Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

Appendix 2.b - Burnie and the north- west region of Tasmania

Page last updated: 28 February 2012

Overview

North-west Tasmania is a large and expansive region covering an area of 22,492 square kms, which is approximately one third of the total area of Tasmania. It is renowned for its unique and diverse environment, including rugged mountainous areas, extensive forests, old mining towns and abundant farm lands. There are just over 100,000 people living in the North West region.


Map showing the location of Burnie, Tasmania.
Figure 4 – Location of Burnie

Burnie is one of the more populated townships in north west Tasmania, and is 302 km to Hobart by car. The Burnie-Somerset urban centre/locality recorded 19,160 people in the 2006 Census, of which 945 (4.9%) identified as Aboriginal and/or Torres Strait Islander (Table 3).

The north west of Tasmania is dispersed; it is comprised of pockets of townships with fair distances between them. For example, there is a two hour drive between Burnie and Queenstown. Most of the population lives along the coast. There are often single roads and no public transport. Therefore, the populations within each of the townships are isolated in many respects.

The north west region has the second highest ageing population in Australia. It has a low socioeconomic status, and has high rates of obesity, diabetes, smoking, teenage pregnancies, heart disease and chronic disease.

Table 3 – Regional population statistics (2006)

Township/ location ARIA+ (GISCA 2010) Remoteness Area SEIFA (ABS 2008) Resident Population (ABS 2011a) ATSI Population (ABS 2011a) % ATSI
Burnie (C) - Pt A (Statistical Local Area)  2.74 RA3-Outer regional 922 16,996 814 4.8
Burnie (C) - Pt B (Statistical Local Area) 3.73 RA3-Outer regional 980 2,056 70 3.4
Somerset 2.74 RA3-Outer regional 901 3,078 143 4.6
Waratah/Wynyard (M) - Pt A (Statistical Local Area) 3.25 RA3-Outer regional 923 10,903 584 5.4

Health service organisation

There are two larger hospitals located in the north west region of Tasmania – North West Regional Hospital and Mersey Community Hospital.  North West Regional Hospital is the third largest hospital in Tasmania Mersey is the fourth largest.Top of page

Table 4 – Profile of local hospitals
Township/location Surgery? No. of beds Same day admits (09-10) Overnight admits (09-10) ED? Care types
Burnie (North West Regional Hospital) Yes 100-200 2,698 5,964 Yes Acute, rehab, sub and non-acute
Latrobe (Mersey Community Hospital) Yes 50-100 4,295 4,200 Yes Acute, rehab, sub and non-acute

The catchment area for these hospitals includes Deloraine, Burnie, Wynyard, Smithton, Rosebery, and Queenstown.

Other hospitals within the north west region are:
      • King Island District Hospital and Health Centre
      • Rosebery Community Hospital
      • Smithton District Hospital
      • West Coast District Hospital at Queenstown.
These are small community hospitals, generally staffed by GPs. In addition, a purpose-built GP clinic has been developed, as well as a ‘health precinct’ in Sheffield, a township outside of Devonport.  It has been funded through Commonwealth funding (which was for the capital component, to refurbish an old school).    The health precinct will provide a variety of services in addition to general practice, the most needed one (according to the community) being obstetrics and gynaecology.

The nearest principal referral hospital to the north west is in Launceston, located approximately 148km by car from Burnie.

Tasmanian Health Organisations (THOs) are the names being given to Local Hospital Networks in Tasmania. North West Regional Hospital, Mersey Community Hospital and the other facilities listed above are in the North West THO.

The division of general practice in which Burnie is located is the North Western Branch Network of the Tasmania Medicare Local.  There are 28 general practices within this Division, with approximately 105 GPs.  Within Burnie and surrounds (i.e. including Wynyard, Sommerset and Penguin) there are approximately five to six practices with about 20-25 GPs.

Local staff reported a generally good relationship between the hospitals and GPs.  For example, the North West Regional Hospital and Acute Services employs a GP liaison officer.  Also both of North West Regional and Mersey Community Hospital work closely with GP North West. Meetings are held regularly between the senior staff at the two hospitals and representatives from GP North West.

