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

Appendix 2.e - Karratha & Roebourne, Western Australia

Page last updated: 28 February 2012

Region

Karratha and Roebourne are located in the Pilbara region of Western Australia. The whole Pilbara region is 507,869 square km (including offshore islands), and extends from the Indian ocean across the Great Sandy Desert to the Northern Territory border. The estimated resident population of the Pilbara was 47,528 in 2009 (2.1% of the Western Australia population).

There has been significant growth in the resident population in the Pilbara over the last decade (2.4% per annum), which is accelerating. The Western Australia Planning Commission and Department of Planning have projected the resident population will grow to 140,000 by 2035 Western Australia Planning Commission and Department of Planning (2011). Pilbara Planning and Infrastructure Framework..
In addition to the resident population, the Pilbara also hosts a very significant non-residential population principally made up of a fly-in fly-out workforce in mining and construction. This workforce was estimated to be around 15,000 in 2010 and is projected to grow to around 34,000 by 2020.
As at the 2006 Census there were an estimated 5,632 Aboriginal people living in the Pilbara, making up 24% of the Pilbara population and 10.5% of Western Australia’s Indigenous population.
The main towns in the Pilbara are Port Hedland/South Hedland, Karratha, Roebourne, Wickham, Dampier, Onslow, Pannawonica,Tom Price, Paraburdoo and Newman. Port Hedland/ South Hedland form the largest population centre in the region (resident population around 11,957 in 2006) followed by Karratha (resident population around 11,728 in 2006). In the state government’s Pilbara Cities strategy, Port Hedland and Karratha are identified as being developed into cities of 50,000 by 2035.
For health services, Port Hedland is identified as a regional resource centre for the Pilbara. Karratha is 242 km from Port Hedland and 1,542 km by road from Perth. Karratha is well services by regular commercial flights to Perth.
Karratha, Roebourne, Wickham and Dampier are located in Roebourne shire/SLA, the largest shire in the Pilbara region. The estimated resident population of the SLA was 16,423 at the 2006 Census with 1,831 Aboriginal people (around 11% of the population (see Table 17). The estimated resident population the SLA in 2010 has grown to 19,143 (ABS 2011b), growth of around 2.5% per year.
Road distances from Karratha to other towns in the Roebourne SLA are 21 km for Dampier, 39 km for Roebourne and 50 km for Wickham. Towns in the Ashburton SLA are closer to Karratha than Port Hedland so to some extent Karratha services these areas as well including Onslow (311 km from Karratha) and Pannawonica (200 km).
Karratha is a catchment for the towns in the west Pilbara. However there are extremely limited public transport options into Karratha from its catchment. Transport is usually by private means or through a limited patient transport scheme (for health services).
Table 17 – Regional population statistics (2006)

Township/ location ARIA+
(GISCA 2010)
Remoteness Area SEIFA
(ABS 2008)
Resident Population
(ABS 2011a)
ATSI Population
(ABS 2011a)
% ATSI
Karratha (Urban Centre/Locality) 9.000 RA4-Remote 846 11,728 742 6%
Roebourne (Urban Centre/Locality) 9.619 RA4-Remote 631 857 524 61%
Wickham (Urban Centre/Locality)       1,825 288 16%
Dampier (Urban Centre/Locality)       1,370 29 2%
Balance of Roebourne SLA       643 248 39%
Total Roebourne  SLA     1,033 16,423 1,831 11%
Ashburton SLA       6,078 585 10%
Port Hedland SLA       11,957 1,785 15%
East Pilbara SLA       6,543 1,429 22%
Total Pilbara region       41,001 5,632 14%


Pilbara and other regions of Western Australia
Figure 9 – Pilbara and other regions of Western Australia

Source: Small Business Development Corporation 2011


Map showing Karratha and Roebourne
Figure 10 – Towns in the Pilbara region

Source: Google Maps

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Both Karratha and Roebourne have relatively young populations, although for different reasons. In the 2006 Census 26.4% of the population usually resident in Karratha Urban Centre/Locality were children aged between 0-14 years, and 6.8% were people aged 55 years and over. The median age of people in Karratha was 30 years, compared with 37 years for people in Australia. Aboriginal people make up around 6% of the Karratha population.

In 2006, 25.0% of Roebourne’s resident population were children aged between 0-14 years, and 18.0% were people aged 55 years and over, with a median age of 32 years. Aboriginal people make up 61% of the Roebourne population.

