DGP & part Hawkesbury Hills DGP Northern Sydney Part NSCCAHS Northern Sydney GPN, Manly Warringah DGP, part GPN Northside & part Hawkesbury Hills DGP Central Coast Part NSCCAHS Central Coast DGP Illawarra Shoalhaven Part ESIAHS Illawarra DGP & Shoalhaven DGP Hunter and Greater Taree Part HNE &NCAHS GP Access and Hunter Rural New England Part HNE &NCAHS New England, North West Slopes & Barwon DGPs North Coast Part NCAHS Hastings Macleay, Mid North Coast, Northern Rivers & Tweed Valley Central and Far Western NSW GWAHS Central West, Dubbo Plains, Outback and former Barrier DGPs Riverina Part GSAHS Riverina PCN & Murrumbidgee DGP Southern NSW Part GSAHS Southern NSW & Southern Highlands DGPs Albury Murray Darling Part GSAHS Albury Wodonga DGP, Mallee Plains, North East Victoria, Murray Plains and part Goulburn Valley DGP
3.5.1.3 Regional PHCOs Characteristics Hunter and Greater Taree and Illawarra Shoalhaven are the two major regional PHCOs. Both these regions have large urban centres, growing coastal populations and a rural hinterland with established general practice and community health service architecture and one or more tertiary referral hospitals.
Both Shoalhaven in the south and Greater Taree in the north are rural hubs that have at least one large rural town with a rural Hospital providing some specialist services (Nowra and Taree) as well as established general practices and community health services. Population growth is occurring in the
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coastal communities and some of the larger inland centres such as Maitland and Muswellbrook which have rural hospitals and local general practice and community health services. The rural hinterland in both these regions includes small communities that rely on primary health services, GP run Community Hospitals and Multi-Purpose Services.
The rural communities in both these regions have strong local identities and local Divisions of General Practice with a rural service focus that address rural workforce needs and have access to MAHS funding in some or part of their catchment. However none of the inland rural or coastal communities is expected to grow into very large centres and their populations currently use the regional centres of Newcastle and Wollongong for tertiary hospital and specialist care, education, services and employment. This combined with the strengthening of regional health professional training networks (including the development of a new Medical School at the University of Wollongong) suggests that a large regional PHCO with a strong local branch structure to support the specific needs of the rural communities is the best model for these areas. These Regional PHCOs range in size from 380,000 to 670,000 population and both are expected to experience strong growth.
3.5.1.4 Regional PHCO Profiles Illawarra Shoalhaven PHCO covers the LGAs of Kiama, Shellharbour, Wollongong and Shoalhaven or a 2008 population of 378,000 that is projected to grow to 425,000 by 2021.
In 2006 this catchment had a relatively disadvantaged socioeconomic profile with an IRSD score of 981 ranging from 964 in Shoalhaven, 973 in Shellharbour and 994 in Wollongong. Kiama is a more advantaged area with and IRSD score of 1062. Approximately 10% of the population were born in non English speaking countries (primarily in Wollongong) and just under 2% speak English poorly.
Hunter and Greater Taree PHCO covers the LGAs of Cessnock, Lake Macquarie, Newcastle, Maitland, Port Stephens, Dungog, Gloucester, Great Lakes, Muswellbrook, Singleton, Greater Taree ad Upper Hunter Shire with a 2008 catchment population of 667,000 that is projected to grow to 758,000 by 2021. Nearly 17% of the population are aged over 65 years and the catchment has a mixed socio-demographic profile with pockets of disadvantage in Greater Taree (942) and Great Lakes (952) and an overall IRSD score of 981. Just over 4% of the population were born in non English speaking countries.
3.5.1.5 Rural PHCOs Under Option 1 there are five rural PHCOs in NSW including North Coast, New England, Central and Far West, Southern and Riverina. New England, Southern and Riverina have populations just under 200,000 and will experience modest overall growth.
New England and Riverina are inland rural regions with stable populations. These areas have several large and medium sized rural towns where the principal acute hospital facilities, specialist services and larger GP practices are concentrated that links with a range of medium, small and very small rural communities with workforce challenges and remote service needs. Both areas have substantial Aboriginal and Torres Strait Islander populations.
Southern NSW includes the South Coast, the Snowy and the Southern Slopes and Tablelands. It includes the LGAs bordering the ACT including the high growth Queanbeyan LGA, Palerang and Yass Valley which are all within an hour drive of Canberra. There is reasonably strong population growth in the coastal
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towns and stable or declining rural and regional populations elsewhere. This option does not include cross border flows from Southern NSW to the ACT.
Central and Far Western covers almost a third of the NSW land mass and has a stable population of 313, 000 with growth in the eastern regional cities of Bathurst, Orange and Dubbo where the major Base or Rural Referral Hospitals are located and with declining populations in the inland and north western LGAs. The far west and northwest include many rural and remote communities with large and growing Aboriginal communities. The north western LGAs covered by the Outback Division include 6 of the 10 most socioeconomically disadvantaged LGAs in NSW.
North Coast includes the coastal growth areas and inland rural areas north of Taree to the Queensland border including Port Macquarie, Coffs Harbour, Lismore and Tweed Heads. North Coast had a population of 494,000 in 2008 and is projected to grow to 574,000 by 2021. The North Coast is home to a growing population of retirees and there is also a substantial Aboriginal and Torres Strait Islander population across the region.
3.5.1.6 Rural PHCO Profiles New England PHCO covers the 14 inland LGAs in the Northern Tablelands, Slopes and Plains shown in Part 3 Appendix 3 and part of Upper Hunter Shire. This catchment had a population of 195,000 in 2008 and will remain stable or lose population by 2021. Nearly 8% of the population are Aboriginal or Torres Strait Islander people and the largest indigenous populations are in Moree, Gunnedah, Guyra and Tamworth. New England has a relatively disadvantaged population with an overall IRSC score of 957 ranging from 923 in Inverell to 1090 in Armidale.
North Coast PHCO in Option 1 covers the 15 coastal and inland LGAs in the Richmond-Tweed and Mid North Coast Statistical Divisions or a catchment population of 494,000 that is projected to grow to 574,000 by 2021. The North Coast is continuing to experience population growth on the coast fuelled by retirees and tree changers.
In 2006 18% of the population were aged over 65 years and nearly 4% of local residents where indigenous with the major communities in Kempsey, Casino, Kyogle and Nambucca. The North Coast has a lower socio-demographic profile than the NSW average with an IRSD score of 956 and pockets in significant disadvantage in Casino (883), Kempsey (900), Nambucca (902) and Kyogle (918). Just under 4% of the population were born in non English speaking countries.
Central and Far West PHCO in Option 1 includes 30 LGAs in the North West, Central West and Far West Statistical Divisions in western NSW plus Lithgow and covers rural and remote communities. This catchment had a population of 313,000 in 2008 and is expected to remain stable by 2021 with growth in the more easterly regional centres of Dubbo, Orange and Bathurst and in Mudgee and stable or declining populations elsewhere.
Nearly 8% of the population come from indigenous backgrounds and the major indigenous communities are in the north western towns of Burke, Brewarrina, Walgett, Cobar, Warren, Coonamble, Wellington, Narromine, Dubbo and in Central Darling Shire.
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This PHCO is generally socio-demographically disadvantaged with an average IRSD score of 956 and pockets of extreme disadvantage in the north western towns above plus Broken Hill (912). Bathurst, Cabonne and Dubbo Pt B are more advantaged areas.
Riverina PHCO covers the 22 LGAs in the Murrumbidgee Statistical Division including the major regional centres and towns of Wagga Wagga, Young, Griffith, Leeton, Hay, Cootamundra and Narrandera. This PHCO had a catchment population of 192,000 in 2008 and is projected to grow to 198,000 by 2021. Four percent of the population are indigenous Australians with the major communities in Murrumbidgee, Narrandera, Junee, Carrathool, Griffith, Leeton and Wagga Wagga and just over 4% of the population are from non English speaking backgrounds and primarily live in Griffith, Leeton and Wagga Wagga.
Riverina has a mixed socio-demographic profile with pockets of disadvantage in Narrandera (932), Junee (933) and Hay (943) and more advantaged communities in Wagga Wagga and Lockhart. This PHCO has an average IRSD score of 978.
Southern NSW PHCO includes the 8 LGAs in the South Eastern Statistical Division including Goulburn, Cooma-Monaro, Bombala, Snowy River, Bega Valley and Eurobodalla Shires on the south coast and Queanbeyan, Yass Valley and Palerang A & B.
This PHCO catchment surrounds the ACT and has a mixed socio-demographic profile with more advantaged communities in Yass Valley (1054), Queanbeyan (1035), the Snowy River, parts of Goulburn, Palerang Pt A and B and more disadvantaged communities on the south coast and in Bombala. This PHCO has an average IRSD score of 978 when LGAs adjoining the ACT including Queanbeyan and Yass Valley are excluded. It is the most advantaged rural PHCO in NSW with a catchment population of 194, 000 in 2008 growing to 231,000 in 2021.
3.5.2 Cross border flows to Victoria There are significant cross border flows and communities of interest between NSW and Victoria in south western NSW that are reflected in health service usage patterns and GP service linkages. Several Victorian GP Networks including North Western, Albury Wodonga, Hume and Mallee Plains already cover border towns and the general practice workforce in parts of south western NSW and NSW residents along some parts of the border tend to flow to Victoria for tertiary hospital care in Melbourne.
NSW and Victoria have a formal agreement specifying shared responsibilities for management of health services in Albury Wodonga and ambulatory and specialist services have been established in Wodonga that attract residents from the border areas in south western NSW. The shared health service architecture that has developed suggests that the current cross border primary health care linkages will continue and should be strengthened in the south west.
One or more PHCOs serving Victoria, NSW and possibly the Riverland area in South Australia should be considered as options in the south west and would incorporate the NSW LGAs of Albury, Berrigan, Conargo, Corowa Shire, Deniliquin, Greater Hume Shire A, Balranald, Jerilderie, Murray, Wakool and Wentworth. In 2008 these LGAs had a resident population of 105,600 people and this is projected to grow to 111,300 by 2021.
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This Option preserves the existing cross border flows and general practice partnerships between NSW and Victoria that operate from Albury and the LGAs along the Murray Darling to the South Australian border.
3.5.3 Strengths and weaknesses The strengths of the Option 1 PHCO configuration include:
• The PHCOs have been built up using contiguous LGAs that align with ABS Statistical Divisions, recognised population groups with similar socio-demographic characteristics and similar service delivery environments. This is a more consistent population based model that many of the historical Division arrangements.
• The size of the proposed PHCOs, especially in metropolitan Sydney, is flexible and reflects the differing needs of established inner urban communities and the metropolitan growth areas with diverse populations where new service architecture, targeted workforce support and human service partnerships are likely to be needed as the population grows.
• The large regional and rural PHCOs have the critical mass needed to fulfil the range of planning, service development and workforce support functions in scope for PHCOs. They are also large enough to enable PHCOs serving rural and remote communities or the rural sector of large regional communities to continue to be rural service providers where needed using Regional Health Service Program, MAHS and other targeted programs and funding sources.
• The proposed PHCOs do not align directly with the current large Area Health Service boundaries in metropolitan and most rural areas but they do align with the local networks and hospital and community health clusters that are currently in place within those Areas. This will facilitate vertical and horizontal integration of primary and acute health services at the local level. These local clusters are likely to be a sensible base from which to develop Local Hospital Networks in NSW under the national reforms. This is a major strength of this configuration and pertains to several Options.
• The established cross border arrangements between Victoria and south western NSW communities are maintained and reflect the orientation of the NSW border communities to Victoria for much of their primary, secondary and tertiary health care.
Weaknesses of the Option 1 include:
• Two metropolitan PHCOs have very large catchment populations that are expected to grow to almost a 1 million people by 2021. This is the upper end of the desirable PHCO catchment population. It exceeds the size of most of the metropolitan PHCO options in other states.
• This option does not address natural flows to the ACT or Queensland.
• Central and Far Western PHCO covers a huge geographic area with diverse populations, several distinct regional centres and very disadvantaged rural and remote communities. At a minimum a branch office structure will be required to ensure the PHCO remains connected with the major local communities. Segmenting this PHCO may provide a more flexible model for the high need population in the Far West of NSW.
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3.5.4 Option 2: 16 PHCOS with 9 metropolitan, 2 regional, 5 rural and flows from south west NSW to Victoria Option 2 increases the number of metropolitan PHCOs from 8 to 9 by creating a new PHCO covering Baulkham Hills and Hornsby LGAs in the northwest Sydney growth area as shown in Figure 7 and Table 5.
The urban growth areas will continue to accommodate a high proportion of young families and families with adolescent children while the established parts of Hornsby and Baulkham Hills will have a more mixed demographic. Baulkham Hills is a high SES area and Hornsby is more mixed. There is no change in this Option to the configuration of the regional, rural and cross border PHCOs.
Figure 7: Option 2 – Nine Metropolitan Sydney PHCOs
The new Hornsby Baulkham Hills PHCO has a current estimated catchment population of 330,000 people and is projected to grow to almost 400,000 people by 2021. Sydney West and Northern Sydney PHCOs will reduce in size to 625,000 and 654,000 respectively under this Option.
3.5.5 Strengths and weaknesses The strengths of Option 2 PHCO configuration include:
• Aligning these contiguous LGAs will produce a new PHCO with similar socio-demographic and service delivery characteristics in the growing north western suburbs of Sydney.
• As well as achieving better local socio-demographic alignments this will reduce the population size of the adjoining Sydney West and Northern Sydney PHCOs to between 700,000 and 800,000 residents in 2021 which is more consistent with the rest of Sydney and other interstate capitals.
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• The population of the new Sydney West PHCO in particular will be more homogenous in terms of both socio economic status and cultural diversity.
The weaknesses reflect the same issues outlined in Option 1.
Table 5: Option 2 - 16 PHCOs Name ERP 2021 LGAS/Region 2008 Pop Inner Western Sydney & Canterbury 677778 763164 Ashfield, Bankstown, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Bankstown Strathfield and part Sydney Eastern and Inner Sydney 418463 484274 Botany Bay, Sydney, Randwick, Waverley and Woollahra St George Sutherland 450502 482935 Hurstville, Kogarah, Rockdale and Sutherland South Western Sydney 657840 856799 Camden, Campbelltown, Fairfield, Liverpool, Wingecarribee and Wollondilly Sydney West 624657 773742 Auburn, Blacktown, Holroyd and Parramatta Outer Western Sydney 320313 362727 Blue Mountains, Hawkesbury and Penrith Illawarra Shoalhaven 378069 425136 Kiama, Shellharbour, Shoalhaven and Wollongong Hornsby Baulkham Hills 330176 395293 Hornsby and Baulkham Hills LGAs Northern Sydney 654865 730077 Ku-ring-gai, Ryde, Hunters Hill, Lower North Shore and Northern Beaches Central Coast 310546 355401 Central Coast and Wyong Hunter and Greater Taree 666847 758616 Greater Newcastle, Upper Hunter and Greater Taree New England 195452 191980 Northern Tables, Slopes and Plains LGAs plus rural Upper Hunter North Coast 493903 574528 LGAs in Richmond-Tweed and Mid North Coast Statistical Divisions Central and Far Western NSW 313258 313692 LGAs in North West, Central West and Far West Statistical Divisions & Lithgow Riverina 192217 197788 LGAs in Murrumbidgee Statistical Division plus Young Southern NSW 193665 231287 LGAs in South Eastern Statistical Division excluding Young Albury Murray Darling 105621 111326 LGAs in Murray Statistical Division including Albury but excluding Greater Hume 6984172 8008495
3.5.6 Option 3: Cross border flows to Queensland, the ACT and Victoria. This Option addresses the issue of natural cross border flows between NSW and Victoria, NSW and the ACT and NSW and Queensland and proposes three sub option adjustments to the Rural PHCOs described in Option 1.
3.5.7 NSW/ACT Cross Border Options The Australian Capital Territory is located within NSW borders and is a major regional education, employment and healthcare hub for South Eastern NSW. The ACT Division of General Practice has members in southern NSW and there are strong training and education linkages as well as referral patterns.
Queanbeyan, one of NSW fastest growing regional towns, borders the ACT (and sits within the ABS Statistical Division of Canberra) as do Palerang and Yass Valley. These LGAs lie within a one hour drive of Canberra and local population growth is largely driven by people seeking affordable housing or rural properties close to the employment opportunities and amenities in Canberra.
There are also strong associations and flows for education and health care between the South Coast LGAs, especially Batemans Bay and Narooma and the ACT and between the Southern Tablelands and the Snowy Statistical Divisions.
While ACT has sufficient population to function as a standalone PHCO, these linkages suggest that a cross border or regional PHCO between NSW and the ACT should be considered. The key question is the scale, size and geographic reach of such a PHCO.
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3.5.8 Option 3a: Cross border PHCO with contiguous NSW LGAs flowing to ACT Under Option 3a only the LGAs/SLAs of Queanbeyan, Palerang A and Yass Valley that are contiguous with the ACT are included in the cross border PHCO. This is a current population of 64,200 people that is projected to grow to 83,200 by 2021.
The remainder of Southern NSW including the South Coast, Southern Slopes and Tablelands excluding Young would form part of a Southern NSW PHCO with an estimated resident population of 129,000 in 2008 and a projected population of 148,000. This configuration is shown in Figure 8 and in Appendix 3.
Figure 8: Option 3a - 15 NSW PHCOs with contiguous LGAs flowing to ACT
3.5.9 Strengths and weaknesses The strengths of this configuration include:
• The rural towns that form part of the ACT growth area have similar demographic characteristics to the ACT and are included in a compatible urban/regional PHCO. This is consistent with current referral and flow patterns and workforce arrangements. Community health workers and other professionals living in these localities already move between NSW and the ACT for employment and receive education and professional support for clinical networks based in Canberra and this will continue under this Option.
• The South Coast, the Snowy and Southern Tablelands retain a discrete rural focus and identity that is generally consistent with their socio-demographic profile and their distances from the major centre in Canberra (travel times to Canberra vary from an average of 2 to over 4 hours from the far South Coast and Bombala).
• A PHCO based in southern NSW would have closer links with each of the local communities and greater capacity to develop practical on the ground partnerships with local government, NGOs and
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other agencies to deliver health promotion and capacity building initiatives that target the social determinants of health.
• A Southern PHCO would focus on the specific service delivery models and workforce needs of the small and medium rural towns and growing coastal communities. This includes a focus on a primary health care approach and skilled generalist community health workers, access to MAHS funding to recruit allied health professionals, and, support for general practitioners in community practice and those with a procedural interest who play a significant clinical role in local hospitals (Cooma, Bateman’s Bay, Moruya, Pambula) that have visiting specialists. The PHCO will also have links with NSW regional hospitals that offer specialist services at Goulburn and Bega and the regional mental health service.
The weaknesses include:
• The Southern PHCO covers quite distinct rural communities (Lower South Coast, Snowy including Cooma and the inland communities bordering Victoria and the Southern Tablelands including Goulburn) that do not have a great deal in common other than their rurality.
• They do not share a common regional centre outside Canberra which is the functional centre of the region.
• There are currently no rural referral hospitals in any of these communities and referrals for tertiary care are likely to continue to flow to ACT or to Sydney.
• Without the major growth centres near Canberra, the Southern NSW PHCO would be the smallest PHCO in NSW and one of the smaller rural PHCOs in Australia. It may lack the critical mass as a stand- alone PHCO to offer cost effective services and deliver professional and practice support to GPs and other health professionals in rural and remote communities.
3.5.10 Option 3b: 14 NSW PHCOs with all of Southern NSW in the ACT PHCO Option 3b suggests that the ACT and Southern NSW should form a single PHCO operating as an extended rural Region as shown in Figure 9. Approximately 194,000 NSW residents would be covered by this regional PHCO centred on the ACT which would have an urban hub in Canberra linked to local communities in Southern NSW.
This regional PHCO would have similar structural characteristics to the PHCOs proposed for Hunter and Greater Taree and Illawarra and Shoalhaven including the need for a branch structure in the rural parts of the regional PHCO.
The demographic characteristics are described in the following Chapter.
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Figure 9: 14 NSW PHCOs with Southern NSW flowing to ACT
3.5.11 Strengths and weaknesses The strengths of this configuration include:
• The proposed PHCO recognises the role currently played by Canberra as the regional centre for south eastern NSW and the hub for education and training, employment and specialist medical care.
• This Option builds on the training and professional support networks that are already in place through the ACT Division of General Practice and the clinical programs linking the Canberra Clinical School and the Universities with hospitals in south eastern NSW. It also recognises the communities of interest and affiliations between the ACT, parts of the South Coast, the Snowy and the rural villages to the north, east and west of Canberra that ACT residents use for recreation, holidays and retirement.
• The configuration is consistent with other regional PHCOs in NSW and other states that have an urban regional centre that supports a diverse rural community.
• The PHCO would have sufficient population to justify a branch office structure to retain connectedness with local communities as a strategy to address the size and diversity of the geographic catchment.
The weaknesses of this configuration include:
• The rural and growing coastal communities in south eastern NSW need to come under the umbrella of a PHCO with a clear focus on and expertise in rural service provision and partnership building.
• A regional PHCO of this scale that crosses states boundaries may encounter obstacles in terms of resource sharing and jurisdiction specific regulations and clinical protocols unless a strong cross border agreement is in place between NSW and the ACT.
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• The need to maintain branch offices will add to PHCO operating costs.
3.5.12 Suggested approach The geography, the population size and distribution and the jurisdictional arrangements in south eastern NSW pose significant challenges for PHCO design. Option 3a and 3b both have merit and also some risks.
The development of a single regionally focussed PHCO with branch offices in key locations in south eastern NSW is our suggested approach for national consistency and to ensure the PHCO has the critical mass needed to provide effective service planning and development and practice support services for the entire catchment population.
With almost 200,000 NSW residents and their communities coming under the regional PHCO umbrella, the development of a formal cross border agreement and resource allocation model between the ACT, NSW and the Australian government will be mandatory and a minimum essential condition for NSW to proceed.
3.5.13 NSW/Queensland Cross Border Option The Tweed Valley and the Gold Coast in south east Queensland is another area with natural cross border flows where an integrated PHCO may have merit.
Significant numbers of NSW residents living in the Tweed Valley, especially Tweed A SLA, flow to the Gold Coast and Brisbane for education, work and to access specialist health care. Tweed Valley GPs have referral linkages with specialists in Queensland and the development of a major 800 bed teaching hospital and university complex on the Gold Coast is likely to further strengthen health service and training links and flows to Queensland. Tweed A is included as part of the North Coast PHCO in Option 1.
The implications for the North Coast PHCO and for Queensland flows under Option 3c are shown in Table 6.
Table 6: Option 3c - 15 NSW PHCOs plus Victorian border flows as in Option 1 with Tweed A flowing to Gold Coast PHCO Name ERP 2021 LGAS/Region 2008 Pop PHCO 1 Inner Western Sydney & Canterbury 677778 763164 Ashfield, Bankstown, Burwood, Canada Bay, Canterbury, Leichhardt, Marrickville, Bankstown Strathfield and part Sydney PHCO 2 Eastern and Inner Sydney 418463 484274 Botany Bay, Sydney, Randwick, Waverley and Woollahra PHCO 3 St George Sutherland 450502 482935 Hurstville, Kogarah, Rockdale and Sutherland PHCO 4 South Western Sydney 657840 856799 Camden, Campbelltown, Fairfield, Liverpool, Wingecarribee and Wollondilly PHCO 5 Sydney West 795622 995468 Auburn, Baulkham Hills, Blacktown, Holroyd and Parramatta PHCO 6 Outer Western Sydney 320313 362727 Blue Mountains, Hawkesbury and Penrith PHCO 7 Illawarra Shoalhaven 378069 425136 Kiama, Shellharbour, Shoalhaven and Wollongong PHCO 8 Northern Sydney 814076 903644 Hornsby, Ku-ring-gai, Ryde, Hunters Hill, Lower North Shore & Northern Beaches PHCO 9 Central Coast 310546 355401 Central Coast and Wyong PHCO 10 Hunter and Greater Taree 666847 758616 Greater Newcastle, Upper Hunter and Greater Taree PHCO 11 New England 195452 191980 Northern Tables, Slopes and Plains LGAs plus rural Upper Hunter PHCO 12 North Coast 428440 487460 LGAs in Richmond-Tweed and Mid North Coast Statistical Divisions less Tweed A PHCO 13 Central and Far Western NSW 313258 313692 LGAs in North West, Central West & Far West Statistical Divisions & Lithgow PHCO 14 Riverina 192217 197788 LGAs in Murrumbidgee Statistical Division plus Young PHCO 15 Southern NSW 193665 231287 LGAs in South Eastern Statistical Division excluding Young Victoria Albury Murray Darling 105621 111326 LGAs in Murray Statistical Division including Albury but excluding Greater Hume QLD Tweed A to Gold Coast 65463 86600 Tweed A to Gold Coast 6984172 8008495
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3.5.14 Strengths and weaknesses
The strengths and weaknesses of this model are:
• The urban component of Tweed Shire is aligned with a similar demographic and the urbanised area of the Gold Coast while the rural component including Murwillumbah continues to be linked with a rural North Coast NSW PHCO.
• There are some differences in legislation and systems in areas such as child protection between NSW and Queensland that impact on GPs and community health staff practice that will need to be resolved by a cross border service model. There are also different Community Health workforce structures. Some of the workforce issues are likely to be harmonised through national registration, national professional competencies and other national workforce initiatives but other issues will need to be addressed through formal cross border arrangements and service protocols.
• The North Coast PHCO will reduce by 65,000 people to a population of almost 430,000 and will remain the rural PHCO with the largest population base in NSW.
3.5.15 Suggested approach We propose that Tweed A form part of a cross border PHCO linked with the Gold Coast with interstate issues to be covered by a cross border agreement for primary health care development similar to agreements in place with Victoria. In 2008 Tweed A had a resident population of 65,400 and this is projected to grow to 86,600 by 2021.
3.5.16 Other cross border options considered and rejected 3.5.16.1 Far South Coast NSW and Victoria There are natural flows from the Far South Coast to Melbourne for tertiary hospital care and some communities of interest given the number of Victorians who are retiring to the South Coast.
However the development of a new regional hospital planned for Bega will supply the majority of the local community needs for Pambula, Merimbula and Eden residents. As there is no major hospital to attract these flows and specialist referrals in northern Gippsland we suggest that the South Coast is planned within NSW or as part of a NSW/ACT PHCO.
3.5.16.2 NSW/South Australia Broken Hill and many far western NSW residents access specialist care and tertiary hospital services in South Australia and some informants suggest that this area should relate to South Australia.
Far West NSW is a unique rural and remote community with a very significant indigenous population and high social and health needs. GWAHS, indigenous communities and the Commonwealth are partners in a range of initiatives such as the Murdi Paaki Partnership which covers these Aboriginal communities and has a strong primary health care approach that includes options to pool resources. The University Department of Rural Health based in Broken Hill is also a major training centre for multidisciplinary rural and remote health care.
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On the basis of the needs of this community and the primary care training infrastructure already in place we believe that Broken Hill and Far West should remain in NSW and be covered by a PHCO with a focus on rural and remote service delivery and improving indigenous health outcomes.
3.5.17 Variations in the number and size of rural PHCOs in NSW
Deciding on the number of PHCOs that are required to support rural and remote communities in NSW is the key design decision to resolve if there is agreement on the interstate flow proposals outlined in Option 3 and if nine metropolitan and 2 regional PHCOs are accepted as the best fit for the metropolitan area and large regional centres.
Approximately 365,000 NSW rural residents would be covered by PHCOs based in other states and territories and this is predicted to grow to 430,000 by 2021.
Options 4, 5 and 6 describe different rural PHCO configurations to serve the remaining rural population of 1.13 million people or 17% of the state population in 2008.
3.5.18 Option 4: 15 PHCOS with 9 metropolitan, 2 major regional, 4 rural plus flows to ACT, Victoria and Queensland Option 4 shown in Figure 10 and Table 7 has four rural PHCOs covering the North Coast, New England, Central and Far Western NSW and the Riverina.
The four rural PHCOs range in size from 192,000 people in Riverina to 428,000 on the North Coast and each of these rural PHCOs have different demographic characteristics and health service architecture.
In terms of future population growth, only North Coast is expected to continue to grow significantly over the next 10 years. Population growth will occur along the coastal strip and the adjoining rural hinterland and within a relatively compact rural geographic area made up of the Mid North Coast and the Richmond and Tweed Valleys. The North Coast has pockets of socioeconomic disadvantage and there are significant Aboriginal and Torres Strait Islander communities throughout the North Coast with large communities in Kempsey, Grafton, Nambucca, Casino and the Northern Rivers.
The North Coast overall is not an area of gross GP workforce shortage but Northern Rivers and the Mid North Coast Divisions both report population to GP ratios (1161 pop/FWE GP and 1213 pop/FWE GP respectively) that are higher than the NSW and national average. The rapid population growth, especially of the retiree cohort, impacts on GP workload.
Rural referral hospitals have been established at Port Macquarie, Coffs Harbour and Lismore that are expanding the range of specialty services they offer. Tweed Heads is also a major rural hospital with a largely specialist workforce. Smaller Community Hospitals on the coast in locations such as Byron Bay and Ballina and inland at Casino and Murwillumbah are networked with these larger hospitals and continue to rely on a GP VMO workforce.
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Figure 10: Option 4 - 15 NSW PHCOs
New England, Central and Far Western and Riverina PHCOs are expected to have stable or declining populations. New England and Riverina have mixed rural demography. Both areas have one or two regional centres that are the service hubs for the surrounding farming communities, several medium sized towns and widely dispersed small towns, hamlets and villages as well as remote communities. New England and Riverina also have significant Aboriginal populations and many small socioeconomically disadvantaged or marginal communities.
There are rural referral hospitals at Wagga Wagga (Riverina) and Tamworth (New England) that provide specialist services and Base Hospitals at Griffith, Narrabri and Armidale.
Full-time equivalent GP to population ratios are high to very high in all the inland rural Divisions with Northern Slopes, Barwon and New England Divisions reporting ratios of 1750, 1247 and 1340, Riverina and Murrumbidgee reporting 1251 and 1210 and Central West, Dubbo Plains and Outback reporting population to GP ratios of 1212, 1300 and 1062. The role and range of functions performed by rural GPs in these areas is also more diverse with many of the District and small Community Hospitals relying on GP VMOs. Between a third and 40% of the practices in Riverina and New England are solo practices and many general practitioners are overseas trained medical graduates.
Community health services operate across these regions with hubs and specialist teams in the major centres and community nurses, child and family health nurses and allied health professionals who often work in both hospital and community services based in the smaller towns. The Divisions of General Practice employ professionals funded through MAHS, Rural Health Services and a range of other programs.
PHCOs in these areas are likely to be service providers and commissioners as well as undertaking workforce support and service planning and needs assessment. This model already operates in several Divisions in the catchment and can be expected to continue in the future.
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A single PHCO supporting a population base of 192,000 to 200,000 people with a role in service provision, planning, workforce development and practice support and a branch office structure is likely to be the most effective model for these regions.
Table 7: Option 4 - 15 metropolitan PHCOs, 2 regional and 4 rural with interstate flows Name ERP 2021 LGAS/Region 2008 Pop PHCO 1 Inner Western Sydney & Canterbury 677778 763164 Ashfield, Bankstown, Burwood, Canada Bay, Canterbury, Leichhardt, Bankstown Marrickville, Strathfield and part Sydney PHCO 2 Eastern and Inner Sydney 418463 484274 Botany Bay, Sydney, Randwick, Waverley and Woollahra PHCO 3 St George Sutherland 450502 482935 Hurstville, Kogarah, Rockdale and Sutherland PHCO 4 South Western Sydney 657840 856799 Camden, Campbelltown, Fairfield, Liverpool, Wingecarribee and Wollondilly PHCO 5 Sydney West 624657 773742 Auburn, Blacktown, Holroyd and Parramatta PHCO 6 Outer Western Sydney 320313 362727 Blue Mountains, Hawkesbury and Penrith PHCO 7 Illawarra Shoalhaven 378069 425136 Kiama, Shellharbour, Shoalhaven and Wollongong PHCO 8 Hornsby Baulkham Hills 330176 395293 Hornsby and Baulkham Hills LGAs PHCO 9 Northern Sydney 654865 730077 Ku-ring-gai, Ryde, Hunters Hill, Lower North Shore & Northern Beaches PHCO 10 Central Coast 310546 355401 Central Coast and Wyong PHCO 11 Hunter and Greater Taree 666847 758616 Greater Newcastle, Upper Hunter and Greater Taree PHCO 12 New England 195452 191980 Northern Tables, Slopes and Plains LGAs plus rural Upper Hunter PHCO 13 North Coast 428440 487460 LGAs in Richmond-Tweed and Mid North Coast Statistical Divisions less Tweed A PHCO 14 Central and Far Western NSW 313258 313692 LGAs in North West, Central West, Far West Statistical Divisions with Lithgow PHCO 15 Riverina 192217 197788 LGAs in Murrumbidgee Statistical Division plus Young PHCO Total in NSW 6619217 7579281 Victoria Albury Murray Darling 105621 111326 LGAs in Murray Statistical Division including Albury but excluding Greater Hume ACT Southern NSW to ACT 193665 231287 LGAs in South Eastern Statistical Division excluding Young QLD Tweed A to Gold Coast 65463 86600 Tweed A to Gold Coast Interstate Flows Total 364749 429213 NSW Population 6984172 8008495
The proposed Central and Far Western PHCO has the largest geographic footprint and covers one third of NSW. Under Option 4 this large rural and remote PHCO has a regional population of 313,000 people living in three distinct sub-regions that have specific service needs.
The Central West is the major rural growth area nearest to Sydney and includes the regional Cities of Orange and Bathurst that have extensive hospital and community service infrastructure, Parkes and Forbes and several smaller towns and hamlets. We include Mudgee and the Mid-Western Regional growth centre and Lithgow in the Central West in our PHCO configuration. This area had an ERP of 185,000 people in 2008 and is expected to grow to 192,000 by 2021.
The Central West has a similar FWE GP to population ratio (1,212) to New England, Mid North Coast and Murrumbidgee with higher GP numbers in the major rural cities and shortages in the smaller towns and communities. Nearly 50% of GPs are in solo practices and many also support community hospitals and Multi-Purpose Services.
The Macquarie region is centred on Dubbo (ERP 40,300 in 2008) and had a stable population of 102,000 in 2008. The region includes the North Western Statistical Division towns of Dubbo, Coonabarabran, Coonamble, Gilgandra, Wellington, Narromine and Warrumbungle Shire which range in size from 3,000 to approximately 10,000 residents and the Upper Darling towns of Bourke, Brewarrina, Cobar and Walgett which range in size from 2,000 to 8,000 residents.
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Dubbo is the service centre and health care hub providing specialist hospital and community health services for the region. This region has rural and remote service characteristics including reliance on the Royal Flying Doctor Service and ‘fly in fly out’ specialist services and outreach from Sydney and Dubbo. The region has a large and growing Aboriginal population with high health needs especially in the Upper Darling which includes 6 of the 10 communities with the lowest socioeconomic status in NSW.
Dubbo Plains GP Division catchment (which includes the north Western Statistical Division towns and Mudgee and Gulgong that are not included in our proposed PHCO) has 85 GPs (40 practising in Dubbo and 45 in the rural towns) and a FWE GP to population ratio of 1300 which is similar to New England and Riverina Divisions.
The Outback GP Division catchment includes the Shires of Walgett, Brewarrina, Cobar and Bourke with 85 GPs. Barrier in Far West and Outback have the lowest FWE GP to population ratio (1062) in NSW.
The Far West region includes the City of Broken Hill with a population of 20,000 and sparsely populated hinterland and remote communities in Central Darling and Unincorporated NSW. Far West had a total population of 22,500 in 2008 which is expected to remain stable or decline marginally by 2021. The Base Hospital at Broken Hill is the acute care facility for the region underpinned by ‘fly in fly out’ services and flows to South Australia.
