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Annual Report 2020 2021

Our Reconciliation Action Plan artwork by Shane Cook – a proud Wulli Wulli and Guwa (Koa) descendent from Queensland

Contents Reports 4 Chair of the Board Report

Chief Executive Officer Report

Chair of Finance Report

Regional Health Priorities Statistics

Our Priority Areas

Aboriginal Health

Aged Care

Alcohol and Other Drugs

Bushfire Response

Community Collaborations

Digital Health

Mental Health

Population Health

Workforce 60

Country SA PHN Annual Report 20/21

Chair of the Board Report In 2020-2021 COVID-19 has continued to test the resilience of our organisation and the resilience of our stakeholders and clients. The author Caryn Sullivan put it best when she said that “In the face of adversity, we have a choice. We can be bitter, or we can be better.”

“We have grown in the COVID-19 environment and learnt and adapted. We have continued to provide support and services during lockdowns and we have adapted to different collaborative models and platforms.”

Our PHN is ‘better’. We have grown in the COVID-19 environment and learnt and adapted. We have continued to provide support and services during lockdowns and we have adapted to different collaborative models and platforms and videoconferencing. We have worked to fulfil our mission of bridging the gap of health inequity and access but we still have much unfinished business. Country SA PHN has worked hard in the COVID-19 environment in providing advice and support to Federal and State taskforces, respiratory clinics, primary-care and general practice. We continue to support primary care in the response to COVID-19. And now we are actively planning for the opening-up of South Australia to mitigate the impact that the virus might have on our communities.

This is in addition to our success in undertaking our usual business in mental health support, suicide prevention programs, headspace, after-hours care, Aboriginal health and general practice support. The Commonwealth has begun a review process of the PHNs nationwide providing us with an understanding of where we sit nationally. It is a credit to our organisation that we compare very favourably with our peers. In the year ahead the Board is looking to undertake a strategic review of our programs to identify opportunities for our organisation to make further impacts on rural primary care. The Board has undergone some change as I have taken on the role of Chair from Dr Alison Edwards. We cannot thank Alison enough for her commitment to our PHN over many years, navigating it through its evolution from the Medicare Locals and Divisions of General Practice. She takes with her our thanks and gratitude for the time she has spent guiding us. She also takes with her a deep understanding and knowledge of the primary care ecosystem

Chair of the Board Report

which will be hard to and probably impossible to replace. I hope that the Board can continue to act with the surety that Alison has been able to provide for many years. The executive team has continued to deliver in the challenging environment of COVID-19 with special thanks to Kim Hosking, our Chief Executive Officer, who has assisted me greatly in my transition to Chair and Mark Hartigan, our Chief Operating Officer. We have also welcomed Bernie Cummins in her first full year in charge of the Health Integration and Coordination portfolio and she has done a remarkable job. But all our staff are to be congratulated. Finally, I would like to pay acknowledgement to our community ‒ the people of rural South Australia that we provide services to. Their strength and their ability to just get on with life through COVID-19 has been incredible. We look forward to another successful year. Simon Lockwood Chair of the Board

Country SA PHN Annual Report 20/21

Chief Executive Officer Report “We are pleased to have a committed and positive workforce, Board, Local Health Clusters and friends within the system who all contribute to our good work, often above and beyond expectation. Their work, commitment and friendship are greatly appreciated. It reflects one of our strengths, not simply as Country SA PHN, but for all rural South Australia. ”

In common with all other enterprise across Australia and the world this year, our task has been to maintain and indeed grow our work, while managing the challenges of the worldwide pandemic. It is a credit to our staff, Board and those directly associated with our ‘product’ that all concerned have adapted to an off-and-on-site work environment, tele and video conferencing, maintaining our work and developing new projects and responses to need while keeping our positive work culture. Country SA PHN has contributed to the National and State COVID-19 response ‒ supporting respiratory clinics, telehealth initiatives, system adaption, support and resilience, general practice and other provider communications and support, distribution of personal protective equipment and vaccination support. Country SA PHN has been actively engaged with the Commonwealth in their approaches and strategies and with the State in planning and response as required. Unusual in the national context we have been engaged by the State in the State Command Centre activities. Service providers contracted by Country SA PHN have been supported and flexibility provided to some, to help them deliver their services in the challenges of the changing environment.

Country SA PHN funded by the Commonwealth, continues to shoulder the burden of Mental Health services at Tier 1 and 2 level across rural South Australia and has expanded its headspace and suicide prevention services as well as maintained psychosocial mental health support activities. We continue, and have expanded our activities, to provide additional allied health in vulnerable small communities across all regions of rural South Australia. We are active in the Aboriginal Health space, through Commissioning of services under the Close the Gap umbrella as well through flexible fund allocations to specific Aboriginal Community Controlled Health Organisations and mental health funding targeted to Aboriginal communities. Our General Practice Support team provides support to general practice capacity, particularly focussed on quality and technology assistance and continuing professional development is provided through our commissioned service provider. We are actively engaged with Wellbeing SA, the SAHMRI Health Translation Centre and the State’s Centre on Excellence and Innovation in Health, as well as Local Health Networks across rural SA. Our Needs Analysis work underpins our engagement in each of the above

Chief Executive Officer Report

and contributes to better decision making in resource allocation and prioritisation of activity. This year has seen two Commonwealth reviews of national PHN performance in addition to our normally scheduled annual reviews. We are very pleased with the review’s positive outcomes and even more pleased and proud of our own review of performance within the network, inspired by the need to evaluate how our activity compares nationally. Our PHN expends 85% of our funds on services directly to the community managing our support to a level of only 15%. This is an exceptional ratio and puts Country SA PHN at the peak of performance in this regard. Our ongoing challenges remain in seeking to meet the needs of the communities within limited resources and with particular regard to the mental health needs of our

Key Highlights

communities. State provided levels of funding and resourcing and a lack of private providers as well as workforce pressures add to the challenges for communities and the architecture of the health system across rural South Australia. We are, however, pleased to have a committed and positive workforce, Board, Local Health Clusters and friends within the system who all contribute to our good work, often above and beyond expectation. Their work, commitment and friendship are greatly appreciated. It reflects one of our strengths, not simply as Country SA PHN, but for all rural South Australia. Our PHN and our communities want what’s best for rural and remote communities and will work together to achieve the best for country South Australia. I would like to recognise a change at the Chair level of Country SA PHN. This past year saw our foundation

We expend

85% of funds on services directly to the community

Chair, Dr Alison Edwards retire from the Board and Dr Simon Lockwood assume the role. Alison provided leadership and wise counsel over all our formative years and was instrumental in our successes and her contribution has been greatly appreciated. Simon steps into the time consuming and challenging ongoing role with the promise of leading us as we grow and adapt. We were sad to see Alison leave and pleased to see Simon step into the breach. I thank our staff, Board, Local Health Clusters and friends for their good work and commitment to the task at hand. This past year has been challenging, more so than at any other point in time and they have risen to the challenges. Kim Hosking Chief Executive Officer

Managing our support to a level of

only 15%

Contributed to the National and State COVID-19 response

Country SA PHN Annual Report 20/21

Chair of Finance Report The past year – from a world and Australian perspective – was somewhat of a tumultuous period, but from a Country SA PHN financial perspective it was very much business as usual. In fact, in many ways a mirror image of the previous year.

“Country SA PHN has been noted by our funders for its strong financial controls and for the leadership in service expenditure relative to operational costs. We sit with best practice in this evaluation.”

