Specialist outreach service provision in the Northern Territory face unique challenges that stem from a widely dispersed population that includes a signification proportion of people who are heavily burdened by chronic disease and extremely low social-economic status.
For many years medical specialists in the Northern Territory have provided services to rural and remote areas. Often these services are based on the goodwill and philanthropic nature of doctors and over time some funding had been dedicated to expand and improve Territorians' access to specialist services.
In broad terms, Territorians access clinical specialist services through three different mechanisms (or a combination of the three):
- Clinical Specialist Outreach services delivered to remote locations
- Clinical Specialist Outpatient Services delivered from hospitals
- Clinical Specialist TeleHealth services delivered to remote locations via an audio / visual link to a clinical specialist in a hospital
The decision regarding the particular mode or combination of service delivery is dependent on client and health related factors ranging from the clients specific complaint, the acuity or the clients geographical location. The overarching emphasis is on the delivery of appropriate, safe and sustainable services.
In addition to the major funding of clinical outreach services by the Northern Territory Government, the NT Department of Health through Specialist Outreach NT (SONT) successfully secured addition Australian Government funding under the Rural Health Outreach Fund (RHOF - formerly known as MSOAP). This addition funding from the Australian Government provides significant assistance by supporting some of the travel and administrative expenses of outreach service delivery.
Specialist Outreach is primarily coordinated by the SONT team. A small number of program areas and private providers also collaborate with SONT to provide outreach services.
Specialist Outreach services available to NT remote communities include:
- obstetrics and gynaecology
- ear, nose and throat
- eye health / ophthalmology
- paediatric cardiology
- general surgery
- hearing health
- mental health
Jeff Gaden, SONT Manager (Manager Access and Service Improvement) 8999 2518
- for overall management, policy, funding, strategy development and stakeholder management.
Kim Gunst, SONT Supervisor 8922 7752
- for managing daily operations and SharePoint Administration (VisitPoint and CharterPoint)
- for coordination of travel and logistics for specialist outreach visits.
The aim of Specialist Outreach Northern Territory (SONT) is to manage the Rural Health Outreach Fund (RHOF) in coordination with existing SONT outreach activities. The specific objectives of RHOF are to:
- Improve the health of remote Territorians through the expansion and enhancement of existing Northern Territory Department of Health outreach activities consistent with Australian Government identified priorities utilising assessed and expressed demand and community needs.
- Maintain the provision of remote outreach services under the priority disciplines while increasing consultation and opportunities for service delivery input from local and regional consumers and service delivery organisations.
Data Collection Strategies
SONT has recently developed new data management templates, policies and procedures to capture the range of outreach activity that is provided. This includes new reporting mechanisms between SONT, service providers, service consumers and receiving health services (hosts).
There is also quarterly financial and service delivery monitoring and reporting to the Australian Government consistent with the Quarterly Data and Quarterly Finance templates required under the funding agreement.
Communication with regard to individual trips is available via access to SONT's VisitPoint Calendar. VisitPoint provides local, regional and discipline specific information regarding visiting schedules and up-skilling education sessions. SONT continues to develop, refine and broaden the reach of this online resource.
SONT's combined services calendar provides a central storage and collaboration space for documents and information. It currently allows the majority of SONT stakeholders to coordinate schedules and calendars and review documents and new proposals. All remote health centres and SONT specialists have access to the site and the calendar is updated on a daily basis by the administration team.
The SONT team also provides the same information from VisitPoint to non-government health service locations that do not have access to the department's intranet. This is done via weekly electronic postings of the relevant information to a growing number of non-government health services.
Australian Government Supported Services
The Rural Health Outreach Fund 2012 flexible fund guidelines provide that:
While the fund supports general health needs in communities, the following priorities have been agreed by the Federal Minister for Health for the first funding round of the fund:
- maternity and paediatric health
- eye health
- support for chronic disease management
- mental health
In accordance with these guidelines and the potential to enhance existing programs, the Northern Territory Department of Health has focused Australian Government support funding on the following health priorities and specialities:
- maternal and paediatric health
- maternity services
- paediatric services (including paediatric cardiology)
- obstetrics and gynaecology services
- eye health services
- mental health services
Needs and Demand Assessment
The provision of clinical specialist outreach services by SONT under RHOF is unique. The services provided are both prescribed (at an established level of service based on factors including size and the perceived levels of chronic disease) and demand driven.
The primary driver of demand in respect to outreach services and subsequent planning is the existing referral system. SONT has initiated work with regional health services and the clinical staff who generate referrals to enhance the quality of this valuable demand assessment, both by region and individual community.
The department, together with other outreach service stakeholders, also facilitated the formation of two Regional Outreach Advisory Groups (ROAGs), one in the Top End and one in Central Australia. Together with other stakeholder groups these ROAGs provide valuable insights to better to inform specialist outreach services and enhance the alignment of services to community and regional need.
SONT 2014 Successes:
- Major enhancements have been made to the delivery of eye health services through stronger integration and coordination of all ophthalmology providers (government, private, not-for-profit and the non-government sector). This collaboration has been pivotal to the negotiations that resulted in securing joint funding for a Top End based ophthalmology fellow, ophthalmology care coordinator and an Aboriginal Ophthalmology Liaison Officer.
- Assessment and planning tools developed by the SONT team facilitate the delivery of efficient and needs-based service delivery. These tools value add to the wider planning and integration strategies for non-Australian Government funded clinical outreach services provided by the NT Department of Health.
- There has been greater exploration and planned use of TeleHealth service delivery options to support patients and increase efficiencies, particularly in respect of interstate service providers.