This is a sparsely populated remote region with a high Aboriginal population and low socio economic communities.
The Barrier Division has approximately 24 GPs working in 6 practices in the region and along with Outback has the lowest FWE GP to population ratio in NSW.
3.5.19 Strengths and weaknesses of 4 rural PHCOs The PHCO configuration in Option 4 has four relatively large and capable rural PHCOs with populations ranging in size from 193,000 to 430,000 people in 2008.
Only the North Coast PHCO is experiencing sustained population growth and an influx of retirees whereas the three inland PHCOS have stable or modestly growing populations overall with internal population redistribution toward the regional centres occurring in most locations. All three of the suggested inland PHCOs need capacity to provide effective remote health care.
Each PHCO is facing workforce challenges with the North Coast advantaged in terms of recruitment but struggling to keep up with the rate of growth while the inland PHCOs have reasonable workforce to population ratios in the regional cities but often rely on overseas medical graduates to fill vacancies in smaller rural towns and remote communities.
The New England and Riverina PHCOs have similar demographic structures and rural service architecture and appear the right size whereas the current Central and Far Western PHCO has three distinct zones with different service challenges and little in common between the remote Far Western and Upper Darling LGAs and the relatively compact LGAs in the Central West.
The high health needs and service delivery challenges faced in the delivering remote health care in the Upper Darling and Far West suggest that two separate PHCOs may be required in western NSW.
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There may also be a case to split the North Coast to create two similar sized PHCOs centred on the Richmond Valley and the Mid North Coast.
3.5.20 Option 5:16 PHCOS 9 metropolitan, 2 major regional and 5 rural Under Option 5 the western region of NSW is split into two PHCOs and the North Coast remains unified as shown in Figure 11.
The Central West PHCO includes Bathurst, Blayney, Cabonne, Cowra, Forbes, Lithgow, Mid Western Regional including Mudgee, Oberon, Orange, Parkes and Weddin LGAs and had an estimated resident population of 186,000 in 2008 growing to 192,000 by 2021.
This PHCO would focus on providing rural health care in a relatively compact geographic area that is able to support multidisciplinary primary care in the majority of towns and communities and provide more specialised allied health and mental health services and general practice support to smaller communities using a hub and spoke or outreach model.
Figure 11: Option 5 - 16 PHCOs with 5 rural
The North and Far Western PHCO would include Bogan, Bourke, Brewarrina, Broken Hill, Central Darling, Cobar, Coonamble, Dubbo, Gilgandra, Lachlan, Narromine, Walgett, Warren, Warrumbungle Shire, Wellington and the Unincorporated Far West LGAs with an estimated resident population of 127,000 in 2008 that is expected to remain stable or decline marginally by 2021.
The North and Far Western would have regional hubs or branch offices in Dubbo and Broken Hill and use a rural hub and spoke model to support the north western towns and communities and a remote service model with a focus on capacity building and strong partnerships in Aboriginal health.
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The North and Far Western PHCO would use a range of workforce models including some fly in primary care services to support the Upper and Central Darling communities and look at funds pooling and integrated service partnerships similar to the Murdi Paaki arrangements between general practice, community controlled Aboriginal Health Services, community health services, the Royal Flying Doctor Service and other welfare and community services.
This PHCO would have similar characteristics to the rural and remote PHCOs proposed in Far North Queensland, Western Australia and in the Northern Territory.
To be viable this PHCO would need funding arrangements that would support innovation to address endemic socioeconomic disadvantage and target capacity building and whole of life cycle improvements in Aboriginal health and compensate for the costs of remote service provision.
3.5.21 Option 6: 17 PHCOS with 9 metropolitan, 2 major regional and 6 rural PHCOs Under Option 6 the North Coast is also split into two PHCOs as shown in Figure 12.
The Northern Rivers PHCO would cover the Richmond Valley and far north coast with the major regional hub in Lismore. Northern Rivers had an estimated resident population of 223,000 in 2008 and is projected to grow to 245,000 by 2021.
Growth will be concentrated in the coastal towns and communities of Ballina, Byron Bay, Clarence Valley coast and in Lismore. The inland communities of Kyogle, the Richmond Valley and Tweed B or Murwillumbah are expected to decline or record very modest growth.
This PHCO would focus on integrated primary health care to address the needs of the fast growing coastal population, especially the retirees, the needs of youth and the needs of the Aboriginal communities on the coast and in Kyogle.
The Mid North Coast PHCO would cover Coffs Harbour, Kempsey, Nambucca, Port Macquarie and Bellingen with an estimates resident population of 205,000 in 2008 growing to 243,000 by 2021 due primarily to expansion of Coffs Harbour and Port Macquarie.
This PHCO would also focus on integrated primary health care to address the needs of Coffs Harbour and Port Macquarie communities and would work in partnership with the rural referral hospitals developing at Port Macquarie and Coffs Harbour and continue to support GPs who work in community hospitals in the smaller communities.
This PHCO would also work in partnership with Aboriginal communities and community controlled Aboriginal Health services in Kempsey, Nambucca and Coffs Harbour.
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Figure 12: Option 6 - 17 PHCOs with 6 rural
3.5.22 Strengths and weaknesses This PHCO configuration is feasible and results in 5 similar sized rural PHCOs and 1 smaller rural remote in NSW. The North Coast PHCOs would be a similar size to likely Local Hospital Networks and would support a relatively compact geographic area with similar demographics.
The North Coast is relatively homogeneous in terms of its socioeconomic status and demographic profile and the models of primary health care delivery. Splitting the region will lead to costly duplication of business and workforce support systems and loss of economies of scale and critical mass for service innovation relative to other high growth coastal PHCOs proposed in other states. It may also encourage competition rather than cooperation between contiguous PHCOs with growing workforce needs.
3.6 Preferred NSW Option Our preferred PHCO configuration for NSW is Option 5.
The nine metropolitan PHCOs are based on contiguous LGAs that serve well defined local communities that range in size from 310,000 to 650,000 ERP. This configuration clusters the urban PHCOs into groupings with similar demographic characteristics, service architecture and workforce requirements.
The inner metropolitan PHCOs serve communities with established primary care infrastructure that will continue to grow and evolve in response to infill population growth and face challenges in relation to cultural diversity and population ageing. The workforce issues include GP succession planning.
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The PHCOs proposed for the outer urban growth areas face workforce shortfalls relative to community need in general practice, private allied professionals, community health services and specialists and will require new service architecture and innovative delivery models to address these gaps. The outer urban communities are also culturally diverse, have large and growing Aboriginal communities and have many low socioeconomic communities.
The metropolitan PHCOs do not align with the state Area Health Service boundaries but they do correspond to the local public hospital and community health service clusters and networks within these Areas to which local GP referrals flow. These hospital networks and clusters could also form the basis for the metropolitan Local Hospital Networks in NSW.
The regional PHCO configuration proposed in the Hunter and Greater Taree and Illawarra Shoalhaven addresses the needs of growing regional centres. The regional centres have strong links to discrete rural and coastal communities with specific local primary health care needs and workforce requirements but they also relate to the regional centre for education, training and tertiary level acute care. The branch office model is proposed in both these PHCOs to ensure the regional PHCO relates effectively to the rural communities.
The five rural PHCOs proposed for New England, Riverina, the North Coast, the Central West and the North and Far Western NSW are configured around the needs of discrete regions. These regions have similar service delivery and workforce needs, strong existing communities of interest and in some cases rural and remote communities that need extra support to access primary health care and address the needs of Aboriginal communities.
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4 Australian Capital Territory 4.1 Overview The Australian Capital Territory is a self governing territory located within southern NSW. The ACT includes the National Capital Canberra and some 2,358 square kilometres of agricultural land and the Namadgi National Park.
The ACT and NSW are sovereign jurisdictions with independent health systems but there are significant cross border flows and service linkages that will impact on the design of PHCOs in the wider region. For this reason we have considered NSW and the ACT together in this Report.
4.2 Demographic Features
4.2.1 Current population The ACT had an estimated resident population of 345,600 people at June 2008 and grew by 1.6% to 351,200 people by June 2009. The northern suburbs of Canberra experienced the highest growth in 2007/08 with the largest increases in Gungahlin-Hall Statistical Sub Division, Belconnen and North Canberra.
The ACT had a younger age structure than other states at the 2006 Census with 15.8% of ACT residents aged 15-24 years and 20.3% over the age of 55 compared to 24.3% nationally.
ACT residents score in the top 10% on the Index of Relative Socio-economic Advantage and the indices of Economic Resources and Education and Occupation. ACT residents had a median weekly individual income of $722 compared to $466 for Australians overall at the 2006 Census and a higher percentage of the population work as Professionals (29.3%), Managers (15.4%) and Clerical and Administrative Workers (19.1%) than the national average.
4.2.2 Indigenous population In 2006 there were 3,873 Aboriginal and Torres Strait Islander people living in the ACT or 1.2% of the population. This is just under half the national average population share.
4.2.3 Projected population and patterns of growth The ACT growth rate to June 2009 was 1.6% which is similar to NSW (1.7%) but below the national average of 2.1%. Canberra is a planned City and the major growth is occurring in the northern suburbs of Canberra and in the adjoining NSW LGAs of Queanbeyan, Palerang A and Yass Valley.
4.3 Structure of Health Services
4.3.1 General Practice The ACT Division of General Practice is an urban Division covering approximately 336 ACT general practitioners and 92 practices as shown in Table 8. The ACT is a State Based Organisation and a Division. In terms of workforce and practice characteristics in 2007/08 there were:
• 336 practising GPs in the ACT of whom 168 or 50% were female
• 1027 people per practising GP and 1487 per FWE GP
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• Approximately 24 solo practices or 26% of the practice base
The Division has a diverse membership including GPs working in Universities, research and in government services as well as clinical practice. The Division also provides service to GP members who reside in NSW and are not shown on the ACT practice demographics.
The ACT has a relatively high population to FWE GP ratio of 1487 - the third highest in Australia after the Northern Territory and Western Australia.
Table 8: ACT Division of General Practice Key Characteristics 2007/08 Name of Division of General Population Total Solo Estimated Number of FWE GPs GPs: FWE GP: Practice 2007 B number of practices number of female as at population population practices practising GPs 30/06/07 E 2007 ratio 2007 ratio GPs ACT Division of General Practice 345048 92 24 336 168 232 1027 1487 Source: Primary Health Care Research and Information Service
The size of the GP workforce in the ACT has fluctuated over the last 10 years from a low of 316 GPs in 2001/02 to a high of 386 in 2002/03 as shown in Figure 13.
Figure 13: Trends in ACT GP Workforce
4.3.2 ACT Health Services ACT Health is a Territory wide Health Service with a clinical operations arm and a policy, inter governmental relations and population health arm.
The Canberra Hospital is a major teaching hospital and the referral centre for the ACT and the wider region and offers a full range of medical specialties. Approximately 25% of hospital referrals flow from NSW. Calvary Public Hospital is a general hospital with a strong focus on surgery, obstetrics, general medicine and mental health. Cancer Services, Mental Health, Aged Care and Rehabilitation and Community Health are managed as clinical streams. Community Health Services include Alcohol and Drug Services; Child, Youth and Women’s Health; Continuing Care Program; and, Dental Health Program.13
13 www.ACTHealth.gov.au/home
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ACT Health and the ACT Division of General Practice collaborate in number of chronic disease management programs.
4.3.3 Aboriginal community controlled health services Winnunga Nimmtyjah Aboriginal Health Clinic and Health Service (ACT) Inc is the community controlled Aboriginal Health Service in the ACT.
4.4 PHCO Design Issues The ACT sits within NSW state boundaries and the NSW LGAs of Queanbeyan, Palerang A and Yass Valley relate directly to the ACT as their regional centre and constitute part of the Canberra growth zone. There are also strong communities of interest, referral pathways, clinical outreach arrangements and academic linkages between the ACT, Greater Southern Area Health Service and the NSW general practice community.
Determining the extent of the cross border flow that should be built into a PHCO based on the ACT is the main design challenge. Many of the issues were discussed in detail in the previous chapter.
4.5 Configuration Options
There are three possible configuration Options for a PHCO covering the ACT and they are shown in Figures 14 to 16 and Tables 9 to 11.
4.5.1 Option 1: ACT as a self contained PHCO Under this Option the ACT PHCO would cover the Australian Capital Territory geographic footprint or an estimated resident population of 345,500 in 2008 that is projected to grow to 397,200 by 2021. The PHCO boundaries would reflect the current ACT Division and SBO boundaries (but not the full membership) and would continue to align directly with the ACT Health Service.
Figure 14: Option 1 - ACT as self contained PHCO
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Table 9: Option 1 - ACT as self contained PHCO PHCO ERP 2021 Pop Division State Health Boundaries LGAs 2008 Boundaries ACT PHCO 345551 397200 ACT DGP ACT Health Service Unincorporated ACT
4.5.2 Strengths and weaknesses The major strength of this Option is that the new PHCO would be a transition from the current Division structure and this would reduce establishment time. There are also pre-existing linkages with the ACT Health Service and local NGOs that would enable the PHCO to formalise partnership arrangements and commence whole of sector planning and service development in a relatively short timeframe.
The PHCO would have sufficient population to be viable and would have a similar population base to urban PHCOs in other jurisdictions.
The major weakness of this Option is that the geographic boundaries do not reflect the regional health care and teaching and training role of the ACT or the communities of interest and GP linkages that form part of the current Division’s operations.
4.5.3 Option 2: Single PHCO for ACT and contiguous NSW LGAs The second Option incorporates Queanbeyan, Palerang A and Yass Valley into a PHCO based on the ACT as shown in Figure 15.
Figure 15: Option 2 – Single PHCO covering ACT and contiguous NSW LGAs
The Greater ACT PHCO would have an estimated resident population of 410,000 in 2008 and is expected to grow to 480,000 by 2021. It would include the LGAs covered by the ACT Division and part of the Southern NSW Division of General Practice as shown in Table 10 and ACT Health and the Yass Valley and Queanbeyan Health Services administered by Greater Southern Area Health Service.
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Table 10: Option 2 - Single PHCO covering ACT and contiguous LGAs in NSW PHCO ERP 2021 Pop Division State Health Boundaries LGAs 2008 Boundaries Greater ACT PHCO 409815 480460 ACT DGP & ACT Health Service and Unincorporated ACT, Palerang Pt A, Yass Southern DGP Queanbeyan and Yass Health Valley and Queanbeyan Services
4.5.4 Strengths and weaknesses The major strengths of this configuration are that the PHCO would be responsible for planning and service development in the actual geographic catchment of the ACT and would better reflect both clinical flows and communities of interest that regard Canberra as the regional hub and service centre.
The PHCO would have greater capacity and critical mass and the local NSW community would continue to relate to this primary health care entity in the same way they utilise other human services and infrastructure in Canberra.
The major weakness is the need to negotiate an appropriate cross border agreement with NSW to enable NSW community health services to come under the partnership agreement and the need to harmonise clinical policies and procedures in some areas.
However the ACT and NSW already have a cross border agreement covering hospital flows and there are a range of common clinical support and service arrangements in place between GSAHS and ACT Health around the provision of specialist services such as cancer care and renal care for NSW patients who receive part of their care in both the ACT and NSW.
Extending these arrangements to more fully cover primary health care may pose fewer problems for the ACT and NSW than it may in some other cross jurisdiction arrangements.
4.5.5 Option 3: Single regional PHCO covering ACT and Southern NSW Under the third option shown in Figure 16 a single regional PHCO would be established covering the ACT, the contiguous LGAs and the South Coast and Snowy SSD or the ABS South Eastern Statistical Division excluding Young.
The catchment had a combined resident population of 539,200 in 2008 that is projected to grow to 628,500 by 2021. Some 194,000 people, or over with 36% of the proposed regional PHCO catchment population, will reside in NSW.
Table 11: Option 3 - Single regional PHCO covering ACT and Southern NSW PHCO ERP 2021 Pop Division State Health Boundaries LGAs 2008 Boundaries ACT & Southern 539216 628487 ACT DGP, ACT Health Service and part Unincorporated ACT plus all the LGAs in the NSW PHCO Southern DGP GSAHS South Eastern Statistical Division excluding Young
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Figure 16: Single regional PHCO covering ACT and Southern NSW
As shown in Table 12, the largest population concentrations in the NSW portion of the catchment are the Lower South Coast (13%) and Southern Tablelands (12%) Statistical Sub Divisions followed by Queanbeyan (7%) and Snowy (4%).
Table 12: Regional PHCO population by SSD and LGA of residence SSD LGA 2008 ERP 2021 % 2008 % 2021 SEIFA Pop ERP Pop Index Lower South Coast Bega Valley (A) 32956 39628 Eurobodalla (A) 37064 46736 70020 86364 13 14 967 Southern Tablelands Goulburn Mulwaree (A) - Goulburn 21304 20156 Goulburn Mulwaree (A) Bal 6402 7965 Palerang (A) - Pt B 3586 3844 Palerang (A) - Pt A 10266 13526 Upper Lachlan Shire (A) 7392 7312 Yass Valley (A) 14395 17639 63345 70442 12 11 995 Snowy Bombala (A) 2601 2328 Cooma-Monaro (A) 10202 10463 Snowy River (A) 7894 9595 20697 22386 4 4 1024 Queanbeyan Queanbeyan (C) 39603 52095 7 8 1040 NSW Total 193665 231287 36 37 ACT Unincorporated ACT 345551 397200 64 63 1066 Total PHCO 539216 628487
Under this Option the demography and the service architecture would change from a purely urban PHCO serving a high SES community to a regional PHCO with an urban service centre and three distinct rural communities with different characteristics and a mixed socioeconomic profile.
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Lower South Coast includes the Bega Valley and Eurobodalla Shires which are coastal communities experiencing moderately strong population growth and interstate migration. The entire South Coast has a major tourism industry which swells population numbers during holiday periods. Batemans Bay and Bega are the main population centres and there are District or Community Hospitals and associated Community Health Services at Bega, Batemans Bay, Moruya and Pambula. A new Regional Hospital is being built near Bega that will offer a wider range of specialist services. The other Hospitals rely on GP VMOs as well as visiting specialists from Bega or Canberra.
There are also significant Aboriginal communities on the South Coast and the area has the lowest socioeconomic status in the region.
Southern Tablelands includes the City of Goulburn which is the major service centre, rural farming towns and communities in the Upper Lachlan Shire, the Yass Valley and the growth area on the ACT border of Palerang. Population growth is projected in the SLAs bordering Canberra and in the rural hinterland.
There is a Base Hospital offering specialist services and a major mental health facility in Goulburn plus associated Community Health Services and a Community Hospital and associated Community Health Services at Yass. The area has mixed socioeconomic status but ranks close to the Australian average.
The Snowy includes the farming and high mountain regions of Cooma-Monaro and Snowy River and the southern farming SLA of Bombala which stretches south of the ACT inland to the Victorian border. There are District Hospitals and associated Community Health Services at Cooma and Tumut that both rely on GP VMOs and a Multi-Purpose Service at Bombala.
Queanbeyan is a fast growing provincial City that sits within the Canberra Statistical Division and is functionally linked to Canberra for employment. Queanbeyan has a District Hospital that relies on GP VMOs and visiting specialists from Canberra and a multidisciplinary Community Health Service.
The Snowy and Queanbeyan both have relatively high socioeconomic status and are demographically similar to the ACT.
Southern NSW Division of General Practice has the highest population to GP FWE ratio in NSW (1566) and the available GP workforce is struggling to keep pace with population growth. The Division is also a MAHS service provider.
4.5.6 Strengths and Weaknesses This Option provides a large regional PHCO serving an urban and mixed rural and coastal catchment that is comparable in structure and demographic profile to the regional PHCOs proposed at Illawarra Shoalhaven and Greater Hunter. All three areas have a major university providing training for doctors and nurses as a central feature of the regional community.
This Option will build on existing regional clinical and education networks that will need to expand to support GP recruitment and retention and hospital upgrades on the South Coast. It will provide a more viable arrangement than retaining a small Southern NSW PHCO which would lack critical mass compared to other rural PHCOs in NSW and nationally if Queanbeyan and other contiguous LGAs combine with ACT under Option 2.
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The major weakness and possible area of risk is the need to ensure the PHCO has expertise in both high density urban primary health care and rural primary care including skills and capacity to support a region with significant GP workforce pressures and allied health staff shortfalls.
A branch office structure will be mandatory to ensure effective local community engagement for service development and planning across southern NSW. The PHCO will also need the capacity to operate as a service provider and/or commission of services to address service gaps in the rural communities.
As with Option 2 there will be a need to develop an even more robust cross border agreement.
4.6 Preferred Option The development of a single regionally focussed PHCO with branch offices in key locations in south eastern NSW is our preferred approach for national consistency and to ensure the PHCO has the critical mass needed to provide effective service planning and development and practice support services for the entire catchment population.
With almost 200,000 NSW residents and their communities coming under the regional PHCO umbrella, the development of a formal cross border agreement and resource allocation model between the ACT, NSW and the Australian government will be mandatory and a minimum essential condition for NSW to proceed.
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5 Victoria 5.1 Overview With a population of 5.4 million and covering an area of 237,629 square kilometres Victoria is the second most populous and the most compact mainland state in Australia. Victoria is also the most densely populated and centralised state with over 70% of the population living in Melbourne. Victoria has rural population centres spread throughout the state and has no areas considered remote or very remote using the ARIA indices.
5.2 Demographic Features
5.2.1 Current population Victoria had an estimated resident population of 5.31 million people at June 2008 and this grew by 2.1% to 5.43 million residents by June 2009. At June 2008 approximately 3.9 million people resided in the Melbourne Statistical Division which grew by 2% and experienced the strongest growth of all capital cities to June 2008.
Population growth was concentrated in the growth corridors on the outer urban fringes in Wyndham in the south west (8,900 population and 7.2% increase), Casey in the south east (8,000 people or 3.5% increase) and Melton in the west (6,000 people and 7% increase). Cardinia in the south east (5.5%) and Whittlesea in the north (4%) also had fast growth rates.
The population of the rest of Victoria increased by 1.3% to 1.4 million people in June 2008. The Cities of Greater Geelong (3,000 people or 1.4%), Ballarat (1,800 people or 2%) and Greater Bendigo (1,600 people or 1.6%) were the regional LGAs recording the greatest population increase. Coastal growth also continued with Surf Coast (3.6%), Bass Coast (2.3%) and Queenscliffe (2.2%) experiencing the fastest growth rate in regional Victoria.
Regional Victoria experienced decline in the agricultural areas in the north west and north east including Benalla, Yarriambiack, Hindmarsh, Northern Grampians and Buloke.
5.2.2 Indigenous population In 2006 Victoria had 30,144 people identifying as Aboriginal and/or Torres Strait Islanders or 0.6% of state population and 6% of the national indigenous population.
Forty seven percent of the indigenous population live in metropolitan Melbourne and the largest communities are in Casey/Cardinia (1,399) and Darebin (1,110).
Nearly 16,000 indigenous people lived in regional Victoria (53%) and the major population centres were in Greater Shepparton (1,820), Greater Geelong (1,448), Mildura (1,432), East Gippsland (1,140) and Greater Bendigo (1,020).
As shown in Table 13, 52% of Victoria’s indigenous population live in regional Australia and 48% live in major cities.
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Table 13: Indigenous population by Remoteness Areas - 2006 Census Major Inner Outer Remote Very Cities Regional Regional Australia Remote Australia Australia Australia % % % % % Victoria 48 36 16 Australia 31 22 23 8 16 Source: Population distribution Aboriginal and Torres Strait Islander Australians ABS 4705. 2006
5.2.3 Patterns of growth and projected population Melbourne 2030 Strategy (2002) 14 and Melbourne @ 5 million (2008) 15 provides the framework for growth and development in Greater Melbourne over the next 20 years.
The Strategy outlines the development of five urban growth corridors (Casey-Cardinia in the Melbourne south east, Melton-Caroline Springs and Wyndham in Melbourne west and Hume, Mitchell and Whittlesea in Melbourne north) that will be expand through land release and infill development to accommodate up to 225,000 new households over the next 20 years.
Melbourne @5million responds to the faster growth occurring post 2008 and identifies the need for 6 new Central Activities Districts in Box Hill, Broadmeadows, Dandenong, Footscray, Frankston and Ringwood that will support a multi centre city model with decentralised access to local employment, business development and access to education, health and recreation precincts.
Melbourne’s outer urban growth boundary will also expand to accommodate 284,000 new dwellings.
In regional Victoria growth is expected to occur in the major regional cities of Geelong, Ballarat and Bendigo and along the coast where ‘baby boomer’ retirement and boutique rural development and tourism will continue to drive population growth.
Victoria in Future 2008 16 outlines the official state government population projections that underpin the urban and regional development strategies. These projections indicate that Victoria’s population will grow from 5.12 million in 2006 to 6.3 million in 2021 and to 7.4 million by 2036 and experience in shift in age structure with increased 23% of population aged over 60 by 2021. Both metropolitan and rural regional areas are projected to grow. These projections have been used by LGA in this study.
5.3 Structure of Health Services
5.3.1 General Practice There are twenty nine Divisions of General Practice in Victoria – 14 in metropolitan Melbourne and 15 in rural and regional areas. Victorian Division boundaries are not contiguous with LGAs as shown in Figure 17 and Figure 18. The Division catchments in metropolitan areas range in size from 144,800 people in Greater Monash GP Network to 476,800 in Melbourne East Division. In rural areas the catchment
14 Department of Planning and Community Development: Melbourne 2030 Strategy . Victoria Government 2002 15 Department of Planning and Community Development: Melbourne 2030: a planning update - Melbourne@5million . Victoria Government 2008 16 Department of Planning and Community Development: Victoria in Future 2008 – Victorian State Government Population Projections . Second release September 2009
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population ranges from 65,970 in South Gippsland to 238,100 in GP Association of Geelong as shown in Table 14.
Figure 17: Victorian Rural Divisions of General Practice
Figure 18: Victorian Metropolitan Divisions of General Practice
In terms of workforce and practice characteristics in 2007/08 there were:
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• 5,966 practising GPs in Victoria of whom 2,049 or 34% were female
• 890 people per practising GP and 1,144 per FWE
• Approximately 1,687 general practices including 532 solo practices or 32% of the practice base
Table 14: Victorian Divisions of General Practice Key Characteristics 2007/08 Division of General Practice Population No of Solo No No FWE GPs No FWE 2007 B practices practices GPs as at GPs: GP: female 30/06/07 E pop pop GPs 2007 2007 ratio ratio Melbourne General Practice Network 209705 152 66 470 NA 279 446 752 North East Valley Division of General Practice 235548 69 19 262 128 198 899 1190 Inner Eastern Melbourne Division of General Practice N/A 73 23 286 138 N/A N/A N/A SouthCity General Practice Services 203653 73 22 376 162 233 542 874 Westgate General Practice Network 212650 51 12 176 54 169 1208 1258 Western Melbourne Division of General Practice 279599 100 40 266 87 251 1051 1114 North West Melbourne Division of General Practice 301072 96 44 294 94 256 1024 1176 Northern Division of General Practice - Melbourne 251601 89 27 203 77 250 1239 1006 Whitehorse Division of General Practice 476804 95 27 408 179 424 1169 1125 Greater Monash GP Network 195050 78 27 276 116 168 707 1161 Monash Division of General Practice 144838 58 25 153 60 133 947 1089 Bayside General Practice Network 181692 46 6 213 110 130 853 1398 Knox Division of General Practice 203052 43 10 192 73 177 1058 1147 Dandenong & Casey General Practice Association 324846 90 23 300 104 322 1083 1009 Peninsula GP Network 286954 75 21 279 90 219 1029 1310 GP Association of Geelong 238119 56 12 250 88 188 952 1267 Central Highlands General Practice Network 179800 41 3 242 94 194 743 927 North East Victorian Division of General Practice 105034 30 4 120 40 84 875 1250 Eastern Ranges GP Association 224576 59 17 191 63 133 1176 1689 General Practice Alliance - South Gippsland Ltd 65970 20 4 82 29 59 805 1118 Central West Gippsland Division of General Practice 113656 31 5 102 34 107 1114 1062 Otway Division of General Practice 122575 33 13 100 21 100 1226 1226 Ballarat & District Division of General Practice 122119 27 5 110 36 89 1110 1372 Central Victoria General Practice Network 107825 40 17 107 28 70 1008 1540 Goulburn Valley Division of General Practice 102255 27 5 102 34 79 1003 1294 East Gippsland Division of General Practice 76829 31 13 96 35 64 800 1200 Albury Wodonga Regional GP Network 107719 25 9 92 29 70 1171 1539 West Victoria Division of General Practice 81365 33 12 90 21 77 904 1057 Murray Plains Division of General Practice 63814 20 5 59 16 54 1082 1182 Mallee Division of General Practice 88729 26 16 69 9 64 1286 1386 Source: PHCRIS 2007/08 Survey of Divisions of General Practice. Note several name changes have occurred since the 2007/08 data was collected. Whitehorse and Inner Eastern Melbourne are now Melbourne General Practice Network; Western Melbourne is now Pivot West; North West Melbourne is now Impetus and Know is now Greater Eastern Primary Health.
5.3.2 GP Workforce Distribution Victoria has a marginally higher patient to FWE GP ratio than other states and territories and uneven workforce distribution. In Greater Melbourne, Bayside (1398), Peninsula (1310) and Westgate (1258) Divisions have the highest patient to GP FWE ratios and Melbourne GP Network (752) has the lowest. In rural Victoria Eastern Ranges (1628), Albury Wodonga (1539), Central Victoria (1540), Mallee (1386) and Ballarat (1372) have the highest ratios and Central Highlands (927) has the lowest.
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5.3.3 Trends in GP Numbers Victoria has maintained a fairly stable GP workforce of just under 6,000 GPs since 2005/06.
Figure 19: Trends in Victoria GP numbers
5.3.4 State Health Services Health and human services in Victoria are organised into three metropolitan regions and 5 rural regions that are responsible for planning, funding and delivery of health, housing and community services in their service catchments. The Metropolitan Regions are North and West, Eastern and Southern as shown in Figure 20 and cover populations ranging in size from 973,000 people in the Eastern Region to 1.184 million in the Southern Region.
Figure 20: Metropolitan regions and public hospitals
Whittlesea
Hume Craigieburn Health Service North and West Nillumbik Melton The Northern Hospital Healesville & District Hospital
Broadmeadows Health Service Melton Health Bundoora Extended Care Centre Brimbank Moreland Darebin Yarra Ranges Moonee Valley Banyule Heidelberg Repatriation Hospital Austin Hospital and pYarra Ranges Health Sunshine Hospital Mercy Hospital for Women Royal Melbourne Hospital, Royal Park Manningham Western Hospital Royal Talbot Rehablilitation Centre Tweedle Child & Family Health Centre St George's Health Service Eastern Maribyrnong Boroondara Maroondah Hospital Melbourne Box Hill Hospital Maroondah Yarra O'Connell Family Centre (Grey Sisters) Inc. Port Phillip Whitehorse Hobson Bay The Alfred Wantirna Health Williamstown Hospital Stonnington The Peter James Centre Mercy Werribee Caulfield General Medical Centre p Calvary Health Care Bethlehem Ltd Glen Eira Monash Angliss Hospital Knox Monash Medical Centre, Moorabbin Monash Medical Centre, Clayton Wyndham Hampton Rehabilitation Hospital Bayside Sandringham & District Hospital Kingston Centre Queen Elizabeth Centre Dandenong Hospital Kingston Cardinia Casey Hospital Boroondara Greater Yarra Dandenong Royal Children's Hospital Royal Women's Hospital Royal Melbourne Hospital, City Dental Health Services Victoria Casey Southern Maribyrnong Caritas Christi Hospice Cranbourne Integrated Care Centre St Vincent's Hospital Royal Victorian Eye Frankston & Ear Hospital INSET Peter MacCallum Cancer Centre INSET 0 500 1000 Frankston Hospital Melbourne Metres Golf Links Road Rehabilitation and PCU p
0 10 20 Kilometres The Mornington Centre Local Government Areas based on Australian Standard Geographical Classification 2006
Mornington Peninsula Rosebud Hospital Rosebud Rehabilitation Unit p Metropolitan Melbourne public hospitals Department of Health regional boundaries Local Government Areas
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The Rural Regions are Gippsland, Hume, Loddon-Mallee, Grampians and Barwon South West as shown in Figure 21.
Figure 21: Rural regions and public hospitals
Mildura Base Hospital
Robinvale District HS
Mildura Swan Hill Mallee Track Health & CS, Ouyen Manangatang & District Hospital Loddon Mallee Regional Victorian public hospitals Swan Hill District Health including Department of Human Services regional boundaries and Local Government Areas Yarriambiack Kerang District Health Gannawarra Cohuna District Hospital Cobram District Hospital Buloke Moira Yarrawonga District HS Nathalia District Hospital Numurkah District HS Albury Wodonga Health, Albury Boort District Health Wodonga Loddon Echuca Regional Health Albury Wodonga Health, Wodonga Hindmarsh Upper Murray Health & CS, Corryong Rural Northwest Health, Warracknabeal Campaspe Indigo Tallangatta HS Kyabram & District HS Northeast Health Wangaratta West Wimmera HS, Nhill Rochester & Elmore District HS Goulburn Valley Health, Shepparton Benalla Beechworth HS Greater Shepparton Towong Inglewood & District HS Benalla & District Memorial Hospital Wangaratta Alpine Health, Myrtleford Dunmunkle HS , Rupanyup East Wimmera HS, St Arnaud Greater Bendigo Strathbogie Hume West Wimmera Wimmera Health Care Group, Horsham Bendigo Health Care Group Horsham Northern Alpine Grampians Central Grampians Goldfields McIvor Health & CS, Heathcote Edenhope & District Hospital Maryborough District HS Maldon Hospital Seymour District Memorial Hospital Stawell Regional Health Mt Alexander Hospital, Castlemaine Mansfield District Hospital Pyrenees Mount Alexander Omeo District Health Mitchell Alexandra District Hospital East Gippsland East Grampians HS, Ararat Kyneton District HS Yea & District Memorial Hospital Southern Grampians Hepburn HS, Daylesford Kilmore & District Hospital Mansfield Hepburn Murrindindi Beaufort & Skipton HS, Beaufort Ballarat Macedon Ranges Moorabool Casterton Memorial Hospital Ballarat HS Gippsland Ararat Djerriwarrh HS, Bacchus Marsh Wellington Orbost Regional Health Western District HS, Hamilton Melton Health Metropolitan map Glenelg Bairnsdale Regional HS Golden Plains Baw Baw Moyne Corangamite Greater Geelong Central Gippsland HS, Sale Heywood Rural Health Barwon South Western Barwon Health, Geelong Terang & Mortlake HS, Terang Kooweerup Regional HS West Gippsland Healthcare Group, Warragul Hesse Rural HS, Winchelsea Surf Coast Queenscliffe Latrobe Regional Hospital, Traralgon Portland District Health Warrnambool Colac Area Health Moyne HS, Port Fairy South West Healthcare, Warrnambool Unincorporated Vic La Trobe Timboon & District Healthcare Service Gippsland Southern HS, Leongatha Lorne Community Hospital Bass Coast Yarram & District HS South Gippsland Colac-Otway Bass Coast Regional Health, Wonthaggi South Gippsland Hospital, Foster Otway Health & CS, Apollo Bay Department of Human Services regional boundaries 0 50 100 based on Local Government Areas Kilometres Australian Standard Geographical Classification 1 July 2004 Hospitals current at 1 February 2010
5.3.4.1 Metropolitan Health Services Acute hospitals, specialist aged care and rehabilitation services, mental health programs and ambulatory and community health services are administered by Metropolitan Health Services in Victoria.
There are nine Metropolitan Health Services that manage multi hospital networks as shown in Table 15 and three providers – The Peter MacCallum Cancer Institute, Dental Health Services Victoria and Royal Victorian Eye and Ear Hospital - that administer statewide programs or provide specialist services for Victoria as a whole. Specialist hospitals such as the Royal Women’s Hospital and the Royal Children’s Hospital in Parkville provide tertiary services and have their own Boards.