Revenue (income $54.5 million) was very much in line with the previous year with a difference of less than one percent in our income. Expenses, likewise, for the most part, were consistent with the previous year. The notable exception being Depreciation Expenses where, due to a change in accounting standards relative to the treatment of Lease Expenses, showed a decline of $260,000 significantly contributing to our year end surplus. The business showed an overall surplus (profit) of $380,000 derived from Depreciation Change (above), Interest on bank deposits, and some minor operational savings. Excluding the Depreciation factor, the surplus of $120,000 whilst lower than the

previous year (so is bank interest), is in line with expectations. The results show a disciplined management of our finances for the period. In keeping with this management control, Country SA PHN has been noted by our funders for its strong financial controls and for the leadership in service expenditure relative to operational costs. We sit with best practice in this evaluation. The Auditor’s report (William Buck) shows no area requiring immediate or special attention, and no area of specific concern. It is a good report and our staff, led by CEO Kim Hosking and his Deputy Mark Hartigan are to be commended for their efforts in managing this business, from both an Operational and Financial position in this unusual period of primary health delivery, with all its uncontrollable periods of disruption and need. John Curnow Chair of Finance

Chair of Finance Report

Country SA PHN Annual Report 20/21

Through the Needs Assessments, Country SA PHN identifies health and service needs within country SA regions and prioritise activities to address those needs through the commissioning of services. An overview of the principal data sources used is documented in the Needs Assessment Data Report - November 2018 which includes a holistic look at demographic, health, and health service patterns to identify locations and populations with particular health and service needs as well as country SA-wide priorities.

Regional Health Priorities Statistics

4 1

6 3 7 2

North and West

Central

1. 2. 3. 4. 5.

9. 10. 11. 12.

Far West Lower Eyre Upper Eyre Flinders & Port Augusta Roxby Downs

Yorke and North 6. Mid North 7. Lower North 8. Yorke Peninsula

Barossa Adelaide Hills Fleurieu Kangaroo Island

9 8 10 11 12

South and East 13. Riverland 14. Murray Mallee 15. South East

Country SA PHN Annual Report 20/21

Aged Care

Aboriginal Health Chronic Disease • Acute

Rheumatic Fever and Rheumatic Heart Disease register has a large proportion of the country SA cases in the far North West of the state from Coober Pedy to Anangu Pitjantjatjara Yankunytjatjara (APY) Lands.

• Diabetes

prevalence rate of 24.4% in country South Australia, increased to 40.2% for remote South Australia for all types of diabetes. Gestational diabetes was highest in the remote Far West at 10.7% of all pregnancies.

• Average

annual agestandardised rate for hospitalised chronic diabetes complications is highest in Eyre (Indigenous Area IARE) with 25.2 per 1,000 followed by Port Augusta (18.1) and Ceduna (13.4).

• The

incidence of end stage kidney disease in Aboriginal and Torres Strait Islander peoples is occurring at a rate of 57.8 per 100,000 versus 8.5 per 100,000 in the non-Aboriginal population in South Australia.

• Cancer

is the second highest rate for leading causes of mortality at 232.1 per 100,000 compared to a rate of 171.6 per 100,000 for the non-Aboriginal population in South Australia.

Eye Health • In

SA 22.2% of Aboriginal and Torres Strait Islander peoples reported eye health problems.

Ear Health

• Hearing

problems for Aboriginal and Torres Strait Islander peoples occurs higher in SA (15.8%) than the national rate (12.3%).

Immunisations

• Vaccination

occurs at a higher rate for Aboriginal and Torres Strait Islander children at age 5 years (96.4%) then they do for other age groups 12 months (91.3%) and 2 year olds (87.1%).

• Vaccinations

for HPV are also occurring at a lower rate for Aboriginal and Torres Strait Islander peoples in South Australia (girls 72.5% and boys 69.1%).

Early detection and treatment

• In

the Outback – North 66.3% of Aboriginal and Torres Strait Islander peoples population accessed a 715 health assessment.

Aboriginal Workforce

• Low

numbers of Aboriginal and Torres Strait Islander health professionals in the Country SA PHN region, General practitioners (0.7 per 100,000), Nurses and midwives (1.54 per 100,000) and Allied health professionals (1.7 per 100,000).

• The

operational ratio for residential aged care places is highest in the Flinders & Far North with 118.2 operational places per 1,000 persons aged over 70 years.

• Concentration

of ageing population in outer regional locations where age-specific services are more limited are in the Fleurieu Peninsula, Yorke Peninsula and Mid North regions.

• There

is a projected increase in aged population throughout the region, particularly in the Riverland, Mallee, and South East.

• There

are no Residential Aged Care Facilities places in the areas of Robe or Mallala and very low rate of RACF dementia specific places in the Outback, Adelaide Hills and Gawler regions.

• High

number of ageing Culturally and Linguistically Diverse (CALD) populations located in the Riverland.

Regional Health Priorities Statistics

Health Workforce

Alcohol and Other Drugs • Country

SA PHN SA4 area that had the highest prevalence of monthly risky drinking with Adelaide Hills (43%), Barossa (40%) and Outback ‒ North & East (35%).

• High

prevalence of recent cannabis use was in Gawler ‒ Two Wells and Barossa (18%).

• The

level of prescribed opioids dispensed in SA3 areas across Country SA PHN ranged from 53,757 (Adelaide Hills) to 94,892 (Barossa).

• Prevalence

of lifetime illicit drug use for school aged children (1217) ranged from 8% in the South East to 18% in the Outback ‒ North & East, while state prevalence was 14%.

• Treatment

for alcohol as a principal drug of concern was most common in very remote areas (64% of all treatment episodes) compared with 30% of treatment episodes in major cities (30%).

• Aboriginal

and Torres Strait Islander peoples, of whom 70% live in rural Australia, were 1.7 times more likely to have recently used illicit drugs compared to the non-Aboriginal population.

• Mental

and substance use disorders accounted for 19% of the total burden of disease for Aboriginal and Torres Strait Islander persons.

• Prevalence

of recent methamphetamine use was highest in South Outback South Australia (4%) whilst state-wide prevalence was 2%.

• All

of the Country SA PHN region except Port Augusta, Whyalla, Gawler, Mount Barker and Victor Harbor are considered GP distribution priority areas.

• Rates

per 1,000 population for podiatrists (0.7), psychologists (1.3%), registered nurses (63.5%), optometrists (0.4%) and physiotherapists (2.9%) are below state averages in all Country SA PHN regions, despite higher rates of chronic disease and mental illness.

• Rates

per 1,000 population for GPs (3.5%), pharmacists (3.1%) and dentists (0.4%) are below state averages in nearly all Country SA PHN regions.

• All

of the Country SA PHN region is considered a district of workforce shortage for medical specialists.

Digital Health • 46%

of general practices and 22% of allied health providers are employing secure messaging software to send information.

• Allied

health providers (61%) are less likely than general practice (99%) to use electronic patient records.

Country SA PHN Annual Report 20/21

Mental Health • Psychological

Distress Measurements revealed 13% of country South Australian’s experienced high or very high levels of distress, compared to the state average of 11.9%. Furthermore, this level increased for Aboriginal and Torres Strait Islander peoples with distress levels equating to 31.8%.

• 1

in 7 young people aged 4-17 years were assessed as having had a mental health disorder(s) in the previous 12 months.

• The

proportion of population aged 12-24 years who accessed at least one service from a clinical psychologist was highest in the Mid North (2.9%), followed by the Lower North (1.9%) and Gawler ‒ Two Wells (1.8%).

• For

the 0-11 years cohort, the proportion of population accessing at least one service was highest in the Mid North (0.6%), followed by the Yorke Peninsula (0.3%) and Eyre Peninsula & South West (0.3%).

• The

number of young people serviced by a headspace centre was highest in Murray Bridge (638), followed by Mount Gambier (506).

• Access

to mental health services varied across the Country SA PHN region, the lowest for each profession was consistently found in the Outback ‒ North & East (0.6%), Eyre Peninsula & South West (1.0%). The highest access for the Country SA PHN region was in the Mid North.

• Clinical

Care Coordination service was delivered to 2,002 clients equalling to 13.3% of country SA population.