Health service organisation

State health services are provided in the Pilbara from the Pilbara regional office of Western Australia Country Health Services (WACHS). The management of the health service is based in Port Hedland. The main hospitals in the Pilbara are located in Port Hedland and Karratha (Nichol Bay Hospital). Population health (community and allied health), mental health and community-based aged care services also operate from these centres. Smaller hospitals are located at Onslow, Newman, Tom Price, Paraburdoo and Roebourne. A former hospital at Wickham has been converted into a health centre incorporating an accident and emergency service.

There are remote area nursing posts in some of the smaller communities, including Marble Bar and Nullagine. Public health services are based in Port Hedland. There is also a renal dialysis satellite service in Port Hedland, although patients on home dialysis modalities are scattered across the Pilbara. Dental services are predominantly publicly provided by private dentists operating in Port Hedland, Karratha and Tom Price.

There are three main Aboriginal Community Controlled Aboriginal Health Services across the region, including Mawarnkarra Health Service (Roebourne), Wirraka Maya Aboriginal Health Service (which provides a service to the greater Port Hedland and South Hedland area and communities at Strelley, Woodstock and Warralong) and the Puntukurnu AMS (which service remote populations in the east of the Pilbara).

The Pilbara Health Network (PHN) (the Pilbara Division of General Practice) works with GPs and other primary health care providers across the whole Pilbara region. In addition to support to GPs, the PHN delivers primary health care services in its own right, including audiology, podiatry, diabetes education, dietetics, primary mental health, chronic disease management and a number of preventative health programs. The network supports 10 medical centres, six hospitals, three AMSs and a number of outlying nursing posts. The PHN is planning to publish on its web site a “Pilbara Outpatient Specialist List”, to provide a guide to the local community and health care providers on visiting services.

The Medicare Local planned for the region will include both the Pilbara and Kimberly regions.

The Royal Flying Doctor Service provides service out of Port Hedland, including emergency transfers to from Pilbara locations to the Hedland Health Campus, inter hospital transfers to Perth, ‘RFDS On the Road’ clinics, health checks and health information and primary Health clinics to some of the more remote Pilbara regions.

There are several residential and home based aged care providers in the region.

General Practice and primary care in Karratha and Roebourne

There are three private GP practices operating in Karratha, with 13 GPs (mostly part time). There is a plan for a GP Super Clinic in Karratha. A community health service is available in Karratha.

In Roebourne, Mawarnkarra Health Service offers a range of primary care services. Mawarnkarra provides services for Aboriginal people living in Roebourne, Karratha and Wickham. It is the only GP service available in Roebourne. It is staffed by four part time GPs, who provide the service on a locum basis, and two GP registrars. The service has a range of community nursing, Aboriginal health workers and other staff. The service has an Aboriginal ear health coordinator but no eye health coordinator. A range of visiting specialist services are also provided out of Mawarnkarra (see below).

There are some limited community health services provided out of the hospital at Roebourne.

Another private GP practice operates out of Wickham which is nearby. Accident and emergency services are available in Karratha and Wickham.
Photo of Mawarnkarra Health Service
Figure 11 – Mawarnkarra Health ServiceTop of page

Hospital services

Nichol Bay hospital (Karratha) is a 41 bed facility which reports slightly over 3,000 hospital admissions a year, of which 45% are same day admissions. The hospital has an emergency department, provides emergency and elective surgery, midwifery and a range of allied health services including physiotherapy, occupational therapy, social worker, mental health, speech therapy, radiology and gynaecology. The hospital is staffed by doctors, but there are no specialists permanently based at the hospital. Port Hedland has resident specialists on staff (general physician, obstetrics and gynaecology, anaesthetist and paediatrician) who also regularly visit Nichol Bay. Around 27 individual medical specialists visit the hospital regularly (see next section). Nichol Bay can provide minor surgery, but major surgery is referred to Port Hedland or Perth.