Table 15: Metropolitan Health Services by site and Health Region Metro Health Service Hospitals Region St Vincent’s Health St Vincent's Hospital, Caritas Christi Hospice, St George's HS Eastern Western Health Sunshine, Western and Williamstown Hospitals North & West Northern Health Broadmeadows HS, Bundoora Extended Care , Craigieburn HS, PANCH HS North & West Eastern Health Angliss, Box Hill, Healesville & Maroondah Hospitals, The Peter James Centre, Wantirna Eastern Health & Yarra Ranges Health Alfred Health Caulfield, Sandringham and The Alfred Hospitals Southern Melbourne Health Royal Melbourne Hospital, North Western Mental Health, North West Dialysis Service, North & West Aged & Palliative Care, Victorian Infectious Diseases Reference Laboratory & Tweddle Child & Family Health Service Southern Health Monash Medical Centre, Dandenong, Casey, Cardinia Hospitals, the Kingston Centre and Southern Craigieburn ICC Austin Health Austin Hospital, Heidelberg Repatriation Hospital & Royal Talbot Rehabilitation Centre Eastern Mercy Public Hospitals Inc Mercy Public, Werribee & Mercy Hospital for Women, O'Connell Family Centre North & West & Eastern Peninsula Health Frankston Hospital, Rosebud Hospital and Mt Eliza Rehabilitation, Southern
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Metro Health Service Hospitals Region Metropolitan Hospitals Peter MacCallum Cancer Institute - East Melbourne Eastern Queen Elizabeth Centre - Noble Park Eastern Royal Children’s Hospital - Parkville Eastern Royal Victorian Eye & Ear Hospital - East Melbourne Eastern Royal Women's Hospital – Parkville Eastern Dental Health Services Victoria – Carlton Eastern
5.3.4.2 Rural Regions and Health Services There are 74 regional and rural health services in Victoria 17 that include acute, aged care, small rural health services, multi-purpose services and bush nursing centres.
The major rural referral centres are Barwon Health Service in Barwon South West Region, Ballarat Health Service in the Grampians Region, Bendigo Health Service in Loddon Mallee/NSW and Albury Wodonga Health Service in Hume Region.
The majority of small rural hospitals rely on GPs as part of their medical team whereas the larger regional hospitals offer a broad range of specialist services.
5.3.4.3 Primary Care Partnerships Victoria has established Primary Care Partnerships that link Community Health Services, Divisions of General Practice, Local Government and NGOs to improve coordination and integration between primary care and community services and to develop joint health promotion plans for their communities. There are 30 Primary Care Partnerships in Victoria with 11 in metropolitan Melbourne as shown in Figure 22 and 19 in rural Victoria as shown in Figure 23.
Figure 22: Metropolitan Primary Care Partners by Health Region
Whittlesea
Hume Nor t h Cent r al Metr o Banyul e-Nil l umbik Hume-Mor eland North and West Nillumbik Melton
Brimbank-Melt on Brimbank Moreland Darebin Yarra Ranges Moonee Valley Moonee Vall ey - Melbour ne Banyule Out er East
Manningham Eastern Maribyrnong Boroondara Maroondah Melbourne Yarra Port Phillip Hobson Bay Whitehorse West bay Stonnington I nner Sout h
Glen Eira Monash I nner East Knox Wyndham Bayside
Kingston Kingst on-Bayside Cardinia Greater Dandenong SOUTH EAST
Casey Southern
Frankston
0 10 20 Kilometres Department of Health regions basedLocal Governmenton Local Government Areas based Areas on Australian Standard Geographical Classification 2006 Frankst on-Mor ningt on
Mornington Peninsula
Primary Care Partnerships, Local Government Areas and Department of Health regional boundaries
17 www.healthcollect.vic.gov.au/directories/rural hospitals Accessed February 2010
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Primary Care Partnerships generally cover several Integrated Planning Areas and LGAs. Their catchment populations vary in size from 31,000 in Grampians Pyrenees PCP to 261,000 in Barwon PCP which includes the City of Geelong to over 600,000 people in the Inner East Primary Care Partnership in Melbourne. 18
Figure 23: Rural Primary Care Partnerships by Region
Mildura Northern Mallee Swan Hill Loddon Mallee Regional Victoria including Primary Care Partnerships, Local Government Areas and Department of Human Services regional boundaries Southern Mallee Yarriambiack
Gannawarra
Buloke Moira Wodonga Hindmarsh Loddon Campaspe Indigo
Benalla Upper Hume Wimmera Bendigo-Loddon Greater Shepparton Wangaratta Towong Campaspe Goulburn Valley Greater Bendigo Strathbogie Hume West Wimmera Central Hume Horsham Northern Central Alpine Grampians Grampians Goldfields Pyrenees Mount Alexander Mitchell Central Victorian Health Alliance East Gippsland East Gippsland Southern Grampians Mansfield Hepburn Macedon Ranges Murrindindi Grampians Pyrenees Ballarat Lower Hume Moorabool Gippsland Southern Grampians-Glenelg Ararat Wellington Central Highlands Metropolitan map Wellington Glenelg Golden Plains South West Baw Baw Moyne Corangamite Greater Geelong Barwon South Western Central West Gippsland Surf Coast Queenscliffe Warrnambool Unincorporated Vic La Trobe
Barwon Bass Coast Colac-Otway South Gippsland
0 50 100 South Coast Health Service Consortium Boundaries based on Local Government Areas Kilometres Australian Standard Geographical Classification 1 July 2006
5.3.5 Aboriginal community controlled health services There are 24 community controlled organisations funded by OATSIH in Victoria and 26 organisations affiliated with NACCHO. They include the peak body VACCHO (Victorian Aboriginal Community Controlled Health Organisation) and Aboriginal Corporations and Co-operatives that operate as multi-function service centres.
These co-operatives provide health services and a range of other programs including prevention of family violence, housing, drug and alcohol management and aged care and disability services.
Services are located at Bairnsdale, Ballarat, Bendigo, Echuca, Geelong, Halls Gap, Heywood, Horsham, Lake Tyers, Melbourne, Mildura, Morwell, Orbost, Portland, Robinvale, Rumbalara, Sale, Swan Hill, Warrnambool and Wodonga.
5.4 PHCO Design Issues The key issues influencing PHCO design in Victoria are outlined below.
5.4.1 Metropolitan and rural design considerations Victoria is a relatively compact and densely populated state and faces different planning issues and demographic challenges to other mainland states in relation to rural and regional service development and the design of metropolitan services.
Greater Melbourne has grown around Port Phillip Bay and has defined northwest, eastern and southern population corridors and relatively stable established inner metropolitan suburbs. Melbourne is bounded
18 DHHS Victoria: Statewide Primary Care Partnerships December 2009. Personal communication February 2010
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by the regional City of Geelong in the south west and by the Mornington Peninsula in the south east. This geography poses some challenges for PHCO design and for metropolitan and rural service classification.
The City of Geelong and Sorrento on the Mornington Peninsula are both approximately 100 kilometres from the Melbourne CBD but are treated differently in terms of urban planning. Greater Geelong forms part of the Barwon South West rural region while Mornington Peninsula is a semi rural generally high socioeconomic area that is regarded as part of Greater Melbourne. It is tied to Frankston in the Hospital Network. For the purpose of PHCO modelling we have accepted the approach used in urban planning in Victoria and treated Geelong as a rural growth centre despite its proximity to Melbourne and included Mornington Peninsula as part of Greater Melbourne.
Regionalism is well developed in rural Victoria and most rural areas relate to one of the three major regional centres – Ballarat, Bendigo and Geelong - that offer comprehensive hospital and specialist services and have established training programs and professional networks. There are no ‘remote’ communities in Victoria that are comparable to those in Queensland, Western Australia, South Australia or far western NSW. This suggests that the regional centre model with hubs and spoke arrangements will continue to be influential and effective planning models in Victoria.
5.4.2 Alignment with Primary Care Partnerships and Regions Victoria Divisions of General Practice, especially in Melbourne, have been developed around professional communities of interest and they vary in population size and the geographic areas they cover. Victoria Divisions are based on postcode groupings rather than LGAs or SLAs and this provides a poor basis for population level planning.
Victoria’s state government health and human service architecture is built around population distribution. There are 5 rural Regions ranging in size from 208,000 in Grampians Region with 4% of the state population to 340,000 in Barwon South West Region with 7% of the state population. The three large Regions in metropolitan Melbourne reflect the major population corridors and range in size from 973,000 people in the Eastern Region to 1.124 million in the North and West Region to 1.184 million people in Southern Region.
The Regions are underpinned by Metropolitan and Rural Health Services that are provider networks based on hospital catchments and Primary Care Partnerships that are LGA based. The Primary Care Partnerships link the major service provider groups in the community including GP Divisions, community health services, local government and Non Government Organisations to plan service development and they also share populations with human services Integrated Planning Areas.
While alignment with regional catchments has benefits in terms of high level human service planning, the metropolitan human service Regions in particular are too large and diverse (in terms of ethnicity, age and socio-economic status) to function effectively as local PHCOs. Expected patterns of population growth in Greater Melbourne will exacerbate the scale problem.
The PCPs provide a sound basis on which to develop PHCOs in Victoria. However the PCP catchment populations vary substantially in size from 30,800 in the Grampians Pyrenees PCP to over 608,000 in Inner East PCP. The current PCP catchments will need to be aggregated in some cases to form viable and nationally comparable PHCOs in rural and metropolitan areas.
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In Victoria we propose using aggregated PCP catchments as the basic building blocks for PHCOs with broad alignment within Regions where possible and appropriate. This will build on the experience of Primary Care Partnerships in primary care service development and provide the population focus that PHCOs need.
5.4.3 Cross border flows Victoria shares state borders with NSW and South Australia. Substantial communities of interest and cross border services already operate between NSW and Victoria and several Victorian Divisions including North East Victoria, Albury Wodonga Regional, Murray Plains and Mallee already cover parts of south western NSW. See Figure 4.
Design of PHCOs in rural NSW has taken account of these existing networks and proposed that up to 105,000 NSW residents would continue to be covered by PHCOs in Victoria subject to appropriate cross border agreements.
There are currently no formal cross border arrangements between South Australia and Victoria but there are socio-demographic similarities in the Riverland area in South Australia and the far north west of Victoria that warrant consideration in cross border PHCO design. There are also communities of interest based on GP training networks and Rural Clinical School linkages between the Otways in the rural south west of Victoria and the Limestone Coast in South Australia.
This suggests that tri-state and bi-state PHCOs will need to be considered amongst the configuration options for Victoria.
5.5 PHCO Configuration Options in Greater Melbourne We have modelled separate metropolitan and rural PHCO options in Victoria in line with the ABS and Victorian government approach to urban and rural planning. There are three metropolitan PHCO Options and three rural Options which in combination give a range of between 11 and 15 possible PHCOs in Victoria.
5.5.1 Metropolitan Option 1: 8 Metropolitan PHCOs Under this Option there are 8 PHCOs in metropolitan Melbourne. The PHCOs have predominantly been configured by aggregating contiguous Primary Care Partnership catchment LGAs that are then aligned with the current metropolitan Health regions. Kingston LGA has been split by SLA with Kingston North attached to Bayside and Inner East PHCO and Kingston South attached to the Peninsula to create more balanced populations. This Option is shown in Figure 24 and Table 16 and Table 17.
Table 16: Metro Option 1 - 8 PHCOs amalgamating PCPs and within DHHS regional boundaries PHCO Name 2008 Pop 2021 Pop LGAs 1 Metro West 562319 775,695 Brimback, Melton, Hobson’s Bay, Maribyrnong , Wyndham 2 Metro North 583230 730490 Hume, Moreland, Moonee Valley, Melbourne, Yarra 3 Metro North East 461200 571760 Banyule, Nillumbik, Darebin, Whittlesea 4 Metro Inner East 608523 655699 Boroondara, Manningham, Monash, Whitehorse 5 Metro Outer East 405171 429999 Knox, Maroondah, Yarra Ranges 6 Metro South East 437889 616756 Cardinia, Casey, Greater Dandenong 7 Bayside 515032 561983 Bayside, Glen Eira, Port Phillip, Stonnington LGAs and Kingston North SLA 8 Peninsula 319667 363136 Frankston, Mornington Peninsula LGAs, Kingston South SLA Total Metro Pop 3893031 4705519
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Table 17: Metro Option 1: 8 PHCOs amalgamating PCPs and within DHHS regional boundaries PHCO Name PCP/IPA Metro Region Indicative Divisions 1 Metro West HealthWest North & West Westgate GPN, Pivot GPN, 2 Metro North Hume-Moreland, Moonee North & West Impetus GPN, Northern DGP, Melbourne GPN Valley/Melbourne, North Central Metro 3 Metro North East Banyule Nillumbik, North Central North & West North East Valley GPN, Northern DGP, Melbourne Metropolitan GPN 4 Metro Inner East Inner East Eastern Greater Monash GPN, Melbourne East GPN 5 Metro Outer East Outer East Eastern Greater Eastern Primary Health, Eastern Ranges 6 Metro South East South East Health Communities Southern Dandenong Casey GPA, Eastern Ranges GPA 7 Bayside Kingston-Bayside, Inner South East Southern Bayside GPN, Monash DGP, SouthCity GP Services, Greater Monash GPN 8 Peninsula Frankston-Mornington Peninsula, Southern Peninsula GPN, Monash DGP, Bayside GPN Kingston-Bayside For readability the Divisions listed in the Division alignment column only include the names of the Divisions that cover significant portions – generally 30% or more - of the proposed PHCO catchment
Figure 24: Metro Victoria PHCO Option 1 - 8 PHCOS aligned with PCPs and Regions
Metro West PHCO covers the LGAs of Brimback, Melton, Hobson’s Bay, Maribynong and Wyndham and had a catchment population of 562,000 in 2008. This PHCO would cover one of the fastest growing areas in Melbourne and is expected to have a population of 775,000 by 2021.
It aligns with the HealthWest PCP, the North and West Region and the Westgate and Western Melbourne Divisions. It has a large multicultural community concentrated in Sunshine and Keilor (40% NESB and 11%
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speak English poorly) and Maribyrnong (34% NESB and 10% speak English poorly) and a mixed socio- demographic profile (IRSD score of 978) with pockets of significant disadvantage in Brimbank (887 IRSD score in Sunshine) and Maribyrnong (IRSD score of 948).
Metro North PHCO covers the LGAs of Hume, Moreland, Moonee Valley, Melbourne and Yarra and the Hume-Moreland, Mooney Valley/Melbourne and part of the North Central Metropolitan 19 PCP catchment and is covered by the North and West Region. The catchment had a 2008 population of 583,000 that is projected to grow to 730,000 by 2021 due primarily to urban development in Hume and Moreland. Twenty six percent of the catchment population are from non English speaking backgrounds and 5% speak English poorly.
The PHCO has a diverse socio-economic profile with an IRSD score of 1000 ranging from a low of 884 in Broadmeadows in Hume to 1105 in Southbank Docklands in Melbourne LGA.
Metro North East PHCO covers the LGAs of Banyule, Nillumbik, Darebin and Whittlesea. It includes the growth area of Whittlesea and had a 2008 population of 461,000 that is projected to grow to 572,000 by 2021. Nearly 22% o the population are from non English speaking backgrounds with the highest populations in Whittlesea (29.5%) and Darebin (28%) and 5% speak English very poorly. One of Melbourne’s largest Aboriginal communities lives in this area.
The catchment has a mixed socio-economic profile with an IRSD score of 1013 ranging from 917 in the south western suburbs of Whittlesea to 1113 in the southern suburbs of Nillumbik.
The proposed PHCO aligns with the catchments of the Banyule-Nillumbik and North Central Metropolitan PCPs and the North and West Region and covers part of the current catchments of the North East Valley, Melbourne and Northern Divisions of General Practice.
Metro Inner East PHCO covers the LGAs of Boroondara, Manningham, Monash and Whitehorse and the catchment of the Inner East PCP in the Eastern Metropolitan Region. The catchment population was 609,000 in 2008 and is projected to grow to 656,000 by 2021. Metro Inner East has a uniformly high socioeconomic profile with an IRSD score of 1073. Twenty six percent of local residents were born in non English speaking countries but only 4% speak English poorly.
Metro Outer East PHCO covers the LGAs of Knox, Maroondah and Yarra Ranges or a catchment population of 405,000 in 2008 predicted to grow to 430,000 by 2021. The PHCO covers the PCP catchment of Outer East PCP in the Eastern Metropolitan Region and coincides with the Knox and part of the Eastern Ranges Divisions. Metro Outer East has a relatively high socioeconomic profile (IRSD score of 1044) with 11% of the population born in non English speaking countries and approximately 1% speak English poorly.
Metro South East PHCO covers the catchment of the South East Health Communities PCP in the Southern region and coincides with the catchment of Dandenong Casey and part of the Eastern Ranges GPAs. The
19 Following a review of the Melbourne PCP boundaries by DHS, Yarra will cease to be part of the North Central Metropolitan PCP on July 1 st , 2010. We have aligned it with the new PCP based on Moonee Valley, Melbourne and Moreland in the modelling.
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PHCO covers the LGAs of Cardinia, Casey and Greater Dandenong. This is a major outer urban growth corridor with a 2008 population of 438,000 that is projected to grow to 617,000 by 2021.
The catchment has a mixed socioeconomic profile with an average IRSD score of 977, significant levels of social disadvantage in Dandenong (IRSD scores of 887.5 and 902) and pockets of relative advantage in Berwick in Casey (IRSD score of 1054) and the northern parts of Cardinia (1046 IRSD score). Twenty seven percent of the population were born in non English speaking countries and nearly 46% of Dandenong residents are from CALD backgrounds. Overall nearly 6% of the NESB population speak English poorly but this rises to 14% in Dandenong.
Bayside PHCO covers the LGAs of Bayside, Glen Eira, Stonnington, Port Phillip and Kingston North SLA or a catchment population of 515,000 in 2008 that is expected to grow at a modest rate to 561,000 residents by 2021. The PHCO covers the catchment of Kingston-Bayside and Inner South East PCPs in the Southern Region and part of the catchments of the Bayside, Monash, SouthCity GP Services and Greater Monash Divisions.
The catchment has a uniformly high socioeconomic profile with an IRSD score of 1069. Nearly 19% of the population were born in non English speaking countries but only 2.6% speak English poorly.
Peninsula PHCO covers Kingston South SLA and Frankston and Morning Peninsula LGAs and includes the catchment of the Frankston-Morning Peninsula PCP and part of the Kingston-Bayside PCP. The PHCO coincides with the catchment of the Peninsula and parts of the Monash and Bayside Divisions.
The proposed PHCO is the smallest in metropolitan Melbourne with a 2008 population of 319,600 and is projected to grow to 363,000 residents by 2021. The area has a mixed socio-economic profile with an average IRSD score of 1015 ranging from 978 in the western suburbs of Frankston to 1064 in the western part of the Mornington Peninsula. Only 9% of the population were born in non English speaking countries although this rises to 20% in Kingston.
5.5.2 Strengths and weaknesses This configuration aggregates PCP catchments with similar socio-demographic profiles into 3 small to medium sized PHCOs with 2008 estimated resident populations under 450,000 (320,000 to 438,000) and five larger PHCOs with between 506,000 and 608,000 residents.
The catchments reflect the populations currently used by the Victorian government for Local Area Planning and this and the relative socio-demographic homogeneity of most of the proposed PHCOs is one of the strengths of this Option.
However there appears to be a socioeconomic mismatch in the Inner East where the localities of Camberwell and Kew in Boroondara LGA sit in the Inner East PCP when they have more in common with Glen Eira, Bayside and Stonnington LGAs in Bayside and Inner South East.
Under this Option four of the eight proposed PHCOs cover the major outer urban growth areas and the size and distribution of the catchment populations in these PHCOs will change significantly by 2021. Metro West (776,000 projected population), Metro North (730,000 projected population), Metro North East (752,000 projected population) and Metro South East (617,000 projected population) will have up to
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a third more people living in new suburbs in outer urban areas where the development of new primary health care services will be required.
These large PHCOs also include the more socio-economically diverse and high need communities that already face extensive workforce challenges. The difference in size, especially the low population of Peninsula relative to the rest of the PHCOs, is one of the potential weaknesses of this Option. However the size range is similar to the structure of the metropolitan Sydney PHCOs.
5.5.3 Metropolitan Option 2: 7 Metropolitan PHCOs Under this Option adjoining LGAs and PCPs in the south east and inner east are linked to form four larger and 3 medium sized PHCOs that will have a more even population base by 2021.
Figure 25: Metro Victoria PHCO Option 2 - 7 PHCOs aligned with PCPs but crossing regions
The major change is the formation of the Peninsula and South East PHCO covering the adjoining LGAs of Cardinia, Casey and Greater Dandenong, Kingston South SLA, Frankston and the Mornington Peninsula. This PHCO had an ERP of 757,556 in 2008 and is projected to grow to nearly 980,000 people by 2021. The scale of this PHCO is larger than the Melbourne average but the geography of the Melbourne basin and the need to include the Mornington Peninsula as well as Frankston LGA is challenging in terms of best fit LGA alignments and size.
The PHCO covers a mixed socioeconomic area with an average IRSD score of 993 ranging from a low of 887 and 902 in Dandenong to 1064 in the west of the Mornington Peninsula. Nineteen percent of the
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population are from non English speaking backgrounds and 4% speak English poorly. The majority of these residents live in Dandenong (46% NESB) and Casey (21% NESB).
The new Bayside and Inner East PHCO includes Boroondara LGA transferred from Metro Inner East. This PHCO had a June 2008 estimated resident population of 680,000 and is projected to grow to 741,000 by 2021. The new PHCO has the highest socio economic profile in Melbourne with an IRSD score of 1078. Nearly 19% of the population were born in non English speaking countries but only 2.6% speak English poorly and this population is highest in Kingston North and Glen Eira.
The residual Metro Inner East now consists of Manningham, Whitehorse and Monash LGAs with a 2008 ERP of 443,000 that is projected to grow to 462,000 residents by 2021. This is also an area with uniformly high socioeconomic status and an overall IRSD score of 1061. Nearly 29% of the population were born in non English speaking countries and 4.7% speak English poorly.
Table 18: Metro Option 2 - 7 similar size PHCOs with contiguous PCPs crossing DHHS regional boundaries PHCO Name 2008 Pop 2021 Pop LGAs 1 Metro West 562319 775,695 Brimback, Melton, Hobson’s Bay, Maribyrnong, Wyndham 2 Metro North 583230 730490 Hume, Moreland, Moonee Valley, Melbourne, Yarra 3 Metro North East 461200 571760 Banyule, Nillumbik, Darebin, Whittlesea 4 Metro Inner East 443130 462042 Manningham, Monash, Whitehorse 5 Metro Outer East 405171 429999 Knox, Maroondah, Yarra Ranges 6 Bayside & Inner East 680425 740742 Bayside, Kingston North SLA, Glen Eira, Port Phillip, Stonnington, Boroondara, 7 Peninsula & South East 757556 979892 Frankston, Mornington Peninsula, Kingston South SLA, Cardinia, Casey, Greater Dandenong 3893031 4705519
Table 19: Metro Option 2 - 7 PHCOs amalgamating contiguous PCPs crossing DHHS regional boundaries PHCO Name Indicative PCP/IPA Indicative Indicative Divisions Metro Region 1 Metro West HealthWest North & West Westgate GPN, PivotWest GPN, 2 Metro North Hume-Moreland, Moonee North & West Impetus GPN, Northern DGP, Melbourne GPN Valley/Melbourne, North Central Metro 3 Metro North East Banyule-Nillumbik, North Central Metro North & West North East Valley GPN, Northern DGP, Melbourne GPN 4 Metro Inner East Inner East Eastern Greater Monash GPN, Melbourne East GPN 5 Metro Outer East Outer East Eastern Greater Eastern Primary Health, Eastern Ranges 6 Bayside & Inner East Kingston-Bayside, Inner South East, Inner Southern Bayside GPN, Monash DGP, SouthCity GP Services, East Eastern part Greater Monash GPN 7 Peninsula & South East Frankston-Mornington Peninsula, Kingston- Southern Peninsula GPN, Monash DGP, Bayside GPN, Bayside, South East Health Communities Dandenong Casey GPA
5.5.4 Strengths and weaknesses This Option increases the size of some of the smaller PHCOs proposed in Option 1 resulting in more even population shares overall and PHCOs that are comparable in size to NSW and Queensland.
The amalgamation of contiguous LGAs to form Peninsula and South East creates the largest PHCO in Melbourne with a 2008 population of 757,000 growing to over 978,000 by 2021. This addresses the concerns about relative critical mass in the stand alone Peninsula option. The socioeconomic profile remains mixed with higher need communities in Dandenong, Frankston East and population growth areas in Casey and Cardinia.
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The inclusion of Boroondara in Bayside links high SES suburbs such as Camberwell and Kew with adjoining SLAs such as Malvern and Prahran in Stonnington LGA. This creates a more uniform population profile that is a better socio-demographic fit.
The configuration in this Option is still largely based on amalgamating contiguous PCPs and has good overall regional alignment but the transfer of Boroondara from Inner East to Bayside splits the Inner East PCP and means the PHCO operates in both the Eastern and Southern Regions.
The primary weakness of this model is the large size of Peninsula and South East in 2021 relative to the rest of the Melbourne PHCOs. However this is not inconsistent with the Options proposed in Sydney or Brisbane.
5.5.5 Option 3: 6 Metropolitan PHCOs The third Option creates six large PHCOs in Melbourne by amalgamating the adjoining Inner and Outer Eastern PHCOs to create the Metro East PHCO . This Option is shown in Figure 26 and Table 20 and 21.
Metro East PHCO would cover the LGAs of Manningham, Monash, Knox, Whitehorse, Maroondah and Yarra Ranges with a 2008 population of 848,000 and is the largest PHCO in metropolitan Melbourne with modest growth projected to 892,000 by 2021. It has a relatively high socioeconomic profile with an IRSD score of 1053, just over 20% of the population were born in non English speaking countries and 3% speak English poorly. The Metro East catchment would cover the Inner and Outer East PCP catchments and fall within the Eastern Region.
Figure 26: Metro Victoria Option 3 - 6 large PHCOs aligned with PCPs
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Table 20: Metro Option 3: 6 PHCOs amalgamating contiguous PCPs PHCO Name 2008 Pop 2021 Pop LGAs 1 Metro West 562319 775,695 Brimback, Melton, Hobson’s Bay, Maribyrnong (C), Wyndham (C) 2 Metro North 583230 730490 Hume, Moreland, Moonee Valley, Melbourne, Yarra 3 Metro North East 461200 571760 Banyule, Nillumbik, Darebin, Whittlesea 4 Metro East 848301 892042 Knox, Manningham, Maroondah, Monash, Whitehorse, Yarra Ranges 5 Bayside & Inner East 680425 740741 Bayside, Kingston North SLA, Glen Eira, Port Phillip, Stonnington, Boroondara, 6 Peninsula & South East 757556 979892 Frankston, Mornington Peninsula, Kingston South SLA, Cardinia, Casey, Greater Dandenong 3893031 4705519
Table 21: Metro Option 3- 6 PHCOs amalgamating contiguous PCPs PHCO Name PCP/IPA Metro Region Indicative Divisions 1 Metro West HealthWest North & West Westgate GPN, PivotWest GPN, 2 Metro North Hume-Moreland, Moonee North & West Impetus GPN, Northern DGP, Melbourne GPN Valley/Melbourne, North Central Metro 3 Metro North East Banyule-Nillumbik, North Central North & West North East Valley GPN, Northern DGP, Melbourne Metropolitan GPN 4 Metro East Outer East, Inner East Eastern Melbourne East GPN, Greater Eastern Primary Health, Eastern Ranges 5 Bayside & Inner East Kingston-Bayside, Inner South East, Southern Bayside GPN, Monash DGP, South City GP Services, Inner East Greater Monash GPN 6 Peninsula & South East Frankston-Mornington Peninsula, Southern Peninsula GPN, Monash DGP, Bayside GPN, Kingston-Bayside, South East Health Dandenong Casey GPA Communities
5.5.6 Strengths and weaknesses This Option creates six reasonably large PHCOs with 2008 populations ranging in size from 461,000 in Metro North East to 848,000 in Metro East. By 2021, 5 of the 6 proposed PHCOs will have populations in excess of 700,000 people.
This Option groups LGAs into large PHCOs that have similar primary care service development needs and socioeconomic profiles and combines the high growth corridors and the more stable established communities.
There is reasonable alignment with existing PCPs and Health Regions under this Option and larger PHCOs would have the critical mass needed to provide cost effective practice support, workforce development and commissioning functions.
The impact of very large PHCOs on local connectedness is a potential weakness under this Option. However retaining the PCP/Integrated Planning Area framework and local linkages as part of the PHCO service development and partnership model could address this issue.
In terms of size and scale the PHCOs under this Option are consistent with Options proposed in NSW and Queensland.
5.6 PHCO Configuration Options in Rural Victoria Rural Victoria is expected to grow by 477,000 or 30% between 2006 and 2036 20 with major growth expected in the regional centres and some of the coastal communities. Some traditional inland farming
20 Victoria in Future 2008 – population projections. Second Release September 2009Accessed February 2010.
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areas with experience population decline. Rural Victoria is relatively compact and there are strong internal linkages and communities of interest between smaller towns and communities and the regional centres.
The cross border health service and Division of GP arrangements in place between south western NSW and north eastern Victoria are key considerations for PHCO design in rural Victoria.
Three Options have been developed that build on the existing health service regions and PCPs as well as considering Options that address cross border flows and communities of interest.
5.6.1 Rural Victoria Option 1: 5 Rural PHCOs aligned with Regions & 2 NSW cross border Under this Option 5 rural PHCOs are established that align with the current DHHS Regions and local PCPs and incorporate cross border flows from NSW. The Option is shown in Figure 27 and
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Table 22 and 23.
Figure 27: Rural Victoria Option 1: 5 rural PHCOs aligned with PCPs and Regions plus 2 NSW cross border
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Table 22: Rural Option 1- 5 PHCOs aligned with PCPs and Regions plus NSW cross border flows with LGAs PHCO Name ERP 2021 LGAs 2008 Pop PHCO 1 Gippsland 255381 291693 East Gippsland, Baw Baw, Latrobe, South Gippsland, Bass Coast, Wellington & Unincorporated Victoria PHCO 2 Barwon South 365696 422754 Colac-Otway, Greater Geelong, Queenscliffe, Surf Coast, Corangamite, Moyne, Warrnambool, Glenelg, Southern Grampians PHCO 3 Grampians 220160 249909 Ararat, North Grampians, Pyrenees, Ballarat, Golden Plains, Hepburn, Moorabool, Hindmarsh, Horsham. West Wimmera, Yarriambiack PHCO 4 Loddon Mallee & South 342337 385048 Greater Bendigo, Loddon, Campaspe, Central Goldfields, Macedon Ranges, West NSW Mount Alexander, Buloke, Gannawarra, Swan Hill, Mildura (Vic) Balranald, Conargo, Deniliquin, Murray, Wakool and Wentworth (NSW) PHCO 5 Hume plus South West 342069 389180 Alpine, Benalla, Mansfield, Wangaratta, Indigo, Towong, Wodonga, Mitchell, NSW Murrindindi, Greater Shepparton, Moira, Strathbogie (Vic), Albury, Berrigan, Corowa Shire, Greater Hume and Jerilderie (NSW) Rural Total 1526443 1738584
Table 23: Rural Option 1 - 5 PHCOs aligned with PCPs and Regions with current Divisions of General Practice PHCO Name Indicative Divisions
PHCO 1 Gippsland East Gippsland DGP, Central West Gippsland DGP, GPA South Gippsland
PHCO 2 Barwon South Otway DGP, Geelong GPA
PHCO 3 Grampians Ballarat & District DGP, West Victoria DGP
PHCO 4 Loddon Mallee & South West Central Victoria GPN, Murray Plains DGP, West Victoria DGP, Central Highlands DGP, Mallee NSW DGP, North East Victoria DGP PHCO 5 Hume plus South West NSW North East Victoria DGP, Albury Wodonga Region GPN, Central Victoria DGP, Eastern Ranges DGP, Goulburn Valley DGP For readability the Divisions listed in the Division alignment column only include the names of the Divisions that cover significant portions – generally 30% or more - of the proposed PHCO catchment
Gippsland PHCO in the south east includes the LGAs of East Gippsland, Baw Baw, Latrobe, South Gippsland, Bass Coast, Wellington and Unincorporated Victoria. It has a 2008 catchment population of 256,000 and is projected to grow to 292,000 by 2021 primarily due to growth on the Bass Coast, Baw Baw and East Gippsland LGAs.
Gippsland PHCO would include the East Gippsland, Central West, South Coast and Wellington PCPs and is covered by the East Gippsland, Central West Gippsland and South Gippsland GPAs.
It is a mixed area in terms of socio-economic status with an overall IRSD score of 974 ranging from a low of 911 in Moe SLA to 1021 in the south west SLA in East Gippsland. Five percent of the population were born in non English speaking countries and 1.3% of the population are Aboriginal or Torres Strait Islanders.
Barwon South PHCO stretches from Greater Geelong on the outer edge of Melbourne along to coast to the South Australian border and includes the LGAs of Colac-Otway, Greater Geelong, Queenscliffe, Surf Coast, Corangamite, Moyne, Warrnambool, Glenelg and South Grampians. It had a 2008 ERP of 366,000 and is projected to grow to 423,000 residents by 2021 with grow in Greater Geelong, Surf Coast and Warrnambool.
Barwon South West PHCO would include the Barwon, South West and Southern Grampians/Glenelg PCPs and the Geelong and Otway Divisions of General Practice.
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It has a mixed socioeconomic profile with pockets of disadvantage in many of the inland rural areas including Glenelg, parts of Colac-Otway, Warrnambool and parts of Geelong. It has an average IRSD score of 997 ranging from 949 in the SLA of Portland in Glenelg to 1083 in the eastern part of Surf Coast. Approximately 6% of the population overall and 9% of the Geelong population are from non English speaking backgrounds and less than 1% of residents speak English poorly.
Grampians PHCO forms the central part of rural Victoria and includes the LGAs of Ararat, North Grampians, Pyrenees, Ballarat, Golden Plains, Hepburn, Moorabool, Hindmarsh, Horsham, West Wimmera and Yarriambiack.
The Region has a population of 220,000 in 2008 and this is projected to grow to 250,000 by 2021. Over half the population currently live in the east of the region in the regional City of Ballarat and in the rural LGAs of Moorabool and Golden Plains that are close to Ballarat, Geelong and Melbourne. Population growth will be concentrated in these areas and there will be stable or declining populations in the west.
The Grampians has a relatively low socioeconomic profile overall with an IRSD score of 984 and more disadvantaged communities in the inland rural LGAs including Pyrenees (941), Yarriambiack (945), Ararat (956) and North Grampians (945). The areas closest to Melbourne including Bacchus March (1015), the northern SLA of Ballarat (1020), parts of Horsham (1033) and Golden Plains (1010) are more advantaged.
Grampians PHCO would include the Grampians Pyrenees, Central Highlands and Wimmera PCPs and are covered by the Ballarat and Districts and West Victoria Divisions of General Practice.
Loddon Mallee/South West NSW PHCO covers the LGAs in the north of Victoria adjoining the South Australian and NSW borders south to Mount Alexander and the Macedon Ranges on the outskirts of Melbourne. Under this Option the Loddon Mallee PHCO would include the Victorian LGAs of Greater Bendigo, Loddon, Campaspe, Central Goldfields, the Macedon Ranges, Mount Alexander, Buloke, Gannawarra, Swan Hill and Mildura and the adjoining NSW LGAs of Balranald, Conargo, Deniliquin, Murray, Wakool and Wentworth.
This bi-state cross border PHCO had a 2008 population of 342,000 and is projected to grow to 385,000 by 2021 due mainly to growth in Greater Bendigo, Macedon Ranges and Mount Alexander. Approximately 31,000 NSW residents will be covered by this PHCO and they will make up 8% of the PHCO population in 2021.