Health services in north-west region

The two larger hospitals in the north west region provide a range of medical and surgical services.  They have been established to work together, with the Mersey Community hospital being the elective, high volume, low complexity arm of the network.  A profile of the services delivered by the hospitals in 2009-10 is shown in the Table below.Top of page

Table 5 – North West Regional Hospital and Mersey Hospital admissions 2009-10
Service area North West Regional Hospital Mersey Community Hospital
Same day admissions Overnight admissions Same day admissions Overnight admissions
Childbirth - <10 10 420
Medical (emergency) 259 2,414 266 1,492
Medical (other) 1,429 1,644 2,689 1,634
Surgical (emergency) 38 518 22 121
Surgical (other) 972 1,388 1,308 533

* From MyHospitals website


The North West Regional Hospital has about 160 beds, of which 98 are inpatient beds. Others are for day procedures and mental health.  There are approximately 26,000 attendances to the emergency department annually. This is about the same as Mersey. It has an intensive care unit, and provides the more complex procedures for the region.  Most of the region’s medical/ surgical workforce is in this hospital, and also provides services to the Mersey Hospital. 

The Mersey Hospital has about 90 beds.  It does not have an intensive care unit, only a high dependency unit. As mentioned above, it has been streamlined to deliver less complex procedures for the region, including endoscopy and gastroenterology (although these are also provided at North West Regional Hospital), and ophthalmology and gynaecology. It mainly has career medical officers (CMOs) (except for 0.5 FACEM).

Medical specialities offered within the region include:
      •  general medicine
      •  respiratory
      • endocrinology
      cardiology (but only as a special interest area for a general physician).
Surgical specialties provided within region include:
      • orthopaedics
      • general surgery
      •  obstetrics and gynaecology
      •  gastroenterology.
The frequencies within which various clinics are conducted are in the Table below.

Table 6 – North West Regional Hospital frequency of specialist outpatient clinics
Specialty Frequency of clinics
Diabetes Educator Daily
Dermatology Monthly
Dietetics Twice Weekly
Endocrinology (Paediatrics) 6 Monthly
Endoscopy Weekly
Epilepsy Monthly
Genetics 4-monthly
Haematology Monthly
Medical Weekly
Neurosurgery Rotate on a monthly basis
Oncology Bi-weekly
Orthotics/Prosthetics Daily
Pacemaker Fortnightly
Paediatrics 3 clinics per week
Paediatric Asthma Clinic Monthly
Paediatric Cardiology 3 Monthly
Paediatric CF Clinic 3 Monthly
Paediatric Diabetes Clinic Fortnightly
Paediatric EEG Weekly
Pain Management -
Radiation Oncology Fortnightly
Respiratory Bi-Monthly
Speech Therapy Daily
Stomal Therapy & Breast Care Nurse Daily
General Surgery Various – as frequent as weekly
Orthopaedic Surgery Various – as frequent as twice weekly
Gynaecology Weekly
Jack Jumpers (Nurse Clinic) Weekly
Cardiology (Nurse Clinic) Various, up to 4 times a week
There are waiting lists for many of these clinics.Top of page

Visiting medical specialist services


Visiting medical specialist services to Burnie, supported under MSOAP in 2009-10 are shown in Table 7 below.
Table 7 – Visiting health services – Burnie, 2009-10
Specialty Visits per year No. of patients ATSI Patients
Dermatology 12 116 0
Physician - Endocrinology 12 0 0
Physician - Haematology 12 132 0
Physician - Neurology 12 75 0
Physician - Oncology 48 223 0
Physician - Palliative 26 249 0
Physician - Respiratory 12 128 0
Psychiatry - Forensic 15 8 0
Psychiatry - General 12 97 7
Psychiatry - General 12 62 0
Psychiatry - Geriatric 12 72 0
Note:  This table represents information collected through MSOAP national data and may not capture all visiting services

All these services visit at the North West Regional Hospital or at the private hospital (which is subcontracted by DHHS to provide services to public patients for some specialities); none are to Mersey Community Hospital at the moment.  Visits to Mersey are from Launceston General Hospital, and they include vascular surgery (once a month) and urology (weekly). MSOAP visits to the local private hospital are for obstetrics and midwifery.

Visiting specialists mainly provide outpatient services, but also consult in relation to inpatients. They also provide a consultation liaison role outside of their visits (e.g. the oncologist is accessed regularly outside of their visit).

Most visiting specialists are from within Tasmania, but some also come in from elsewhere, particularly Melbourne.
Organisation of accommodation and travel for some visiting specialists is done by the hospital, and some by the specialists themselves.  For example, specialists from Launceston and Hobart tend to make their own arrangements, while arrangements are usually made locally for the others.
Visits for any year are mapped out at the beginning of the period.

