Origins of the MDMC Regional Project
The MDC regional project’s origins go back to a “Request For Offer” issued by the Community Services Unit, Health Services Purchasing and Logistics Branch, on account of Queensland Health [OFFER NO CSU2010/11.013], which closed at 11.00am on Wednesday, 9th February 2011.
The “Request For Offer” emanated from the Indigenous Health National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes of the Council Of Australian Governments (COAG). Under the Indigenous Health NPA, the Queensland Government’s co-contribution is $162.2 million over four years from July 2009.
Specifically, under the Indigenous Health NPA, the State and the Commonwealth Governments committed to complementary action around chronic disease. The Multi-Disciplinary Models of Care (MDMC) “Request for Offer” was a significant part of the Queensland Government’s state-wide contribution; a similar but separate contribution from the Commonwealth Government was the “Complementary Care and Supplementary Services” Program (CCSS). Both MDMC and CCSS initiatives offered multi-year funding.
Queensland Health funding of approximately $8.5 million over three years (2010 – 2011 to 2012 – 2013) was committed under the ‘primary health care services that can deliver’ priority for multi-disciplinary models of care that encompass allied health and medical specialist clinical services to treat Aboriginal and Torres Strait Islander people with complex chronic disease conditions, specifically for the early intervention, treatment and management of cardiovascular diseases, diabetes and respiratory diseases.
The “Request For Offer” specified six eligible regions, two of which were Central Queensland and Wide Bay, and stated that preference will be given to:
- Community Controlled Health Services located in the specified geographical locations;
- Established regional consortia with a membership that reflects local Community Controlled Health Services, where one exists;
- Other health service providers working in partnership with Community Controlled Health Services, where the Community Controlled Health Service has the capacity and is identified as the lead partner; and
- Proposals that can demonstrate integration with existing COAG investments related to improving primary health services for Aboriginal and Torres Strait Islander people with complex chronic diseases.
- The “Request For Offer” identified the following five types of multi-disciplinary models of care which would be considered by Queensland Health for funding:
- strategies or activities that provide new or expanded use of allied health professionals, medical specialists, and community based Indigenous health workers to deliver coordinated care for Aboriginal and Torres Strait Islander people with chronic disease conditions;
- programs tailored for specific Aboriginal and Torres Strait Islander communities or hard -to- reach populations that experience difficulty in accessing appropriate health services for chronic disease conditions;
- enhancement of existing programs, medical equipment and workforce resources to better address the needs of Aboriginal and Torres Strait Islander people with chronic disease conditions;
- brokerage services; where services can be drawn from community, acute care settings, private or public sectors to ensure that services can be sourced that reflect the patients’ chronic disease management and treatment needs; and
- services that are either co-located or virtually networked from a range of disciplines for the early intervention, management and treatment of complex, chronic disease conditions and improving health outcomes ( e.g. a hub and spoke outreach model).
Application Process and Initial Funding
The timing of the “Request For Offer” coincided with a consultation process about the formation of a regional organization amongst four Aboriginal and Islander Community Controlled Health Services (AICCHS) located in the Central Highlands and in Wide Bay, led by Nhulundhu Wooribah Indigenous Health Organization Inc.
Nhulundhu Wooribah assembled a consortium of seven partner organizations:
- The four AICCHSs who wanted to establish CQ RAICCHO;
- Queensland Health (because the Hospitals managed by Queensland Health at Eidsvold and at Childers were key facilities where General Practitioners associated with the consortium had formal medical practice positions); and
- “GP Links”, the trading name of the Wide Bay Division of General Practice – which subsequently became the core of the Medicare Local Wide Bay (MLWB) under nation-wide reforms to the health system introduced under the first Rudd Government.
As lead partner, Nhulundhu Wooribah coordinated a team of people to pull together the contents required to complete the detailed “Request For Offer” application, including a manager from MLWB. The drafting team, supported by senior managers in QAIHC, IUIH, and GP Links, met initially on 28th January 2011 at QAIHC and then on 1st February 2011 at Galangoor Duwalami. A decision was taken to submit a response that embraced two of the specified regions, Central Highlands and Wide Bay, because a successful application for these two regions would mean that the MDMC regional project would cover off the geographies intended for CQ RAICCHO. Other crucial decisions were taken and signed off, including the decision to propose six local chronic disease models of care which would respond to all of the five types referred to in the “Request For Offer”. This approach would ensure that all the partners would be involved and that service location ‘gaps’ could be ‘filled’. The focus and geographic scope of each of the six models was agreed and documented. Decisions were also taken regarding governance of the regional project and its management roll-out within the service delivery providers of the consortium partners. Accountabilities were assigned to specific individuals in the consortium partners for follow-up actions.
The application sought funding for the position of “Regional Strategy Manager”, which was for a full-time coordinator of the MDC regional project. A detailed budget allocated dollar costs for each medical/health position linked to the six models of care, across the three years of the regional project.