Loddon Mallee is the most disadvantaged socio-economic PHCO and Region in Victoria with an IRSD score of 980 ranging from 895 in part of Central Goldfields to 1008 in the Inner East of Greater Bendigo. Nearly 4% of the population were born in non English speaking countries and the NESB population is concentrated in Mildura and Swan Hill LGAs. Nearly 2% of the Loddon Mallee population are Aboriginal and Torres Strait Islanders and this is one of the largest Aboriginal communities in rural Victoria.
The proposed Loddon Mallee catchment includes the Bendigo Loddon, Campaspe, Central Victoria, southern Mallee and Northern Mallee PCPs and aligns with the Loddon Mallee Region in Victoria and parts of Greater Southern Area Health Service in NSW. It coincides with part of the current catchments of Central Victoria, West Victoria, North East Victoria, Central Highlands, Murray Plains and Mallee Divisions of General Practice.
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Hume and South West NSW PHCO includes the Victorian LGAs of Alpine, Benalla, Mansfield, Wangaratta, Indigo, Towong, Wodonga, Mitchell, Murrindindi, Greater Shepparton, Moira and Strathbogie and the NSW LGAs of Albury, Berrigan, Corowa Shire, Greater Hume and Jerilderie.
This catchment had a population of 342,000 in 2008 and is projected to grow to 389,000 residents by 2021 due primarily to projected growth in Mitchell LGA which adjoins Melbourne and in the major towns of Wodonga, Shepparton and Albury. Approximately 75,000 NSW residents were covered by this bi-state PCHO in 2008 or 22% of the total catchment population and the NSW portion of the PHCO population is projected to grow to 80,000 by 2021.
This area has a mixed socioeconomic profile with an overall IRSD score of 997 with more disadvantaged communities in SLAs in Greater Shepparton (958),Wangaratta (959) and Strathbogie (968) and more advantaged communities in some of the Alpine resort areas, Towong Pt A(1021) and Indigo Pt A (1023). Five percent of the Victorian catchment population were born in on English speaking countries and less than 1% speak English poorly. Indigenous people make up 1.5% of the Victorian catchment population and the largest communities are in Shepparton and Wodonga.
The proposed catchment includes the Upper, Central and Lower Hume PCPs and the Goulburn Valley PCP centred on Shepparton and coincides with the Hume Region in Victoria and part of Greater Southern Area Health Service in NSW. It coincides with part of the current catchments of North East Victoria, Central Victoria, Albury Wodonga, Eastern Ranges and Goulburn Valley Divisions of General Practice.
5.6.2 Strengths and weaknesses This Option creates five large rural PHCOs ranging in size from 220,000 people in Grampians to 365,000 in Barwon South West.
These PHCOs are strongly aligned with the existing Health Regions and the Primary Care Partnerships in Victoria but also incorporate the existing cross border GP linkages and Health Service networks in place between Victoria and south western NSW. Building the PHCOs on the existing service architecture and recognising the established cross border communities of interest is a strength of this model.
These large rural PHCOs will also have the critical mass needed to address the changing demographics and differing workforce needs of rural communities that have stable or declining populations and the growing regional centres and LGAs that form part of the Greater Melbourne rural hinterland. Using the PCP partnership arrangements to continue to facilitate local needs assessment and service development processes under the PHCO umbrella will also ensure effective local planning for the more isolated or disadvantaged rural communities.
The proposed PHCOS are consistent with the size of rural PHCOs proposed in other states.
The principal weakness of this model is the need to formalise cross border arrangements between NSW and Victoria for the 105,000 south western NSW residents that will be covered by the proposed bi-state Loddon Mallee and Hume PHCOs.
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5.6.3 Rural Option 2: 6 Rural PHCOs with 2 bi-state & 1tri-state PHCO This Option proposes 6 rural PHCOs in Victoria including a new a tri-state PHCO that reflects the linkages and demographic similarities between the rural communities in north east Victoria, far south western NSW and north western South Australia. This Option is shown in Figure 28 and Table 24 and Table 25.
Under this Option a new PHCO is proposed covering the border between NSW, South Australia and Victoria.
Lower Murray PHCO includes the Victorian LGAs of Buloke, Gannawarra, Mildura and Swan Hill, the NSW LGAs of Balranald, Wakool, Wentworth and the South Australian LGAs of Berri &Barmera, East Loxton Waikerie and Renmark. This catchment had a population of 136,000 in 2008 with a similar population projected for 2021.
These contiguous rural communities have similar agricultural and socio-demographic characteristics with IRSD scores ranging from 910 in Swan Hill to 978 in Renmark to 991 in Mildura Part B. Approximately 6% of the catchment population were born in non English speaking countries. In terms of geography, the South Australian LGAs are closer by road to Mildura than to Adelaide and this will impact on local hospital referrals and clinical linkages.
Table 24: Rural Option 2 - 6 Rural PHCOs including Lower Murray tri-state PHCO with LGAs PHCO Name ERP 2021 LGAs 2008 Pop PHCO 1 Gippsland 256151 291693 East Gippsland, Baw Baw, Latrobe, South Gippsland, Bass Coast, Wellington & Unincorporated Victoria PHCO 2 Barwon South 365696 422754 Colac-Otway, Greater Geelong, Queenscliffe, Surf Coast, Corangamite, Moyne, Warrnambool, Glenelg, Southern Grampians PHCO 3 Grampians 220160 249909 Ararat, North Grampians, Pyrenees, Ballarat, Golden Plains, Hepburn, Moorabool, Hindmarsh, Horsham. West Wimmera, Yarriambiack PHCO 4 Loddon & South 234708 277199 Greater Bendigo, Loddon, Campaspe, Central Goldfields, Macedon Ranges, Mount West NSW Alexander (Vic), Conargo, Deniliquin, Murray (NSW) PHCO 5 Hume & South West 342069 389180 Alpine, Benalla, Mansfield, Wangaratta, Indigo, Towong, Wodonga, Mitchell, NSW Murrindindi, Greater Shepparton, Moira, Strathbogie (Vic) Albury, Berrigan, Corowa Shire, Greater Hume and Jerilderie (NSW) PHCO 6 Lower Murray 136186 135673 Buloke, Gannawarra, Mildura, Swan Hill(Vic), Balranald, Wakool, Wentworth (NSW), Berri &Barmera, East Loxton Waikerie, Renmark SA) Rural Total 1554970 1766408
Table 25: Rural Option 2 - 6 Rural PHCOs including Lower Murray tri-state PHCO & current GP Divisions PHCO Name Indicative Divisions PHCO 1 Gippsland East Gippsland DGP, Central West Gippsland DGP, GPA South Gippsland PHCO 2 Barwon South Otway DGP, Geelong GPA PHCO 3 Grampians Ballarat & District DGP, West Victoria DGP PHCO 4 Loddon & South West NSW North East Victoria DGP, Murray Plains DGP, Central Victoria DGP, Western Victoria DGP PHCO 5 Hume & South West NSW North East Victoria DGP, Albury Wodonga Region GPN, Central Victoria DGP, Eastern Ranges DGP, Goulburn Valley DGP PHCO 6 Lower Murray Mallee, DGP, Murray Plains DGP, West Victoria DGP, North East Victoria DGP & SA Riverland DGP
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Figure 28: Rural Victoria Option 2
The Lower Murray PHCO includes part of the current catchments of Mallee, Murray Plains, West Victoria and North East Victoria Divisions and the Riverland Division in South Australia.
Loddon and South West NSW PHCO reduces in size under this Option to a population of 235,000 in 2008 and 277,000 in 2021 and now includes the LGAs of Greater Bendigo, Loddon, Campaspe, Central Goldfields, Macedon Ranges, Mount Alexander in Victoria and Conargo, Deniliquin and Murray in south west NSW.
Gippsland, Barwon South and Grampians PHCOs are unchanged in this Option.
5.6.4 Strengths and weaknesses This Option creates six medium to large rural PHCOs that have catchments ranging in size from 136,000 to 360,000 residents and which are similar in size to the rural PHCOs in the other mainland states.
The Lower Murray PHCO configuration recognises the socio-demographic similarities and communities of interest that operate across state borders in the rural communities in the Riverland Lower Murray catchment.
Mildura is a major rural centre with specialist hospital services that can support a network of smaller local towns and communities with true rural service needs. This configuration will enable this PHCO to focus on the specific support needs of GPs operating in isolated rural practice as well as medium rural towns and the recruitment challenges for all health professionals. This is a strength of this approach.
Loddon and South West NSW is also more homogenous under this Option supporting primary health services in rural LGAs that are closely linked to the regional centre in Bendigo or form part of the rural hinterland of Greater Melbourne.
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The tri-state Option will require a three way agreement between South Australia, NSW and Victoria to support cross border service development and to harmonise relevant state policies and procedures and arrangements for resource pooling. This is a potential weakness of this Option but the arrangements in place between NSW and Victoria could serve as a prototype.
In terms of operating structures the main office for this cross border PHCO would be in Mildura, the largest town in the catchment but a branch office would also be required in Renmark to support local engagement and planning in South Australia.
5.6.5 Rural Option 3: 7 Rural PHCOs with 2 cross border services in South Australia Under this Option a second cross border PHCO would be created between Victoria and South Australia linking the rural areas of Colac-Otway with the adjoining LGAs in the Limestone region in south east South Australia. This would result in 7 rural PHCOs in Victoria and five with bi-state or tri-state linkages. The Option is shown in Figure 29 and Table 26 and Table 27.
Figure 29: Rural Victoria Option 3 - 7 PHCOs including cross border south west Victoria and south east SA
The Otway Limestone PHCO would link the rural LGAs of Corangamite, Moyne, Warrnambool, Glenelg and Southern Grampians in Victoria with Mt Gambier, Grant and Wattle Range LGAs in south east South Australia. This PHCO could have a catchment population of 150,000 in 2008 growing to 159,000 by 2021. Nearly 31% of the catchment population (46,000 people) live in South Australia. There is also an argument for including the adjoining LGAs of Naracoorte and Robe in South Australia (another 10,000 people) in this PHCO but this is not shown in the present configuration.
The Otway Limestone PHCO would link contiguous inland rural and coastal LGAs that have similar socio- demographic characteristics and an IRSD score of 999. There are already strong GP and professional linkages in these communities through the Greater Green Triangle GP Training and Education Network
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and common links with the Rural Clinical School. It is a large rural PHCO that is similar in scale and critical mass to Country South Australia but is focussed on more compact rural communities and LGAs with substantial populations and significant towns with similar service delivery architecture and professional support needs rather than sparsely populated rural communities.
Barwon PHCO would be reconfigured under this Option and reduce in size to a population of 261,000 in 2008 and 311,000 by 2021. It would cover the LGAs of Colac-Otway, Greater Geelong, Queenscliffe and Surf Coast and have a more homogenous socio-demographic profile with an IRSD score of 1000 ranging from 928 in Corio in Greater Geelong to 1084 in Surf Coast. This PHCO would also have workforce and service delivery characteristics of rural and coastal communities that are linked to a major regional centre such as Geelong.
Table 26: Rural Option 3 – 7 Rural PHCOs with 2 SA cross border PHCOs PHCO Name ERP 2021 LGAs 2008 Pop PHCO 1 Gippsland 256151 291693 East Gippsland, Baw Baw, Latrobe, South Gippsland, Bass Coast, Wellington & Unincorporated Victoria PHCO 2 Barwon 260987 311169 Colac-Otway, Greater Geelong, Queenscliffe, Surf Coast and the catchments of the PHCO 3 Grampians 220160 249909 Ararat, North Grampians, Pyrenees, Ballarat, Golden Plains, Hepburn, Moorabool, Hindmarsh, Horsham. West Wimmera, Yarriambiack PHCO 4 Loddon & South West 234708 277199 Greater Bendigo, Loddon, Campaspe, Central Goldfields, Macedon Ranges, Mount NSW Alexander (Vic), Conargo, Deniliquin, Murray (NSW) PHCO 5 Hume & South West 342069 389180 Alpine, Benalla, Mansfield, Wangaratta, Indigo, Towong, Wodonga, Mitchell, NSW Murrindindi, Greater Shepparton, Moira, Strathbogie (Vic) Albury, Berrigan, Corowa Shire, Greater Hume and Jerilderie PHCO 6 Lower Murray 136186 135673 Buloke, Gannawarra, Mildura, Swan Hill, (Vic), Balranald, Wakool, Wentworth (NSW), Berri &Barmera, East Loxton Waikerie, Renmark SA) PHCO 7 Otway Limestone 150687 158576 Corangamite, Moyne, Warrnambool, Glenelg, Southern Grampians, (Vic) Mt Gambier, Grant, Wattle Range (SA) Rural Total 1600948 1813399
Table 27: Rural Option 3: 7 rural PHCOs with 2 cross border PHCO Name Indicative Divisions PHCO 1 Gippsland East Gippsland DGP, Central West Gippsland DGP, GPA South Gippsland PHCO 2 Barwon Otway DGP, Geelong GPA PHCO 3 Grampians Ballarat & District DGP, West Victoria DGP PHCO 4 Loddon & South West NSW North East Victoria DGP, Murray Plains DGP, Central Victoria DGP, Western Victoria DGP PHCO 5 Hume & South West NSW North East Victoria DGP, Albury Wodonga Region GPN, Central Victoria DGP, Eastern Ranges DGP, Goulburn Valley DGP PHCO 6 Lower Murray North East Victoria DGP, Mallee, DGP, Murray Plains DGP, West Victoria DGP, SA Riverland DGP PHCO 7 Otway Limestone Otway DGP, part Limestone Coast DGP
5.6.6 Strengths and weaknesses This cross border PHCO configuration creates 7 more evenly sized PHCOs where the primary care service and workforce support needs of more rural communities are better defined than in the other Options. Mt Gambier in South Australia and Warrnambool in Victoria would act as hubs for this PHCO which would build on the local relationships forged through training and education networks.
This is the second cross border PHCO that would require a formal cross border agreement between South Australia and Victoria.
5.7 Preferred Option/s Each of the metropolitan and rural PHCO configuration Options proposed in Victoria is viable and could be adopted effectively with good arguments in favour of both 8 and 7 metropolitan PHCOs.
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On balance the 8 metropolitan PHCO Option is our preferred approach. This Option is strongly aligned with Primary Care Partnership catchments and potentially with the Hospital Networks for integrated local planning and has large enough catchments to be efficient and effective.
It groups the urban growth corridors that traditionally face primary care workforce shortages and have diverse community needs together and also aligns the more stable inner city population centres. The PHCOs in this Option have large enough catchments to undertake effective service development, partnership building and workforce support activities for populations with reasonably similar socio- demographic characteristics.
In rural Victoria our preference is also the 7 PHCO Option with the tri-state Lower Murray and the bi-state Otway Limestone configuration. This provides two PHCOs that are focussed on the more stand alone and isolated rural communities and their specific needs while also supporting the regional centres and associated rural communities.
This Option is dependent on negotiating cross border agreements with both South Australia and NSW. In the event that South Australia chooses to remain self sufficient we would strongly support the continuation of the existing NSW/Victoria cross border arrangements as part of the 5 rural PHCO Option.
The recommended total of fifteen PHCOs in Victoria with cross border links is consistent with the number of PHCOs and the metropolitan, regional and rural configuration proposed in NSW and the size and scale of the rural and the metropolitan PHCOs is similar to those in the other mainland states.
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6 Queensland 6.1 Overview Queensland is the third most populous state after NSW and Victoria and is bounded by NSW in the south, Northern Territory in the west and South Australia in the south west. With a land area of 1.85 million square kilometres it is the second largest state by area.
The state’s population in concentrated in the south east stretching from the Sunshine Coast north of Brisbane through to the Gold Coast adjoining northern NSW. There are also large and growing regional centres on or near in coast in the north of the state. The Far North and the majority of the land area in the central west, north west and south west is sparsely populated and requires remote and rural service delivery models.
6.2 Demographic features
6.2.1 Current population Queensland had an estimated resident population of 4.29 million people at June 2008 and this rose by 2.6% to 4.4 million residents by June 2009. Queensland was the fastest growing state in Australia between 2003 and 2008 with an average annual growth rate of 2.4% until it was overtaken by Western Australia in 2007/08.
At June 2008 South East Queensland, which includes Brisbane, Gold Coast, Sunshine Coast and Moreton Bay, accounted for 66% of Queensland population and grew by 67,500 people or 69% of Queensland total population growth in 2007/08.
Brisbane Statistical District had the largest growth (43,400 people to June 2008) and reached 1.95 million or 45% of Queensland population.
All 10 Local Government Areas in South East Queensland grew strongly in 2007/08 with Brisbane LGA (1.7% or over 17,000 people), Gold Coast (2.7% or 13,200), Moreton Bay (3.4% or 11,800), Sunshine Coast (8,700 or 2.9%) and Ipswich (6,100 or 4.1%) experiencing the largest population growth.
Elsewhere in Queensland population grew strongly in the coastal cities and associated regions. Cairns had the largest and fastest growth (3.9% and 6,000 people) followed by Townsville (5,100 people and 3.0%), Fraser Coast (3,100 and 3.4%), Mackay (2,650 or 2.4%) and Bundaberg (2,039 or 2.3%).
Population decline in the central and south western areas of Queensland continued with Burdekin, Paroo, Winton, Balonne and Barcaldine experiencing the largest declines.
6.2.2 Indigenous population Queensland has an estimated Aboriginal and Torres Strait Islander population of 127,580 in 2006 and indigenous people made up 3.3% of the Queensland population. Queensland has 28.3% of Australia’s indigenous population and the Aboriginal and Torres Strait Islander population grew by 16.3% between the 2001 and 2006 Census.
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The largest numbers of Aboriginal and Torres Strait Islander people in Queensland live in Brisbane, Townsville, Cairns, Rockhampton and Roma. As shown in Table 28 Indigenous people make up the highest percentage of the overall population in Torres Strait, Cape York and Mt Isa.
Table 28: Distribution of Queensland Indigenous population 2006 Indigenous geographic area Indigenous pop % population Brisbane 41369 1.6 Townsville 19036 5.6 Cairns 18267 9.1 Rockhampton 15114 3.8 Roma 12247 4 Torres Strait 7106 82.9 Mt Isa 6998 24.2 Cape York 6944 54.7 Source: ABS Catalogue 4705.5 Distribution of Aboriginal and Torres Strait Islander Australians 2006
Twenty six percent of Indigenous Queenslanders live in major cities, 52% in inner and outer regional areas, 8 % in remote areas and 14% in very remote areas as shown in Table 29. Queensland has more Aboriginal and Torres Strait Islander people living in Outer Regional Areas than Australia as a whole.
Table 29: Indigenous population by Remoteness Areas - 2006 Census Major Inner Regional Outer Regional Remote Very Remote Cities Australia Australia Australia Australia % % % % % Queensland 26 20 32 8 14 Australia 31 22 23 8 16 Source: Population distribution Aboriginal and Torres Strait Islander Australians ABS 4705. 2006
6.2.3 Projected population and patterns of growth Queensland’s future population 2008 edition 21 suggests that Queensland will grow to 5.5 million people by 2021 and to 6.3 million by 2031. South East Queensland is expected to continue to grow strongly and will account for 70% of this growth.
In terms of population distribution, the recent pattern of growth in South East Queensland and the coastal cities in the centre and north of the state is expected to continue as shown in Figure 30.
By 2031 South East Queensland will accommodate for 67.7% of the Queensland population with 43.5% of the state population residing in the Brisbane Statistical Division, 14.1% on the Gold Coast, 8% on the Sunshine Coast and 2.1% in West Moreton.
The coastal regions are expected to grow strongly with Mackay (1.9%), Wide Bay Burnett, Northern and Fitzroy Statistical Districts expecting 1.7% annual growth and Far North expecting 1.3% growth. Darling Downs, which is a rural District close to Brisbane, is expected to record 1.4% per annum growth.
All the inland Statistical Districts are expected to record modest grow ranging from 0.2% per annum in the South West to 0.5% in the North West.
21 Dept of Infrastructure & Planning: Queensland’s future population 2008 edition. December 2008
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Figure 30: Queensland population share by Statistical District
The South East Queensland Regional Plan 2009-2031 22 outlines the policy settings and preferred pattern of urban development for South East Queensland over the next 20 years. The Plan estimates that 754,000 additional dwellings will be required through new build in outer urban areas and infill development to accommodate a projected population of 4.4 million by 2031.
The strongest growth in this period is expected across Brisbane LGA, Gold Coast, Sunshine Coast, urban growth areas in Ipswich and adjoining semi-rural areas such as Lockyer Valley, Scenic Rim/Beaudesert and Somerset, parts of Moreton Bay including North Lakes and Caboolture, Logan, Redland and Toowoomba.
Coastal regions are also expected to grow strongly including the Far North Coast, Townsville and Frasier Coast, Wide Bay Burnett, Darling Downs and parts of the South West.
Continued population growth in South East Queensland and regional centres will require expansion of the primary health care workforce in outer urban areas and new communities as well as maintenance and support for the workforce in inland communities that are stable or loosing population.
6.3 Structure of Health Services
6.3.1 General Practice There are 17 Divisions of General Practice in Queensland including 5 classified as urban, 8 provincial and 4 as rural and eligible for MAHS funding. Queensland has some of the largest LGAs in terms of population in Australia and the majority of Division catchments are not contiguous with the reformed LGAs 23 as shown in shaded areas in Figure 31, 32 and 33.
As shown in Table 30, the Division catchments range in size from 63,800 in Central Queensland Rural Division to 614,000 in GP Partners which covers the northern suburbs of Brisbane. In terms of workforce and practice characteristics in 2007/08 there were:
22 Queensland Government: South East Queensland Regional Plan 2009-2031. July 2009 23 New large Local Government Areas were introduced in Queensland in 2008
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• 4,274 practising GPs in Queensland of whom 1,670 or 39% were female
• 977 people per practising GP and 1,138 people per GP FWE
• Approximately 1,278 general practices including 358 solo practices or 28% of the practice base
Table 30: Queensland Divisions of General Practice Key Characteristics Division of General Practice Pop No Solo No of Female FWE GPs GPs: op FWE GP: 2007 practices practices practising GPs as at 2007 pop 2007 GPs 30/06/07 ratio ratio South East Alliance of GP (Brisbane) 345122 95 22 391 174 294 883 1174 Brisbane South Division Ltd. 285924 85 24 287 149 259 996 1104 SouthEast Primary HealthCare Network 292922 78 13 279 101 285 1050 1028 GPpartners 614022 216 68 856 406 545 717 1127 General Practice Gold Coast 477251 129 32 408 162 445 1170 1072 Moreton Bay General Practice Network 197261 67 19 181 52 164 1090 1203 Ipswich & West Moreton Division of General Practice 200183 60 19 168 42 157 1192 1275 GP Connections 162816 64 19 140 53 140 1163 1163 Central Queensland Rural Division of General Practice 63828 24 11 35 7 38 1824 1680 Mackay Division of General Practice 137107 38 12 123 37 98 1115 1399 Townsville General Practice Network 167849 36 7 178 81 125 943 1343 General Practice Cairns* 144583 36 11 129 35 118 1121 1225 RHealth 181987 59 32 152 35 152 1197 1197 North & West Qld Primary Health Care 108177 30 12 87 37 76 1243 1423 Far North Queensland Rural Division of GP 106930 30 7 77 35 74 1389 1445 Sunshine Coast Division of General Practice 341003 128 26 464 166 377 735 905 Capricornia Division of General Practice 154814 43 9 143 51 139 1083 1114 GP Links Wide Bay 194227 60 15 176 47 184 1104 1056 Queensland Total 4176004 1278 358 4274 1670 3670 977 1138 Source: PHCRIS 2007/08 Survey of Divisions of General Practice * Now amalgamated with Far North Queensland Rural Division of General Practice
6.3.2 GP Workforce Distribution Queensland has a population to GP FWE ratio of 1,138 which is marginally higher than the national average of 1,129 and there are significant GP workforce shortfalls in rural and remote communities based on Division data collection.
Central Queensland Rural (1,680), North and West and Far North Queensland Rural (1,423 and 1,435 respectively), Townsville (1,343), Mackay (1,399) and the former Cairns (1,225) all have population to FWE GP ratios that are significantly higher than the state and national averages. Coastal Divisions including GP Links Wide Bay (1,056) and Sunshine Coast (905) are much better served.
Divisions in the urban growth areas in Brisbane and South East Queensland including Ipswich and West Moreton (1,275) and Moreton Bay (1,203) have high population to FWE GP ratios whereas Divisions in the remainder of Brisbane were similar to the Queensland average in 2007/08.
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Figure 31: Far North Queensland Divisions
Figure 32: North, Central and South Western Queensland Divisions
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Figure 33: Brisbane Divisions
6.3.3 Trends in GP Numbers Queensland has had a gradual increase in the number of GPs since 1999/2000 although the numbers fell from 4,317 in 2006/07 to 4,274 in 2007/08 as shown in Figure 34. Given the rate of population growth the increase in the GP workforce in Queensland does not appear to be keeping up with demand.
Figure 34: Trends in Queensland GP numbers
6.4 State Health Services Health Services in Queensland are organised into 15 Health Service Districts that are generally based on geographic populations that generally coincide with Statistical Districts and state planning areas in rural and regional Queensland and . There are two major Districts in metropolitan Brisbane – Metro North and Metro South - as shown in Figure 35.
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6.4.1.1 Health Service Districts Health Service Districts cover general and specialist public hospitals and community based health services. The health service architecture in Queensland shown in Table 31 reflects the needs of the highly urbanised south east and sparsely populated rural communities.
It includes Primary Health Care Centres that offer first line and community health care in rural and remote communities; Multi-Purpose Services; local community hospitals; larger general hospitals in rural and metropolitan areas that offer a range of specialty services; Regional Base Hospitals that offer a broad range of specialty services in regional cities such as Cairns, Townsville, Mackay, Toowoomba and Rockhampton; and, tertiary referral centres such as The Royal Brisbane and Women’s Hospital, The Prince Charles Hospital and The Princess Alexandra Hospital that are based in Brisbane.
New University teaching hospitals are being developed on the Gold Coast and the Sunshine Coast, the new Queensland Children’s Hospital is being built near the Mater Hospital site south of the Brisbane River. The capacity of the Regional Hospitals in the major rural centres such as Cairns and Townsville has been upgraded to service a much broader catchment population.
Figure 35: Queensland Health Service District catchments and key facilities
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Table 31: Queensland Health Service Districts and health services District 2008 2006 2021 Major Hospitals and Health Services Cairns and Hinterland 224419 281352 Cairns Base Hospital , 12 Acute and Community Hospitals, 2 Health Centres, 1 MPS and 1 Primary Health Centre Cape York 12529 14565 Weipa Hospital, 9 Primary Health Centres, 1 MPS Central Queensland 200816 243888 Rockhampton Hospital , 10 Community Hospitals & 1 Nursing Home Central West 12535 12805 6 Community Hospitals & 6 Primary Health Centres Darling Downs-West Moreton 458584 678740 Ipswich Hospital, Toowoomba Hospital , 3 Rural Community Hospitals, 20 Health Services, Park Centre for Mental Health Gold Coast 466433 681449 Gold Coast Hospital and Robina Hospital Mackay 159800 231654 Mackay Base Hospital , 6 Community Hospitals and 8 Community Health Services Metro North 794767 1017380 Royal Brisbane and Women's Hospital , The Prince Charles Hospital , Redcliffe Hospital, Caboolture Hospital, Kilcoy Hospital and Halwyn Centre Metro South 948577 1199864 Princes Alexandra Hospital , Queen Elizabeth 11, Logan, Beaudesert, Redland, Wynnum Hospitals Mt Isa 30333 33110 Mt Isa Hospital, 6 Community Hospitals and 3 Health Health/Primary Health Care Centres South West 26366 27474 13 Community Hospitals Sunshine Coast Wide Bay 532620 736877 Nambour Hospital, Bundaberg Hospital , 6 Community Hospitals, 7 Health Services Torres Strait-Northern Peninsula 10347 12028 2 Community Hospitals and a Primary Health Care Centre Townsville 212782 288006 Townsville Hospital , 3 Community Hospitals, Charters Towers Rehabilitation Centre, Eventide Nursing Home & 6 Health Centres/Services Royal Children’s Hospital New Queensland Children’s Hospital being built in South Brisbane Queensland Total 4090908 5478366 Source: Queensland Health District and Hospital Services accessed February 2010
6.4.1.2 Precincts, Connecting Healthcare in Communities Initiatives and Health Community Councils Queensland has a range of initiatives in place to increase the capacity and connectedness of primary and community based health services and build links with local communities.
Queensland has invested in Health Precincts or integrated care centres that provide an alternative to hospital care and offer a wide range of ambulatory, chronic disease and community based health services. A major Precinct has been built and is operating at North Lakes in the northern suburbs of Brisbane and at Robina on the Gold Coast and other sites, including Browns Plains, Caboolture, Sunshine Coast and Cairns, are planned.
The Connecting Healthcare in Communities Initiative is a 5 year program established in 2006. The Initiative uses CHIC Partnership Councils to link Divisions of General Practice, Community Health Services, community nursing services, other local providers and consumers to strengthen service partnerships and funds local initiatives to improve coordination and joint management of chronic and complex disease.
Thirty six Health Community Councils have been established to enable local communities to provide advice on health needs and feedback on local health services.
6.4.2 Aboriginal community controlled health services There are approximately 54 organisations in Queensland funded by OATSIH to provide health services for Aboriginal and Torres Strait Islander peoples including Queensland Health and the Royal Flying Doctor Service and 21 Community Controlled Aboriginal Health Services affiliated with the state peak body Queensland Aboriginal and Islander Health Council (QAIHC) and with NACCHO.
Aboriginal and Torres Strait Islander Community Controlled Health Services are located in Brisbane, Mackay, Cape York, Rockhampton, Bundaberg, Charleville, Cunnamulla, Darling Downs/Toowoomba, Bowen, Dalby, Yarrabah, Burleigh Heads on the Gold Coast, Ipswich, Cherbourg, Stradbroke Island, Mt Isa, Maroochydore, Sarina, Gladstone, Townsville, Hervey Bay. Several of the rural and remote AHSs offer
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community clinics in a range of locations and QAIHC has Associate Members at George, Kuranda, Atherton, Cleveland, Bedourie, Rockhampton and Cairns.
Community controlled Aboriginal and Islander Health Services and state government Health Services are the major primary care service providers in Far North Queensland and other remote areas and employ salaried medical officers as well as Aboriginal Health Workers, nurses and allied health professionals. They generally have close working relationships with local Division of General Practice and the Royal Flying Doctor Service.
There has also been extensive partnership planning that has looked at integrated workforce and service delivery initiatives through Regional Health Councils and the Queensland Aboriginal Health Partnership . Strengthening primary care partnerships with the community controlled sector is an important consideration for PHCO design in Queensland.
6.5 PHCO Design Issues The needs of rural and remote communities combined with the projected rate of population growth in South East Queensland and major coastal regions pose significant issues for PHCO design in Queensland.
6.5.1 Keeping pace with growth in South East Queensland The population of South East Queensland is projected to increase by 60% to 4.4 million people by 2031 driven by interstate and overseas migration and natural increase. There are already significant primary health care workforce pressures in outer urban growth areas such in Ipswich and West Moreton, Moreton Bay, Logan and Beaudesert in south Brisbane and parts of the Gold Coast. These will continue as new development areas are opened up.
Attracting the range of primary health professionals required in new communities and low socioeconomic suburbs to keep pace with population growth is a key challenge for South East Queensland. This includes access to GPs, community nurses and allied health professionals in public and private practice.
6.5.2 Regional, rural and remote community needs There are five distinct population distribution patterns in rural and regional Queensland that make Queensland unique in terms of service planning and which require tailored service development responses as part of PHCO design.
The large regional centres on the coast such as Cairns, Townsville, Mackay and Rockhampton and have catchment populations ranging in size from 111,000 (Rockhampton) to 175,000 (Townsville) and are between 1,700 kilometres and 600 kilometres from Brisbane. Toowoomba is the major inland regional centre for the south west and is part of the South East Queensland growth zone.
These large regional centres have major acute hospitals providing specialist services, tertiary education facilities and are health and human service hubs for the surrounding region. Specialist recruitment will increase self sufficiency further in the future and larger centres tend to support a wide range of local primary care providers, specialist services and private practitioners.
Large rural towns and regions with populations of between 30,000 and 60,000 people offer core services locally and may have some local specialist services and may provide a hub or service centre for a wider region. This includes inland and some coastal towns such as Gladstone, Gympie and Dalby and regions
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such as the Cassowary Coast or the Whitsundays. The range of local service providers will vary and some PHCOs may need to auspice or provide services from hubs in some of these communities.
Medium sized inland towns and communities with populations ranging in size from 12,000 to 25,000 tend to offer core services locally and provide the hub or service centre for large and sparsely populated regions. Examples include Roma and Kingaroy in the south west, Mt Isa and Charters Towers in the north and west and Sarina and Mareeba on the coast. The range of local service providers is generally more limited, integrated hospital and state government community health services are a common operating model and PHCOs are likely to need to auspice or provide primary care services to remote inland and coastal communities from regional hubs.
Small rural towns with populations under 5,000 such as Barcaldine, Longreach, Cloncurry, Balonne and Quilpie typically have integrated community hospitals and community health services. Current Divisions of General Practice often provide MAHS services and auspice related programs for these communities.
Remote or isolated small communities with populations ranging from 400 to about 2,500 residents such as Hope Vale, Boulia, Mornington, Aurukun, Palm Island, Weipa, Cherbourg, Paroo and Quilpie. These communities tend to rely on local primary care services and visiting or fly in specialist services. They include many of the Aboriginal communities in Far North and Western Queensland and the Gulf of Carpentaria as well as farming communities in the north, west and south west of the state. The Aboriginal and Islander communities generally have poorer health status than the Queensland average and rely heavily on salaried primary care services, provided by Queensland Health and community controlled health services, for local service provision. They face major workforce and access challenges.
Funds pooling partnerships and shared or integrated service provider arrangements already operate successfully in many of these communities under regional initiatives and will need to continue in the future.
The design challenge for rural PHCOs in Queensland is to ensure rural and remote PHCOs have the critical mass needed to deliver and commission services and to provide effective workforce and practice support while also ensuring there is effective local planning and community engagement.
The rural Divisions of General Practice in Queensland currently cover larger geographic areas and larger inland populations than their counterpart Divisions in NSW because of lower inland population densities. Projected growth patterns suggest that retaining larger entities with an appropriate branch structure to ensure local engagement may be the preferred approach in Queensland.
6.5.3 Partnerships with Aboriginal and Islander Health Services Aboriginal and Islander Health Services are significant service providers in Queensland and play a major role in Far North Queensland, the Gulf of Carpentaria, Townsville and many parts of regional Queensland. PHCOs will need to work closely with the community controlled sector in Queensland to improve health outcomes, address common access and workforce gaps in rural and remote communities and to develop effective governance and commissioning models.
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6.5.4 Cross border issues Queensland shares borders with NSW, South Australia and the Northern Territory but the only location where there are significant cross border flows is between the Tweed Valley in northern NSW and the Gold Coast. The South East Queensland development strategy considers population growth in Tweed as part of the global planning considerations for the Gold Coast region. We have applied this approach as part of PHCO design.
6.5.5 Alignment with hospital and health service boundaries Several Divisions identified the importance of aligning PHCOs with hospital boundaries or catchments to facilitate referral relationships and integrated care for people with chronic and complex care needs. During the consultation process several Queensland Divisions also indicated that PHCOs needed to have the critical mass to partner and negotiate effectively with large tertiary hospitals.
Like Western Australian and Victoria, Queensland’s major tertiary hospitals are located in central Brisbane and attract 30% or more of their workload from rural Queensland and metropolitan areas outside their local geographic catchments. There is also reasonably extensive role delineation between the hospitals in the northern suburbs of Brisbane with hospitals specialising in different services and this affects referral arrangements.