• Access

to clinical psychology was lowest in the Eyre Peninsula & South West where 0.4% of the population had at least one session, this was followed by Outback - North & East with 0.6%. Highest access was in the Adelaide Hills, Gawler – Two Wells, and Barossa.

• Access

to mental health services by allied health professionals was lowest in both Eyre Peninsula & South West and Outback - North & East, equally providing at least one session for 0.6% of the population. Highest access for the Country SA PHN region was in the Limestone Coast, Gawler ‒ Two Wells, and Fleurieu Peninsula & Kangaroo Island.

• The

preparation of GP mental health care plans per 1,000 population was highest in Gawler – Two Wells, Adelaide Hills, and Fleurieu Peninsula & Kangaroo Island with the lowest in Lower North, Eyre Peninsula & South West, and Mid North regions.

• Highest

rates of mental health conditions were Lower North (26.4%), Mid North (22.2%), Barossa (20.6%), Gawler ‒ Two Wells (20.4%), all of which were above the state average.

• Psychological

distress was highest in the Mid North (19.7%) followed by Gawler ‒ Two Wells (17.4%), Barossa (17%) and Adelaide Hills (13.3%).

• The

highest self-reported mental health service utilisation was in the Fleurieu Peninsula & Kangaroo Island (8.0%) followed by Lower North (7.6%), Limestone Coast (6.5%), and Murray & Mallee (5.6%) regions.

Suicide Prevention

• The

highest rate of suicide was in Eyre Peninsula & South West, Yorke Peninsula, and Murray & Mallee regions, while the highest attempt rates were found in the Limestone Coast, Murray & Mallee, and Eyre Peninsula & South West regions.

• Country

SA PHN region had 1,041 hospitalisations for intentional self-harm. The highest rates were in the Yorke Peninsula SA3 (3.6 per 1,000), Limestone Coast (3.1 per 1,000), and Fleurieu Peninsula & Kangaroo Island (2.9 per 1,000) regions.

• Males

in the Country SA PHN region accounted for 79% of all deaths by suicide, a ratio of more than 3:1. However females accounted for the highest rates of suicide attempts.

• Aboriginal

and Torres Strait Islander South Australians suicide (25.5 per 100,000) at a rate of more than twice that of non-Aboriginal and Torres Strait Islander peoples in South Australia (12.5 per 100,000) respectively. Suicide was the second leading cause of death among Aboriginal and Torres Strait Islander men at a rate of 39.2 per 100,000.

Regional Health Priorities Statistics

Population Health Chronic Disease • Highest

rates of Arthritis were in the Gawler – Two Wells (31.1%), followed by Outback ‒ North and East (26%), Yorke Peninsula (25.9%) and the Mid North (25%); all other areas are close to SA rate or below (21.1%).

• Highest

rates of Osteoporosis were in the Gawler ‒ Two Wells (11.9%) followed by Yorke Peninsula (6.2%) and the Mid North (5.6%); all other areas were below the State rate (5.1%).

• High

rates of cardiovascular disease found in the Yorke Peninsula (11.3%) while the Adelaide Hills had the lowest with 2.7%.

• While

high rates of diabetes are recorded across the Country SA PHN region, the Barossa (5.2%), Adelaide Hills (6.2%) and Lower North (6.8%) are well below Country SA PHN overall rate (10.8%).

• The

SA3 level area which had the highest rate of Asthma above the state level (14.5%) was Mid North (23.4%), the Lower North had the lowest rate (11.3%), whereas other areas are below Country SA PHN (15.3%) and SA (14.5%) rates.

• SA3

level areas which had the highest rates of COPD included Outback ‒ North & East (11.2%) which were over double the SA rate (4.9%), followed by Fleurieu Peninsula & Kangaroo Island (7.2%); all other areas were equal to or less than the SA rate (4.9%).

• Rates

of high blood pressure, high cholesterol, insufficient physical activity, and unhealthy weight are highest in the Yorke Peninsula and above SA averages for almost every region.

Cancer

• Prevalence

of cancer is highest in the Fleurieu Peninsula & Kangaroo Island region followed by Murray & Mallee, Yorke Peninsula, and the Barossa regions; all other areas were equal to or below State and Country SA PHN rates.

• Bowel

Cancer screening rates were at 40.1% in the Outback ‒ North & East. Only Yorke Peninsula and Fleurieu Peninsula & Kangaroo Island were above 50% participation across the Country SA PHN region.

• Breast

Cancer screening rates were under 50% participation in Outback ‒ North & East region followed by Lower North, Mid North, Fleurieu Peninsula & Kangaroo Island, Murray & Mallee, and Adelaide Hills regions which were all under 60%.

Immunisation

• Barossa

(97.2%), Gawler ‒ Two Wells (96.2%), Murray & Mallee (95.7%) and Limestone Coast (95.8%) all achieved the national target of 95% for 1 year of age Immunisation.

• No

SA3 area achieved 95% coverage for 2 years of age immunisation, however all but two SA3s achieved 95% coverage for 5 years of age which were Adelaide Hills (92.8%) and Fleurieu Peninsula & Kangaroo Island (94.6%).

After Hours

• No

or limited after hours sites in Tatiara and upper South East regions.

• In

the majority of hospitals in the Country SA PHN region, emergency departments double as after-hours, serviced by on-call GPs from the area.

• Cervical

Cancer screening rates were below 50% in Outback ‒ North & East, followed by the Mid North, Murray & Mallee, Yorke Peninsula, Limestone Coast, Fleurieu Peninsula & Kangaroo Island, Eyre Peninsula and Gawler ‒ Two Wells regions which were rates under 60%.

Country SA PHN Annual Report 20/21

Our Priority Areas The Federal Government has identified key priority areas for PHNs. The best way to demonstrate how we are bridging the gap in health access within these priority areas is to share program highlights that have been achieved across country South Australia during 2020-2021.

Aboriginal Health

Aged Care

Our Priority Areas

Alcohol and Other Drugs

Digital Health

Mental Health

Population Health

Workforce

Country SA PHN Annual Report 20/21

Aboriginal Health Continuing to create welcoming environments for Aboriginal and Torres Strait Islander peoples A host of country South Australian general practices and contracted primary health services, are now more welcoming environments for Aboriginal and Torres Strait Islander peoples, thanks to the display of stunning artwork by local Aboriginal artists.

Due to the overwhelming success of the Welcoming Environments grants in 2018-2019, Country SA PHN once again offered grants to make even more country South Australian primary health care providers more welcoming for Aboriginal peoples. The artwork is displayed in the main entrances of the buildings to make Aboriginal and Torres Strait Islander peoples feel welcome, encouraging greater access to primary health care services. “The intention with this initiative is to contribute to closing the gap in life expectancy by improved access to culturally appropriate, mainstream primary health care services for Aboriginal and Torres Strait Islander peoples,” said Country SA PHN Chief Executive Officer Kim Hosking. “The grants have been awarded to mainstream general practices and commissioned primary health care services that are demonstrating a commitment to doing just that in their service area. “Successful general practices and primary health services were able to commission Aboriginal and Torres Strait Islander artwork by a local artist. The results have been wonderful. This round of grants has funded six general practices and four primary health services.”

1. Summit Health

Summit Health sought guidance from local Peramangk Elders, the Hahndorf Aboriginal Art business and Mount Barker Council to commission local Aboriginal artist David Booth to create a piece of artwork to welcome Aboriginal and Torres Strait Islander peoples. David’s artwork reflects Peramangk Country and its relationship to the community and health. It depicts a sunrise behind the Mount Barker Summit. The red U shapes are staff, and the orange are the young and old who are sick and being cared for. The kangaroo tracks in a circle indicate a cycle of moving forward continually in the journey of closing the gap in Indigenous health. The purple and blue U shapes show different cultures and stages of health and healing as we all have our own journey.