Queensland Health extended the deadline for lodgement of responses to April 2011. The application from the consortium was successful.
By late-April 2012, the regional organization development process which had been encouraged by the existence of the MDMC-CQWB regional project, resulted in commitments by the four AICCHSs’ participating in the MDMC regional project to incorporate the “Central Queensland Regional Aboriginal and Islander Community Controlled Health Organisation” (CQ RAICCHO) under the Corporations Act 2001 (Cth). These commitments took the form of each of the Boards adopting a standard resolution. ASIC had issued a certificate of incorporation on 1st March 2012.
In late 2012, IUIH Ltd, as one of the supportive and advisory organizations involved in the development of the MDMC regional project, as well as in the formation on CQ RAICCHO, approached Queensland Health to explore options for taking over the lead agency role for the MDMC regional project. IUIH Ltd would control and manage the MDMC-CQWB Project funds and furnish all required financial reports and acquittal statements to Queensland Health at the same time as managing, supporting, and guiding the CEO of CQ RAICCHO who would have operational responsibility for implementing the deliverables in the six locations for the MDMC-CQWB Project, under a Memorandum of Agreement between the Board of IUIH and the Board of CQ RAICCHO.
Queensland Health eventually agreed to the revised proposal, with IUIH to be the funds holder. The Contract offered by Queensland Health to IUIH Ltd specifically approved the involvement of CQ RAICCHO in the MDMC regional project, more or less as had been envisaged back in January/February 2011 when IUIH Ltd, QAIHC and the four AICCHSs came together to develop a consortium application.
“The Institute for Urban Indigenous Health will administer a brokerage arrangement with the Central Queensland Regional Aboriginal and Islander Community Controlled Health Organisation [CQ RAICCHO] in order to manage and support the functions of building corporate capacity, facilitating health service integration, improving patient care and health service delivery, undertaking workforce development and supporting regional planning.
“CQ RAICCHO will have operational responsibility for implementing the MDMC-CQWB Regional Project deliverables in the six locations of Bundaberg, Hervey Bay/Maryborough, Central Highlands, Childers and surrounds, North Burnett and Gladstone / Calliope.”
The Six Chronic Disease Models
The following summary descriptions of the six models of care have been extracted from the project application lodged for MDMC covering Central Queensland/Wide Bay.
Geographical Location No. 1: Galangoor Duwalami Health Service – Hervey Bay/Maryborough
Aboriginal and Torres Strait Islander persons (approximately 870) in the Maryborough community was the first focus area proposed by the consortium. The Galangoor Duwalami Health Service in nearby Hervey Bay would be the auspicing service provider in a ‘hub and spoke’ arrangement with support from GP Links Wide Bay. GP Links was to enter in to co-location arrangements of its staff at Galangoor Duwalami, specifically to provide an Indigenous Outreach, Healthy Lifestyle and Tobacco action presence at the Hervey Bay Clinic, utilising staff from the Hervey Bay Closing the Gap team. Funds were also be used from the Supplementary Services component of Closing the Gap funding received through GPQ to access allied health and specialist services to complete the multi-disciplinary model.
To fully establish Galangoor Duwalami and also to provide an appropriate level of services to Maryborough’s Aboriginal and Torres Strait Islander clients, the consortium identified a need for short term supplementary seed funding of $50,000 to facilitate the appointment of a Medical Officer to work in both locations. The GP would use MBS income to top-up her/his salary. Funding was sought to employ a full-time Registered Nurse/Care Coordinator. In addition, it was proposed that a Manager position be created and funded to oversight and coordinate operations and expansion of services across the Hervey Bay and Maryborough sites.
Geographical Location No. 2: Bundaberg I.H.N.P. identified General Practice
The consortium acknowledged that the establishment of an AICCHS in Bundaberg might eventuate in the long term, but meanwhile it saw a real and immediate need to establish a culturally appropriate location that can offer a multi-disciplinary model of care in the short to medium term, to close the gap for Aboriginal and Torres Strait Islander patients.
There were at the time five (5) General Practices in Bundaberg that have enlisted in the Practices Incentives Program (PIP) Indigenous Health Incentive (IHI) program. Of these five Practices, GP Links and Nhulundu Wooribah identified one which could be enhanced to better address the needs of Aboriginal and Torres Strait Islander people with chronic disease in Bundaberg.
The consortium believed that the Practice could be significantly enhanced by the addition of three additional personnel – a Registered Nurse, an Aboriginal Health Worker and a Medical Receptionist. The AHW would assist with appointments, communication, transportation, compliance with medication regimes etc. It was also proposed that brokerage services be used to engage allied health and other specialised services to meet ATSI chronic disease needs.