Hospital capacity will continue to expand in line with population growth in South East Queensland and this may change relationships and linkages in the future. The upgrading of Gold Coast Hospital, development of a new university teaching hospital on the Sunshine Coast and ongoing improvements in Rural Base Hospitals are all likely to increase the level of self sufficiency in these regions. These developments will also reinforce the need for strong local linkages between acute hospitals and PHCOs for teaching and training, chronic and complex disease management and post acute care.
In many parts of rural Queensland general practitioners work in the local hospital as the Medical Officer/Medical Superintendent and have rights of private general practice. These GPs are a vital part of the hospital medical workforce. Community and allied health services are unified and support community clients and hospital services.
PHCO configuration options in South East Queensland and regional and rural Queensland will need to take account of these linkages as well as the needs of their local communities and populations.
6.5.6 Post 2006 Changes in Queensland LGAs and SLAs The size of Local Government Areas, especially in Brisbane and environs (e.g. LGAs of Moreton Bay, Logan and Redlands) and changes to the LGA and SLA boundaries since the 2006 Census posed some technical challenges for PHCO modelling in Queensland. The LGA of Brisbane had a population of 1.03 million at June 2008 and is the largest LGA in Australia. Because there are distinct communities within Brisbane LGA we have used Statistical Local Areas as our PHCO building blocks in Brisbane.
Changes to the Queensland SLAs and LGAs since the 2006 Census also mean that the available socio- demographic information produced by the ABS (IRSD Index, non English speaking background and indigenous background information) does not line up. This information is reported at SLA level in Part 3 Appendix 6 but scores are not provided for the proposed PHCOs.
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6.6 Configuration Options Four broad options for the configuration of PHCOs in Queensland have been developed and are described below. Three of the proposed rural and remote PHCOs and the proposed Gold Coast and Sunshine-Wide Bay PHCOs remain constant in all Options. The major differences centre on the configuration of PHCOs in Greater Brisbane and the impact of these different Options on the adjoining South West rural PHCO.
6.6.1 Option 1: Nine PHCOs - 3 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote This Option includes the PHCO configurations proposed for the Gold Coast and Sunshine Coast-Wide Bay and for four rural and remote PHCOs. The LGAs and alignments with Queensland Divisions of General Practice and Health Service Districts covered by each PHCO are shown in Table 32 and Table 33.
Far North Queensland PHCO shown in Figure 36 is a remote rural PHCO covering LGAs and Aboriginal and Islander communities in the Far North Statistical District which includes Cairns, the Cassowary Coast, Weipa, Torres Strait and communities in Cape York and Torres Strait and Northern Peninsula.
This PHCO had a 2008 population of 262,000 that is projected to grow to 299,000 by 2021 with the bulk of the population residing in Cairns and environs. The PHCO catchment coincides with the existing Far North Rural Division of General Practice and the Cairns and Hinterland, Cape York and Torres Strait & Peninsula Health Service Districts.
In terms of service development, Far North Queensland PHCO is primarily a remote rural PHCO with a regional centre in Cairns. This PHCO needs the capacity to provide a well structured primary health care program focussed on prevention and effective local management of chronic and complex disease and strong community engagement with local Aboriginal and Islander communities to improve health outcomes.
This PHCO is also likely to require a formal partnership between the community controlled sector and Aboriginal Regional Councils and Queensland Health Services as well as links to the developing tertiary referral centre at Cairns Hospital and to Brisbane for specialist services.
A branch office structure (both real and virtual) will be needed to facilitate local needs assessment and service development processes in Cape York, Torres Strait and Cairns and Hinterland. While the hub is likely to be in Cairns the best locations for branch offices will need to be determined through local consultation.
The Far North Queensland PHCO socio-demographic profile indicates that the PHCO has a younger age profile than Queensland as a whole (7.4% aged 0-4 and 10.4% aged 65 years plus compared to 6.7% aged 0-4 and 12.3% aged over 65 years for Queensland as a whole).
It contains the LGAs with the lowest socio-demographic status (IRSD scores ranging from 485 in Yarrabah to 1055 in the northern suburbs of Cairns) in Queensland. The Far North PHCO configuration remains constant in all Options.
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Figure 36: Far North Queensland PHCO
North and West PHCO covers the Central West, Northern and North West Statistical Divisions. It had a combined 2008 catchment population of 434,500 that is projected to grow to 565,000 by 2021 as shown in Figure 37. This is the largest PHCO by area proposed in Queensland and covers 24 LGAs.
The suggested configuration recognises the challenges inherent in planning for large parts of rural and regional Queensland. The largest population centres and the coastal growth hubs are Townsville LGA (175,500 population rowing to 239,000) and Mackay LGA (112,000 growing to 158,000). Mt Isa, 900 kilometres from Townsville, is the major inland regional centre (21,500 in 2008 growing to 24,000) in the North West Statistical District. Mt Isa is the hub of a dispersed regional population of 11,200 people living in 7 small LGAs covering 300,000 square kilometres and ranging in size from 562 people in Burke LGA to 3,394 in Cloncurry.
The other large inland towns are Charters Towers (8,500 population), which is under 200 kilometres from Townsville, and Maronbah (pop 8,000) in Isaac LGA (22,000 population) which is south west of Mackay. Barcaldine (pop 3,400) and Longreach (pop 4,300) are the major towns in the Central West and have stable or declining populations.
The Townsville Hospital is the region’s referral centre with a catchment stretching from Mt Isa in the north to Sarina in the south. Mackay Base Hospital and Mt Isa Hospital are the other hospitals providing secondary and specialist services.
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Figure 37: Option 1 - Queensland Central and Southern Rural PHCOs
Various configuration options were considered to address the geography and demography of the North and West of Queensland including retaining the current Division or Health Service boundaries. While this approach would have worked for the coastal areas, retaining Mt Isa as a standalone rural PHCO was not seen as feasible given the size and distribution of the population.
Aligning Mt Isa and the Central West LGAs was also considered but not seen as feasible because of distance, low overall population density, lack of a major population centre and the existing links and referral patterns between the Central West inland towns and the regional centres on the coast.
The preferred approach is to develop North and West as a single overarching rural and regional PHCO based in Townsville with major branch offices in Mt Isa and Mackay that would act as service development, service delivery and professional hubs for their local communities and health service networks.
Mt Isa would continue to act as a primary care hub servicing remote and inland rural communities and would have the capacity to provide or auspice a range of local primary health services to close gaps in local communities. It would be connected to Townsville for practice support, training and clinical referrals.
Mackay would act as the hub for Isaac LGA with training and business links to Townsville. The shaded areas within North & West in Figure 38 show the indicative population catchments that would be supported by each of these hubs.
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Figure 38: North & West PHCO with local hub catchments
North and West PHCO aligns with the catchments of the North and West Queensland, Townsville and Mackay Divisions of General Practice and the Mt Isa, Mackay and Townsville Health Service Districts.
North and West has a mixed socio-demographic profile with high levels of disadvantage in Aboriginal communities such as Palm Island (IRSD score 479), Doomadgee (IRSD 545) and Mornington (IRSD score 560) and suburbs such as Garbutt (IRSD of 820) in Townsville. It also includes more advantaged communities with IRSD scores well above the Queensland average such as Douglas (IRSD 1092) and Pallarendra-Shelly Beach (IRSD 1070) in Townville LGA and Belyandro in Isaac LGA.
In terms of age, 7.2% of the catchment population were aged 0-4 which is higher than the Queensland average and only 11% were over the age of 65 years.
Capricornia PHCO shown in Figure 37 includes the Fitzroy Statistical Division and the LGAs of Banana, Central Highlands, Gladstone, Rockhampton and Woorabinda. It had a 2008 catchment population of 215,000 and is projected to grow to 271,000 by 2021.
Rockhampton and Gladstone are the main population centres and the proposed PHCO catchment aligns with the Capricornia and Central Queensland Rural Divisions and the Central West and Central Queensland Health Service Districts. Rockhampton and Gladstone are the main acute hospitals.
In terms of socio-economic status the Central Highlands LGA is a relatively advantaged area (IRSD scores ranging from 1013 to 1054) while Rockhampton has a mixed profile with disadvantaged communities such as Mount Morgan (IRSD 807) and a range of advantaged areas.
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In terms of age distribution 7% of Capricornia’s population was aged 0-4 years in 2008 and nearly 11% were over 65 years.
South West PHCO primarily covers the rural south west of Queensland. It includes the regional centre of Toowoomba in the Darling Downs in the east, large regional LGAs in the south and inner west such as Southern Downs (34,600 pop), Goondiwindi (11,000 pop), Dalby (31,000 pop) and Roma (13,000 pop) and more sparsely populated Shires in the west such as Balonne, Murweh, Quilpie, Paroo and Bullo that have populations ranging from 400 to 4,800 people.
Under Option 1 the South West PHCO also includes the rural areas of Gatton SLA in the rural part of the Lockyer Valley LGA and Ipswich West SLA in West Moreton. This catchment had a population of 283,000 in 2008 and is projected to grow to 344,000 by 2021. Toowoomba is the regional centre and service hub and the major inland growth area in Queensland with a population of 155,000 in 2008 growing to nearly 200,000 by 2021.
This PHCO is aligned with RHealth, GP Connections and part of the Ipswich and West Moreton Division of General Practice and the Darling Downs West Moreton and South West Health Service Districts.
Toowoomba Hospital is the major acute hospital in the catchment and offers comprehensive specialty services as well as training and tertiary education. Toowoomba has a Rural Clinical School with training and clinical links with several communities in the South Burnett LGA including Kingaroy and Nanango.
The option of including these SLAs in the South West PHCO catchment has been raised for consideration to preserve the existing training networks. While this is feasible and Kingaroy is closer to Toowoomba (approximately 2 hours by road) than the Sunshine Coast we have been reluctant to split the South Burnett LGA at this time.
The development of the Sunshine Coast University Hospital at Kawana Waters and planned upgrades to the highway network feeding into the Sunshine Coast will improve access and travel time between Kingaroy and the Sunshine Coast (currently about 2 hours 50 minutes by road). This is likely to change referral patterns and may affect teaching and training networks.
At the same time Toowoomba and nearby parts of West Moreton and the Darling Downs are growing and this will increase Toowoomba’s local referral base and may realign the service and teaching and training catchment. Further review of the best location for Kingaroy and Nanango is required during the PHCO implementation phase.
The proposed South West catchment has a socio economic profile similar to Queensland as a whole. The majority of SLAs have IRSD scores between 955 and 999 with pockets of rural disadvantage such as Paroo (IRSD of 875) and relative advantage in parts of Toowoomba.
This catchment has a higher proportion of older people than the Queensland average with 14% of residents aged over 65 years and nearly 2% aged over 85. The 0-4 age group at 6.9% is similar to the Queensland average.
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Table 32: Option 1 - Nine PHCOs with LGAs PHCO Name ERP 2021 LGAs 2008 Pop 1 Far North 262095 299285 Aurukun, Cairns, Cassoway Coast, Cook, Croydon, Etheridge, Hope Vale, Kowanyama, Lockhart River, Mapoon, Napranum, Northern Peninsula, Pormpuraaw, Tablelands, Torres, Torres Strait Island, Weipa, Wujal Wujal, Yarrabah 2 North & West 434324 565923 Barcaldine, Barcoo, Blackall Tambo, Boulia, Burke, Carpentaria, Charters Towers, Cloncurry, Diamantina, Doomadgee, Flinders, Hinchinbrook, Isaac, Longreach, Mackay, McKinlay, Mornington, Mount Isa, Palm Island, Richmond, Townsville, Whitsunday & Winton 3 Capricornia 214753 271651 Banana, Central Highlands, Gladstone, Rockhampton, Woorabinda 4 South West 283342 343669 Balonne, Bulloo, Dalby, Goondiwindi, Ipswich West, Murweh, Paroo, Quilpie, Roma, Southern Downs, Toowoomba, Gatton 5 Sunshine Coast-Wide Bay 590769 765681 Bundaberg, Cherbourg, Fraser Coast, Gympie, North Burnett, South Burnett, Sunshine Coast 6 Gold Coast 563311 768047 Gold Coast, Tweed Part A 7 North Brisbane 827436 1002151 SLAs in North West Inner and North West Outer Brisbane Statistical Divisions plus some Inner South East as per Appendix and Moreton Bay LGA 8 South East Brisbane 652621 818192 SLAs in South East Inner, South East Outer and some Inner Brisbane Statistical Divisions as per Appendix plus Logan and Redlands LGAs 9 South Brisbane/Ipswich 530727 727563 SLAs in Brisbane South East Inner and South East Outer Brisbane Statistical Division as per Appendix plus Ipswich, Lockyer Valley less Gatton, Scenic Rim and Somerset LGAs Total 4359378 5562162
Table 33: Option 1: Nine PHCOs with GP Division and Health District alignment PHCO Name ERP 2021 GP Division alignment QH Health District alignment 2008 Pop 1 Far North 262095 299285 Far North Queensland Rural Division of Torres Strait - Northern Peninsula, Cape York General Practice and Cairns & Hinterland 2 North & West 434324 565923 North & West Queensland PHC, Townsville Mt Isa, Townsville & Mackay HSDs GPN, Mackay DGP 3 Capricornia 214753 271651 Capricornia DGP, Central Queensland Rural Central West and Central Queensland HSDs DGP 4 South West 283342 343669 Ipswich & Moreton DGP, GP Connections & South West and Darling Downs West Moreton RHealth HSDs 5 Sunshine Coast-Wide Bay 590769 765681 Sunshine Coast DGP, GP Links Wide Bay Sunshine Coast/Wide Bay HSD
6 Gold Coast 563311 768047 General Practice Gold Coast & Tweed Gold Coast HDS and part NCHS, NSW Valley DGP 7 North Brisbane 827436 1002151 GP Partners, Moreton Bay GPN Metropolitan North HSD
8 South East Brisbane 652621 818192 South East Alliance of General Practice & Metropolitan South HSD Southeast Primary Healthcare Network 9 South Brisbane/Ipswich 530727 727563 Brisbane South Division Ltd &Ipswich & Metropolitan South HSD, Darling Downs West West Moreton DGP Moreton HSD Total 4359378 5562162
6.6.1.1 Regional and Rural PHCOs Sunshine Coast-Wide Bay PHCO includes the Sunshine Coast and Wide Bay Burnett Statistical Divisions. It had a population of 590,000 at June 2008 and is projected to grow to 766,000 by 2021.
The Sunshine Coast is defined as part of South East Queensland for urban planning and had a 2008 population of 313,000 that is projected to grow to 421,000 by 2021 and includes the population centres of Noosa, Maroochydore and Caloundra on the coast and Nambour in the hinterland.
Wide Bay Burnett is a diverse coastal and inland rural region encompassing Bundaberg, Fraser Coast, South and North Burnett and Cherbourg LGAs and covering approximately 52,381 square kilometres. The Fraser Coast has the largest population (with 95,600 people in 2008 growing to 128,000 in 2021) and is a rapidly growing coastal LGA that includes Maryborough (256 kilometres north of Brisbane) and nearby
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Hervey Bay. Bundaberg LGA, 385 kilometres north of Brisbane, is the other major population centre (92,000 growing to 111,000 in 2021) with a mix of coastal development and rural industry.
Gympie (46,000 population in 2008 growing to 58,000 in 2021), South Burnett (32,000 in 2008 growing to 36,000 in 2021 and centred on Kingaroy) and North Burnett (10,600 to 11,200) are inland rural LGAs that have links with the Sunshine Coast, Maryborough and Bundaberg.
The Sunshine Coast and Wide Bay Burnett Statistical Divisions encompass distinct coastal regional and inland rural communities that have many demographic characteristics in common. These include an older age profile than the Queensland average (17% of residents over 65 years in 2006 compared to 12% for Queensland as a whole) and relatively stable inland rural populations.
The Sunshine Coast SLAs are more advantaged and have IRSD scores ranging from 1002 in the Noosa Hinterland to 1057 in Buderim. Bundaberg, Fraser Coast SLAs and Gympie SLAs are similar socio- demographically to the Queensland country average IRSD score of 985. The inland SLAs in North and South Burnett are more disadvantaged with IRSD scores ranging from 911 in Biggenden in North Burnett to 981 in Kingaroy.
Cherbourg LGA, which has 97% indigenous population and an IRSD score of 506, Eidsvold SLA in North Burnett, which has 20.1% indigenous population and an IRSD score of 889, and, Nanango in South Burnett with an IRSD score of 915 are the most disadvantaged parts of the region.
Combining Sunshine Coast and Wide Bay Burnett will create one large and capable regional PHCO with similar coastal and inland rural demographic characteristics and workforce needs. The PHCO will relate to the new Sunshine Coast University Hospital as the region’s referral centre and the health care and teaching and training hub.
Distances within the PHCO as well as the coastal and rural characteristics suggest that there will need to be a hub at Maroochydore on the Sunshine Coast and branch offices in Bundaberg and one or more of the inland rural towns. The specific branch office locations should be determined as part of the next stage of planning.
The boundaries of this PHCO align with the current Sunshine Coast and GP Links Wide Bay Divisions and the Sunshine Coast-Wide Bay Health Service District.
This is a similar PHCO configuration for a regional growth area with adjoining rural areas proposed for the Gold Coast and parts of NSW and Victoria.
Gold Coast PHCO includes the Gold Coast in Queensland and Tweed A in northern NSW as shown in Figure 39. The Gold Coast PHCO catchment had a population of 563,000 in 2008 that is projected to grow to 768,000 by 2021. The Gold Coast LGA makes up 88% of the population base (a population of 498,000 in 2008 that is projected to grow to 681,000 by 2021) and Tweed A in NSW (with a cross border population of 65,000 in 2008 that is likely to grow to 86,600 by 2021) will make up nearly 12%.
The Gold Coast PHCO aligns with General Practice Gold Coast, part of Tweed Valley Division in NSW and the Queensland Gold Coast Health Service District and part of North Coast Health Service in NSW. The
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800 bed Gold Coast University Hospital being developed near Southport will be the major referral centre for this growing region and will have referral links with northern NSW and Brisbane.
This PHCO would support a predominantly urban population with a nearby rural hinterland. In terms of the socio-demographic profile the Gold Coast has a slightly older age structure than the Queensland average with 13.8% of the 2008 population aged over 65 years and 1.7% aged over 85 years and 5.9% are children aged 0-4 years. The Gold Coast is also relatively advantaged with the majority of SLAs recording IRSD scores between 1018 and 1084. However some of the more established SLAs including Coolangatta (IRSD score of 939) and Southport (965) are more disadvantaged.
Approximately 9% of the population were born in non English speaking countries but only 1% speak English poorly. The catchment for this PHCO remains constant in all Queensland options.
6.6.1.2 Metropolitan PHCOs Brisbane, Morton Bay, Logan, Redland and Ipswich and West Moreton LGAs make up the greater metropolitan area of Brisbane and several PHCO configuration options have been considered for this catchment.
Option 1 has three metropolitan PHCOs as shown in Figure 39 made up of 1 in the north and 2 in the south of Brisbane. Brisbane LGA is split according to SLAs which are assigned according a combination of GP Division catchments and Queensland Health District boundaries.
North Brisbane PHCO in Option 1 is the largest metropolitan PHCO with a 2008 population of 827,400 growing to over 1 million people by 2021. It includes SLAs in North West Inner and North West Outer Brisbane Statistical Divisions as shown in Appendix 6a and Redcliffe, Bribie Island and Caboolture SLAs in Moreton Bay LGA.
The northern Brisbane SLAs had a catchment population of 471,000 in 2008 and will grow to approximately 538,000 people by 2021. Growth will predominantly be infill development with modest growth projected in all the established SLAs and only Taigum-Fitzgerald and Pinkenba-Eagle Farm SLAs recording significant population increases of 3,500 new residents and 7,600 new residents respectively) between 2008 and 2021.
The majority of the northern Brisbane SLAs in the proposed catchment are advantaged with the IRSD scores ranging from 1,011 at Taigum-Fitzgerald to 1120 at Bellbowrie. Zillmere (IRSD score of 922), Pinkenba-Eagle Farm (935) and Chermside (941) are the most disadvantage SLAs in the catchment.
Moreton Bay LGA is expected to continue to grow strongly from a base of 357,000 in 2008 to 464,000 in 2021 due mainly to continuing expansion of the outer urban growth SLAs that make up Caboolture and the new development areas in the outer northern suburbs of Brisbane including North Lakes and the former Pine Rivers Shire. Redcliffe adjoining Moreton Bay is an established area with an older population that will experience infill development and turnover of housing stock over the next fifteen years.
Moreton Bay has a more disadvantaged socio-demographic profile overall with the SLAs of Caboolture Central (IRSD score of 913), Deception Bay (926), Margate-Woody Point (915), Morayfield (955), Rothwell-Kippa-Ring (966) and Redcliffe Scarborough (975) scoring below the Brisbane average of 1022.
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Figure 39: Option 1 - 3 Metropolitan Brisbane PHCOs – 1 North & 2 South
Northern Brisbane PHCO in Option 1 aligns with the catchment of GP Partners and Moreton Bay General Practice Network and Metro North Health Service District. The major hospitals in the catchment are Royal Brisbane and Women’s Hospital, The Prince Charles Hospital, Redcliffe Hospital and Caboolture Hospital. There is currently strong role delineation and specialisation between the tertiary hospitals in specialties such as orthopaedics, cardiology and transplantation services and clinical networks operate between Redcliffe and the Royal Brisbane and Women’s Hospital in specialist services such as cancer care and renal medicine.
South East Brisbane PHCO includes the south eastern SLAs in the South East Inner and South East Outer and some of the Inner Brisbane Statistical Divisions as shown in Part 3 Appendix 6A, Logan LGA and Redland LGA or a combined catchment population of 652,000 in 2008 that is projected to grow to 818,000 people by 2021. This catchment had a marginally higher proportion of children aged 0-4 (7%) and fewer people aged 65 years and over (10.1%) than Queensland as a whole.
The Brisbane SLAs had a catchment population of 246,000 in 2008 and will grow to 296,000 by 2021 through infill development in most SLAs and significant expansion in the suburbs of Calamvale (growth of 4,000 residents or 25%) and Parkinson-Drewdale (growth of approximately 3,600 or 30%). Logan LGA had a 2008 catchment population of 270,000 and is projected to grow to 351,000 by 2021. Redland LGA is the smallest catchment with a 2008 population of 137,000 that is projected to grow to 171,000 by 2021.
The majority of the Brisbane SLAs in this catchment ranked above the Brisbane LGA IRSD average of 1022 but there were pockets of disadvantage in Dutton Park (IRSD score of 958), Murarrie (964), Woolloongabba (968) and Wynnum (996). Logan was the most disadvantaged LGA in 2006 with an IRSD score of 971 ranging from 823 in Woodridge to 999 in Browns Plains.
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Nearly 20,000 people or 11.4% of the Logan population were born in non English speaking countries and 1.8% spoke English poorly or not at all in 2006. There were 4,374 Aboriginal and Torres Strait Islander people in Logan or 2.5% of the population.
Redland is a relatively advantaged LGA with an IRSD score of 1034 in 2006 which is higher than the metropolitan Brisbane average of 1022. Nearly 8,000 people or 6.2% of the Redland population were born in non English speaking countries and 0.5% spoke English poorly or not at all in 2006. There were 1,944 Aboriginal and Torres Strait Islander people in the LGA or 1.5% of the population.
This PHCO is aligned with the catchments of the South East Alliance Division and the Southeast Primary Healthcare Network and part of the Metro South Health Service District. The Princess Alexandra Hospital at Woolloongabba, one of the major tertiary facilities in Queensland, Logan Hospital and Redlands Hospital are the main acute care facilities in the catchment.
Brisbane South/Ipswich PHCO is the third metropolitan PHCO proposed under Option 1. It covers the residual SLAs in Brisbane South East Inner and South East Outer Statistical Division, the metropolitan part of Ipswich LGA and the outer urban growth areas on the southern fringe of greater Brisbane including the SLA of Laidley in the Lockyer Valley, Scenic Rim (includes Beaudesert and Boonah) and Somerset (which includes Esk and Kilcoy) LGAs.
In 2008 this catchment had a population of 531,000 and is projected to grow to 727,000 by 2021.
The Brisbane SLAs in this catchment shown in Appendix 6A had a population of 311,000 in 2008 or 60% of the total population and are projected to grow through infill development to 350,000 people by 2021.
Ipswich LGA is projected to grow from 146,000 or 28% of the catchment population to 274,000 or 37% of the catchment population by 2021. Scenic Rim will also grow strongly (47% increase) from 36,000 people in 2008 to 54,000 in 2021.
The Brisbane SLAs in this catchment include some of the most disadvantaged localities in metropolitan Brisbane including Inala (IRSD score of 752), Upper Mount Gravatt (763), Acacia Ridge (884), Richlands (897), Durack (917), Darra-Sumner (921), Archerfield (941) and Rocklea (961). Ipswich (971) and Laidley (946) are also below the metropolitan Brisbane IRSD average of 1022.
This PHCO is aligned with the catchments of the Brisbane South Ltd and Ipswich and West Moreton Divisions of General Practice. The Princess Alexandra Hospital, Ipswich Hospital and Beaudesert Hospital are the main acute care facilities in the catchment.
6.6.2 Strengths and weaknesses A major strength of Option 1 is the grouping of regional, rural and remote Queensland into PHCOs that have the critical mass to address the challenges of primary health care provision in growing regional and stable rural and remote communities.
The alignment of coastal growth areas, where the major acute hospitals are generally located, with large inland towns and more remote communities reflects the logical service development model for Queensland’s relatively unique geography. It also reflects current or emerging referral linkages and the communities of interest that exist in terms of training and workforce support.
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The large PHCOs proposed in rural and regional areas will have the critical mass and capability to auspice direct service delivery to fill service gaps in inland communities. Establishing branch offices in relevant locations will help to overcome the tyranny of distance by providing a focus for local community engagement and they will enable PHCOs to have inland hubs to tailor on the ground workforce support in locations and communities that are hard to recruit for or have specific workforce needs.
Option 1 also recognises the impacts of the rapid growth in South East Queensland and the impacts on the Sunshine Coast, greater Brisbane, Ipswich and Scenic Rim and the Gold Coast.
The proposed Gold Coast and Sunshine Coast-Wide Bay PHCOs are large regional PHCOs able to respond to rapid coastal growth and with capacity to support populations and primary care services in nearby rural communities. These regional areas are becoming self sufficient in terms of primary, secondary and tertiary health services and serve an older demographic than Queensland as a whole.
The cross border links proposed between Tweed A in NSW and the Gold Coast reflect the demographic similarities in these growing coastal populations and the existing links for hospital referrals that will strengthen with the development of the Gold Coast University Hospital. A cross border agreement between NSW and Queensland will be necessary to support this configuration.
The three metropolitan PHCOs proposed for greater Brisbane and Ipswich reflect the major urban development corridors in the north, south east and south west of Brisbane and align with existing Divisional and secondary and tertiary hospital catchments. Each of the proposed metropolitan PHCOs has a mixed socio-demographic profile with high need or disadvantaged communities in the outer northern and southern suburbs and in Brisbane’s western suburbs and Ipswich. The more advantaged populations live in the established parts of Brisbane in each PHCO.
The model links established areas in Brisbane that have a relatively stable and adequate workforce with outer urban growth and lower socio-economic areas where there are already primary care workforce shortages that will be exacerbated by the next wave of population growth. These large metropolitan PHCOs will have the critical mass to support the workforce in both of these environments and the capacity and skills to tailor local service solutions for high need localities and to work with a range of partners to implement integrated service delivery models.
Given the relatively centralised and tiered structure of acute hospitals in Brisbane, these large metropolitan PHCOs will also have the bargaining power to relate to the major tertiary facilities as peers and to collaborate effectively in the design of hospital avoidance/diversion programs and community care services and systems.
Lastly, the regional and rural PHCOs proposed in Queensland under Option 1 are similar in size and scale to those proposed in NSW and Victoria and the large metropolitan PHCOs are also similar in size to PHCOs in the NSW and Victorian urban growth corridors.
The major weakness of this Option is the scale of the PHCOs proposed in Greater Brisbane which has a number of distinct communities and communities of interest that are absorbed within the larger PHCOs. Effective needs assessment processes and linkages at the local community level will need to be developed to ensure the PHCOs remain connected and accessible.
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Some of the PHCOs in rural, remote and regional areas also have larger populations (although not necessarily geographic catchments) than equivalent PHCOs in other states and territories. However this is an artefact of the unique coastal and regional development in Queensland and is partially offset by the proposed branch structures.
6.6.3 Option 2: 10 PHCOs – 4 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote Option 2 retains the remote, rural and regional PHCO structure recommended in Option 1 but changes the service catchment and boundaries of the greater metropolitan Brisbane PHCOs to create 4 more locally oriented PHCOs.
South East Brisbane and South Brisbane Ipswich remain unchanged in this Option. A second PHCO in the northern suburbs of Brisbane is created by splitting Moreton Bay LGAs and North Brisbane SLAs as shown in Figure 40 and Table 34 and
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Table 35.
Figure 40: Option 2 - 4 metropolitan Brisbane PHCOs – 2 north and 2 south
Under Option 2 North Brisbane PHCO had a 2008 population of 471,000 and is projected to grow to a population of 538,000 by 2021. It would include the SLAs in North West Inner and North West Outer Brisbane Statistical Divisions as shown in Appendix 6A.
The majority of growth in the North Brisbane PHCO catchment will be infill development with Taigum- Fitzgerald SLA recording a 25% increase (3,500 new residents) and Pinkenba-Eagle Farm also projecting rapid growth (7,600 new residents) between 2008 and 2021.
The North Brisbane PHCO is relatively homogenous and socio-demographically advantaged with the majority of SLA IRSD scores in the range of 1,011 at Taigum-Fitzgerald to 1120 at Bellbowrie. SLAs such as Zillmere (IRSD score of 922) and Chermside (941) are the most disadvantaged SLAs in the catchment and had a 2008 population of approximately 15,000 people.
North Brisbane PHCO coincides with part but not all of the catchment for GP Partners Division and part of the Metro North Health Service District. The Royal Brisbane and Women’s Hospital and The Prince Charles Hospital are the major acute public hospitals in the catchment.
Redcliffe Caboolture PHCO (could also be called Moreton Bay) would form the second northern PHCO in Brisbane under Option 2 and would cover the established Redcliffe and Bribie Island communities on
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Moreton Bay, the growing north eastern suburbs covered by the previous Pine Rivers Shire and the urban growth area of Caboolture.
This PHCO catchment had a population of 357,000 in 2008 growing strongly to 464,000 by 2021 due mainly to infill development, new estate growth in the former Pine Rivers Shire suburbs and continued expansion of Caboolture which has been one of the fastest growing SLAs in Australia since 2001.
Caboolture’s outer suburbs and parts of Redcliffe have a more disadvantaged socio-demographic profile but the developing suburbs such as North Lakes are more advantaged with higher cost housing stock and planned new urban communities with a range of amenities.
This PHCO catchment coincides with the Moreton Bay General Practice Network and includes some SLAs historically attached to GP Partners. Redcliffe and Caboolture are the major hospitals in the catchment and were linked as part of a previous Health Service District. Redcliffe Hospital is strongly networked with statewide cancer and renal services and with Royal Brisbane and Women’s Hospital.
Table 34: Option 2: Ten PHCOs with LGAs PHCO Name ERP 2021 LGAs 2008 Pop 1 Far North 262095 299285 Aurukun, Cairns, Cassoway Coast, Cook, Croydon, Etheridge, Hope Vale, Kowanyama, Lockhart River, Mapoon, Napranum, Northern Peninsula, Pormpuraaw, Tablelands, Torres, Torres Strait Island, Weipa, Wujal Wujal, Yarrabah 2 North & West 434324 565923 Barcaldine, Barcoo, Blackall Tambo, Boulia, Burke, Carpentaria, Charters Towers, Cloncurry, Diamantina, Doomadgee, Flinders, Hinchinbrook, Isaac, Longreach, Mackay, McKinlay, Mornington, Mount Isa, Palm Island, Richmond, Townsville, Whitsunday & Winton LGAs 3 Capricornia 214753 271651 Banana, Central Highlands, Gladstone, Rockhampton, Woorabinda 4 South West 283342 343669 Balonne, Bulloo, Dalby, Goondiwindi, Ipswich West, Murweh, Paroo, Quilpie, Roma, Southern Downs, Toowoomba, Gatton 5 Sunshine Coast-Wide Bay 590769 765681 Bundaberg, Cherbourg, Fraser Coast, Gympie, North Burnett, South Burnett, Sunshine Coast 6 Gold Coast 563311 768047 Gold Coast, Tweed Part A 7 North Brisbane 470727 537996 SLAs in North West Inner and North West Outer Brisbane Statistical Divisions as per Appendix 8 Redcliffe/Caboolture 356709 464155 Moreton Bay LGA 9 South East Brisbane 652621 818192 SLAs in South East Inner, South East Outer and some Inner Brisbane Statistical Divisions as per Appendix plus Logan and Redlands LGAs 10 South Brisbane/Ipswich 530727 727563 SLAs in Brisbane South East Inner and South East Outer Brisbane Statistical Division as per Appendix plus Ipswich, Lockyer Valley less Gatton, Scenic Rim and Somerset LGAs Total 4293915 5562162
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Table 35: Option 2 - Ten PHCOs with GP Divisions and Health District alignment PHCO Name ERP 2021 GP Division alignment QH Health District alignment 2008 Pop 1 Far North 262095 299285 Far North Queensland Rural Division of General Torres Strait - Northern Peninsula, Cape Practice York and Cairns & Hinterland 2 North & West 434324 565923 North & West Queensland PHC, Townsville Mt Isa, Townsville & Mackay HSDs GPN, Mackay DGP 3 Capricornia 214753 271651 Capricornia DGP, Central Queensland Rural DGP Central West and Central Queensland HSDs 4 South West 283342 343669 Ipswich & Moreton DGP, GP Connections & South West and Darling Downs West RHealth Moreton HSDs 5 Sunshine Coast-Wide Bay 590769 765681 Sunshine Coast DGP, GP Links Wide Bay Sunshine Coast/Wide Bay HSD 6 Gold Coast 563311 768047 General Practice Gold Coast & Tweed Valley Gold Coast HDS and Part NCHS NSW DGP 7 North Brisbane 470727 537996 GP Partners Metropolitan North 8 Redcliffe/Caboolture 356709 464155 Moreton Bay GPN Metropolitan North HSD 9 South East Brisbane 652621 818192 South East Alliance of General Practice & Metropolitan South HSD SouthEast Primary HealthCare Network 10 South Brisbane/Ipswich 530727 727563 Brisbane South Ltd & Ipswich & West Moreton Metropolitan South HSD, Darling Downs GP West Moreton HSD Total 4293915 5562162
6.6.4 Strengths and weaknesses Option 2 creates four more evenly sized urban PHCOs that are socio-demographically coherent and this is its major strength. The proposed PHCOs in the north are still large enough to deliver core services for their local communities and primary care partners and to link with local hospitals to develop integrated service models and hospital avoidance strategies.
Their connectedness with their discrete local communities will also increase even though many of these communities (such as Redcliffe and the public housing estates in Caboolture) are expected to become more homogenous over time.
The weaknesses of this Option include the long term differences in critical mass of the four PHCOs. Both the southern Brisbane PHCOs will have significantly larger populations by 2021 but their configuration still remains the best fit for overall service development given the patterns of urban growth projected in the south of Brisbane.
There may also be reduced capacity for the northern outer urban grow areas to link directly and bargain effectively as a peer with The Royal Brisbane and Women’s Hospital and The Prince Charles Hospital which will remain the tertiary referral centres for this catchment.
The two north Brisbane PHCOs will be at the lower end of the national metropolitan PHCO size range and Redcliffe Caboolture will be at the lower end of the national range for PHCOs in urban growth areas.
6.6.5 Option 3: 8 PHCOs – 2 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote Option 3 is a further refinement of the metropolitan PHCO configuration and reflects one of the initial Options developed by Queensland Divisions and GP Queensland.