Aboriginal Health

2. Save the Children Australia/Aboriginal Mothers and Children Hospital Avoidance Program Save the Children at Ceduna sought community input to ensure they used their grant to make the supported accommodation facilities culturally welcoming and child centred. Children and young people were involved in creating a collective art piece that has been installed at the facility in a previously underutilised outdoor area. The local women’s group run by Eyre Plus, an Aboriginal Community Controlled job network, made cushion covers and Save the Children purchased Aboriginal designed mats and an outdoor setting to make this a safe welcoming environment for families. Through input from staff and community a table was also converted into a children’s sensory table, incorporating themes of Aboriginal culture, land and coastline.

Country SA PHN Annual Report 20/21

3. Mission Australia

Mission Australia engaged in community consultations, surveys and conversations, to identify local Aboriginal feedback regarding welcoming environments cultural spaces at the Mission Australia Whyalla office. A working group was established, with local Aboriginal services, Traditional Owners, members from other service agencies and the Whyalla City Council. Based on this feedback a meeting room was converted into a culturally appropriate space in the reception area. It was designed as a calming engagement space, with neutral furnishings to be inviting for Aboriginal families, including children.

The project has positively impacted the organisation and service access for Aboriginal people. Mission Australia clients and community members have provided verbal feedback that the new space has a relaxing feel, is more comfortable and suitable for children. Colours of Country is by proud Barngarla woman and Traditional Owner Jody Croft. According to Jody, this painting is her interpretation of the ‘Colours of Country’. It shows just how diverse the colours are within our area from the wildflowers to trees and water holes.

Nurture is by Scott Rathman, an Aboriginal Artist who was born in Loxton. According to Scott, this painting is two hands wrapped around the circles in the middle which will have a symbol painted in there to represent nurturing growth. The two outer circles will have symbols to represent walking together and finding your voice, they are linked to the middle circle by the hands to represent a journey as being the journey people are on.

Aboriginal Health

Sonder Sonder engaged six country South Australian general practices to commission local Aboriginal artists to create a piece of artwork that will help make the practices more welcoming to the local Aboriginal and Torres Strait Islander community. The participating practices are Owen Terrace Medical Practice (Wallaroo), Kadina Medical Associates (Kadina), Kadina Medical Associates, Wallaroo Practice (Wallaroo), Terrace Clinic (Port Pirie), Adelaide Road Clinic (Gawler), Medical HQ (Ardrossan). “It makes it a more welcoming environment,” Sonder Indigenous Health Project Officer Peta Purba said. “Clients and community can come in and feel more approachable with staff.”

4. Kadina Medical Associates, Wallaroo

The painting by Narungga artist Violet Buckskin depicts the Seven Sisters Dreaming and incorporates the history of Narungga peoples not being able to access health services. To acknowledge this history, Point Pearce sits at the bottom, where people have travelled across through to birthing places in Wallaroo. It is a sad story, with a lot of pain and hurt, but also one of strength and resilience as well as hope and rebirth. The Seven Sisters is a complex story from which many lessons can be learned.

5. Adelaide Road Clinic, Gawler

Artists Codi and Kira Buckskin named the artwork Warrawarra- meaning doctor in traditional Narungga language. The large circle represents the clinic and the various sections within the circle are the services provided to the patients. The two circles underneath represent the north and south para rivers converging and the background represents the river and riverbed. The small white dots throughout the piece represent all the people that have been clients of the clinic. There are 30 circles throughout the piece, this represents the thirty years the clinic has been serving the community.

Country SA PHN Annual Report 20/21

6. Terrace Clinic, Port Pirie

Artist Jessica Turner gained her inspiration for the spectacular artwork from her children. She asked them what a healthy lifestyle meant to them when they were in country. “Straight away they say we like going for walks so I decided to add the tracks and they start talking about the animals and my Dad used to tell me about the animals he used to eat here when he was a kid so we decided to throw all that together,” Ms Turner said. 7.

“I think this is the first painting where I actually did fruit. We’ve also got kangaroo, emu and lizard tracks on there. I think seeing Aboriginal art in a hospital or clinic like this makes Aboriginal people feel a bit more relaxed knowing that it is not just westernised in here.” 7. Medical HQ, Ardrossan

Medical HQ at Ardrossan commissioned artist Violet Buckskin who created a stunning piece called Winda the Owl. This piece is inspired by the Narungga Dreaming Story of the same name, which features Ardrossan’s coastline. This is represented in the artwork along with squid and crab, which are caught in the town’s waters. Winda the Owl is depicted in the cave and the dogs on the left-hand side of the painting.

Aboriginal Health

Uniting Country SA The manager and team leader worked to identify the land the Country Wellness Connections service was delivered on and consulted the Aboriginal communities in each location to identify their own artists – engaging Ngarrindjeri, Ngadjuri and Narungga artist Sonya Rankine and Jessica Turner, a Nukunu woman who is also of Adnyamathanha and Kokotha background. This engagement has elevated the relationship that Uniting Country SA has with some Nukunu and Narungga peoples, resulting in a positive impact locally. General feedback provided by the community has been very positive. The distinctive woven pieces in Kadina and Clare have been a great talking piece among staff and visitors – engaging people to come together in conversation.

8. Kadina Office

Sonya Rankine drew from her Narungga culture to develop a woven wall hanging that included locally collected hag stones that were framed and installed in the Kadina front office – acknowledging we are living, working and meeting on Narungga Country. The design symbolizes people coming together. The centre beach hagstone represents the Kadina Uniting Country SA office and the five beach hagstones represent the community coming there for support. 9. Clare Office

Sonya Rankine also drew from the Ngadjuri side of her culture, to develop a second woven wall hanging that is proudly displayed in the Clare front office – acknowledging we are living, working and meeting on Ngadjuri country. The design symbolizes people coming together. The small weaving mat at the centre represents the Clare Uniting Country SA office and the weaving around is the support that is offered and wrapped around the community.

10. Port Pirie Office

Jessica Turner called on her Nukunu ancestry to create a piece to represent the work that Uniting Country SA does with community, on Nukuna Land. 10.

Country SA PHN Annual Report 20/21

Aged Care Psychological Therapies Services in Residential Aged Care Facilities The overwhelming success of Country SA PHN’s Psychological Therapies Services in Residential Aged Care Facilities pilot program in the Barossa Valley in 2018, has led to the model now being expanded to 19 facilities across five regions of country South Australia.

The initial pilot situated in two Barossa Valley Residential Aged Care Facilities (RACFs), paved the way for the program to be expanded across the Barossa Valley and Gawler (Sonder Care), the Limestone Coast (FocusOne Health), Lower Fleurieu (Mind Australia) and Adelaide Hills (Community Options Australia). The program sees Psychological Therapy services delivered directly to residents in their facility and enables those with a mental illness to access mental health services onsite, similar to those available in the community. The program adapts to the residents needs and environment and is codesigned in a way that complements personal care and accommodation services provided by RACFs, dementia services and broader physical health and social support. The psychological services delivered to RACF residents focuses on: •

•

argeting residents with a T diagnosed mental illness or who are assessed as at risk of mental illness if they do not receive services; roviding evidence-based, timeP limited psychological therapies which are adjusted to be responsive to the needs of older people;

•

orking within a stepped care W framework with a particular focus on meeting the needs of older people with mild to moderate mental illness;

•

ollaborative Implementation, in C close communication with RACFs and other key stakeholders, including consumers and family members; and

•

ocally developed assessment and L referral arrangements which ensure services are matched to need for mental health services.

Country SA PHN Chief Executive Officer, Kim Hosking said it was fantastic that the Federal Government had recognised the importance of offering aged care residents support within their RACF. “Many aged care residents are dealing with anxiety and depression revolving around the loss of long-term partners and other loved ones and leaving their home and other family members,” Kim said. “This program is designed to alleviate some of those issues and give aged care residents a better quality of life.”

