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

Appendix 2.f - Leongatha, Victoria

Page last updated: 28 February 2012

Region

Leongatha is a town located in South Gippsland Shire, 135km south-east of Melbourne. The ABS estimated the Statistical Local Area (SLA) to have 12,318 people, 4,818 of whom lived in Leongatha. Leongatha serves as a centre point for education, health and commerce in the region, which includes a population of approximately 25,000 people, coming mostly from the three South Gippsland SLAs (Table 24). Located approximately 15km from Leongatha is Korumburra, a smaller town that has some commercial and medical services available for people in the region.

Table 20 – Regional population statistics (2006)
Township/ location SLA ARIA Remoteness Area SEIFA Population ATSI Pop
Leongatha (state suburb) South Gippsland - Central 1.49 RA2 - Inner regional 996 4,818 20
SLA South Gippsland – Central 1.92 RA2 - Inner regional 964 7,500 27
SLA South Gippsland – East 3.12 RA3 – Outer regional 945 5,637 50
SLA South Gippsland – West 1.42 RA2 - Inner regional 945 7,783 28

Shown principal town then balance of SLA related to that town where appropriate. SEIFA used is index of relative disadvantage.


Health service organisation
Leongatha is served by one hospital and one health centre and is located in the Department of Health, Victoria Gippsland DHS region (Figure 12). The nearest major regional Hospital is located in Traralgon, approximately 73km from Leongatha.

Figure 12 – Gippsland DHS region

Map of the South Gippsland Division of General Practice

General practice

Leongatha is served by the GPA South Gippsland Division of General Practice and will be a part of the Gippsland Medicare Local (Figure 13), which is made up of the GPA South Gippsland, Central West Gippsland and the East Gippsland Primary Health Alliance Divisions of General Practice.

The Leongatha catchment is served by two health centres, located in Leongatha and Korumburra. The centre in Leongatha has approximately 10.5 FTE GPs and the centre in Korumburra has 5.8 FTE GPs. Within the GPA South Gippsland Division there are 14 practices and 72 FTE GPs.

Specialist services

Specialist services in Leongatha are provided by visiting doctors through the Leongatha or Korumburra hospitals. A small amount of Psychiatry services are provided through the Korumburra Community Mental Health Service operated by Latrobe Hospital, Traralgon.

Figure 13 –Gippsland Medicare LocalTop of page

Map of the Gippsland Medicare Local

Hospital

Gippsland Southern Health Service operates two hospitals, with the main campus in Leongatha and a secondary location in Korumburra. Leongatha Hospital has fewer than 50 beds, with approximately 3,000 admissions per year (Table 12) and Korumburra hospital has approximately 1,000 admissions per year. Over the next three years there is a planned renovation of Leongatha Hospital, including the construction of all new and modern facilities.

Table 21 – Admissions to Leongatha Hospital

  Same day admissions Overnight admissions
Childbirth <10 210
Medical (emergency) 85 750
Medical (other) 665 289
Specialist mental health 0 0
Surgical (emergency) <10 17
Surgical (other) 792 255
Total 1,542 1,521


The specific services that are provided through Leongatha include:
    • aged care
    • chemotherapy
    • outpatient services
    • urgent care services.

Optometry

Leongatha is well served by optometrists, with two resident optometrists in town and one additional practitioner located in Korumburra.

Travelling into Leongatha

Leongatha is a service hub for people living in the region, serving an estimated population of about 27,000 people. Travel time into Leongatha from the catchment is typically 15-30 minutes, with some people traveling up to an hour. The key services that people are travelling into Leongatha for include gynaecology, general surgery and ENT services. Patients are even traveling into Leongatha from the outer suburbs of Melbourne because the waiting lists for some specialties are shorter than at the metropolitan public hospitals. Transport into Leongatha is primarily through private vehicles (up to 95%), with community transport making up the rest. Options for travel by community and public transport are very limited and are not time efficient when available.