Under Option 3, shown in Figure 41 and Tables 46 and 47, there are 2 major metropolitan PHCOs – one in the north and one in the south – and the configuration of the South West PHCO changes significantly with the addition of Ipswich and environs to the rural catchment.
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Figure 41: Option 3 - 2 metropolitan Brisbane PHCOs - 1 north & 1 south
Under Option 3 North Brisbane PHCO would consist of the northern SLAs in Brisbane and Moreton Bay LGAs or a population of 827, 000 in 2008 growing to over 1 million people by 2021. The demographic characteristics and service linkages for this PHCO were described in Option 1.
South Brisbane PHCO would consist of the residual SLAs south of the Brisbane River (a catchment population of 551,000 in 2008 growing to 640,000 by 2021) and the LGAs of Logan and Redland.
This PHCO would have a combined catchment population of 958,000 in 2008 and 1.17 million people by 2021. It would include the more affluent inner Brisbane suburbs south of the Brisbane River where predominantly infill development will occur with the disadvantaged western suburbs of Inala, Upper Mount Gravatt, Acacia Ridge, Durack and the fast growing mixed communities in Logan and Redland.
The other urban growth area made up of Ipswich and West Moreton LGAs would link with the South West PHCO under this Option creating a very mixed outer urban, rural regional and rural remote PHCO stretching from outer Brisbane to the Northern Territory and South Australian borders. This arrangement is shown in Figure 42 and Tables 36 and 37.
Retaining Ipswich and West Moreton as a standard alone outer urban and semi-rural PHCO was considered as part of the development of this configuration but with a 2008 population of 243,000 in 2008 growing to just over 400,000 in 2021 this was not considered viable.
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Figure 42: Option 3: Queensland South with expanded South West rural & 2 metropolitan Brisbane PHCOs
Table 36: Option 3 - 8 PHCOs with LGAs PHCO Name ERP 2021 LGAs 2008 Pop 1 Far North 262095 299285 Aurukun, Cairns, Cassoway Coast, Cook, Croydon, Etheridge, Hope Vale, Kowanyama, Lockhart River, Mapoon, Napranum, Northern Peninsula, Pormpuraaw, Tablelands, Torres, Torres Strait Island, Weipa, Wujal Wujal, Yarrabah 2 North & West 434324 565923 Barcaldine, Barcoo, Blackall Tambo, Boulia, Burke, Carpentaria, Charters Towers, Cloncurry, Diamantina, Doomadgee, Flinders, Hinchinbrook, Isaac, Longreach, Mackay, McKinlay, Mornington, Mount Isa, Palm Island, Richmond, Townsville, Whitsunday & Winton LGAs 3 Capricornia 214753 271651 Banana, Central Highlands, Gladstone, Rockhampton, Woorabinda 4 South West 508759 725720 Balonne, Bulloo, Dalby, Goondiwindi, Ipswich West, Murweh, Paroo, Quilpie, Roma, Southern Downs, Toowoomba, Ipswich, Lockyer Valley, Scenic Rim and Somerset LGAs 5 Sunshine Coast-Wide Bay 590769 765681 Bundaberg, Cherbourg, Fraser Coast, Gympie, North Burnett, South Burnett, Sunshine Coast 6 Gold Coast 563311 768047 Gold Coast, Tweed Part A 7 North Brisbane 827436 1002151 SLAs in North West Inner and North West Outer Brisbane Statistical Divisions plus some Inner as per Appendix and Moreton Bay LGA 8 South Brisbane 957931 1163149 All SLAs in South East Inner, South East Outer and some Inner Brisbane Statistical Divisions as per Appendix plus Logan and Redlands LGAs Total 4359378 5562162
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Table 37: Option 3 - 8 PHCOs with Division and Health District alignment PHCO Name ERP 2021 GP Division alignment QH Health District alignment 2008 Pop 1 Far North 262095 299285 Far North Queensland Rural Division of Torres Strait - Northern Peninsula, Cape York General Practice and Cairns & Hinterland 2 North & West 434324 565923 North & West Queensland PHC, Townsville Mt Isa, Townsville & Mackay HSDs GPN, Mackay DGP 3 Capricornia 214753 271651 Capricornia DGP, Central Queensland Rural Central West and Central Queensland HSDs DGP 4 South West 508759 725720 Ipswich & Moreton DGP, GP Connections & South West and Darling Downs West RHealth Moreton HSDs 5 Sunshine Coast-Wide Bay 590769 765681 Sunshine Coast DGP, GP Links Wide Bay Sunshine Coast/Wide Bay HSD 6 Gold Coast 563311 768047 General Practice Gold Coast & Tweed Valley Gold Coast HDS and Part NCHS NSW DGP 7 North Brisbane 827436 1002151 GP Partners, Moreton Bay GPN Metropolitan North HSD 8 South Brisbane 989100 1169982 Brisbane South Ltd, South East Alliance of Metropolitan South HSD General Practice & SouthEast Primary HealthCare Network Total 4390547 5568440
6.6.6 Strengths and weaknesses The major strength of this PHCO configuration is the creation of two large and capable metropolitan PHCOs that each have a socio-demographically mixed population profile. Both these PHCOs will need the capacity to support the primary care workforce in high growth outer urban communities and more stable primary care services in established inner city areas.
These PHCOs will match the Brisbane catchments of both the three major teaching hospitals and the current Metropolitan Health Service Districts. This direct alignment will add to their status and were seen as enhancing the PHCO bargaining power relative to the metropolitan teaching hospitals.
This is also a truly urban PHCO configuration.
There are a range of weaknesses associated with this Option. The scale of these two PHCOs relative to the rest of Queensland and to metropolitan PHCOs in other states is very large. Branch offices will be required to address the large urban geography and to ensure local connectedness, especially in the more disadvantaged southern and western suburbs.
South Brisbane will continue to grow at a faster rate than North Brisbane leading to longer term imbalances (2031 and beyond) in the population and the likely need to split the southern suburbs.
The alignment of Ipswich and West Moreton with the South West PHCO will create a very large mixed urban regional and remote rural PHCO with a population of 509,000 in 2008 growing to 726,000 in 2021.
Rather than a single regional rural centre or hub based in Toowoomba, this configuration with have two potentially competing growth centres with Ipswich and West Moreton facing Brisbane and Toowoomba supporting the regional and rural communities to the west and south. This is likely to be unsustainable in the longer term and represents a poor design fit for both the regional and rural communities and the urban growth area which face different socio-demographic challenges.
This is our least preferred Option in Queensland because it appears driven by the unique structures of the metropolitan teaching hospitals rather than the primary care needs of diverse communities.
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6.6.7 Option 4: 9 PHCOs – 3 metropolitan Brisbane, Gold Coast and Sunshine Coast-Wide Bay and 4 rural and remote Option 4 shown in Figure 43 and Tables 38 and 39 is another variation on the metropolitan PHCO configurations and is included for completeness.
It retains the smaller North Brisbane (2008 population of 471,000 growing to 538,000 by 2021) and Redcliffe Caboolture PHCOs (2008 population of 357,000 growing to 464,000 by 2021) described in Option 2.
It also aligns the SLAs in Brisbane South and South East with Logan and Redland LGAs in the same southern PHCO configuration (population of 958,000 in 2008 growing to 1.16 million in 2021) described in Option 3.
Again Ipswich and West Moreton LGAs are linked with the South West rural PHCO to create a large outer urban, regional and rural PHCO with a population of 509,000 growing to 726,000 by 2021.
Figure 43: Option 4: 9 PHCOs with 2 north and 1 south metropolitan Brisbane
6.6.8 Strengths and weaknesses While the Option would preserve the communities of interest in the north of Brisbane, the South Brisbane PHCO and the South West PHCO are both extremely large and would be expected to grow further between 2021 and 2031.
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Their scale in both urban and rural regional terms is at the upper limit of PHCO design across Australia and is likely to be unsustainable given Queensland’s geography and would require multiple branch offices to deal with the diverse communities they would be required to cover.
The lack of a defined regional centre for the rural South West and the risk of completion for resources between Toowoomba and Ipswich is also a significant disadvantage.
Table 38: Option 4 - 9 PHCOs with LGAs PHCO Name ERP 2021 LGAs 2008 Pop 1 Far North 262095 299285 Aurukun, Cairns, Cassoway Coast, Cook, Croydon, Etheridge, Hope Vale, Kowanyama, Lockhart River, Mapoon, Napranum, Northern Peninsula, Pormpuraaw, Tablelands, Torres, Torres Strait Island, Weipa, Wujal Wujal, Yarrabah 2 North & West 434324 565923 Barcaldine, Barcoo, Blackall Tambo, Boulia, Burke, Carpentaria, Charters Towers, Cloncurry, Diamantina, Doomadgee, Flinders, Hinchinbrook, Isaac, Longreach, Mackay, McKinlay, Mornington, Mount Isa, Palm Island, Richmond, Townsville, Whitsunday & Winton LGAs 3 Capricornia 214753 271651 Banana, Central Highlands, Gladstone, Rockhampton, Woorabinda 4 South West 508759 725720 Balonne, Bulloo, Dalby, Goondiwindi, Ipswich West, Murweh, Paroo, Quilpie, Roma, Southern Downs, Toowoomba, Ipswich, Lockyer Valley, Scenic Rim and Somerset LGAs 5 Sunshine Coast-Wide Bay 590769 765681 Bundaberg, Cherbourg, Fraser Coast, Gympie, North Burnett, South Burnett, Sunshine Coast 6 Gold Coast 563311 768047 Gold Coast, Tweed Part A 7 North Brisbane 470727 537996 SLAs in North West Inner and North West Outer Brisbane Statistical Divisions as per Appendix 8 Redcliffe/Caboolture 356709 464155 Moreton Bay LGA 9 South Brisbane 989100 1169982 All SLAs in South East Inner, South East Outer and some Inner Brisbane Statistical Divisions as per Appendix plus Logan and Redlands LGAs Total 4390547 5568440
Table 39: Option 4 - 9 PHCOs with GP Division and Health District alignment PHCO Name ERP 2021 GP Division alignment QH Health District alignment 2008 Pop 1 Far North 262095 299285 Far North Queensland Rural Division of Torres Strait - Northern Peninsula, Cape York and General Practice Cairns & Hinterland 2 North & West 434324 565923 North & West Queensland PHC, Mt Isa, Townsville & Mackay HSDs Townsville GPN, Mackay DGP 3 Capricornia 214753 271651 Capricornia DGP, Central Queensland Central West and Central Queensland HSDs Rural DGP 4 South West 508759 725720 Ipswich & Moreton DGP, GP South West and Darling Downs West Moreton Connections & RHealth HSDs 5 Sunshine Coast-Wide Bay 590769 765681 Sunshine Coast DGP, GP Links Wide Bay Sunshine Coast/Wide Bay HSD 6 Gold Coast 563311 768047 General Practice Gold Coast & Tweed Gold Coast HDS and Part NCHS NSW Valley DGP 7 North Brisbane 470727 537996 GP Partners Metropolitan North HSD 8 Redcliffe/Caboolture 356709 464155 Moreton Bay GPN Metropolitan North HSD 9 South Brisbane 989100 1169982 Brisbane South Ltd, South East Alliance Metropolitan South HSD of General Practice & SouthEast Primary HealthCare Network Total 4390547 5568440
6.7 Preferred Option Option 1 is the preferred configuration and has the greatest overall capacity to address the challenges of rapid urban growth in south east Queensland and to provide an appropriate response to the needs of the sparsely populated rural and remote communities in the far north, north, centre and south west.
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The four remote and rural PHCOs and two large regional PHCOs covering the Sunshine Coast-Wide Bay and Gold Coast and Tweed A all serve distinct communities with largely similar socio-demographic characteristics. They have the scale to operate as large and capable PHCOs with the critical mass to address the challenges of rural isolation, community diversity and service delivery over vast distances by using a rural branch structure to ensure effective engagement with local communities and services. They also align the major hospital resources in the growing coastal communities with their regional and rural catchment and this will support effective chronic and complex disease management and teaching and training networks.
The three metropolitan PHCOs – North Brisbane, South East Brisbane and South Brisbane/Ipswich – share similar socio-demographic profiles and incorporate established inner metropolitan communities and outer urban growth areas that have specific primary care service development and workforce needs. While North Brisbane is the largest PHCO in 2008, the populations will become more equal over time as major population growth continues beyond 2021 in the south east and southern parts of Brisbane and in Ipswich and West Moreton. Both the South East and South Brisbane/Ipswich PHCOs support relatively disadvantaged outer urban populations and this combined with grow would indicate that smaller scale urban PHCOs may be more appropriate as vehicles for targeted service development and integration in these high need communities.
Option 2, which segmented the North Brisbane PHCO and created four smaller metropolitan PHCOs, is also feasible but on balance it is less desirable than Option 1.
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7 South Australia 7.1 Overview South Australia is the fourth largest state in Australia and covers an area of 983,482 square kilometres. It includes some of the most arid parts of the continent and shares borders will all the mainland states and the Northern Territory.
7.2 Demographic Features
7.2.1 Current population South Australia had an estimated resident population of 1.6 million people at June 2008 and this grew by 1.2% to 1,622.7 million people by June 2009. It has the smallest population of the mainland States.
South Australia’s population is concentrated in the Adelaide Statistical District which had a population of 1.17 million people or 73% of the state population in 2008. Adelaide Statistical District grew by 13,000 people or 1.1% in 2007/08. The remainder of South Australia also grew by 1.1% or 4,600 people.
The LGAs recording the largest growth were all in Adelaide; Playford, Gawler, Salisbury and Port Adelaide Enfield. However, the LGAs recording the fastest growth were Victor Harbor on the southern Fleurieu Peninsula (3.5%), Mt Barker (2.9%) in the Lofty Ranges and the rural LGAs of Copper Coast and Roxby Downs (all 2.7%). Playford in Adelaide also grew at 2.7% per annum.
Outside Greater Adelaide Copper Coast, Roxby Downs in the far north, Murray Bridge and Grant in the south east were the fastest growing LGAs. Mt Gambier and Whyalla also recorded consistent high growth.
Several rural LGAs outside greater Adelaide that had been affected by consecutive years of drought experienced population decline, including Berri and Barmera in the Riverland SD, The Coorong, Cleve, Coober Pedy, Ceduna, Southern Mallee and Goyder.
South Australia has the oldest population of the States and Territories with people over the age of 65 making up 15.2% of the population in 2007.This is projected to increase to 350,000 or 21% by 2021.
In terms of socioeconomic status, South Australia with an IRSD score of 979 ranks below the national IRSD average. The score is 987 in Adelaide and 961 in Country South Australia. However socioeconomic status varies considerably by Sub Division with Northern Adelaide (944) and Western Adelaide (951) Statistical Sub Divisions ranked low compared to Eastern (1050) and Southern Adelaide (1009). Barossa (1011) and Mt Lofty Ranges (1039) ranked above the national average. The majority of the rural and remote Sub Divisions are ranked below the National and South Australia average.
7.2.2 Indigenous population South Australia has an indigenous population of 25,556 people or 1.7% of the SA population and 5% of the national indigenous population. The Aboriginal and Torres Strait Islander community has a younger age profile than South Australians as a whole and have the poorest health status and worst health outcomes.
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In 2006, 48% of Aboriginal and Torres Strait Islander people in South Australia lived in Adelaide, 23% in outer Regional areas and 19% in remote or very remote Australia. South Australia has a relatively high urban indigenous population and a relatively high proportion of the population living in very remote areas. Table 40.
Table 40: Indigenous population by Remoteness Areas - 2006 Census Major Cities Inner Regional Australia Outer Regional Australia Remote Australia Very Remote Australia % % % % % South Australia 48 10 23 5 14 Australia 31 22 23 8 16 Source: Population distribution Aboriginal and Torres Strait Islander Australians ABS 4705. 2006
7.2.3 Patterns of growth and projected population Population Projections for South Australia (2001 – 2031) suggest that South Australia will have a population of 1.688 million under the medium growth scenario and up to 1.768 million under the high growth scenario by 2021.
The majority of the expected population growth in South Australia will occur in the southern and northern suburbs of Adelaide and the Adelaide Statistical Division is expected to have between 1.19 million and 1.29 million people by 2021. The fastest growth is expected to continue to occur in Outer Adelaide due to retirees moving to the coastal areas and young families and others in search of low cost housing moving to the Adelaide Hills. Most of the other Statistical Divisions are expected to remain stable or grow modestly by 2021 and several of the rural Divisions including Yorke, Lower North, Murray Lands, South East and Eyre are expected to continue to age significantly due to the loss of young working age people to the metropolitan area.
The 30-Year Plan for Greater Adelaide (2010) 24 identifies the regions and localities where population growth is planned over the next 30 years. The targets shown in Table 41 indicate that Northern Adelaide, the Barossa, Western and Southern Adelaide are expected to absorb the majority of the proposed growth.
Table 41: Regional Planning Localities and Population Targets Locality Additional population target Northern Adelaide 169,000 Barossa 110,000 Western Adelaide 83,000 Southern Adelaide 82,000 Eastern Adelaide 37,700 Adelaide Hills and Murray Bridge 29,000 Adelaide City 27,300 Fleurieu 22,000 Source: 30-Year Plan for Greater Adelaide. SA Government 2010
7.3 Structure of Health Services
7.3.1 General Practice There are 14 Divisions of General Practice in South Australia as shown in Figure 44 and Figure 45 – 5 urban and 9 rural although 10 Divisions are eligible for MAHS funding. The Division catchments range in
24 Dept Planning & Local Government: The 30 –Year Plan for Greater Adelaide. SA Government 2010
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size from 363,000 to 183,000 in the urban areas and from 67,000 to 25,300 in the rural Divisions as shown in Table 42. These catchments in Adelaide are not contiguous with LGAs.
Figure 44: SA Divisions of General Practice Adelaide
Figure 45: SA Rural Divisions of General Practice
In terms of workforce and practice characteristics in 2007/08 there were:
• 2,004 practising GPs in South Australia of whom 662 or 33% were female
• 790 people per practising GP and 1089 per FWE GP
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• Approximately 567 general practices including 191 solo practices or 34% of the practice base
Table 42: South Australian Divisions of General Practice Key Characteristics 2007/08 Division of General Practice Pop Total Solo Estimated No of FWE GPs Number FWE 2007 B number practices number of female as at of GPs: GP: of practising GPs 30/06/07 pop 2007 pop practices GPs E ratio 2007 ratio Adelaide Western General Practice Network 228215 91 46 198 62 195 1153 1170 Adelaide Northern Division of General Practice 205217 66 24 229 60 186 896 1103 Adelaide North East Division of General Practice 210840 56 13 270 93 157 781 1343 Adelaide Central & Eastern Division of General Practice 183811 120 47 380 129 250 484 735 Southern Division of General Practice 363315 108 21 474 175 338 766 1075 Barossa Division of General Practice 35688 10 3 44 18 26 811 1373 Yorke Peninsula Division of General Practice 25371 8 1 30 9 27 846 940 Mid North Division of Rural Medicine 46145 15 2 47 10 43 982 1073 Riverland Division of General Practice 34759 8 3 37 7 25 939 1390 Limestone Coast Division of General Practice 65109 15 7 62 20 47 1050 1385 Eyre Peninsula Division of General Practice 57412 25 10 50 10 52 1148 1104 Flinders and Far North Division of General Practice 26799 14 6 39 12 23 687 1165 Murray Mallee General Practice Network 32799 7 3 35 10 29 937 1131 Adelaide Hills Division of General Practice 66934 24 5 109 47 55 614 1217 SA Total 1582415 567 191 2004 662 1453 790 1089 Source: PHCRIS 2007/08 Survey of Divisions of General Practice
7.3.2 GP Workforce Distribution Overall South Australia has a lower patient to GP FWE ratio than other states and territories but the distribution is not even. The rural Divisions of Riverland (1390), Limestone Coast (1385), the outer urban/rural growth area of Barossa (1373) and Adelaide Hills (1217) and Adelaide North East in the urban growth area of Adelaide (1343) have significantly higher patient to GP FWE ratios than South Australia as a whole whereas Adelaide Central and Eastern is oversupplied in relative terms.
7.3.3 State Health Services The South Australian Health Services (SAAHS) are administered through 3 geographic regions – two based in Adelaide - Central and Northern Adelaide Health Service and Southern Adelaide Health Service - and Country Health which administers health services throughout rural South Australia. Figure 46.
The Child, Youth and Women’s Health Service is a statewide service that includes the Women’s and Children’s Hospital in Adelaide and community based health child health services across South Australia. There are also a series of statewide clinical networks targeting Cancer, Cardiology, Child Health, Maternal and Neonatal Health, Mental Health, Orthopaedics, Rehabilitation and Renal Services.
Central Northern Area Health Service covers the LGAs of Playford, Salisbury, Tea Tree Gully, Port Adelaide Enfield, Charles Sturt, West Torrens Adelaide, Unley, Burnside, Prospect, Walkerville, Norwood/Payneham/St Peters, Campbelltown and Adelaide Hills or a catchment population of approximately 792,000 people in 2006.
It includes Royal Adelaide Hospital, Lyell McEwin Hospital, Modbury Hospital, Hampstead Rehabilitation Centre, St Margaret’s Rehabilitation Centre and The Queen Elizabeth Hospital, mental health, dental and
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state pathology services and Primary Health Care Centres in the West, Central East, North and North East suburbs.
Figure 46: SA Health Regions
Southern Adelaide Area Health Service (SAAHS) covers the LGAs of Onkaparinga, Holdfast Bay, Marion and Mitchum or a catchment population of 335,000 in 2006.
SAAHS includes Flinders Medical Centre, Noarlunga Health Services, Repatriation General Hospital, Drug and Alcohol Services South Australia, Southern Mental Health Service and a range of Primary Health Services including Seaford, Noarlunga, Clovelly Park and GP Plus sites at Aldinga and Morphett Vale.
Country Health SA covers a catchment population of 433,000 people and auspices or funds all the rural health services in South Australia. This includes Country General Hospitals at Berri, Mount Gambier, Port Lincoln and Whyalla. These hospitals are being upgraded to provide the majority of acute care for rural residents locally and are staffed by resident and visiting specialists. Other rural services include Country Community hospitals providing primary health care, palliative care, community rehabilitation and aged care; Peri-Urban Health Services in Mt Barker, Gawler and Victor Harbor; Local Area Health Services; Remote Area Health Services and Small Rural Health Clinics run in partnership with local GPs and Divisions of General Practice 25 .
Child, Youth and Women’s Health Service is a statewide service that administers the Women’s and Children’s Hospital in Adelaide and child health and women’s health services across South Australia. The Service works in partnerships with other Regions and Country Health SA.
25 SA Health: Strategy for Planning Country Health Services in SA. 2008
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7.3.4 GP Plus Initiative The South Australian GP Plus Health Care Strategy 26 is focused on patient centred and population focused health services with increased capacity for health promotion, illness prevention and early intervention. The Strategy includes a commitment to population health planning and the strengthening of Primary Health Care Networks and partnerships between state government community health and allied services and general practice.
GP Plus Health Care Centres are being established in high health need metropolitan and country areas to improve coordination and delivery of care. These Centres bring together multidisciplinary teams to work with local GPs and Divisions to improve service coordination and management of people with chronic and complex conditions. A planning target of 1 GP Plus Health Care Centre per 100,000 population in metropolitan areas is suggested in the Strategy.
7.3.5 Aboriginal community controlled health services There are 14 organisations providing Aboriginal Health Services funded by OATSIH in South Australia including the community controlled sector peak body - the Aboriginal Health Council of South Australia, Aboriginal Health Services, Country Health SA and local government.
There are 12 community controlled Aboriginal Health Services affiliated with NACCHO in South Australia and AHCSA also supports Aboriginal Health Advisory Committees in Eyre, Hills Mallee, Mid North, Northern, South East, Riverland and Wakefield.
7.4 PHCO Design Issues Determining the best configuration to support growing urban and outer urban communities in Greater Adelaide and the diverse rural and remote areas in South Australia is the main challenge for PHCO design.
7.4.1 Urban and growing outer urban communities South Australia is highly urbanised and like other cities in Australia population growth will continue to be concentrated in Adelaide and Outer Adelaide Statistical Divisions over the next 15 years.
The character of some of the rural areas that are close to Adelaide is changing and will continue to change as planned population growth occurs in the Barossa, Adelaide Hills and along the Fleurieu Coast. The character of the health services, especially primary care services, needed in these areas will change over time and PHCOs able to support established communities and primary care workforces and growing outer urban/rural communities will be required.
The 2007/08 Division Survey indicates there are relative GP shortfalls and high population to GP ratios in the growing northern and southern suburbs of Adelaide and the Barossa and these will need to be addressed as part of Primary Health Care service development in the future.
7.4.2 Rural and remote health services Rural South Australia is expected to maintain population share overall with growth in the larger centres and accelerating migration from sparsely populated communities to towns with services as the population ages. Key trends include:
26 SA Department of Health: GP Plus Health Care Strategy August 2007
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• Maintenance of a small number of larger regional centres with populations over 22,000 such as Mt Gambier and Whyalla and major towns with populations ranging in size from 15,000 to 17,000 people. These include Port Lincoln, Port Pirie and Port Augusta that are the service centres that support industry and agriculture in the wider region
• Stable or declining populations in a range of mid-sized LGAs of between 10,000 and 12,000 people and a large numbers of small towns and rural communities with under 5,000 people including remote Aboriginal communities and centres with fluctuating population that support industries such as mining
• Continuing migration of young people to larger centres for education and employment will lead to ageing in many rural communities
Recruitment and retention of GPs, nurses, allied health professionals and Aboriginal Health Workers in rural and remote communities remains a challenge in rural communities. Divisions of General Practice already play an important role in marshalling resources from different funding sources to build local services in these rural communities and the need for this community development function and for auspicing of MAHS services is expected to continue.
7.4.3 Cross border flows South Australia shares borders with Western Australia, Northern Territory, Queensland, Victoria and New South Wales. One of the major areas of cross border flow that are relevant to PHCO design are the Anangu Pitjantjatjara lands in the north west that already form part of the Northern Territory Division of General Practice. The other areas where cross border PHCOs could be considered are the Riverland where Renmark Paringa or a wider range of LGAs could form part of a tri-state PHCO linked with Mildura in Victoria and the south east where parts of Limestone have community of interest links with Colac Otway in Victoria.
7.4.4 Alignment with SA Health Services There are two differently sized metropolitan Area Health Services in Adelaide that appear to reflect hospital catchments rather than similar sized populations or communities with similar socio-demographic characteristics. The Central and Northern Area has 792,000 residents in the northern, central and eastern suburbs. This Area’s catchment has some high to very high socio economic areas such as Burnside (IRSD Score of 1088) and Adelaide Hills (1083) but also includes low socio economic LGAs such as Playford ( 884), Port Adelaide Enfield (916) and Salisbury (943) that are high growth localities.
The Southern Area has a population of 335,000, less than half that of Central and Northern. It has a more homogenous socio-demographic profile with most LGAs recording IRSD scores between 975 and 980 with a high score of 1069 in Mitcham.
Country Health SA currently covers all the rural regions including the growing localities such as Barossa, Gawler and Victor Harbor that both the ABS and Planning South Australia regard as part of Outer Adelaide.
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These localities have different primary health care characteristics and workforce needs and options which align population based on primary health care characteristics may be more appropriate for PHCO service development, planning and workforce support.
7.5 Configuration Options Four options to configure PHCOs in South Australia have been developed to address these issues and are described below.
7.5.1 Option 1: 4 PHCOs with 3 metropolitan and1 rural PHCO aligned with health service catchments and Central Desert flows to Northern Territory Under this Option there are three metropolitan PHCOs that are broadly aligned with health service boundaries and a single rural PHCO with Central Desert communities flowing to the Northern Territory. The configuration is shown in Figure 47 and Figure 48 and the LGA and Division catchments are shown in Table 43 and
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Table 45.
Figure 47: PHCO Option 1 – 4 PHCOs -3 Metro aligned with hospital catchments plus 1 Rural
The Central and Northern PHCOs broadly align with the Central and Northern Area Health Service catchment but are grouped in North and Central to better reflect the differing socioeconomic profiles of these localities. They also incorporate growth areas on the fringes of Adelaide such as the Barossa, Adelaide Hills, Mt Barker, Gawler and Light that are defined as Peri-Urban in South Australia’s Health Plan (2006) and are currently linked with Country Health SA.
Table 43: Option 1- 4 PHCOs -3 Metro and 1 Rural aligned with SA Health Service catchments by LGAs PHCO Name ERP 2008 2121 Pop LGAs 1 North Adelaide 266949 299961 Barossa, Gawler, Light, Mallala, Playford, Salisbury 2 Central Adelaide 652900 669594 Adelaide, Adelaide Hills, Burnside, Campbelltown, Mount Barker, Norwood Payneham St Peters, Port Adelaide Enfield, Tea Tree Gully, Unley, Walkerville, West Torrens 3 South Adelaide 386341 419385 Alexandrina, Holdfast Bay, Kangaroo Island, Marion, Mitcham, Onkaparinga, Victor Harbour, Yankalilla 4 Rural South Australia 294808 299375 All LGAs in Eyre, Murray Lands, Northern, South East and Yorke and Lower North Statistical Divisions and excludes Outer Adelaide LGAs Total 1600998 1688315 NT 2363 2363 Anangu Pitjantjatjara which flows to Northern Territory Total SA Population 1603361 1690678
Table 44: Option 1- 4 PHCOs - 3 Metro and 1 Rural aligned with SA Health Service catchments by Division PHCO Name ERP 2008 2121 Pop Indicative* Divisions 1 North Adelaide 266949 299961 Adelaide North, Barossa 2 Central Adelaide 652900 669594 Adelaide Central & Eastern, Adelaide Hills, Adelaide North & East, Adelaide West
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3 South Adelaide 386341 419385 Adelaide South 4 Country South Australia 294808 299375 Eyre, Flinders, Mid North, Murray, Limestone, Riverland, York Total 1600998 1688315 NT 2363 2363 Northern Territory Total SA Population 1603361 1690678 *Only the Divisions covering a major portion of the proposed PHCO are listed for readability
Metro North PHCO has a catchment population of 267,000 growing to 300,000 plus by 2021 and includes the low socioeconomic LGAs of Playford, Salisbury, Gawler and Mallala covered by Adelaide North Division and Barossa and Light covered by the Barossa Division.
Metro Central PHCO has a catchment population of 653,000 that is projected to grow to 670,000 by 2021 and includes predominantly high socio economic localities such as Adelaide Hills, Adelaide, Walkerville and Unley as well as lower socio economic areas such as Charles Sturt and Port Adelaide Enfield. These LGAs are covered by Adelaide Central and Eastern, Adelaide West, Adelaide North & East and Adelaide Hills Divisions.
Metro South PHCO has a catchment population of 386,000 growing to 419,000 by 2021 and aligns with Southern Adelaide Area Health Service. Metro South includes the growth area of Onkaparinga as well as Alexandrina, Holdfast Bay, Marion and Mitchum plus Victor Harbor and Yankalilla.
Rural South Australia has a catchment population of 295,000 growing to 299,000 and includes all the LGAs in Eyre, Murray Lands, Northern, South East and Yorke and Lower North Statistical Divisions that are covered by Country Health SA and Eyre, Mid North, Flinders, Limestone, Murray, and Yorke Divisions. Given the size of geographic catchment there will be a need to establish branch offices in several key locations across rural South Australia to undertake local needs assessment and service development activities, support rural and remote practitioners and work with the local community and regional hospitals operating across the catchment.
The Anangu Pitjantjatjara lands in the northwest continue to flow to the Northern Territory.
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Figure 48: Option 1- 4 PHCOs – 1 rural and 3 Metro plus Central Desert flows to NT
7.5.2 Strengths and weaknesses The strengths of this Option are:
• The PHCOs are generally aligned with the state government metropolitan and rural health service catchments and follow hospital referral patterns.
• The Outer Adelaide Statistical Division growth areas are regarded as urban for service development and planning purposes which reflects both their proximity to Adelaide and the type of primary health services that will be required in the future. As the population grows these LGAs will resemble outer urban service delivery settings in other states rather than rural and remote service environments. However there may be some localities in these LGAs that remain semi rural which may have workforce supply problems that would justify continuing access to MAHS funding.
• Metro Central and Metro North PHCOs are separated into more socio-demographically cohesive PHCO catchments that are well aligned with current metro GP Division catchments.
• The three Metropolitan PHCOs are within the range of size and critical mass of urban PHCOs in other states.
The weaknesses of this Option are:
• The Central PHCO has a disproportionately large population and includes LGAs that are actually contiguous with the southern suburbs and Metro South catchment.
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• The single Rural PHCO covers a huge geographic area with diverse demography and differing rural industries.
7.5.3 Option 2: 4 PHCOs - 3 Metro configured with primary care catchments plus 1 Rural This Option redraws the catchments of the three metropolitan PHCOs to create a more balanced central and southern population split and ensure that the contiguous SLAs in the Outer Adelaide Statistical Division are appropriately aligned. This Option is shown in Figure 49 and Figure 50 and
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Table 45 and 46.
Adelaide Hills SLAs of Central, Ranges and Balance and all of Mount Barker LGA are added to the Metro South PHCO rather than Metro Central which retains the Adelaide Hills North SLA.
Metro Central’s catchment is reduced to 591,000 people growing modestly to 602,000 by 2021 and the Metro South catchment increases to 448,000 people with a projected population of 454,000 reflecting growth in Onkaparinga and Mount Barker.
There is no change in the population of Metro North or the Rural PHCO.
Figure 49: Option 2: 4 PHCOs - 3 Metro configured in primary health care catchments and 1 Rural
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Table 45: Option 2- 4 PHCOs - 3 Metro based on primary care catchments and 1 rural PHCO by LGAs PHCO Name ERP 2008 2121 Pop LGAs 1 North Adelaide 266949 299961 Barossa, Gawler, Light, Mallala, Playford, Salisbury 2 Central Adelaide 591006 601877 Adelaide, part Adelaide Hills, Burnside, Campbelltown, Norwood Payneham St Peters, Port Adelaide Enfield, Tea Tree Gully, Unley, Walkerville, West Torrens 3 South Adelaide 448235 453987 Alexandrina, Holdfast Bay, Kangaroo Island, Marion, Mitcham, Onkaparinga, Victor Harbour, Yankalilla, part Adelaide hills and Mount Barker 4 Country South Australia 294808 299375 All LGAs in Eyre, Murray Lands, Northern, South East and Yorke and Lower North Statistical Divisions except for Barossa and Adelaide Hills Total 1600998 1688315 NT 2363 2363 Anangu Pitjantjatjara which flows to Northern Territory Total SA Population 1603361 1690678
Table 46: Option 2 – 4 PHCOs - 3 Metro and 1 Rural by Division PHCO Name ERP 2008 2121 Pop Current Divisions 1 North Adelaide 266949 299961 Adelaide North, Barossa 2 Central Adelaide 591006 601877 Adelaide Central & Eastern, Adelaide Hills, Adelaide North & East, Adelaide West 3 South Adelaide 448235 453987 Adelaide South, Adelaide Hills 4 Country South Australia 294808 299375 Eyre, Flinders, Mid North, Murray, Limestone, Riverland, York Total 1600998 1688315 NT 2363 2363 Anangu Pitjantjatjara which flows to Northern Territory Total SA Population 1603361 1690678
Figure 50: Option 2 – 4 PHCOs - 1 Rural and 3 Metro based on contiguous primary health catchments
7.5.4 Strengths and weaknesses The strengths of this configuration are that the Outer Adelaide growth areas are linked with contiguous LGAs in the Central and Southern suburbs of Adelaide that have similar primary health care service development and workforce support needs rather than reflecting hospital referral patterns.
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Populations in Greater Adelaide are more evenly spread and the Centre and South have more balanced populations and similar critical mass. To achieve contiguous populations the Adelaide Hills LGA is split at the SLA level.