Aged Care

Country SA PHN Annual Report 20/21

Boandik Lodge, Mount Gambier The Psychological Therapies Services in RACFs has been very successful in the Limestone Coast where FocusOne Health (FOH) has been providing effective, personalised psychological services to RACF residents during 2021. “It’s been a privilege to work with people at this stage of their life to sort through their thoughts and feelings about their past, present and future,” said FOH Mental Health Social Worker Clinician at Boandik Lodge’s three sites, Davina Hodgson. “It’s been so important to build a rapport so that the residents trust me to share their stories. “Clinically, I have seen residents move through the cycles of grief and loss, and I have helped to remind them of their coping skills.

I have helped residents develop problem solving skills, assisted residents to adjust to their new life circumstances and to settle into their changed home environment positively.”

“Together we have identified individualised strategies to manage these and I have been able to work with staff, where appropriate, to assist the resident to live a fulfilled life in care.

Kay Hutchinson, Mental Health Nurse Clinician for FOH at Pinchunga in Penola is equally enthusiastic about the program.

“The opportunity to work with other members of the care team including families has been a fabulous component of holistic care in action.

“It has been an honour to work with the residents of Pinchunga,” Kay said.

“The staff have been amazing in embracing the program and several broader programs, groups and activities have evolved by the facility to address meaningful activity and personhood needs.

“I have had the privilege of hearing their stories, worries and concerns and validating their lived experiences. These have included mental illness, life traumas, isolation due to COVID-19 restrictions, transition (often abruptly) into care and changes associated with aging.

“Witnessing the difference that the Psychological Therapies Services in RACFs program has brought to the residents, staff and facility has been both a rewarding and humbling experience.”

Aged Care

“We have some that have returned to engaging with others and rekindling friendships. I can truly recommend the service as worthwhile and necessary.”

Boandik Lodge residents have reported to Chief Executive Gillian McGinty that because of the program: “I have been able to do activities that I haven’t done for a long time. It has been wonderful.” “I have enjoyed the one-on-one chats with someone other than staff who are always busy.” Corinne Galwey, Nurse Unit Manager at Penola War Memorial Hospital and Pinchunga RACF says the program has made an immense difference to their resident’s quality of life. “I can say that the psychological support that the sessions have provided to those living here has been outstanding,” Corinne said. “Those who have consented to engaging with Kay have all discussed the benefits and positive difference it has made to the day-to-day experiences.”

“We have some that have returned to engaging with others and rekindling friendships. I can truly recommend the service as worthwhile and necessary.” FOH Limestone Coast Services Manager Karen Olive said the success of the program in the Limestone Coast is strongly based on the skills of clinicians who bring their professionalism and their personalities to their roles. “Additionally, our clinicians are local country people and so they understand local country people and the related issues, and they can really quickly establish rapport and relationships with their clients and with our stakeholders,” she said. With the continued demonstrated evidence of the importance of the Psychological Therapies Services in RACFs, it is hoped that there may be further opportunity to expand the program to other regions of country South Australia in the future.

Country SA PHN Annual Report 20/21

Alcohol and Other Drugs A significant first for the AOD sector in South Australia Country SA PHN’s Strategic Vision for Drug and Alcohol treatment will align to the National Drug Strategy (NDS) 2017-2026. The National Drug Strategy aims to “build safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug-related health, social, cultural and economic harms among individuals, families and communities.”

The outcomes particularly impacting country South Australia highlighted:

In a significant first for the Alcohol and other Drug sector in South Australia, a statewide needs assessment was commissioned and developed by a collaboration of key organisations across the sector, to ensure the services best meet the needs of the State’s diverse population. The South Australian Alcohol and Other Drugs Health Needs Assessment (HNA) was led by Drug and Alcohol Services South Australia (DASSA) in partnership with Country SA PHN, Adelaide PHN and the South Australian Network of Drug and Alcohol Services. Evidence from the HNA will inform the most effective way of allocating scarce resources to improve health outcomes for South Australians experiencing alcohol and other drug problems and provide support to their families. The assessment informs service planning,

Key at-risk populations

Aboriginal peoples, youth, people from culturally and linguistically diverse communities, and older males

procurement and coordination for the DASSA, Department for Health and Wellbeing, and other bodies commissioning Alcohol and other Drug (AOD) services in South Australia up to 2030. This statewide collaborative approach to the Health Needs Assessment brought together the previously quite disjointed sector – increased transparency, reduced program duplication, increased information transfer and assistance, increased active planning, ensured all regions are serviced by at least one of the commissioning bodies and ensured the tender process was implemented simultaneously across organisations to provide increased AOD service access where most required for all South Australians. “Country SA PHN aims to improve health and social outcomes for individuals, families, and communities affected by substance misuse in

Areas of low service access and increased need

The APY Lands, Port Augusta, Outback South Australia and the Riverland, particularly Berri and Renmark

Alcohol and Other Drugs

Australia,” said Reg Harris, Country SA PHN Director Mental Health and Alcohol and Other Drugs. “Supporting the development of accurate drug and alcohol data is paramount to help support evidencebased treatments, national policy and service delivery.” Overall, the effect of the statewide Health Needs Assessment has been to provide a view of the whole of the state’s AOD needs, rather than as individual communities across different regions. It has allowed for a targeted approach across all commissioning bodies to ensure consistency and transparency across the sector – resulting in a better understanding of the state population’s AOD needs as whole, increased access to appropriate AOD services and ultimately better health outcomes for all South Australians.

Drug trends

An increase in Cannabis and alcohol consumption during COVID-19 and a reduction in MDMA, Cocaine and Ketamine use

Co-occurring issues and co-morbidity

During COVID increased stress, domestic violence, child safety issues, social isolation and suicidality were all noted

Country SA PHN Annual Report 20/21

Bushfire Response

Bushfire Response Building resilience for times of need The devastating bushfires that ravaged many parts of the State during the summer of 20192020 will be forever etched in the memories of South Australians. As part of the Australian Government’s Bushfire Recovery program, Country SA PHN responded quickly ‒ providing immediate short and mediumterm mental health support for communities, including emergency service workers. However, recognising that recovery is long-term and made more complex by the challenges of COVID-19, Country SA PHN is funding a Community Resilience and Readiness program to assist fire affected communities’ recovery, by increasing their psychological and practical preparedness and increasing their resilience for future bushfires and other disasters.

Yorke Peninsula In November 2019, Yorke Peninsula communities experienced three significant fires at Yorketown, Price and Maitland. While not as densely populated as some of the State’s other bushfire affected areas, Yorke Peninsula Community Resilience Officers (CROs) Kate Martin and Katie Hughes, say the fires highlighted many real gaps in the community’s preparedness and exposed other well-being issues that were bubbling beneath the surface. “The fires were a catalyst for many Yorke Peninsula communities to identify some of the concerns and gaps that they had in their disaster resilience and awareness and general well-being,” Kate said. “This resilience and preparedness education is the key to improving understanding about natural hazards in the local environment and ways to keep communities safe from harm before, during and after an emergency or disaster.”