Roebourne is a much smaller hospital providing around 300 hospital admission a year of which 27% are same day. There are no doctors working at the hospital. Medical support is provided by Nichol Bay hospital. Roebourne hospital provides a step down service related to Nichol Bay hospital. There are no specialists doctors who visit the hospital.
Table 18 – Characteristics of Nichol Bay and Roebourne hospitals, 2009-10
  Nichol Bay hospital Roebourne hospital
Same day admissions Overnight admissions Same day admissions Overnight admissions
Admissions 2009-10:        
Childbirth <10 163 0 0
Medical (emergency) 493 1523 43 207
Medical (other) 391 71 20 26
Specialist mental health 0 0 0 0
Surgical (emergency) 16 70 0 <10
Surgical (other) 439 72 0 <10
Total 1,339 1,899 63 233
Services available:    
Beds
41
<50
Elective Surgery:
Yes
No
Emergency Department
Yes
Yes
Obstetrics
Yes
No
Paediatrics
Yes
No



Visiting services – Nichol Bay Hospital

A broad range of specialists visit Nichol Bay, supported by either WACHS or MSOAP (see Table 19). A general physician, obstetrician and gynaecologist, anaesthetist and paediatrician visit from Port Hedland, but other visiting specialists are from Perth. MSOAP-ICD is supporting a range of visiting allied health services.

Table 19 – MSOAP services to Karratha and Roebourne
Program Specialty No. of visits No. patients No. of ATSI patients
Karratha
MSOAP Ophthalmology – General 2 0 0
MSOAP Paediatrics – General 12 0 0
MSOAP Paediatrics – General 8 76 18
MSOAP Physician – General 10 22 2
MSOAP Physician – Nephrology 4 37 12
MSOAP Physician – Palliative 4 2 0
MSOAP Surgery – Orthopaedic (two separate surgeons) 22 364 14
MSOAP Surgery – Urology 4 20 2
MSOAP-ICD Physician – Endocrinology (Diab) 4 * *
MSOAP-ICD Allied Health – Diabetes Educator 4 * *
MSOAP-ICD Allied Health – Dietician 4 * *
MSOAP-ICD Allied Health – Podiatrist 4 * *
WACHS Physician – Cardiologist 6 NA NA
WACHS Paediatric Cardiologist + Echo Technician + Nurse 4 NA NA
WACHS Physician – Respiratory 2 NA NA
WACHS Physician – Gastroenterology 4 NA NA
WACHS Dermatologist 4 NA NA
WACHS Surgery – General Surgeon 21 NA NA
WACHS Surgery – Plastic Surgeon 4 NA NA
Roebourne
MSOAP Ophthalmology – General 38 24 2
MSOAP Paediatrics – General 36 14 8
MSOAP Physician – Palliative 2 2 2
MSOAP-ICD Allied Health – Cardiac Ultrasonographer 4    
MSOAP-ICD Nurse - Chronic Disease 2    
MSOAP-ICD Allied Health – Podiatrist 2    
MSOAP-ICD Physician – Cardiology 2    
MSOAP-ICD Administration – Service 10    

Notes: This list is based on information provided during consultations and may not be complete or accurate


Where services are supported by WACHS the costs of travel and accommodation are paid for by the Pilbara Regional Office of WACHS. Where the specialist is employed by WACHS (at Port Hedland) the costs of salary will also be provided by the Pilbara Regional Office of WACHS.

For MSOAP visiting services the Pilbara Regional Office of WACHS is the organisation that is the ‘sub-contractor’. Proposals are usually developed by the Pilbara Regional Office and submitted to the WA fundholder (Rural Health West). The MSOAP contract is usually between WACHS Pilbara Regional Office and Rural Health West. Pilbara Regional Office then makes arrangements directly with visiting specialists and allied health staff.

The Medical Specialist Services Officer at the Pilbara Regional Office of WACHS (at Port Hedland) coordinates all visiting services including those funded under MSOAP and WACHS. Prior to the beginning of the calendar year, the Office coordinates dates with visiting specialists for the region, putting these into a larger calendar. Details of visiting services and scheduled dates are forwarded to hospitals, GPs, health centres across the Pilbara. The Officer books and pays for airfares for all visiting services and other aspects of accommodation.

There is additional coordination that occurs at Karratha. A position at Nichol Bay Hospital is responsible for organising accommodation and local transport. Typically a car is hired for visiting specialists and is available when the specialist arrives. Otherwise transport needs to be provided. Specialists may be accommodated in a property managed for this purpose or in commercial accommodation. Commercial accommodation is undersupplied and booking are required three to four months in advance. The Pilbara West section manages approximately 270 properties for local and visiting staff.