7.5.5 Option 3: 4 PHCOs - 3 Metro, 1 Rural PHCO & cross border flows to Victoria/NSW This Option builds on the 3 metropolitan PHCOs with primary health care catchments and 1 rural PHCO described in Option 2. However the Option allocates the Riverland LGAs of Berri and Barmera, Loxton Waikerie East and Renmark Paringa in the south east to a new cross border PHCO incorporating contiguous rural areas in South Australia, Victoria and NSW. This Option is shown in Figure 51.
The proposed south eastern cross border LGAs have a stable population of 28,000 as shown in Table 47 made up of similar sized communities with similar agricultural and socio-demographic characteristics as the adjoining Victorian and NSW rural communities.
Table 47: South Australian LGAs proposed for cross border flow to Victoria and NT Flow State LGA name ERP 2008 2021 Indicative Division/s SA Health Region Victoria Berri and Barmera (DC) 11283 10761 Riverland Country Health SA Loxton Waikerie East SLA 7406 6974 Riverland Country Health SA Renmark Paringa (DC) 9868 10089 Riverland Country Health SA Unincorporated Riverland 132 132 Total 28689 27956
Figure 51: Option 3 - 4 SA PHCOs plus cross border flow to Victoria
Under this Option the catchment population covered by the Rural PHCO will reduce by 28,671 to 221,000 ERP in 2008 and 224,500 projected in 2021. Overall 31,000 South Australian residents will be covered by
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cross border PHCOs under this Option when the Anangu Pitjantjatjara flows to the Northern Territory are includes as shown in Table 48.
Table 48: Option 3 PHCO catchment populations by Division plus cross border flows PHCO Name ERP 2008 2121 Pop Indicative Divisions 1 Metro North Adelaide 266949 299961 Adelaide North, Barossa 2 Metro Central Adelaide 591006 601877 Adelaide Central & Eastern, Adelaide Hills, Adelaide North & East, Adelaide West 3 Metro South Adelaide 448235 453987 Adelaide Hills, Adelaide South 4 Country South Australia 266251 271551 Eyre, Flinders, Mid North, Murray, Limestone, York Total 1567779 1622917 Victoria 28689 27956 Riverland NT 2363 2363 Anangu Pitjantjatjara Cross border total 31052 30319 SA Total 1603361 1690678
7.5.6 Strengths and weaknesses Cross border communities of interest in the south east are strengthened under this Option. The South Australian rural PHCO continues to have a population that is comparable to other PHCOs supporting widely dispersed rural and remote populations in Western Australia, Queensland and NSW and the critical mass needed for service development in these diverse environments. The boundaries also align with the rural and remote localities covered by the SA Country Health Service which relies on rural GPs to staff community and regional hospitals.
There is also potential to improve Community and Base Hospital networks in the cross border catchment. There are South Australian Community Hospitals with GP involvement at Renmark (22 beds), Berri (36 beds), Loxton (22 beds), Barmera (22 beds) and Waikerie (22 beds) but the nearest Base Hospital offering specialist care is Mildura Base Hospital (146 beds) in Victoria.
While no information on hospital flows or referrals is available some cross border flows for specialist inpatient care are likely because Mildura is closer by road to the majority of towns in this catchment than Adelaide. A cross border PHCO with hospital linkages to both South Australia and Victoria will support rapid access to acute specialist and emergency care when needed.
The major weakness is the need for local Riverland GPs and primary health professionals to work across state boundaries where different service systems traditionally operate.
7.5.7 Option 4: 5 PHCOs – 3 Metro and 2 Rural This Option builds on the metropolitan PHCO configuration in Option 2 and separates rural South Australia into two PHCOs in the north and south of the state in response to the vast distances and the differences in population density between the remote rural north and the more populous southern rural communities.
This Option with cross border flows is shown in Figure 52.
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Figure 52: Option 4 - 5 PHCOs 3 Metro and 2 Rural
Under this Option Rural North would cover over 85% of the rural land mass and include coastal, inland and remote communities. Whyalla would be the major regional centre and the PHCO would include the major towns at Port Pirie, Port Augusta and Port Lincoln, large LGAs such as Copper Coast and Yorke Peninsula and approximately 21 LGAs with populations of less than 5,000 people.
Rural North would have an ERP of 164,000 in 2008 with growth to 168,000 projected mainly due to population growth on the Copper Coast and Port Lincoln.
Under the cross border flow Option shown in Figure 52 Rural South would include regional centres at Mt Gambier and Murray Bridge, several LGAs with medium sized towns including Grant, Mid Murray, Naracoorte and Wattle Range and three or four LGAs with populations below 5,000. It would have a population of between 102,000 and 103,000 with stable or declining populations in most LGAs and modest growth expected at Mt Gambier and Murray Bridge.
If Riverland Statistical District is retained in South Australia then the Rural South PHCO would have a population of 135,000 and three additional LGAs with medium sized towns and populations ranging in size from 10,000 to 12,000. Table 49 shows Option 4 populations by LGAs and Table 50 shows the catchments with the current Divisions.
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Table 49: Option 4 - 5 PHCOs – 3 Metro with primary care catchment and 2 rural with LGAs PHCO Name ERP 2008 2121 Pop LGAs 1 North Adelaide 266949 299961 Barossa, Gawler, Light, Mallala, Playford, Salisbury 2 Central Adelaide 591006 601877 Adelaide, Adelaide Hills, Burnside, Campbelltown, Mount Barker, Norwood Payneham St Peters, Port Adelaide Enfield, Tea Tree Gully, Unley, Walkerville, West Torrens 3 South Adelaide 448235 453987 Alexandrina, Holdfast Bay, Kangaroo Island, Marion, Mitcham, Onkaparinga, Victor Harbour, Yankalilla 4 Rural North 159420 163575 All LGAs in Eyre, Flinders, Mid North, Yorke 5 Rural South 102176 103524 All LGAs in Murray & Limestone Total 1567786 1622924 Retain Riverland in South 33351 32415 All LGAs in Riverland SA Total 1601137 1655339
Table 50: Option 4: 5 PHCOs – 3 Metro with primary care catchment and 2 rural with Divisions PHCO Name ERP 2008 2121 Pop Indicative Divisions 1 North Adelaide 266949 299961 Adelaide North, Barossa 2 Central Adelaide 591006 601877 Adelaide Central & Eastern, Adelaide Hills, Adelaide North & East, Adelaide West 3 South Adelaide 448235 453987 Adelaide Hills, Adelaide South 4 Rural North 159420 163575 All LGAs in Eyre, Flinders, Mid North, York 5 Rural South 102176 103524 Murray, Limestone Total 1567786 1622924 Victoria 33351 32415 Riverland NT 2363 2363 Anangu Pitjantjatjara
7.5.8 Strengths and weaknesses This Option provides more localised and better targeted rural PHCOs in South Australia that still have relatively large geographic catchments.
It creates a better defined rural and remote PHCO in the North which has the larger geographic footprint and more small rural LGAs and remote communities that require mixed service delivery models and service development and support expertise. There will be a continuing need for a branch office structure in the Rural North under this Option.
The Rural South is more homogenous with a higher proportion of LGAs with populations over 10,000 and local community hospitals that rely on a GP workforce.
The catchment populations in both PHCOs are still within the range for viable rural PHCOs in other states and territories but Rural South would be more viable and logical if Riverland LGAs are retained as part of the South Australia PHCO network.
The weakness of this Option is the trade off between rural critical mass overall and more locally targeted PHCOs working in more homogenous environments. This Option is also probably only viable if Riverland is retained as part of a South Australian PHCO.
7.5.9 Option 5: 5 PHCOs– 3 metro, 1 rural, 1 cross border based in SA and 1 cross border based in Victoria This Option extends the cross border arrangements described in previous options and establishes a second cross border bi-state PHCO with Victoria based in Mt Gambier. The proposed Otway Limestone PHCO would cover the South Australian Limestone Coast LGAs of Grant, Mt Gambier and Wattle Ranges and the rural LGAs in south west Victoria that are contiguous with the South Australian border as shown in Figure 53.
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These include the LGAs of Corangamite, Moyne, Warrnambool, Glenelg and Southern Grampians. This cross border PHCO would be administered in South Australia with hubs in both Mt Gambier in South Australia and Warrnambool in Victoria.
Figure 53: Option 5: 3 metro, 1 rural and 2 cross border PHCOs
The five SA based PHCOs would have a current population of 1.68 million and a 2021 population of 1.74 million as shown in Table 51 and Appendix 7.
This includes approximately 100,000 Victorians covered by the Otway Limestone PCHO. Approximately 35,000 South Australians would be covered by PHCOs administered in Victoria and the Northern Territory.
Table 51: 5 PHCOs including 1 cross border administered in South Australia PHCO Name ERP 2008 2121 Pop Current Divisions 1 Metro North Adelaide 266949 299961 Adelaide North, Barossa 2 Metro Central Adelaide 591006 601877 Adelaide Central & Eastern, Adelaide Hills, Adelaide North & East, Adelaide West 3 Metro South Adelaide 448235 453987 Adelaide Hills, Adelaide South 4 Country South Australia 220273 224561 Eyre, Flinders, Mid North, Murray, part Limestone, part Riverland, Yorke SA Local Total 1526463 1580386 5 Otway Limestone 150687 158576 Otway DGP and Limestone DGP Total 1677150 1738962 Victoria 28689 27956 Riverland NT 2363 2363 Anangu Pitjantjatjara SA cross border outflow 31052 30319
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The remainder of South Australia would be configured as 3 metropolitan PHCOs with primary care boundaries and a single rural PHCO covering the north-west and the remainder of the southeast including Loxton Waikerie West. The Riverland LGAs and Anangu Pitjantjatjara would flow to Victoria/NSW and Northern Territory as in Options 3 and 4.
7.5.10 Strengths and weaknesses This Option creates a cross border PHCO that covers broadly contiguous rural communities in both South Australia and Victoria and reinforces the communities of interest that have been created between Otway and Limestone regions by collaborations with the rural clinical school in South Australia.
It is a large rural PHCO that is similar is scale and critical mass to Country South Australia but is focussed on more compact rural communities and LGAs with substantial populations and significant towns with similar service delivery architecture and professional support needs rather than sparsely populated rural communities. It also builds on pre-existing practitioner networks that cross state boundaries including the links between the Flinders and Deakin University Departments of Rural Health and the Greater Green Triangle GP Training and Education Network.
The weakness of this Option reflects the concerns and challenges inherent in cross border service development and planning, professional support and commissioning that have been discussed elsewhere in this Report and in other South Australian Options.
Both the Lower Murray/Riverland and Otway Limestone Coast Options will require agreement from the South Australian and Victorian governments as well as the Australian Government to proceed and these cross border PHCOs will need to be underwritten by robust service agreements.
7.6 Preferred Option/s South Australia is a highly urbanised state with a vast rural and remote hinterland that is projected to grow at a slower rate than the east coast or west coast states.
The concentration of population in Greater Adelaide and the patterns of growth that are projected and or being planned suggest that three metropolitan PHCOs designed on the basis of primary care not hospital catchments is the most appropriate and robust urban configuration.
A single PHCO with a strong branch office network that is able to specialise in rural and/or remote service delivery at the local level offers the most robust overall rural PHCO structure. However there are also sound arguments in favour of two rural PHCOs that can target rural and remote communities with different socio-demographic characteristics and needs and workforce challenges and in the bi-state and tri-state configurations.
In terms of relativities with other states Option 2 made up of 3 metropolitan PHCOs designed around primary care population catchments and 1 rural PHCO with branch offices or Option 5 including the Lower Murray/Riverland and Otway Limestone Coast cross border PHCOs would be preferred.
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8 Western Australia 8.1 Overview Western Australia is Australia’s largest state by area and covers 2.645 million square kilometres or one third of the continent. The majority of the population of 2.2 million people live in the south west corner of Western Australia making WA Australia’s most sparsely population states.
8.2 Demographic Features
8.2.1 Current population Western Australia has an estimated resident population of 2,171,197 people at 30 June 2008. At 2.8% annual growth Western Australia recorded the fastest growth of all the Australian states to June 30 th27 .
1.6 million people or 75% of Western Australia’s population reside in Perth Statistical Division and in 2008 Perth was the city with the fastest growth rate in Australia. The five LGAs with the highest growth rate (3,000 or more people in the year to June 2008) were Wanneroo and Stirling in the north, Swan in the east and Rockingham and Cockburn in the south. Perth (10.8%), Serpentine-Jarrandah (7.6%) and Wanneroo (6.8%) were the fastest growing LGAs in 2007/08.
The South West was the state’s fastest growing region (3.9% growth) with Mandurah and Murray experiencing the strongest growth rate. The Kimberly was the second fastest growing region with 2.8% growth concentrated in Wyndham-East Kimberley and Raventhorpe.
Population was either stable or declined in 37% of the LGAs outside Perth metropolitan area and nearly two thirds of these LGAs had populations of less than 1,000 residents. This reflects trends in rural areas across Australia.
8.2.2 Indigenous population There were estimated to be 77,900 Aboriginal and Torres Strait Islander people in Western Australia in 2006 and Indigenous people made up 3.8% of the WA population compared to 2.5% for Australia and WA had 15.1% of the Australian indigenous population. This is likely to be an underestimate due to the high rates of under reporting in many communities in the Kimberly and Pilbara.
Approximately 21,300 Indigenous people or 34% of the population lived in Perth and 41% of the Indigenous population in WA live in remote or very remote areas as shown in Table 52. This is the second highest rate in Australia after Northern Territory. The Indigenous Regions with the highest population include Narrogin, South Hedland, Kalgoorlie, Geraldton, Derby, Kununurra and Broome. Table 52: WA Indigenous population by Remoteness Areas - 2006 Census Major Inner Regional Outer Regional Remote Very Remote Cities Australia Australia Australia Australia % % % % % Western Australia 34 9 15 15 26 Australia 31 22 23 8 16 Source: Population distribution Aboriginal and Torres Strait Islander Australians ABS 4705. 2006
27 ABS Cat 3218.0 Regional Population Growth, Australia 2007-08: Western Australia. Released April 2009
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Indigenous people in Western Australia have a younger age profile, higher fertility rates and higher premature mortality rate than the population as a whole.
8.2.3 Projected population and patterns of growth Western Australia Tomorrow (Western Australian Planning Commission 2005) provides population projections for Western Australia and each LGA to 2021 based on the 2001 Census and projected a population of 2.535 million people by 2021. These LGA projections are an underestimate given the high growth rate recorded in Perth and WA as a whole since the 2006 Census but are used as a guide only until official state projections based on the 2006 Census are produced.
Population growth will continue to be concentrated on the coast and in the established urban centres. Metropolitan Perth and the Peel and Kimberley regions are expected to have the highest growth rates and the South West will continue to have the highest growth of the other non metropolitan regions. Rural towns and communities outside these regions are likely to continue to see declining populations.
Growth in Perth will continue to be concentrated in the northern suburbs, including Wanneroo and Stirling, in Swan in the east and Cockburn in the south. The population of the Peel region is projected to double by 2026 due mainly to coastal growth at Mandurah and the adjoining Murray LGA.
The opening of southern rail line has linked the Mandurah growth area to Perth and the new Fiona Stanley Hospital is being constructed in this region.
The Kimberly is also expected to continue to grow strongly and strong growth in the Aboriginal population across the state is expected.
These projections are likely to understate growth in Western Australia and key LGAs as they predate the 2006 Census and the impact of mining boom and other factors that have seen Perth record higher than expected growth rates for the last three years. The ABS Medium Series Population Projections 28 suggest Western Australia will have a population of 2.7645 million people by 2021 with 2.067 million in Perth.
8.3 Structure of Health Services
8.3.1 General Practice There are 13 Divisions of General Practice in Western Australia and 8 are classified as rural and remote and entitled to access More Allied Health Services program. The Divisions are shown in Figure 54 and Figure 55 and Table 53.
The Division catchments range in size from 462,428 in Perth Primary Care Network to 45,206 people in the Pilbara Division of General Practice.
The boundaries of the rural Divisions generally correspond to the state planning regions and the metropolitan Division boundaries are largely consistent with SLAs rather than LGAs. In terms of workforce and practice structure the 2007-08 Survey of Divisions 29 indicates there were approximately:
• 2205 practicing general practitioners in WA of whom 35% were female
28 Population Projections, Australia 2006 to 2101 Cat 3222.0 June 2008 29 Key Division of General Practice Characteristics 2007-08 : PHCRIS 2009
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• 955 people per GP and 1,366 per GP FWE
• Approximately 569 general practices including 173 solo practices or the equivalent of 30% of the practice base.
Table 53: Western Australian Divisions of General Practice Key Characteristics 2007/08 Name of Division of General Practice Pop Number Solo No of No of 2007 Est no FWE GP: 2007 practices practices practising female FWE GPs: pop pop 2007 GPs GPs GPs 2007 ratio ratio Perth Primary Care Network 462428 139 36 557 202 395 830 1171 Osborne GP Network 408563 91 33 361 164 288 1132 1419 Canning Division of General Practice 312245 81 24 310 116 214 1007 1459 Fremantle GP Network 253149 70 20 289 124 193 876 1312 Rockingham Kwinana Division of General Practice 120178 21 3 100 20 76 1202 1581 GP Down South 149240 45 11 168 43 128 888 1166 Great Southern GP Network 78309 23 10 82 24 57 955 1374 Kimberley Division of General Practice 33158 8 1 57 Unknown 18 582 1842 Goldfields Esperance GP Network 56526 19 5 49 12 34 1154 1663 Mid West Division of General Practice 63307 21 10 71 14 44 892 1439 Greater Bunbury Division of General Practice 75136 14 1 58 17 44 1295 1708 Pilbara Health Network 45026 15 7 58 25 20 776 2251 Wheatbelt GP Network 48854 22 12 45 15 31 1086 1576 Source: PHCRIS 2007/08 Survey of Divisions of General Practice
Figure 54: Current WA Metropolitan Divisions
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Figure 55: Current Western Australian Divisions
8.3.2 State Government Health Services Hospital and community health services operate as part of an integrated system in Western Australia using an Area Health Service model and statewide specialist programs. The major acute hospitals and tertiary services for Western Australia are all located in greater metropolitan Perth.
Services in the northern and western suburbs are administered by the North Metropolitan Area Health Service which covers Cambridge, Claremont, Cottesloe, Joondalup, Midland, Mosman Park, Nedlands, Peppermint Grove, Perth (north), Stirling, Subiaco and Wanneroo LGAs and includes Charles Gairdner Hospital, King Edward Memorial Hospital for Women, Osborne Park Hospital, Swan Kalamunda Health Service, Graylands Health Service as well as community health and mental health facilities.
South Metropolitan Area Health Service covers hospital and community health services in the southern suburbs of Perth, Fremantle and the Peel and Rockingham Kwinana districts. It includes Royal Perth Hospital, the Fremantle Group, Armadale and Bentley Group and the Peel Rockingham Group as well as mental health and community health services. The new 635 bed Fiona Stanley Hospital is being built at Murdoch in SMAHS and will serve the southern suburbs and Western Australia.
WA Country Health Service manages the hospital and community health services and the population health, mental health, aged care and indigenous health services for all the rural regions in Western Australia and covers 2.5 million square kilometres. This includes Health Services in Goldfields, Greater Southern, Kimberley, Midwest, Pilbara, South West and Wheatbelt Districts.
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8.3.3 Aboriginal community controlled health services The Australian government Office of Aboriginal and Torres Strait Islander Health (OASTIH) funds approximately 37 organisations in Western Australia including community controlled Aboriginal Health Services in Albany, Bentley, Broome, Bunbury, Carnarvon, Derby, Esperance, Halls Creek, Kalgoorlie, Kununurra, East Perth, Newman, Roebourne, South Hedland, Wiluna and Wyndham.
Aboriginal Health Council of Western Australia (AHCWA) is the state peak body and has 19 affiliated organisations. Kimberley Aboriginal Medical Service Council is the major regional body providing support and advocacy for the 5 ACCHS in the Kimberley and primary health services in remote communities.
8.4 PHCO Design Issues in Western Australia Western Australia covers the largest land area in Australia and includes remote and sparsely populated rural areas with Perth as the only major city. This geography poses specific challenges for primary health care service and workforce planning.
8.4.1 Balancing demand due to urban growth and the need to strengthen primary care capacity in rural and remote communities The key challenge for design of PHCOs in Western Australia is how to balance the high rate of population growth expected in Greater Perth while also addressing the needs of the rural and remote communities in the north, east, south and south west.
Western Australia is the fastest growing state in Australia and the pattern of urban growth and concentration in coastal areas north and south of Perth reflect the trends in the Eastern States.
Western Australia faces major challenges in providing access to appropriate health care in rural and remote communities that cover four and a half million square kilometres. The majority of rural Western Australia is sparsely populated with a limited number of regional centres and large numbers of small towns and communities that generally have stable or declining populations.
The size and high health needs of the WA indigenous population and the geographic distribution and isolation of many Aboriginal communities creates demand for community controlled and mainstream primary health care and specialist services that can be provided locally and on a regional basis.
The major challenge for design of Primary Health Care Organisations in Western Australia is to develop models that are responsive to the needs of people, communities and health professionals working in rural, remote and indigenous communities and mining towns with large fly in fly out populations that can also address the challenge of rapid population growth in Perth and south west.
8.4.2 Central desert peoples cross border issues Western Australia shares borders with Northern Territory and with South Australia and there are linkages between the Aboriginal communities in parts of WA, the Northern Territory and South Australia. The major cross border issue likely to impact on primary health services relates to the central desert peoples in the APY Lands in the north of South Australia, east of Warburton in Western Australia and the central Australian region in Northern Territory. This includes the Pitjantjatjara , Yankunytjatjara , Ngaanyatjarra , Luritja and Antikirinya peoples.
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To reflect the linkages to the Central Desert peoples we have transferred the Ngaanyatiarra Shire to the Northern Territory in most of the options for configuring PHCOs in Western Australia.
8.5 Configuration Options for PHCOs in Western Australia Three Options to configure Primary Health Care Organisations in Western Australia have been developed to address the population distribution and indigenous health needs in the community.
8.5.1 Option 1: 4 PHCOs with 2 metropolitan and 2 rural PHCOs and no interstate flows This Option aligns the Primary Health Care Organisations in Greater Perth with the Metropolitan Area Health Services and aggregates the rural regions into two similar sized PHCOs serving distinct rural and remote communities in the north east and south west of the State as summarised in Table 54 and Figure 56 and Appendix 8 in Part 3.
Figure 56: Option 1: Two metropolitan PHCOs in Perth
Table 54: Option 1- Four PHCOs – 2 metro and 2 rural PHCO 2008 2021 WA Health alignment GP Division alignment ERP Metropolitan North PHCO 902033 1029300 North Metro AHS Perth and Osborne Metropolitan South PHCO 783214 946700 South Metro AHS Canning, Fremantle, Rockingham/Kwinana and part GP Down South Rural North East 202296 240070 WA Country Health part Goldfields, Kimberley, Pilbara and Midwest Rural South West 283654 313670 WA Country Health part Greater Bunbury, GP Down South, Greater Southern and Wheatbelt Total Population 2171197 2529740
Metropolitan North PHCO includes 19 LGAs in the northern, western and inner eastern suburbs of Perth stretching from Peppermint Grove to Wanneroo. It includes the growth areas of Wanneroo and Stirling to
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the north and Swan in the east and had an estimated resident population of 902,033 in 2008 that is projected to grow to 1.03 million residents by 2021 based on the 2005 WA Planning Commission population projections. The PHCO has a mixed socio-economic profile with new developments and lower socioeconomic areas in the north and west and more affluent suburbs in the centre of Perth.
The PHCO includes the catchment of the current Perth Primary Care Network and the Osborne GP Network and aligns with the North Metropolitan Area Health Service.
Metropolitan South PHCO includes fifteen contiguous LGAs to the south of Perth covered by the Fremantle, Canning and Rockingham Kwinana regions and the LGAs of Mandurah and Murray in the Peel region. Again this area reflects the catchment of WA Health’s Metropolitan South Area Health Service and incorporates the high growth LGAs of Cockburn, Rockingham, Mandurah, Murray, Armadale and Serpentine-Jarrahdale.
Metropolitan South PHCO catchment had an estimated resident population of 783,214 in 2008 and this is projected to grow to 947,000 by 2021. This PHCO also has a mixed socioeconomic profile with established affluent areas and coastal towns and mixed infill areas and inland LGAs.
The Metropolitan South PHCO includes the catchment of the current Canning, Fremantle and Rockingham Kwinana GP Divisions plus the urban growth centres currently located in GP Down South. It aligns with the South Metropolitan Area Health Service and the catchment for the new Fiona Stanley Hospital.
Rural North East PHCO includes thirty nine LGAs to the north and east of Perth including the Kimberley and Pilbara growth areas and the Midwest and Goldfields regions to the north, east and south east of Perth. The PHCO includes major rural towns and service hubs in the north and east, mining communities, small towns and villages. In 2008 this area had an estimated resident population of 202,296 and this is projected to grow to 240,070 by 2021. However this is likely to be conservative given the rapid growth in WA as many of the larger towns and regional centres had achieved or were approaching the 2021 projected population in 2008.
Rural North East PHCO includes 4 of the 8 rural and remote regions covered by WA Country Health and equates to the catchments of the Kimberley, Pilbara, Midwest and Goldfield Divisions of General Practice.
Rural South West PHCO includes 68 LGAs in the west, south west and south of Western Australia including the Wheatbelt region which surrounds Perth and major rural towns, service hubs and coastal growth areas of Dardanup, Capel, Augusta-Margaret River, Albany and Busselton as well as small towns in the wine growing country and the south. In 2008 this area had an estimated resident population of 283,600 and this is projected to grow to 313,670 by 2021.
8.5.2 Strengths and weaknesses The strengths of this PHCO configuration are as follows:
• Strong alignment between the metropolitan PHCO and Area Health Services which will facilitate vertical and horizontal integration of primary and acute health services
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• Two large metropolitan PHCOs that both include major population growth areas and socioeconomically diverse communities and will have similar workforce support and recruitment and service development challenges in their growth areas
• Two large rural PHCOs rather than 8 Divisions or small Health Services that will have the critical mass needed to provide effective planning, service development and commissioning for their populations and targeted workforce support for general practitioners and other primary health professionals working in rural and remote communities. Both rural PHCOs will have the opportunity to partner with major Aboriginal Community Controlled Health Services within their catchment to meet the needs of their local Aboriginal communities.
• There is reasonable concordance between the boundaries and population catchments of the current GP Divisions and the proposed PHCOs except for GP Down South Division where the growth areas of Mandurah and Murray are linked with the Metro South PHCO.
The weaknesses of this configuration are:
• The two metropolitan PHCOs have very large catchment populations that are expected to grow to 1 million people or more by 2021. This is the upper end of the desirable PHCO catchment population. It exceeds the size of most of the metropolitan PHCO options in other states.
• The populations in the lower socioeconomic growth areas and the affluent inner and central Perth and coastal suburbs have distinct primary health care needs. Large PHCOs will have to undertake carefully targeted needs assessment and population planning processes to ensure the needs of their entire catchment population are met.
8.5.3 Option 2: 6 PHCOs with 4 metropolitan and 2 rural PHCOs This Option establishes four metropolitan PHCOs in Greater Perth and maintains the Rural North East and South West PHCO configuration described in Option 1 except that Ngaanyatjarraku (S) in the Goldfields is transferred to the Northern Territory to maintain the integrity of the Central Desert Aboriginal lands.
As shown in Table 55 and Figure 57, the metropolitan PHCOs are split into 4 in line with the WA region boundaries in Greater Perth.
Central Metropolitan PHCO includes 16 LGAs in the central and inner eastern suburbs of Perth and includes the growth area of Swan in the east. This catchment had an estimated resident population of 431,461 in 2008 that is projected to grow to 487,100 residents by 2021. The PHCO has a fairly homogenous socio-economic profile including relatively affluent established suburbs in the centre of Perth.
The PHCO includes the catchment of the current Perth Primary Care Network and aligns with part of the North Metropolitan Area Health Service.
Northern Metropolitan PHCO includes the growth LGAs of Joondalup, Stirling and Wanneroo in the northern and western suburbs of Perth. This catchment had an estimated resident population of 470,572 people in 2008 that is projected to grow to 542,200 residents by 2021 based on the 2005 WA Planning Commission population projections. The PHCO has a lower socio-economic profile than the integrated
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option with new developments and more young families and low income earners than the established parts of Perth.
The PHCO includes the catchment of the current Osborne GP Network and aligns with part of the North Metropolitan Area Health Service.
Table 55: Option 2 - Four metropolitan and 2 rural PHCOs plus NT flow PHCO 2008 2021 WA Health GP Division alignment ERP Projected alignment POP Central Metropolitan Perth PHCO 431461 487100 Part North AHS Perth Northern Metropolitan Perth PHCO 470572 542200 Part North AHS Osborne Fremantle PHCO 218707 251500 Part of South AHS Fremantle Southern Metropolitan Perth PHCO 564507 695200 Part of South AHS Canning, Rockingham/Kwinana and part GP Down South Rural North East 200745 236570 WA Country Health Goldfields, Kimberley, Pilbara, Midwest Rural South West 283654 313670 WA Country Health Greater Bunbury, GP Down South, Greater Southern and Wheatbelt Total WA PHCO 2171197 2526240 Northern Territory 1551 3500 Ngaanyatjarraku (S) WA Population 2172748 2529740
Figure 57: Option 2: 4 metropolitan PHCOs in Perth
Fremantle PHCO includes the four LGAs to the south and east of Perth and includes the growth areas of Cockburn and Melville as well as Fremantle and Fremantle East. This catchment had an estimated resident population of 218,707 people in 2008 and is projected to grow to 251,500 residents by 2021. The PHCO has historically had a mixed socio-economic profile but is becoming more affluent.
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The PHCO includes the catchment of the current Fremantle GP Division and aligns with part of the South Metropolitan Area Health Service.
Southern Metropolitan PHCO includes eleven contiguous LGAs under this Option and includes the Canning and Rockingham Kwinana regions and the LGAs of Mandurah and Murray in the Peel region. It incorporates the high growth LGAs of Rockingham, Mandurah, Murray, Armadale and Serpentine- Jarrahdale and had an estimated resident population of 564,507 in 2008 and this is projected to grow to 695,200 by 2021. This PHCO also has a mixed socioeconomic profile with established affluent areas and growing coastal towns and mixed infill areas and inland LGAs.
The Southern Metropolitan PHCO includes the catchment of the current Canning, Rockingham Kwinana GP Divisions plus the urban growth centres currently located in GP Down South and aligns with part of the South Metropolitan Area Health Service including the catchment for the new Fiona Stanley Hospital.
The Rural PHCOs have the same configuration as Option 1 but Ngaanyatjarraku (S) to the east of Warburton in the Goldfields is transferred to the Northern Territory. This reduces the North East Rural PHCO projected catchment population to 288,250 people in 2021.
8.5.4 Strengths and weaknesses The strengths of this PHCO configuration are:
• The four metropolitan PHCOs provide a smaller, more homogenous catchment population in each of the main corridors in Greater Perth. However the four metropolitan PHCOs are still configured in such a way that the Central and Northern Metropolitan PHCOs and the Fremantle and Southern Metropolitan PHCOs together fall within the respective boundaries of the North and the South Area Health Services to facilitate integrated planning between the acute and primary care sectors.
• The two rural PHCOs remain largely unchanged and the transfer of the Ngaanyatjarraku (S) to the Northern Territory enables the integrity of the Central Desert Aboriginal communities to be maintained.
The weaknesses of this configuration include:
• There is substantial variation in the size of these metropolitan PHCOs with Fremantle in particular lacking the population base of the Southern or two northern PHCOs. Fremantle will be on the lower end of the metropolitan PHCO range when compared to other states and may need to partner with another service to provide cost effective business and workforce support services for providers in its catchment.
• The alignment with the Area Health Services is reduced which may impact on the bargaining power and vertical partnership capabilities of all the metropolitan PHCOs relative to Option 1.
8.5.5 Option 3: 5 PHCOs with 3 metropolitan and two rural PHCOs This Option proposes three contiguous metropolitan PHCOs of similar size in Greater Perth to better distribute the population in more manageable sized entities while maintaining the 2 rural PHCOs less Ngaanyatjarraku Shire as proposed in Option 2. The configurations are shown in Figures 58 and 59 and Table 56.
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Northern Metropolitan PHCO would consist of the high growth LGAs of Joondalup, Stirling and Wanneroo in the northern and western suburbs of Perth with an estimated resident population of 470,572 people in 2008 that is projected to grow to 542,200 residents by 2021. The PHCO has a lower socio-economic profile than the integrated option with new developments and more young families and low income earners than the established parts of Perth.
The PHCO includes the catchment of the current Osborne GP Network and aligns with part of the North Metropolitan Area Health Service and is the same configuration proposed in Option 2.
This PHCO catchment is expected to grow faster than projected and we expect that Stirling LGA will be reviewed and split by the ABS and the north western populations will attach to this catchment.
Central Metropolitan Perth PHCO would consist of 22 LGAs covering central and eastern Perth and Fremantle. This catchment had an estimated resident population of 672,600 people in 2008 and is projected to grow to 738,100 residents by 2021. The PHCO has historically had a mixed socio-economic profile but is becoming more affluent. The PHCO includes the catchment of the current Fremantle GP Division and aligns with part of both the North and the South Metropolitan Area Health Services.
Southern Metropolitan PHCO catchments in Option 3 consists of nine contiguous LGAs including Cockburn and the Canning and Rockingham Kwinana regions and the LGAs of Mandurah and Murray in the Peel region and incorporates the high growth LGAs of Rockingham, Mandurah, Murray and Serpentine-Jarrahdale. This area had an estimated resident population of 542,000 in 2008 and this is projected to grow to 695,700 by 2021. This PHCO also has a mixed socioeconomic profile with established affluent areas and growing coastal towns and mixed infill areas and inland LGAs.
The Southern Metropolitan PHCO includes the catchment of the current Canning, Rockingham Kwinana GP Divisions plus the urban growth centres currently located in GP Down South and aligns with part of the South Metropolitan Area Health Service including the catchment for the new Fiona Stanley Hospital.
The two Rural PHCOs have the same configuration as Option 1 except that Ngaanyatjarraku (S) to the east of Warburton in the Goldfields is transferred to the Northern Territory. This reduces the North East Rural PHCO projected catchment population to 288,250 people in 2021.
Table 56: Option 3- Five PHCOs - 3 metropolitan and 2 rural PHCO 2008 2021 WA Health alignment GP Division alignment ERP Projected Pop Central Metropolitan Perth PHCO 672675 738100 Part North and South AHS Perth and Fremantle Northern Metropolitan Perth PHCO 470572 542200 Part North AHS Osborne Southern Metropolitan Perth PHCO 554200 695700 Part South AHS Canning, Cockburn, Rockingham/Kwinana and part GP Down South Rural North East 200745 236570 WA Country Health Goldfields, Kimberley, Pilbara and Midwest less Ngaanyatjarraku (S) Rural South West 283654 313670 WA Country Health Greater Bunbury, GP Down South, Greater Southern and Wheatbelt Total PHCO 2171197 2526240 Northern Territory 1551 3500 Ngaanyatjarraku (S) WA Total Population 2172748 2529740
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Figure 58: All Options - Perth Rural PHCOs
Figure 59: Option 3: 3 Metropolitan PHCOs in Perth
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8.5.6 Strengths and weaknesses The strengths of this configuration include:
• Greater metropolitan Perth has three urban PHCOs with populations ranging in size from 470,000 to 672,000 in 2008 that are expected growth to between 542,000 to 738,000 people by 2021. This is within the range of the Options and critical mass for major metropolitan PHCOs suggested in NSW, Queensland and Victoria.
• LGAs with similar socio-demographic profiles are grouped together and this will assist population based planning and targeting of primary health partnership initiatives.
The weaknesses of this configuration are:
• The alignment with the Area Health Services is poor with the Central Metropolitan PHCO including LGAs in both the North and South Metropolitan Area Health Services. This means that this PHCO will need to have formal linkages for planning and acute community care partnering with both Areas. However the local communities are already using tertiary hospitals outside their geographic catchments for specialty services and cross Area planning will need to continue.