Region activities • Engaging

Emerging Minds to work with the Community Trauma Toolkit

• Community

Consultation breakfast and follow up evening session

• Support

for the Yorke Peninsula Indigenous Round

• Mental

Health First Aid with Breakthrough Mental Health Research Foundation

• Edithburgh

CFS Paint By Numbers Mural

• Yorke

on a Fork events

• Mandalla

Art with Cathy Gray

• International

Women’s Day morning tea with Red Cross

• Are

You Bogged Mate? events with Mary O’Brien in collaboration with Weaver’s Ag Bureau

• Grant

writing workshops with Tessa Colliver

• Mates,

Meals and Mental Health Day

• Mayor’s

Morning Tea for Volunteers

• Playgroup

SA Family Fun Day

• Fiona

Meade Mindfulness Sessions

• An

Evening Under the Stars event

• The

Resilience Project with Hugh Van Cuylenburg

• Facilitating

Seasons for Growth at the local area school

Country SA PHN Annual Report 20/21

Adelaide Hills The idea for the program was sparked when current Adelaide Hills Council Community Resilience Officer (CRO), Miranda Hampton identified gaps in people’s practical and psychological preparedness and education when working with hills communities following devastating bushfires throughout the region. Miranda saw the potential benefits of building resilient communities – emotionally and mentally prepared to face future disasters - rather than just react to them.

and that the community needed help beyond this to be proactive and develop resilience strategies for the long term – rather than just recovery,” Miranda said.

In December 2019, the Cudlee Creek bushfire burnt more than 25,0000 hectares including homes and other property and threatened many townships across the hills. In January 2021, the Cherry Gardens bushfire burnt 2,500 hectares of land and threatened many homes before the valiant actions of CFS volunteer fire fighters and the rain abated the blaze.

“As the emergency response services were wrapping up, we could see the importance of keeping the great work of many in these communities going and continuing that momentum in a capacity building role,” Sally said.

“I was conscious that recovery services would have an end point

Region activities • Engaging

Emerging Minds to work with the Community Trauma Toolkit

“That it is a marathon – not a sprint – and the more prepared the community is for whatever comes next, the better.”

• Mental

Country SA PHN Bushfire Response Coordinator, Sally Patten, agreed and collaborated with Miranda to make the CRO role a reality.

• Development

“We’re very pleased to fund and work with the CROs in such an important initiative to assist communities to face inevitable future challenges with resilience, preparedness and a sense of empowerment.”

Health First Aid

• Australian

Red Cross Community Led Emergency Resilience Sessions

of the Adelaide Hills Council website as a central source of community resilience and preparedness information

Bushfire Response

Kangaroo Island The 2019-2020 bushfires on Kangaroo Island were the largest in the island’s recorded history and burnt more vegetation than any fire on the island. Fires burnt across the island for weeks – two lives were lost, many businesses, homes and farms were destroyed, countless numbers of livestock and habitat and wildlife perished. Following these fires, services delivering mental health supports directly to Kangaroo Island increased by up to 65%. Much of this funding ceased by June 30, 2020. It is vital the island works to build the capacity, strengths, skills and talents of its community to support a collective move towards a mentally healthy future. Kangaroo Island CRO Maree Baldwin says the bushfires exacerbated mental health challenges already present on the island.

“With the added trauma of COVID-19, the community was restricted in meeting socially to support each other through the crisis,” she said. “As such, we’re aware that many Islanders are still struggling to move beyond the traumatic experience.” Maree is also co-ordinator of the KI Community Centre, managed by leading social enterprise, Junction. The Centre has been a haven of support and connection for locals, particularly in the aftermath of the fires and has become one of the key providers of ongoing support and services.

Region activities • Mental

Health First Aid

• Youth

Mental Health First Aid Training

• Community

Garden Program with Sophie Thompson

• Grant

writing and governance training

• Recruiting,

supporting and managing volunteers training

“We need to recognise that recovering from the bushfire crisis will take more than just rebuilding physical structure, we need to repair the social bonds that uphold our community and ensure it is prepared for future such events,” she said.

Country SA PHN Annual Report 20/21

Keilira In December 2019, a bushfire ran through almost 25,000 hectares at Keilira in the State’s south-east ‒ devastating prime cropping land and killing thousands of livestock. Kingston District Council’s CRO, Kristen Wilks, has been working with “a range of wellbeing programs, events and training courses that we can provide to the Kingston Community, primarily bringing in providers and experiences that we have not had in Kingston before,” Ms Wilks said. Ms Wilks’ first priority has been to offer her services to people directly impacted by the Keilira bushfires. “The Community Resilience Role is to primarily help support them with their recovery and resilience so it has

been critical to establish good relationships and understanding going forward,” she said. According to the Australian Psychological Society: “You are more likely to stick with a household plan if you have also prepared psychologically for a bushfire. Being able to manage your emotions in an emergency (that is being psychologically prepared), can save your life and that of others.” “It is recognised that traditionally, bushfire preparedness has primarily focused on physical preparedness, but that it is psychological preparation that will reduce or manage the potential mental and emotional impacts of a bushfire,” Miranda said.

Region activities • In

the Heart of a Country Girl Podcast by Mandy Curnow - with Keilira farmers Amanda and Tania

• Kingston

Kids Disco supported by Be You

• The

Grants Guy Workshop

• Barbed

Wire Ball

• Mountain

Bike Skills Session

Bushfire Response

Country SA PHN Annual Report 20/21

Community Collaborations Local Health Cluster grants deliver meaningful community outcomes

In 2020-2021 the Local Health Clusters (LHCs) continued to engage and grow as they provided further opportunity for communities to have their say in the primary health priorities of their communities. Clusters now cover most of country South Australia, serviced by nine LHCs: Yorke Peninsula, Riverland, Mid-North, Barossa, Far West, Upper Eyre, Lower Eyre, Upper South-East, and the Roxby Downs Health Forum. This year many of the LHCs took up the opportunity to apply for grants to commission worthy projects in their communities.

“The diverse range of activities that the grant recipients engaged is testament to the importance of local communities making local decisions about what’s needed in their own communities,” said Country SA PHN Community Collaborations Manager, Brenton Chappell. “It’s important that as a PHN we are empowering LHCs to self-manage and engage in these kinds of unique activities that directly benefit their own communities. Country SA PHN is proud to continue to support the clusters in their own individual endeavours.”

Community Collaborations

No-one Left Behind – Lower Eyre LHC Mentally Fit EP worked closely with the newly formed Elliston Well-being Group to hold three events for the community to come together and make connections across a broad demographic. The events were designed to create a sense of support to a community otherwise feeling isolated and alone, share resources and empower community members to look after themselves and each other or seek support when needed. The first was a men’s games night, designed as a fun way for men in the community to get together, have conversations and reconnect. This was followed by a Family Day with guest speaker Chris Blowes for adults. Chris is a shark attack survivor and spoke about responding to life after crisis, hope and recovery

Community Feedback

and living with a disability. The third event was a kids’ movie and activity night. These activities provided the community with an opportunity to discuss and gather a wide range of information on local health needs as well as education and social issues affecting them in their communities. Feedback from the events indicated that communities enjoyed the opportunity to come together with all participants saying they would attend the same type of event again and would encourage others to do the same. 67% of attendees knew about the clusters prior to the events with more than half saying they would be interested in joining.

“Two useful things I got from the event is knowing that there is always support around you and be open to listen, never know who you could be helping,” – men’s event participant. “Both guest speakers were well worth listening to. Recommend anyone and everyone listen if they get the chance,” – men’s event participant. “Really great to hear positive, local, relatable stories that inspire mental growth,” – family event participant.

Country SA PHN Annual Report 20/21

MC Coaching and Podcasts (Mandy Curnow), In the Heart of a Country Girl – Lower South-East LHC Mandy Curnow is a personal and professional coach based in the South-East. Mandy received a previous grant to create a series of podcasts based on interviews with rural men, called In the Head of a Country Bloke. Mandy wanted to build on the overwhelming success of the men’s series and make a podcast for rural women. Nine women were interviewed for the series from a wide range of backgrounds and locations with a link to the South-East – focusing on primary health care and depression and anxiety. “(It’s) a series of genuine ‘real life’ open-hearted, and at times raw conversations with rural women on their personal and professional journeys,” Mandy said. “I wanted to give a chance for local women to tell their stories, to not only lessen the stigma about how we ‘all’

Listener Feedback

face life’s challenges, but in the hope other women (and possibly men) may learn, heal and grow from such personal and brave stories. “Which they did. I received many comments and compliments from both men and women about just what they got from the series. I even had a couple of men ‘tear up’ when they were telling me just how inspiring the stories were, and what a good thing it was to have created the series.” There were more than 1,500 clicks to the site and more than 1,700 total plays. Feedback from each interviewee was very positive due to the flow on effect that the interviews had to workplace, family, friends and community. Telling their stories on mental health, well-being, grief, success, or failure was very powerful.