The hospital runs around 80 clinics a month with 2.5 outpatient clinic rooms. There is extremely high demand on space and visiting specialists are demanding more room. Some visiting services are inpatient based (e.g. cataract surgery). Some specialists will bring a nurse who will undertake a range of processes related to the consultation. Some clinics require more than one room. Some visiting services require surgical facilities and this will often have a significant impact on the hospital.

For Karratha and its catchment areas, GP referrals are made to Nichol Bay hospital. There are around three staff who manage outpatient clinics and appointments. When a referral is received the patient will be triaged and assigned to a clinic appointment. In some instances the visiting doctor will be consulted and the patients triaged. In others, hospital staff will triage the patient. Patient details will be recorded in a spreadsheet used to manage the outpatient clinic appointments (these are manually entered). Patients will be advised on when the clinic will occur by letter. There is no additional reminder system. The nature of the community creates issues (e.g. high mobility of the workforce and regular movements of address). A current project is looking to create better systems (e.g. SMS reminders).

There are very limited public transport options for patients from the catchment to travel to Karratha. The Pilbara Office of WACHS and Aboriginal health services will assist with these issues. An example was given of Aboriginal patients needing to attend a clinic from Onslow. The process involved admitting the patients to Onslow the night before the clinic, using a transport truck to take the patients from Onslow at 4:00 am arriving at Karratha at 7:30 am, undergoing the procedure/consultation, and then the truck taking patients back to Onslow in the late afternoon/evening. Mawarnkarra Health Service offers a transport service to get patients in the Roebourne, Wickham and Karratha areas to specialist clinics at Nichol Bay.

Prior to the clinic the staff will retrieve the medical records. As patients attend they will be crossed off the spreadsheet list. Hospital staff make a note in the record about the visit and also record this in the patient administration system. An occasion of service is recorded on the local patient administration system. Recording of the number of clinic ‘sessions’ is manual. Indigenous status of patients is retrieved from the patient record. Statistics are reported by hospital staff to the Medical Specialist Services Officer who consolidates these and reports them to the Rural Health West.

Some doctors bring their own patient records. Some make notes and leave a copy at Nichol Bay, some prepare a letter locally and a copy is placed directly on the patient charts, and some provide letters after the visit.

For any one clinic there are large numbers of patients who do not attend (estimated at 50%). The issues for Nichol Bay include unwillingness to take time off work (e.g. for people working in the mining industry), high mobility of the local population with household members employed in the mining industry (including regular trips out of the region and frequent changes of address), and difficulties in getting to Karratha (for patients living in the west Pilbara).

No facility fees are charged for visiting specialists. Visiting specialists display a range of different attitudes towards billing patients, and it was reported these attitudes are changing towards a more commercial orientation. In one case, the specialist charges all patients a gap fee, which has meant Aboriginal people are very unlikely to see the specialist, despite the specialty being in an area of very high need. The administrative steps associated with billing are undertaken by the specialist and administrative staff are not supposed to be involved. However, some specialists want staff to provide assistance on billing issues.

There is a Patient Assisted Travel Scheme (PATS) officer at Nichol Bay Hospital. The scheme is principally used to assist patients to travel out of the region (to Perth), rather than assist patients within the Pilbara to get to Nichol Bay hospital.

Visiting services – Mawarnkarra Health Service

Top of pageA range of visiting specialists provide services at Mawarnkarra Health Service (see Table 19) including an obstetrician, cardiologist, paediatrician, and ophthalmologist. WACHS employs dentists who also visit from Port Hedland. Visiting allied health services are from the Pilbara Health Network (podiatrist, audiologist, dietitian and diabetes educator). An optometry service is offered by an optometrist who provides outreach services to the Kimberly and Pilbara regions.

Referral to the visiting specialists are made by GPs. Referrals will be entered in to the electronic system. GPs will be consulted in terms of triaging patients. Appointment cards are sent to patients prior to visit, a transport service is provided on the day, and patients are chased up where they don’t attend. There is a dedicated driver for Karratha.

It was reported that visiting specialists at Mawarnkarra Health Service get very high attendance because of the efforts in coordinate the visiting services.

There are pressures on space in the facility, particularly when some teams are visiting. For example, the cardiology team requires three rooms when they attend. There are plans to expand the facility to address some of the space issues.