Geographical Location No. 3: (GPARIA Category C) Barambah Regional Medical Service – Eidsvold, Mundubbera and Monto
At Eidsvold, in the North Burnett, Dr Brad Murphy, a medical officer of Aboriginal and Torres Strait Islander descent, operated a General Practice and was the appointed Medical Superintendent of the 14 bed public hospital under arrangements with Queensland Health. His Practice (Eidsvold Medical Centre) provided culturally appropriate and welcoming services to the Aboriginal and Torres Strait Islander population. The Practice was accredited, bulk-billing, well run and maintained, and was familiar with processes and management of chronic diseases such as diabetes, respiratory and coronary heart diseases, having recently completed Wave 4 of the Australian Primary Care Collaboratives. The Practice was currently staffed by the GP and a Practice Manager. Previous attempts to recruit a second General Practitioner and to recruit/retain a Practice Nurse had not been successful.
The consortium proposed the employment of a full-time Chronic Disease Registered Nurse who would work full time with Dr Brad Murphy at the three locations, as well as the employment of a General Practitioner to work at Dr Murphy’s Eidsvold clinic full time. The MDMC regional project requested a contribution of $100,000.00 for this GP, who would use MBS income to top-up her/his salary.
The GP and RN were to be employed by Barambah and posted to Eidsvold and would, in operational terms, implement a work plan developed with Dr Brad Murphy in consultation with the Barambah CEO and professionally supervised by Dr Murphy. This innovative model reflected the practical realities of enhancing primary health care service delivery into these communities by taking advantage of the unique opportunity for Barambah that was presented by having Dr Murphy as a local partner.
Geographical Location No. 4: (GPARIA Categories B and C) Childers and rural/remote locations
It was proposed that Dr Tim Lloyd-Morgan of the Isis Medical Centre in Childers work in conjunction with GP Links and other key players as the local coordinator of the MDMC project’s local model of care. Dr Lloyd-Morgan also held appointments with Queensland Health as the Medical Superintendent of the Childers Hospital and Regional Medical Officer for the area. He was therefore ideally placed to identify gaps in the system in terms of chronic disease management in the Aboriginal and Torres Strait Islander community and to assist in the coordination of additional Allied Health and Specialist resources. The application proposed adding a full-time Aboriginal Health Worker based in his Childers Practice.
Geographical Location No. 5: Nhulundu Wooribah Gladstone and surrounding communities
The application proposed that the employment of a full-time Registered Nurse to oversee chronic disease coordination would facilitate the preparation of care plans while the allocation of brokerage funding would enhance access to allied health and medical specialist services and maximise the value of COAG investment in the area.
Outcomes and key performance indicators for this model could include the numbers (and increase in numbers) of Aboriginal and Torres Strait Islander patients and the uptake of the PIP IHI and numbers of occasions of service as indicated by the relevant Medicare item numbers associated with chronic disease conditions and consultations
Geographical Location No. 6: (GPARIA Categories C x 2; D x 4; E x 2) Bidgerdii – remote locations
Aboriginal and Torres Strait Islanders in the remote communities of Capella, Clermont, Dingo, Duaringa, Emerald, Mount Morgan, Rolleston and Springsure were the focus of the sixth geographical location proposed by the consortium. The total Aboriginal and Torres Strait Islander population in these communities was in excess of 1,200 persons.
The focus of this proposal was to establish a multi-disciplinary team comprised of a General Practitioner – for whom the application requested a salary contribution of $100,000.00, to be topped-up from MBS self-generated income – a Registered Nurse (with experience in chronic disease management) and an Indigenous Health Worker/Driver. This team would visit the above-named remote communities to offer Aboriginal and Torres Strait Islander patients a health service focusing on chronic disease and, in particular, diabetes, coronary heart and respiratory diseases. It was proposed that once recruited, the outreach team would use the already converted ‘Winnebago’ owned by Bidgerdii as a mobile clinic to conduct the visiting services.
Operational costs such as staff recruitment and orientation, fuel, servicing, travel, accommodation, medical supplies and medical sundries, computers, communications etc were itemised as part of the application. The consortium foreshadowed a need for an allocation of funding to cover travel and accommodation costs for Aboriginal and Torres Strait Islander people to access specialist and allied health services not readily available in remote locations and not allowed for in existing MSOAP budget provisions.
In July 2013, CQ RAICCHO published a comprehensive “Business Case for the Implementation of the Indigenous Health Strategy in Central Queensland”, which for the first time pulled together available demographic, epidemiological and health service data and information.
The “Business Case” generated:
- 38 Community Profiles by SLA.
- Population, age and gender distribution Tables
- SEIFA Index by LGA
- Current access patterns by Service
- Use of key MBS Items by Service
CQ RAICCHO has used the analysis of this data to generate Closing the Gap performance targets for Member Services, including with input from the MDMC Regional Project. The Table below provides a broad overview of Aboriginal and Torres Strait Islander population distribution throughout the MDMC Region.
Table: Indigenous Population Data by Local Government Area
|Local government Area(LGA)||Indigenous Population||% of Total IndigenousPopulation in CQ|