Feedback from listeners was extremely positive. Listeners stated that hearing the women share their vulnerable stories was very healing, especially in relation to grief and loss, but also health and feelings of empowerment. Many men and women could relate in various ways and even listeners who didn’t personally know the podcast guests found themselves relating to their stories, learning as well as feeling compassionate and empathetic to the stories being told.

Community Collaborations

Well-being Conference – Lower Eyre LHCs A well-being collaboration and connection conference was held at the Port Lincoln Hotel in March to engage and support well-being groups, LHCs and Suicide Prevention Networks across the Eyre Peninsula. Workshops focused on looking at the region’s strengths, key focus areas and community driven responses and sharing of resources. Specialist guest speakers spoke on the following topics: Research and Evaluation, Population Health and Co-design, Community Connection and the Government sector, setting up safety around sharing, self-care and vicarious trauma, bringing together philanthropic business to communities, grant writing and health literacy.

A workshop was also held to teach practical tools and ways that they could incorporate these learnings back into their communities and share resources and experiences with each other. The event feedback was very positive. Attendees appreciated the opportunity to collaborate and connect with people volunteering in their communities who are trying to create change in mental health strategies. Importance was placed on the opportunity to bring the groups together to connect and to design the conference based on community needs.

“The networking opportunities with likeminded EP locals and wellbeing groups was what made this event so great!! It was honestly an amazing opportunity. I feel very lucky to have attended.” “I loved that it was built on our community voices.”

Country SA PHN Annual Report 20/21

Circle in Time Seating – Yorke Peninsula LHC St Columba’s Memorial School in Yorketown designed a Circle in Time Seating through their Yorke Peninsula LHC Grant. The specially designed circular form seating has been installed in the school’s orchard. Members of the school community organized and provided rocks, landscaping and sensory planting to bring their seating vision to life. “It’s a quiet place for reflection and meeting and forms an important part of our school’s social and emotional literacy teaching that involves circle time sharing,” St Columba’s Memorial School Chaplain Katie Hughes said. “Students love the change of scenery and being outdoors in nature for some of their lessons. The space is a fantastic ‘break out’ space for

staff meetings, Parents’ and Friend’s gatherings, and small group work with our garden extraordinaire ESO Terri. “The space will be enjoyed by students, staff and the wider school community for many years to come as part of St Columba’s Social and Emotional Learning curriculum, incorporating circle time and growth mindset themes.” The school also held a pop-up outdoor cinema night for students and their families. The children and their families enjoyed having a family activity on a Friday night, the movie selections and discussing the themes of resilience. Resources provided were also appreciated, with many families commenting they weren’t aware of services such as Regional Access

Advanced Care Directive Session – Upper Eyre LHC This successful event was provided by the Council on the Ageing SA in collaboration with the Upper Eyre Local Health Cluster. It attracted a broad and diverse range of 70 community members, including culturally and linguistically diverse groups. These face-to-face sessions offered in the heart of a regional community, provide information in an accessible and tangible way for those who

may find it challenging to obtain it otherwise. Eight aged care service providers hosted information tables. Community members appreciated having time to gather information, ask questions and make connections in a non-pressured environment. My Aged Care and Advance Care Directives are relevant topics older people want to learn more about.

Community Collaborations

Stories Between Time – Riverland LHC FocusOne Health and headspace Berri worked collaboratively to create Stories Between Time ‒ bringing together a small group of Aboriginal Elders and non-Aboriginal young people to listen, build trust and understanding, document memories, stories and shared learning and increase opportunity for future collaborations. This was initiated by handdelivered invitations to the six original participants inviting them to an initial in-person gathering to introduce the project and each other. Further gatherings built on these relationships using an artsin-health framework of guided dialogue, small creative activities and mini-interviews. The group was deliberately kept small to foster deep discussions and trust building.

The group held four in-person gatherings and community engagement events within NAIDOC celebrations. These gatherings included informal yarning, small creative activities such as a jewelry making table facilitated by Aunty Gurt (Faith Morgan), an Instax photography activity at the Friday Family Fun Day and short interviews (including one recording with Aunty Yvonne Koolmatrie). Stories were exchanged through conversation and slow trust-building. The three non-Aboriginal young people were commissioned to respond creatively to their learning/ experience in the project in the creative medium of their choice. They reported that the project completely changed their view of their own community and made them more aware of issues facing Aboriginal community members.

Nuriootpa High School – Barossa LHC Year 11 students invited the entire school of more than 1000 students to engage in a Well-being Expo focusing on positive well-being, engagement and challenge. Northern Adelaide Community Youth Services attended, providing opportunities to learn about alcohol and other drugs abuse. Students distributed personal care products and there were free, fun, interactive activities including:

A rock-climbing wall, a blow-up castle, farm barn, vortex throw, car pull and a barbeque. Staff and student feedback was that the 2021 Well-being Expo was their best. Students modelled to their peers their strengths in the activities, displaying leadership and enthusiasm.

Country SA PHN Annual Report 20/21

Digital Health Assisting primary health providers implement new digital initiatives This year has been a busy and exciting time for Country SA PHN’s Digital Health team as it continues to assist country South Australian primary health providers to implement new digital initiatives amid the ongoing challenges and digital opportunities of COVID-19.

Secure Messaging

Country SA PHN has continued to work collaboratively with SA Health to implement state-wide Secure Messaging. This is seeing discharge summaries, specialist’s letters and electronic referrals as the means of exchange between SA Health, general practice and allied health providers. Country SA PHN’s role is to continue to prepare general practices for the transition, provide a testing platform, partner with SA Health and support the Secure Messaging pilot. This transition work will be ongoing with the roll out of Secure Messaging in 2021, including Healthcare Identifier details maintenance, the transition to the use of a NASH certificate with the Secure Messaging product and ensuring general practices have updated their details with the HPrY directory used by SA Health. As a testing partner, for some time Country SA PHN has run a test platform to be able to create templates, test software upgrades and workflows. This platform became an invaluable tool. It was used by SA Health to test the sending of discharge summaries to different clinical systems with differing Secure Messaging Delivery products – allowing the program to successfully transition from the pilot phase.

Country SA PHN also contributed to the development of an electronic referral form which will be online and accessible within general practice systems in 2022. The electronic referral transition will include acknowledgement of receipt and capacity to support booking options. Electronic Prescribing

Electronic Prescribing was introduced last year and fast tracked to support telehealth consults in response to COVID-19. Electronic Prescribing required work with practices as prescribers and pharmacy as dispensers. Country SA PHN’s work with pharmacies included refreshing Healthcare identifier registration, updating provider details and workflow for the implementation of electronic dispensing. It also included updating of scanning hardware, software and the distribution of resources. By the end of 2020, 85% of pharmacies were able to complete electronic dispensing. As the Active Script function goes live, pharmacies will be able to register patients so that the Active Script list will provide a collective view of the prescriptions. Practices have gradually started to take up Electronic Prescribing following some system conformance delays. Country SA PHN’s practice support team also worked with practices on their HI Service maintenance and software upgrades.