North West Regional Hospital organises its own visits, and Mersey also does its own. For the other district hospitals within the region, this is done by the clinic managers at each site.
North West Regional Hospital is trying to make better use of telemedicine. A paper is currently being prepared around this to be presented at a regional level. There is currently poor use of telemedicine for clinic to clinic services (i.e. patient sitting in a clinic on one end receiving a service directly from a clinician at the other end).

Telemedicine is currently used in a significant way for burns in the region. There are also plans to use it for diagnostics on King Island, and also, for pre-admission for neurology.

In addition to visits to deliver services to patients, the region, through GP North West, has also been successful in obtaining funding for visiting specialists to upskill local GPs. This was in the areas of endocrinology and geriatrics.  The geriatrician has worked with GPs as well as aged care facilities. A comment was made that a targeted approach to upskilling such as this is important, as it is unlikely to occur with specialists trying to deliver this alongside patient care. Also, GPs cannot easily access specialists who deliver services in the hospitals for upskilling purposes.

Organisational factors impacting on visiting specialist services

Attracting medical specialists to work in the north west of Tasmania is an issue.  The populations in many places are small, and do not justify a full time person. Although the region is not remote, the dispersion of the population means that there are rarely opportunities to keep specialists occupied full time.

Another issue impacting on visiting specialists is flight times in and out of the region.  Specialists usually fly into Devonport, which is the closest airport to the region.  The flights from Melbourne do not get in until well into the morning, and leave in the late afternoon, which only provides a short time for specialists flying in and out in the same day to be ‘on the ground’.
Clinic space is also an issue.  North West Regional Hospital has 12 clinics from which visiting specialists operate. There is a lot of pressure on rooms on Tuesdays to Thursdays, as many specialists prefer not to come in on Mondays or Fridays.

Effectiveness of visiting services

MSOAP is vital for Burnie and the north west region because of sparse geography.

Patient numbers should not always be the justification for a service.  In some instances, numbers might be low due to a low population base, but the service is still needed.

In addition, flexibility is required for visiting services within the funding provided.  That is, if one service falls through, local health services should be able to use the funds for another needed service.

Assessment of need and gaps in specialist services

Assessment of need is mainly done through examining the issues for which patients present to emergency departments, and also through GP referrals.  GPs in particular have expressed the need for a geriatric specialist, mainly around dementia management.

Sometimes a community will raise the need for a particular speciality through their local MP. Palliative care is one of the specialities for which need has been expressed in this way. Another is endocrinology, specifically in relation to diabetes.

This need is then discussed locally, and raised with DHHS (as the fundholder) to develop proposals for services.

However, the approach to need was described as non-strategic, especially in relation to competing needs.  That is, it was felt that there was no overall strategic direction on how needs are prioritised.

Palliative care is a need area in Burnie and surrounds, yet this specialty is struggling. This is due to low patient numbers.  The service is provided in people’s homes, and the time taken to do this means that only very low numbers can be accommodated.  Therefore, it is not attractive to specialists financially. Usually there are two palliative care specialists providing services in the area, but currently there is only one practicing.
Other gaps are:
      • neurology (particularly for stroke and degenerative disorders)
      • neurosurgery
      •  ophthalmology (there is currently only one provider in the region, with very high waiting times)
      • rehabilitation (particularly around people with strokes and degenerative disorders)
      • thoracic surgery
      • cardiothoracic surgery (although cardiothoracic/cardiology patients are able to be followed up locally due to local general physician with cardiology skills)
      •  geriatrics and psychogeriatrics
      • paediatric specialities, particularly ophthalmology and psychiatry/psychology (e.g. behavioural issues in children is a big issue; there is a paediatrician locally with an interest in this area, but the waiting list is high)
      • disability services for under 65s is an issue, for example, for people with Huntington’s and other motor neuron diseases
      • pain management (this is only available in Hobart, and the largest difficulty is that some pain management drugs are only available through a script by a pain specialist rather than any other specialist, thereby limiting access to anyone who cannot see the specialist in Hobart).
Eating disorders is a gap for the whole of Tasmania; patients have to travel to the mainland to receive this service. Other services not available within Tasmania, which are not expected due to the low population base, are high end treatments/surgery for cancer, heart problems and brain injury or tumours. These are mostly available through Melbourne.Top of page