Mawarnkarra Health Service uses CommuniCare (an electronic medical record and patient management system) . All matters are recorded electronically there are no paper medical records kept. All follow up letters from visiting specialists are scanned into CommuniCare. Some visiting specialist enter notes directly into the system. CommuniCare records care plans and has a recall system for identifying patients requiring follow-up.

Optometry

A number of private optometrists operate in Karratha. As mentioned above, an outreach optometry service is offered.

Benefits of MSOAP services

All informants thought that almost all visiting services supported under MSOAP were needed, and that the program was extremely important. It was generally considered unrealistic to have a significant expansion of local specialist staff resident in Karratha, due to cost and other factors. Existing visiting services into the Aboriginal health service were considered to be working very well.

Outreach services into Nichol Bay hospital were all needed, but there were significant pressures in the facility due to the numbers of visiting services, pressures on space in the facility and staff supporting the services and accommodation for visiting service providers in the community. Coordination issues are still a major challenge.

An example of the positive impact of visiting services was given in relation to ophthalmic surgery. Previously procedures were only provided in Port Hedland. This entailed a three day trip for patients from West Pilbara, which was logistically difficult and very expensive. The recently established IRIS model for delivery of services in Karratha and Roebourne was considered a vast improvement. The IRIS team does not charge patients, brings a team of staff and their own equipment (although Nichol Bay is looking to acquire required equipment in the future).

Upskilling of local GPs and health providers was considered an important benefit, but this varies across the visiting specialists. There are more limited opportunities in Nichol Bay due to the nature and location of the services relative to general practices in the town.

Assessment of need

Local informants felt that historically there had been limited opportunities for having input into decision making on priorities for visiting services. Despite some specific issues, there was a sense that this was changing, particularly with the implementation of MSOAP-ICD.

An important local development has been the establishment of a Regional Aboriginal health forum for the Pilbara. The forum involves, from the Pilbara, the three Aboriginal health services, the Pilbara Women’s Aboriginal Corporation, Pilbara Health Network, the Pilbara Regional Office of WACHS and the local RFDS base, and from the state level: the Aboriginal Health Council of Western Australia, OATSIH and WAHCS. The forum has been operational for around three years and is supported by a statewide technical group.

The approach to the forum has been to consider all resources related to particular issues, identify priorities, develop jointly supported proposals in terms of new services, and monitor the effectiveness of new services.

The forum should consider all proposals for MSOAP services. One concern was raised about a particular outreach service that was proposed, but was not supported by the Regional Aboriginal health forum. However, it appeared the proposal was still pursued.

One view was that a similar approach was required in relation to health services generally for all people in the Pilbara, but this was not currently in place.

Priority areas for improved outreach services identified by informants included:
    • renal and associated specialties
    • cardiology
    • ENT
    • expanded diabetes education (there are two diabetes educators for the whole Pilbara)
    • other chronic disease
    • dentistry (whole communities haven’t seen a dentist for 12 months).
    • allied health.
Several informants suggested there were still significant gaps in visiting services with demand exceeding supply in some key areas (e.g. ophthalmology).

Areas for improvement

It was recognised there was a need to organise clinics well in advance. One factor is that there is a three to four month waiting time for accommodation for visiting staff. Over the last eight months local coordination had improved with only a limited number of ‘stuff ups’. It was felt there was a disconnect between the process through which funding was approved and the need to plan services well in advance.

It was felt communication from the state level to operational level was not always good. In the past decisions had been made without adequate consultation with the hospital; with the hospital not being informed early enough about decisions. It was felt decisions were more supply driven rather than need driven, with a relative ad hoc approach to planning.

All informants recognised the need for good local coordination, and the need for more support of these roles. Coordination between visiting specialists can sometimes be poor from a patient’s perspective. An example was given in which one patient was booked to see four separate visiting specialists in one day.

The Aboriginal health service emphasised the need for visiting services to be closely linked into the primary health care delivery team.

One informant emphasised the need to have joint plans of three years, but to build in evaluation of what has been achieved. Sometimes what appears to be a good idea cannot be implemented in practice and it is always important to test how well services or policies are working.

It was felt that the state MSOAP Advisory Forum needed to move more towards a group that reflects the needs of communities/services receiving outreach services, rather than the outreach services themselves. Program reporting was considered onerous and inefficient.Top of page