Travelling out of Leongatha

Travelling out of Leongatha for health services is very common as the hospital only has the capacity and capabilities to handle 45-50% of the workload for the region. There are two other small hospitals in the region, Wonthaggi and Warragul, which receive a small number of cases from the Leongatha area. Wonthaggi is around a 30 min drive from Leongatha and has a hospital of a similar size. Patients would be referred to Wonthaggi for dermatology, ophthalmology and cardiology if they lived nearby. Warragul is a one hour drive from Leongatha on a very challenging road, so only a few paediatric patients get sent to the hospital there. Most patients are sent to Latrobe Hospital in Traralgon, which at 73 km is the closest regional hospital to Leongatha. Services at Latrobe are significantly greater than Leongatha, having over 200 beds and upwards of 28,000 admissions in 2009-10. Most services are available at Latrobe and patients will often be sent there for oncology and other specialty services that are not available in Leongatha. The other main referral pathway out of Leongatha is to the Monash hospital system in Melbourne, primarily the Dandenong campus. Melbourne is approximately a one and a half hour drive from Leongatha.

Visiting specialist services

Top of pageAll specialist services available in Leongatha or Korumburra are provided on a visiting basis. Visiting services are supported by the hospital through free or low cost use of consulting rooms and operating theatres as well as MBS payments for services provided. The hospital is set up for and dependent on visiting specialists to provide many of the services that it offers to the community, from consultations to procedures. Much of the administration for specialist services is handled by the hospital and visiting specialists are closely integrated with the operations of the hospital.

MSOAP plays an important role in delivering specialist services to Leongatha Hospital (Table 19), providing payments for over half of the visiting specialists. The feedback we received during the visit was that many of the visiting services that the hospital receives through MSOAP would not be viable without the program.

The non-MSOAP specialties that visit Greater Southern Health Service (Leongatha and Korumburra) are:
    • general surgeon/endoscopist
    • ENT/head and neck surgeon
    • orthopaedic surgeon
    • surgical assistant
    • physician/endoscopist
    • endocrinologist
    • ophthalmologist
    • physician/neurologist
    • sports physician.
Table 22 – MSOAP services to Leongatha

Program Specialty No of visits No patients No of ATSI patients6 Where delivered
MSOAP Dermatology 8 0 0 Leongatha Hospital (new provider to resume services)
MSOAP O&G - General 12 75 1 Leongatha Hospital
MSOAP O&G - General 18 119 0 Leongatha Hospital
MSOAP O&G - Gynaecology 4 0 0 Leongatha Hospital
MSOAP Paediatrics - General 36 204 0 Leongatha Hospital
MSOAP Paediatrics - Haematology 20 244 0 Leongatha Hospital
MSOAP Psychiatry - General 22 81 0 Leongatha Hospital
MSOAP Surgery - General 12 66 0 Leongatha Hospital
MSOAP Surgery - General 20 133 0 Leongatha Hospital
MSOAP Surgery - Urology 24 426 0 Leongatha Hospital
MSOAP Physician - General       Leongatha Hospital


Services to catchment

MSOAP services to the catchment region are all located in Korumburra and are presented in Table 23.

Table 23 – MSOAP services to Korumburra

Program Specialty No of visits No patients No of ATSI patients Location
MSOAP Paediatrics - General 17 113 0 Korumburra Hospital
MSOAP Surgery - Plastic       Korumburra Hospital
State Psychiatry       Korumburra Mental Health Service


Role of visiting services

Visiting specialist services in Leongatha are integrated with the state health system, supplementing available services and providing a greater variety of specialists at rural hospitals. Services are seen locally as both valuable and efficient because they are experienced as well integrated with their existing health care system. For example, patients are admitted to the hospital by a local GP, who also serves as the anaesthetists for surgery for these patients. The GPs therefore have responsibility for the patient before and after the specialist performs a procedure. A secondary outcome of the GP support is that the local GPs get significant exposure to the specialist, providing important time for upskilling and education.

Leongatha Hospital is currently exceeding all of its targets for activity, an achievement that is dependent on services from MSOAP providers. The overall volume of services at Greater Southern is estimated at 45-50% of the total demand within the catchment. The target for the Health Service is around 60-70%, which is dependent on the pending facilities upgrade and secondarily on recruiting additional specialists to provide services.

Gaps in specialist services

The primary service gap identified in Leongatha was a shortage of services available in the region. Local providers see that the types of services that are available meet most of the major health priorities of the region. However, some specialties in Leongatha have long waiting lists or infrequent visits and are therefore unable to handle all of the need that exists in the community.

Gaps in surgery and diagnostics exist, but are not unreasonable given the size and scope of the hospital. CT, ultrasound and pathology services are available locally, with some specialty CT scans available one day per week. General surgery, endoscopies and basic orthopaedics are also typically done locally with more complicated and higher risk procedures sent out of the area. The common diagnostics that are referred out include MRIs, invasive diagnostics, stress testing and nuclear medicine.