8.6 Preferred Option Each of the Options described above is reasonably robust and either one could be used as the basis for development of Primary Health Care Organisations in Western Australia.
Option 3 or five PHCOs in Western Australia appears to offer the best demographic fit overall given the size of WA and the strong population growth that is projected.
The three metropolitan Primary Health Care Organisations proposed in the north, centre and south of Perth reflect existing communities of interest and populations with similar socioeconomic profiles and each PHCO catchment is expected to grow strongly to 2021. The proposed populations are similar to the numbers proposed in metropolitan areas in other states.
All three metro PHCOs will have outer urban or growth areas where support for the primary health care workforce and collaborative inter agency planning will be essential. This Option therefore favours horizontal integration and service development with the rest of the primary and community service system as the priority compared to vertical integration with the acute care system.
The two proposed Rural PHCOs will have projected populations of between240,000 and 290,000 in 2021 and this is similar to rural PHCOs in other states. They will target rural and remote communities with similar population and workforce needs and will have the critical mass they need to provide effective planning, service development and workforce support to a range of primary health care partners including general practice, state government community health and fly in services and to Aboriginal Community Controlled Health Services and peak agencies.
Lastly the transfer of the Ngaanyatjarraku Shire to the Northern Territory will preserve the cultural and language links between the people of the Central Desert.
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8.6.1 Transfer Jurien Bay/Dandaragan Shire to Rural South West PHCO The rural LGAs in the Options Tables above have generally been allocated to reflect the Statistical Divisions and the catchments of the rural Divisions of General Practice which generally align with the WA Regions.
As part of the feedback received from Western Australia we have been advised that the Shire of Dandaragan and Jurien Bay is regarded as part of the Wheatbelt Region and has been included in the Wheatbelt Health Planning Initiative undertaken as a collaborative whole of government exercise.
The Shire of Dandaragan and Jurien Bay is currently included in the Midwest Division catchment in our Options and PHCO maps. However local planning indicates there is a good case to transfer the Shire of Dandaragan to the Rural South West PHCO as part of the Wheatbelt Region and this should be considered as part of the next stage of planning.
The 2008 ERP for Dandaragan Shire was 3,146 people and this is projected to grow to 4,500 by 2021. Table 57 shows the impact on the catchment populations of the two rural PHCOs if Dandaragan Shire is relocated to the Rural South West PHCO. The population of Rural North East will decrease to 1999,150 in 2008 and 235,570 in 2021. Rural South West population will increase to 286,800 in 2008 and 318,170 in 2021.
Table 57: Rural PHCO populations if Dandaragan Shire transfers to Rural South West PHCO 2008 ERP 2021 POP Rural North East 199150 235570 Rural South West 286800 318170
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9 Tasmania 9.1 Overview Tasmania is an island state and the smallest state in the Commonwealth with a land mass of 68,401 square kilometres including 37% covered by reserves, national parks and World Heritage sites. Tasmania has three main population centres – Hobart, the state capital and largest city in the South, Launceston in the North and Devonport and Burnie in the North West and four Statistical Divisions – Greater Hobart, Northern, Mersey-Lyell and Southern.
9.2 Demographic Features
9.2.1 Current population Tasmania has an estimated resident population of 497,500 at June 2008 and grew by 1% to 502,600 by June 2009. Southern Statistical Division is the most populous region followed by Northern and the North West.
Greater Hobart Statistical Division, which includes the cities of Hobart, Clarence and Glenorchy and the municipalities of Kingborough, Brighton and Sorell, had a population of 209,300 people in 2008, Northern Statistical Division which includes the city of Launceston had an ERP of 140,300, Mersey-Lyell Statistical Division which includes Burnie and Devonport had a population of 111,100 and Southern Statistical Division had a population of 36,900.
Growth has been strongest in Greater Hobart LGAs including Kingborough, Brighton, Sorell and Clarence and in Launceston.
Tasmania has an older age structure than Australia as a whole with a lower proportion of people aged 20- 44 years and a median age of 39.4 year. Fifteen percent of the Tasmanian population is aged 65 years and above and this is the second highest proportion.
9.2.2 Indigenous population There were 16,767 people who identified as Aboriginal or Torres Strait Islanders or both living in Tasmania at the 2006 Census or 3.5% of the state population. Tasmania had the second highest proportion of Indigenous people of any jurisdiction after Northern Territory.
9.2.3 Projected population and patterns of growth The Tasmanian Demographic Change Advisory Council Population Projections (2008) suggest that Tasmania will have a population of 547,500 by 2021 with the majority of population growth expected in Greater Hobart and Launceston and the Northern Statistical Divisions.
9.3 Structure of Health Services
9.3.1 General Practice There are approximately 550 GPs and 405 FWE GPs in the three Divisions of General Practice in Tasmania. All the Divisions include a major city or population centre as well as rural and remote communities and each of the Tasmanian Divisions is eligible for MAHS funding for a proportion of their catchment.
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The boundaries of GP South, GP North and GP North West shown in Figure 60 are similar to the state Health Service boundaries.
Figure 60: Current Tasmanian Divisions of General Practice
In terms of workforce and practice characteristics in 2007/08 there were:
• 545 practising GPs in Tasmania of whom 236 or 43% were female
• 905 people per practising GP and 1230 per FWE GP
• Approximately 167 general practices including 53 solo practices of 32% of the practice base
In terms of workforce supply and distribution the GP South Division, which includes Greater Hobart and the rural and remote parts of Southern Tasmania, has 51% of FWE GPs compared to 49% population, GP North Division has 26% of the GP FWE and 29% of the population and GP North West has 23% of the GP FWE and 22.3% of the population. As shown in Table 58, the North has the highest patient to GP FWE ratio in Tasmania.
Table 58: Tasmanian Divisions of General Practice Key Indicators 2007/08 Division of General Practice Population Total Solo Estimated Number of FWE GPs Estimated FWE GP: 2007 B number of practices number of female as at number of population practices practising GPs 30/06/07 E GPs: 2007 ratio GPs population 2007 ratio General Practice South 242634 90 27 304 142 204 798 1189 General Practice North 140652 49 21 136 56 106 1034 1327 General Practice North West 110085 28 5 105 38 91 1048 1210 Tasmania Total 493371 167 53 545 236 401 905 1230
Tasmania as a whole has a higher patient to GP ratio than the national average of 1129.
As shown in Figure 61, the number of GPs in Tasmania increased gradually between 2003/04 and 2006/07 and decline gradually in subsequent years. Tasmania has a higher patient to GP ratio than the national average of 1129.
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Figure 61: GP Workforce Trends
9.3.2 State Health Services The Department of Health and Human Services administers health, disability, child family and youth and community welfare services and is responsible for state wide planning, policy development, funding and system reform.
Area Health Services in the South, North and Northwest of the state manage acute hospital and community based health services.
There are four main acute Hospitals providing specialist services in Tasmania – the Royal Hobart Hospital which is the state’s tertiary referral centre, Launceston General Hospital which is a major acute care facility, Burnie Hospital and Mersey Hospital. There are also 20 small rural hospitals and Multi-Purpose Services in the rural areas of Tasmania where GPs provide the acute and emergency medical care.
Community Health Services include community nursing, allied health services, health promotion and development services, youth health services and HACC services that operate out of 23 Community Health Centres across Tasmania. Some of these sites in rural areas are the only health care presence in the locality and are used by GPs, Community Health Services and other agencies.
Child and family services operate from these Community Health Centres and other sites across Tasmania but are administered as part of the Human Service stream.
Mental Health, Alcohol Tobacco and Drug and Oral Health Services are managed as statewide programs and utilise community health facilities across Tasmania.
9.3.3 Aboriginal community controlled health services There are seven community controlled organisations funded by OATSIH in Tasmania including Aboriginal Health Services in Hobart, Launceston and Burnie and Aboriginal corporations which also provide health services and programs in Cygnet, Devonport, Whitemark and Cape Barren Island.
The Tasmanian Aboriginal Health Service is the state NACCHO affiliate.
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9.4 PHCO Design Issues While Tasmania is a relatively compact state it is the most decentralised state in Australian in terms of population distribution with nearly 60% of the population living outside the Capital City Statistical Division.
The population is concentrated in the urban areas of Hobart, Launceston, Burnie and Devonport but large areas of the state including the Central Plateau, the South West and the West Coast are uninhabited or sparsely populated.
Distance and travel times by road are significant with travel time between the major centres of Hobart and Launceston of 2 hours 45 minutes, Launceston and Burnie of over 2 hours and Hobart and Burnie of over 4 hours.
Achieving the right balance in terms of population distribution and the unique characteristics and communities of interest across Tasmania and efficient operating size relative to other states and territories is the main design challenge for a PHCO in Tasmania.
9.5 Options considered The Tasmanian population of 497,000 is similar to the size of PHCOs serving mixed urban and rural communities in other states.
One Option considered is to have a single statewide PHCO covering all of Tasmania. This would line up with state health service planning and policy development and provide the critical mass needed for practice support and service innovation.
While this Option has appeal in terms of economies of scale it ignores the functional health service delivery zones in the South, North and North West that include hospitals, community health services and general practice and which reflect local referral patterns, education and training arrangements and local communities of interest.
Establishing 3 PHCOs in Tasmania following the south, north and north western splits would create three geographically based PHCOs that preserve these local relationships and functional clinical linkages. However the size of the PHCOs would vary significantly from over 243,000 in the South (an average rural PHCO in other jurisdictions) to 110,000 in the North West. This would be one of the smallest PHCOs anywhere in Australia.
The Option of a north/south split with one PHCO covering the North and North West and one for the South would address the population relativities but still cuts across communities of interest and ignores the benefits of statewide service planning and workforce initiatives and referral linkages required with Royal Hobart Hospital.
9.6 Preferred PHCO configuration We believe that establishing a single PHCO covering all of Tasmania with three branch offices in the South, North and North West offers the best model for Tasmania. This single PHCO option is shown in Figure 62 and the proposed Branch Offices would service the catchments shown in Figure 60.
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Figure 62: Tasmanian PHCO Preferred Option
The PHCO would have a 2008 population base of 497,500 growing to 537,200 by 2021 and would cover all 29 LGAs in Tasmania as shown in Table 59.
Table 59: Preferred Option for Tasmania – Single Statewide PHCO PHCO ERP 2021 Division State Health LGAs 2008 Pop Boundaries Boundaries Primary Health Care 497529 537247 General Practice Southern, North 29 LGAs making up Greater Hobart, Mersey-Lyell, Northern Tasmania North, North West and and Southern Statistical Districts West and South Northern Area Health Services
The Tasmania PHCO would be the legal entity and undertake statewide planning and systems development, partnership building and major workforce planning and support processes and would represent Tasmania in national negotiations. The Branch Offices would undertake local needs assessment and tailored partnership building to support service development and innovation on the ground and undertake local workforce support under the auspice of the Tasmania PHCO.
This would provide the critical mass required for effective and efficient operations at both a state and national level while also providing the local focus needed in Tasmania to reflect both the organisation of health services and population distribution.
However to ensure local community engagement and on the ground links with local hospital Services retention of 3 branch offices consistent with the current Division boundaries shown in Figure 60 is proposed.
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10 Northern Territory 10.1 Overview The Northern Territory is a self governing federal territory occupying 1.3 million square kilometres in the north and centre of Australia and shares boundaries with Western Australia, South Australia and Queensland. 10.2 Demographic Features
10.2.1 Current population The Northern Territory had an estimated resident population of 219,800 people at June 2008 and this grew by 2.3% to 224,800 people by June 2009, the smallest population of any state or territory. However the Northern Territory has had the third fastest growth rate in Australia after Queensland and Western Australia for the past five years.
The Northern Territory has Australia’s youngest population with the highest proportion of population aged under 15 and the smallest over the age 65 years and a median age of 30.6 years. This in part reflects lower life expectancy in the Aboriginal population. The Northern Territory population also comes from diverse cultural backgrounds.
10.2.2 Indigenous population Aboriginal peoples made up 30% of the Northern Territory population in 2008 and the Northern Territory has the largest proportion of Indigenous people of any state or territory. Approximately 45% of Aboriginal people lived in the Alice Springs and Darwin regions and the remainder lived in the rural towns and remote communities in East Arnhem, Barkly, Katherine and the rest of Darwin regions.
In terms of Remoteness Areas, Northern Territory had the highest proportion of Aboriginal and Torres Strait Islander people living in Very Remote Australia (63%) of any state or territory.
Table 60: Indigenous population by Remoteness Areas - 2006 Census Major Inner Outer Remote Very Cities Regional Regional Australia Remote Australia Australia Australia % % % % % Northern Territory 19 18 63 Australia 31 22 23 8 16 Source: Population distribution Aboriginal and Torres Strait Islander Australians ABS 4705. 2006
Aboriginal people in the Northern Territory have rights to their traditional lands under the provisions of the Aboriginal Lands Rights (Northern Territory) Act 1976 and the Native Title Act 1993 and many Aboriginal people live on their Homelands and in Outstations as well as in Towns Camps and the major cities. Aboriginal people in the Northern Territory have the poorest health status and the highest levels of disability and chronic illness in Australia.30
30 AIHW: Australia’s Health 2008 . AIHW Canberra, Cat. No. AUS 99.
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Communities with the largest Aboriginal population have the lowest socio-economic status in the Northern Territory and nationally as shown in Table 61.
The Closing the Gap Strategy aims to achieve dramatic improvements to indigenous health status and close the life expectancy gap in the NT and elsewhere in Australia over the next 20 years.
Table 61: SEIFA Index for Northern Territory LGAs 2006 LGA Index score Minimum Maximum (Australian score for score for score = 1000) CDs in area CDs in area Darwin 995 332 1147 Darwin City 998 399 1147 Palmerston-East Arm 960 332 1147 Litchfield Shire 1022 914 1106 Northern Territory – Bal 753 205 1155 Finniss 822 435 984 Bathurst-Melville 582 540 613 Alligator 736 463 1074 Daly 626 406 1001 East Arnhem 659 224 1089 Lower Top End NT 713 205 1155 Barkly 762 349 982 Central NT 819 298 1141 Source: PHIDU: Social Health Atlas of Australian Local Government Areas 2009
10.2.3 Population distribution, patterns of growth and projected population The Northern Territory population is distributed between Greater Darwin (54.3%) and the rest of Darwin region (7.5%) in the north, the Alice Springs region (19%) in the centre, the Katherine region (8.8%) and the Barkly region (2.9%) along the Stuart Highway and the East Arnhem Region (7.5%). The major towns are Darwin, Palmerston, Alice Springs, Katherine, Nhulunbuy, Tennant Creek, Wadeye, Jabiru and Yulara.
Darwin is the main population centre in the Northern Territory and 55% of the NT’s population resided in the Darwin Statistical Division at June 2008 and this SD recorded two thirds of the Territory’s growth in 2007/08. All SLAs in the Northern Territory experienced population growth in 2007/08 but the fastest growth was in Palmerston – East Arm SSD and Litchfield Shire SSD which both recorded over 5% growth followed by East Arnhem (2.6% growth), Barkly (2.1%) and Alice Springs (1.8%).
The Northern Territory 2030 Strategic Plan 31 Growing the Territory Strategy outlines the economic development and urban and regional growth strategies for the Northern Territory including continued development of Darwin and Palmerston as the major urban and economic centres; expansion of the Katherine region as a regional hub for tourism, transport, agriculture, mining and government services; expansion of Alice Springs and Tennant Creek; and, development of the 20 largest remote (predominantly Aboriginal) communities into Territory Growth Towns to act as regional service hubs with schools, health facilities, police and internet and transport services for the surrounding outstations.
31 Territory 2030 Strategic Plan : Northern Territory Government 2009
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The Northern Territory Population Projections32 describe population trends by Statistical Region and by indigenous and non indigenous population. As shown in Table 62, the NT population is projected to growth to 263,235 people by 2021 with Indigenous people accounting for 31% of the Territory population.
Table 62: Northern Territory Projected Population 2008 and 2021 2008 2021 Northern Territory Indigenous population 66,231 81,585 Northern Territory non-Indigenous population 153,880 181,650 Northern Territory 220,111 263,235 % Indigenous 30 31 % Non indigenous 70 69 Source: Northern Territory Population Projections (Northern Territory Treasury July 2009)
The expected distribution of population by region is shown in Table 63. Growth is expected to occur in all regions but Greater Darwin will have 58% of the population by 2021 compared to 53% in 2006. The indigenous population is expected to grow at a faster rate than the population overall (27.5% compared to 25%) with growth in all regions.
Aboriginal peoples will make up between 60% and 76% of the population of the rural and remote regions, 43% of the Alice Springs region and 12.5% of the Greater Darwin region by 2021.
Table 63: Projected population by region and indigenous status Region Total pop Indigenous pop % Indigenous 2006 2021 2006 2021 2006 2021 Greater Darwin 114,361 153,393 12,652 19,243 11.1 12.5 Rest of Darwin region 15,719 17,832 11,316 13,532 72.0 75.9 East Arnhem region 15,784 19,053 9,930 12,141 62.9 63.7 Katherine region 18,639 20,267 9,937 12,124 53.3 59.8 Barkly region 6,154 6,683 4,003 4,665 65.0 69.8 Alice Springs region 39,971 46,006 16,168 19,880 40.4 43.2 Total 210,628 263,234 64,006 81,585 30.4 31.0 Source: Northern Territory Population Projections (Northern Territory Treasury July 2009) 10.3 Structure of Health Services The Northern Territory health system faces a range of unique challenges including:
• The need to provide culturally appropriate health and social care services for the very large and dispersed Aboriginal population with high health needs;
• Access and cost issues associated with rural and remote service delivery over a vast and sparsely populated geographic area;
• Workforce shortages and recruitment and retention issues in all professions including medicine, nursing, midwifery, allied health and dental professions and lack of local specialists; and,
32 Northern Territory Population Projections: Northern Territory Treasury July 2009
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• Higher costs structures and lower historical income from MBS and PBS due to lack of specialist services 33 .
The Territory has a different service structure with state government funded primary health and remote health services and OATSIH funded Aboriginal Health Services playing a much larger role in service provision and few privately practising health professionals than in other jurisdictions.
There are moves towards greater joint funding initiatives involving the Australian and the Northern Territory governments and the community controlled sector such as the $99.7m Expanding Health Service Delivery Initiative which commenced in 2008 and is designed to expand regionally based primary health care services in remote Northern Territory communities and town camps.
10.3.1 State Health Services The Department of Health and Families is the major health care funder and provider in the Territory. The Department has a divisional structure and provides a range of acute, community health and remote health services. 34
10.3.1.1 Hospital Services There are five public hospitals in the Northern Territory located in Darwin, Alice Springs, Gove, Katherine and Tennant Creek. Royal Darwin Hospital is the Northern Territory tertiary hospital and the National Critical Care and Trauma Centre for northern Australia and the South East Asian regions.
10.3.1.2 Community and Remote Health Services The Department of Health and Families provides community health services consisting of Child, Youth and Family Health, Community and Primary Care, Home Birth, Well Women’s cancer screening and hearing services in urban centres including Darwin, Nhulunbuy, Katherine, Tennant Creek and Alice Springs.35
Health services in remote areas are delivered by the Department, Aboriginal Community Controlled Health Services and by NGOs. There are 54 Departmental and 30 community controlled health centres across the Territory that deliver multidisciplinary clinical and health promotion services including infant and child health assessments, antenatal care, immunisation, chronic condition prevention and management, health screening, acute primary health care and emergency response and prevention and control of infectious diseases.
10.3.1.3 Community Services The Community Services Division administers aged and disability services programs, alcohol and other drugs services, mental health services and family and children’s services for children, families and communities including statutory child protection services, family support, violence and homelessness and youth and child care services.
10.3.2 General Practice There are approximately 247 practicing GPs and 115 GP FWE in the Northern Territory with 62% working in the Top End and the remainder in Central Australia.
33 Data from state comparisons on Australia’s health 2008: AIHW Canberra, Cat. No. AUS 99. 34 Department of Health & Community Services: Strategic Directions 2007-09 35 www.healthynt.nt.gov.au
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In terms of workforce and practice characteristics in 2007/08 there were:
• 247 practising GPs in South Australia of whom 115 or 46% were female
• Approximately 119 general practices including 74 solo practices of 62% of the practice base
The Northern Territory has the highest population to GP ratio in Australia of 1883 population per FWE GP which is a third higher than the national average of 1129. Recruitment and retention is a major issue for GPs and the entire NT Network is eligible for MAHS funding.
Table 64: NT Divisions Key Statistics Division of General Practice Population Total Solo Estimated Number FWE GPs Estimated FWE GP: 2007 B number practices number of as at number of population of of female 30/06/07 E GPs: 2007 ratio practices practising GPs population GPs 2007 ratio
Top End Division of General Practice 216559 73 41 153 107 115 1415 1883 Central Australian Division of Primary N/A 46 33 94 40 N/A N/A N/A Health Care Northern Territory Total 216559 119 74 247 147 115 877 1883 Source: PHCRIS: Key Division of General Practice Characteristics 2007-08
The number of GPs in the Northern Territory has fluctuated year on year but overall numbers have remained stable at around 245 over time as shown in Figure 63.
Figure 63: GP Workforce Trends
General Practice Network Northern Territory consists of the former Top End and Central Australian Divisions of General Practice (amalgamated in 2008), the NT SBO and the NT Rural Workforce Agency. General Practice Network Northern Territory membership includes GPs and other primary health professionals and the Network has taken a lead role in provision of remote allied health, chronic disease and mental health program delivery and workforce recruitment and support for general practice, AHSs and for rural health services and hospitals.
10.3.3 Aboriginal community controlled health services Aboriginal Community Controlled Health Services funded by OATSIH are major service providers in the Northern Territory. There are 41 organisations funded by OATSIH in the Northern Territory including Aboriginal Medical Services Alliance Northern Territory (AMSANT), the NT peak body for the community
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controlled sector, 11 community controlled Aboriginal Health Services who are full members of NACCHO and 14 associate members.
Aboriginal Health Services operate in all the major towns and the local communities in the Territory and provide primary health care, clinical services, health promotion and capacity building.
AMSANT is the peak advocacy body and a party to the NT Framework Agreement on Aboriginal Health with the Commonwealth and NT Health and Families and is involved in health planning, workforce development and support and community consultation.
10.3.4 Regional Health Services The development of 15 Regional Health Services incorporating both community controlled health services and NT government primary health care services has been foreshadowed in the Northern Territory as part of the Expanding Health Service Delivery Initiative.
10.4 PHCO Design Issues The Northern Territory presents unique service delivery challenges and strengthening access to and the capacity of the primary health care system in the NT is a priority and core service development strategy for both the Australian and the Northern Territory governments.
The size of the Northern Territory population and its geographic distribution means that more than any other jurisdiction the PHCO will need to work in partnership at Territory and local level with the Aboriginal community controlled sector, NT Health and Families, general practice and other non government agencies to plan, deliver and support multidisciplinary primary health care.
The Northern Territory has the smallest population in the Federation and it is sparsely distributed over a vast rural and remote area. Top End and Central Australian communities have unique needs that need to be considered in PHCO design. The Territory geography also poses major challenges in terms of local access to services and the need to consult effectively with local communities.
The PHCO will also need to have critical mass, technical skills and capability to provide effective recruitment, training and workforce development and business support skills for primary health care providers and services working in urban, rural and remote environments.
Cross border issues also need to be considered with Western Australia and South Australia where Ngaanyatjarraku (S) and the Anangu Pitjantjatjara (AC) traditional lands cut across state and territory boundaries.
10.5 Preferred approach
10.5.1 Approach to cross border issues We recommend that the Ngaanyatjarraku Shire in WA and the Anangu Pitjantjatjara lands in South Australia which have populations of 1,551 and 2,363 people respectively are included as part of the Northern Territory PHCO. The Anangu Pitjantjatjara lands already form part of the Northern Territory GP Network catchment and including the Ngaanyatjarraku Shire is also culturally and logistically appropriate.
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10.5.2 Single PHCO with Branch Offices for Northern Territory Our preferred approach is the development of a single PHCO covering the Northern Territory and cross border communities with branch offices in Alice Springs and Darwin to maintain local partnerships and community and professional networks in the Top End and Central Australia.
We considered the option of forming two PHCOs in Northern Territory but rejected this approach on the grounds of critical mass and efficient size and the fact that both PHCOS would need to have similar expertise in remote health care. This Option is shown in Figure 64 and Table 65.
Figure 64: Northern Territory PHCO
Table 65: Northern Territory PHCO with population, provider boundaries and LGAs ERP 2021 Division Boundaries State Health LGAs 2008 Pop Boundaries Northern 219818 266700 General Practice NT Health Alice Springs, Barkly, Belyuen, Central Desert, Coomalie, Territory PHCO Network Northern Darwin, East Arnhem, Katherine, Litchfield, MacDonald, Territory Palmerston, Roper Gulf, Tiwi Islands, Unincorporated NT, Victoria-Daly, Wagait & West Arnhem 1551 3500 Goldfield WA Health Ngaanyatjarraku (S) 2363 2363* General Practice SA Health Anangu Pitjantjatjara (AC) Network Northern Territory Total 221369 270200 * Population projections for Anangu Pitjantjatjara not available in SA LGA Projections
The proposed Northern Territory PHCO had a 2008 population of 221,369 and is projected to grow to 270,200 people primarily due to population growth in the Top End. In 2006 the Northern Territory PHCO catchment had 67,056 Aboriginal people or 30.3% of the population and this is projected to grow to 85,000 people or 31.5% of the catchment population by 2021.
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The Northern Territory PHCO would be a statewide legal entity with a Branch Office structure but the detailed operating model will need to be determined in consultation with the key service partners including AMSANT and the Northern Territory government and the state and federal funding bodies.
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11 References and Appendices 11.1 Acronyms ABS Australian Bureau of Statistics ACCHS Aboriginal Community Controlled Health Services AGPN Australian General Practice Network AHCSA Aboriginal Health Council of South Australia AHCWA Aboriginal Health Council of Western Australia AH&MC NSW Aboriginal Health & Medical Research Council AIHW Australian Institute of Health & Welfare AMSANT Aboriginal Medical Services Alliance Northern Territory AMS Aboriginal Medical Service APY Anangu Pitjantjatjara Yankunytjatjara COAG Council of Australian Government DoHA Department of Health and Ageing ERP Estimated resident population IRSD Index of Relative Socioeconomic Disadvantage GPNLG AGPN General Practice Network Leadership Group MHPN Mental Health Professionals Network NACCHO National Aboriginal Community Controlled Health Organisation NHHRC National Health and Hospitals Reform Commission OATSIH Office of Aboriginal and Torres Strait Islander Health PHCO Primary Health Care Organisation PCP Primary Care Partnership QAIHC Queensland Aboriginal and Islander Health Council SBO State Based Organisations VACCHO Victorian Aboriginal Community Controlled Health Organisation WHO World Health Organisation
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11.2 References Australian Institute of Health and Welfare: Australia’s Health 2008 . AIHW Canberra, Cat. No. AUS 99.
Australian Bureau of Statistics: 4705.0 – Population distribution, Aboriginal and Torres Strait Islander Australians, 2006 Release 15.08.2007
Australian Bureau of Statistics: 4705.0 – Population distribution, Aboriginal and Torres Strait Islander Australians , 2006 Release 15.08.2007
Australian Bureau of Statistics: 3101.0 – Australian Demographic Statistics , June 2009 Release
Australian Government: A Healthier Future for All Australians: Final Report of the National Health and Hospitals Reform Commission . Commonwealth of Australia 2009
Australian Government: A National Health and Hospitals Network for Australia’s Future. Commonwealth of Australia March 2010
Australian Government: A National Health and Hospitals Network: Further Investments in Australia’s Health. Commonwealth of Australia April 2010
Australian General Practice Network (2009): Connecting Care: A Blueprint for improving health and wellbeing of the Australian population – the role and function of Primary Health Care Organisations . November 2009
Council of Australian Governments: National Health and Hospitals Agreement . April 2010
Department of Health and Ageing: Towards a National Primary Health Care Strategy: A Discussion Paper for the Australian Government . Commonwealth of Australia 2008
Department of Health and Ageing: Building a 21 st Century Primary Health Care System: A Draft of Australia’s First National Primary Health Care Strategy . Commonwealth of Australia 2009
Department of Health and Ageing: Primary Health Care Reform in Australia: Report to Support Australia’s First National Primary Health Care Strategy . Commonwealth of Australia 2009
Department of Health and Ageing: Australia: The Healthiest Country by 2020 - National Preventative Health Strategy – roadmap for action Commonwealth of Australia 2009
Department of Health (2008): NHS Next Stage Review – Our vision for primary and community care. London: Department of Health
Department of Health (2009): NHS 2010-2015: From good to great - Preventive, people centred, productive. London: Department of Health
Department of Health (2010) PCT Procurement Guide for Health Services. London: Department of Health
House of Commons Health Committee: Changes to Primary Care Trusts Second Report of Session 2005-06 . London 2006
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Lewis, R. et al.: Future Directions for Primary Care Trusts Discussion Paper. The King’s Fund 2003
Treasury: Australia to 2050: future challenges Commonwealth of Australian January 2010
World Health Organisation: World Health Report 2008: Primary health care: Now more than ever. Geneva 2009
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11.3 Appendix 1 - PHCO Options by Service Delivery Environment The Table below shows the PHCO Options in each state and territory with their 2008 ERP and 2021 population and an indication of the service delivery environment/s in which each PHCO will operate. Many of the proposed PHCOs will operate in more than one environment. The star ratings give an indication of the environment where the bulk of the proposed PHCO population lived in 2008 and whether the PHCO crosses state borders. A three star rating indicates where the majority of population is concentrated and one star indicates the reverse. This is only a snapshot to indicate the types of service delivery environment where the PHCO will need to operate with more detail in the State Profile in Part 2.
The first Option is generally the Base Case in each state and territory. In subsequent Options, only PHCOs where the configuration has changed are shown in the Table.
Service Delivery Environment/s PHCO by Option and State/Territory 2008 ERP 2021 Established Urban Urban/rural Rural Stable Rural & Cross urban growth region growth rural remote border NSW Option 1 Inner Western Sydney & Canterbury 677778 763164 *** * Bankstown Eastern and Inner Sydney 418463 484274 *** St George Sutherland 450502 482935 *** South Western Sydney 657840 856799 * *** Sydney West 795622 995468 ** *** Outer Western Sydney 320313 362727 * ** Illawarra Shoalhaven 378069 425136 *** * * Northern Sydney 814076 903644 *** * Central Coast 310546 355401 ** ** Hunter and Greater Taree 666847 758616 *** ** ** New England 195452 191980 *** * North Coast 493903 574258 *** * Central and Far Western NSW 313258 313692 *** ** Riverina 192217 197788 *** Southern NSW 193665 231287 ** * Albury Murray Darling 105621 111326 ** *** NSW Option 2 Sydney West 624657 773742 ** *** Hornsby Baulkham Hills 330176 395293 ** ** Northern Sydney 654865 730077 *** * NSW Option 3 North Coast 428440 487460 *** * Tweed A to Gold Coast 65463 86600 ** *** NSW Option 4 Albury Murray Darling 105621 111326 *** Southern NSW to ACT 193665 231287 ** * *** Tweed A to Gold Coast 65463 86600 ** *** Service Delivery Environment/s
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PHCO by Option and State/Territory 2008 ERP 2021 Established Urban Urban/rural Rural Stable Rural & Cross urban growth region growth rural remote border NSW Option 5 Central West 186,000 192,000 *** North and Far West 127,000 127,000 ** ** NSW Option 6 Northern Rivers 223,000 245,000 ** Mid North Coast 205,000 243,000 ** ACT Option 1 ACT PHCO 345551 397200 *** ACT Option 2 Greater ACT PHCO 409815 480460 *** ** ACT Option 3 ACT & Southern NSW PHCO 539216 628487 *** ** *** Victoria Metro Option 1 Metro West 562319 775,695 ** *** Metro North 583230 730490 ** *** Metro North East 461200 571760 ** *** Metro Inner East 608523 655699 *** Metro Outer East 405171 429999 *** Metro South East 437889 616756 ** *** Bayside 515032 561983 *** Peninsula 319667 363136 ** ** Victoria Metro Option 2 Metro Inner East 443130 462042 *** Bayside & Inner East 680425 740742 *** Peninsula & South East 757556 979892 ** *** ** Victoria Metro Option 3 Metro East 848301 892042 *** * Victoria Rural Option 1 Gippsland 255381 291693 ** *** Barwon South 365696 422754 ** ** * Grampians 220160 249909 ** * ** Loddon Mallee & South West NSW 342337 385048 ** * ** ** Hume plus South West NSW 342069 389180 ** * ** ** Victoria Rural Option 2 Loddon & South West NSW 234708 277199 ** ** ** Lower Murray 136186 135673 * ** ** Victoria Rural Option 3 Barwon 260987 311169 ** ** * Otway Limestone 150687 158576 * *** ** Service Delivery Environment/s PHCO by Option and State/Territory 2008 ERP 2021 Established Urban Urban/rural Rural Stable Rural & Cross urban growth region growth rural remote border
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Queensland Option 1 Far North 262095 299285 *** North & West 434324 565923 *** ** ** Capricornia 214753 271651 ** ** South West 283342 343669 ** ** ** Sunshine Coast-Wide Bay 590769 765681 *** ** ** Gold Coast 563311 768047 *** ** North Brisbane 827436 1002151 *** *** South East Brisbane 652621 818192 *** *** South Brisbane/Ipswich 530727 727563 ** *** * Queensland Option 2 North Brisbane 470727 537996 *** ** Redcliffe/Caboolture 356709 464155 ** *** Queensland Option 3 South West 508759 725720 *** ** ** ** North Brisbane 827436 1002151 *** *** South Brisbane 957931 1163149 ** *** Queensland Option 4 North Brisbane 470727 537996 *** ** Redcliffe/Caboolture 356709 464155 ** *** South Brisbane 989100 1169982 ** *** South Australia Option 1 North Adelaide 266949 299961 *** ** Central Adelaide 652900 669594 *** ** South Adelaide 386341 419385 ** *** Rural South Australia 294808 299375 * ** *** South Australia Option 2 Central Adelaide 591006 601877 *** South Adelaide 448235 453987 ** ** South Australia Option 3 Riverland Cross Border 28689 27956 ** * *** Anangu Pitjantjatjara (AC) to NT 2363 2363 *** *** South Australia Option 4 Rural North 159420 163575 * ** *** Rural South 102176 103524 * ** *** South Australia Option 5 Country South Australia 220273 224561 * *** *** Otway Limestone 150687 158576 * ** *** Riverland to Victoria 28689 27956 ** * *** Anangu Pitjantjatjara (AC) to NT 2363 2363 *** ***
Service Delivery Environment/s
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PHCO by Option and State/Territory 2008 ERP 2021 Established Urban Urban/rural Rural Stable Rural & Cross urban growth region growth rural remote border Western Australia Option 1 Metropolitan North PHCO 902033 1029300 ** *** Metropolitan South PHCO 783214 946700 ** *** Rural North East 202296 240070 ** ** *** Rural South West 283654 313670 *** ** ** Western Australia Option 2 Central Metropolitan Perth PHCO 431461 487100 *** * Northern Metropolitan Perth PHCO 470572 542200 ** *** Fremantle PHCO 218707 251500 *** ** Southern Metropolitan Perth PHCO 564507 695200 ** *** Ngaanyatjarraku (S) to NT 1551 3500 *** *** Western Australia Option 3 Central Metropolitan Perth PHCO 672675 738100 *** ** Northern Metropolitan Perth PHCO 470572 542200 ** *** Southern Metropolitan Perth PHCO 554200 695700 ** *** Tasmania Primary Health Care Tasmania 497529 537247 ** ** ** * Northern Territory Northern Territory PHCO 219818 266700 ** ** *** Ngaanyatjarraku (S) 1551 3500 *** *** Anangu Pitjantjatjara (AC) 2363 2363 *** ***
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