Despite this there was an overall sense that the services meet the major priorities of the community, there are some additional specialties that are seen as missing or underserved in the community:
    • neurology/neurosurgery
    • orthopaedics (especially major fractures)
    • dermatology
    • ENT
    • psychiatry
    • breast surgery
    • paediatric surgery
    • cardiology (including cath. lab)
    • oncology
    • high risk paediatrics
    • high risk gynaecology
    • rheumatology
    • ophthalmology
    • gastroenterology
    • endocrinology

    Assessment of need

    Top of pageNo coordinated effort exists in Leongatha for assessing the need or setting priorities for visiting specialist services. Most of the services that exist have been developed on an ad hoc or opportunistic basis. The fundholder has not directly engaged the local health centres or the Division to help in the preparation of a needs assessment. The hospital has been most involved in developing new services, but they feel that it is not a coordinated effort and that they often have to initiate the process. The hospital also felt that the recruitment process has not been sufficient in identifying new providers to meet existing need.
The success of visiting services is dependent on patient access to the services and integration of care between the visiting service and other service providers.

Referrals to the visiting specialist are usually handled through the specialist. The hospital handles appointments and letter writing for several of the specialists who work from their facilities. In these cases the hospital does not charge for these services. Surgery at the hospital is also managed by the specialist, who has the responsibility to schedule theatre time.

Leongatha Hospital manages the process of notifying local providers of the visiting specialists. When a specialist begins a service, a ‘meet and greet’ is arranged for the local GPs to learn about the specialist and to begin to form a relationship with them. Once a service is set up specialists are encouraged to liaise with the local practices. The hospital provides information to GPs at practice meetings, and a clinical liaison exists to inform of changes in visiting services.

In addition to the efforts of the Hospital, the Division also informs all GPs and registrars of visiting services. A list is maintained at the Division that documents the visiting services and is updated approximately every six months. The list is used both in the education process for GPs and as a resource to assist people who contact the Division. Overall, most providers are aware of the visiting services to the area and are able to contact the Division or the hospital if they need more information.

MSOAP impacts

MSOAP has had a significant positive impact on Leongatha. Since MSOAP began some of the previous services have stopped, but through MSOAP the number of specialist services has increased and they have become more varied. Having visiting specialists has also meant that people do not have to travel out of the area as often and that the local GPs have access to specialists for advice or quick referrals. In some cases, patients get appointments with a visiting specialist or surgeon earlier than if they had to travel to Melbourne. The relationships that GPs are forming with specialists are also leading to opportunities for education and upskilling that improve the overall level of service for patients whether or not a specialist is there.

The hospital has indicated that the level of service that they are able to provide the community is dependent on MSOAP. They have found that it would be very difficult if not impossible to recruit doctors if the doctors did not receive the additional payments from MSOAP. The hospital also estimates that they are able to provide services more efficiently than in the metropolitan areas due to lower overheads and higher overall efficiency. Therefore, when a service can be provided at the regional hospital it is cheaper to operate and reduces the money and time lost in patient travel.

Areas for improvement

Increasing the number of services provided through MSOAP was seen as the most important improvement that could be made to the program. Improving recruitment and specialist engagement was also consistently raised as an area that needed work. Providers have found that once a specialist comes out they tend to stay; the challenge is getting them there in the first place. To improve recruitment, stakeholders suggestions included:
    • Getting specialists involved early in their careers so they can make MSOAP part of their practice.
    • Involving interns and registrars in the program to make them more aware of outreach services.
    • Providing more funds for recruiting.
    • Development of a national formalised recruitment structure that has specific goals and measureable outcomes.
    • Develop a needs assessment and then recruit specialists to fill that need.
    • Developing marketing and recruiting events that get specialists involved (i.e. dinners).
    • Pay for some specialists to be employed part time and use that time solely for visiting services.
Upskilling was raised as one of the major benefits of the program, but the hospital thought that the provision of upskilling by specialists could be improved through more structure and increased funding. More specific outcomes and metrics around upskilling could improve the services significantly through encouraging the specialists to provide this service to local providers. Finally, when upskilling is scheduled it is important that a block of time is set aside to encourage a more comprehensive service.
Some general points of improvement were also raised:
    • increase funding for MSOAP
    • make administration and room rental payments directly to the location rather than through the specialist (when possible)
    • perform better gap analysis of services in the community.Top of page