Digital Health

Australian Immunisation Register connection changes

Changes to rules on provider use and access to the Australian Immunisation Register (AIR) required providers to upload all immunisations and to have viewing access. Transition from individual access to an organisational level configuration to the AIR is now required for viewing access. This required substantial support to providers including verification of business naming, refreshing and updating immunisation provider numbers and linking codes, details, navigation and demonstration of how to view. Many pharmacies who had not previously been immunising completed training and required support for registering with SA Health. This work on the broader changes was completed through some shared webinars with the Pharmacy Guild and the Pharmaceutical Society. General practices were also assisted by Country SA PHN’s Practice Support team. This support was extended to more than 300 country South Australian general practice and pharmacy immunisers.

Country SA PHN Annual Report 20/21

Aged Care Digital Health In late 2020 Country SA PHN was given an opportunity to respond to the Royal Commission recommendations for Residential Aged Care services. All recommendations relating to Digital Health such as telehealth, use of electronic medication charts and My Health Record and conformant software were subsequently accepted and endorsed by the Federal Government in May 2021.

allows families to be involved in care decisions and updates on their loved ones.

The program Country SA PHN is delivering is a forerunner of the services Primary Health Networks will be engaged with in supporting Residential Aged Care Facilities (RACFs) across Australia.

Building upon the previous work of Country SA PHN’s after-hours program in the Adelaide Hills, Silver Connections (telehealth in RACF for GP access), Country SA PHN has started implementing comprehensive VC capability across all country RACFs. Through this program Health Connections Video, for use with SA Health Specialists, will be implemented to connect to general practice with the option to use HealthDirect for case conferencing and connection to family members and healthcare providers.

The first part of the program this year has been to engage, raise awareness and gain agreement from RACFs to participate in telehealth. Use of telehealth and video conferencing (VC) is improving access to specialist and allied health providers, particularly in rural areas, while improving GP options for regular care. With COVID-19 limiting travel and access to RACFs, it also

Secure Messaging will support VC use in RACFs. The current clinical information exchange between RACFs and their healthcare providers is at best inconsistent. The use of Secure Messaging Delivery will enable RACFs to be included in discharge summaries, receive GP progress notes and send clinical information to providers. Awareness on the purpose and

The outcomes particularly impacting country South Australia highlighted:

Electronic Prescribing

By the end of 2020, 85% of pharmacies were able to complete electronic dispensing

use of Secure Messaging has been completed, and all RACFs will implement Secure Messaging over the next twelve months via the use of the Healthlink Portal ‒ this will in time be incorporated into their Aged Care Case management software.* Country SA PHN has also provided support for country South Australian RACFs to access My Health Record. Awareness and agreement to use has been completed and work has started on its registration and use. Strategic Digital Health initiatives will continue to provide opportunities for all Australians and primary health workers. Our Digital Health team looks forward to continuing to work collaboratively with SA Health to help these initiatives benefit all country South Australians. As well as providing many challenges COVID-19 has also shown the ways in which Digital Health can be of particular benefit to those living and working in rural and remote South Australia.

Australian Immunisation Register connection Support was extended to more than 300 country South Australian general practice and pharmacy immunisers

*Aged Care Case Management software is undergoing a software development program with the ADHA to become more conformant with the standards in other clinical systems, with improved coding, in system access to My Health Record, Secure Messaging and the ability to connect to monitoring devices.

Digital Health

Aged Care Digital Health Started implementing comprehensive VC capability across all country RACFs

Country SA PHN Annual Report 20/21

Mental Health National Suicide Prevention Trial Evaluation The National Suicide Prevention Trial in country South Australia has helped to reduce the stigma around depression, increased community awareness and provided helpful guidance to community members when responding to people in distress according to a University of South Australia evaluation report.

Country SA PHN commissioned the university to evaluate activities delivered by the community led trial in country South Australia.

education, led by the community, has strengthened services in country South Australia, with clear evidence of people at risk being helped.

Country South Australia was announced as one of the 12 trial sites in 2017. Since this time, the trial has brought significant resources, activity and funding to areas of need throughout the country North region of South Australia including Whyalla, Port Augusta, Port Pirie, Port Lincoln and the Yorke Peninsula.

“The trial has been immensely beneficial. Working with a communityled approach to suicide prevention has made a real impact in increasing awareness of suicide and our regional communities’ capacity to support those in distress,” Country SA PHN Chief Executive Officer Kim Hosking said.

The University of South Australia’s Mental Health and Suicide Prevention Research and Education Concentration led by Professor Nicholas Procter found the trial has been an unqualified success engaging up to 775,000 residents across the region. The evaluation’s results show suicide prevention training, events and

The key findings reveal:

An increase in compassion towards people presenting in distress and awareness of suicide and suicide prevention

“In the largest suicide prevention activity ever to be undertaken in country South Australia, nearly 775,000 people were engaged through the trial, with more than 4,500 people undertaking relevant suicide prevention training. This level of engagement has flowed to an increase in community capacity building as people applied what they learnt.”

An increase in community competence and confidence to communicate more openly and connect with people in distress

Mental Health

A decrease in judgement and stigma and a drop in reported depressive symptoms.

Country SA PHN Annual Report 20/21

University of South Australia Lecturer and mental health academic, Dr Kate Rhodes, who led the National Suicide Prevention Trial’s evaluation, said the most effective strategies were those that were community driven, relevant and relatable to the local population, and included participant engagement and connection. “The evaluation demonstrates the desired effectiveness of suicide prevention programs and events for both community and professional groups alike,” Dr Rhodes said. “These are promising results for they contribute to the major aim of interrupting the trajectory towards suicide by encouraging people to accept and receive help from others, as well as help offering and advocacy on behalf of others.” In the focus groups/interviews following the trial 98% of people reported that attending a trial activity had impacted on them in a variety of ways. The most frequent impact

Youth Aware Mental Health findings:

was an increased competence and confidence (58%) to communicate more openly and connect with people (63%), even with people they didn’t know. There was also a stated individual and community awareness of mental health generally and how to recognise and respond to suicide distress. Not only was there an increase in listening and engaging with people using more appropriate suicide-related language but there was an increase in compassion and help offering. One interviewee emphasised the important role that awareness has on people being able to recognise that “they are actually struggling, and that they can actually do something about it” before they can even reach out for assistance. There was also a flow on, or ripple effect from people who had attended the trial activities, as conversations and learnings were

A decrease in suicidal thoughts

shared. Furthermore, there was an increase in community engagement and support for suicide prevention activities and examples of businesses (such as gyms) partnering with service providers to run wellbeing events. Evaluating Youth Suicide Prevention Training

Youth Aware Mental health (YAM) is a universal mental health promotion and suicide prevention program for young people, 14 to 16 years of age. The program is aimed at encouraging adolescents to learn about and discuss everyday mental health concerns, promoting peer support and providing youth with a guide to available local resources and services. As part of the trial Country SA PHN implemented the YAM program in three rural high schools. The evaluation indicated that YAM’s impact was significant.

A decrease in depressed mood

An increase in intentions to seek help if needed.

Mental Health

Country SA PHN Annual Report 20/21

Impact of Aftercare Services

The provision of appropriate care after a suicide attempt is important for reducing future attempts and suicides. A suicide attempt is a strong predictor of future attempts or suicide. A general population Aftercare Service was introduced into all five communities after consultation identified that this was a current service gap across the trial region. The My Life program was implemented and delivered by Country and Outback Health. During the threeyear timeframe the service supported over 200 clients and delivered more than 3,200 support sessions. The Aftercare Service data identified that service provision is effective in reducing depressive symptoms over time and maintaining symptoms at low rates.

Evaluating an Aftercare Service Model in an Aboriginal Controlled Health Organisation The Aboriginal Aftercare Service commenced under the trial in July 2018. The first of its kind, the service was established and delivered by Pika Wiya Health Service Aboriginal Corporation of Port Augusta.

The evaluation helped to inform Federal Budget investment in the continuation of the service and expansion of Aboriginal Aftercare services on a national scale.

In October 2018, Country SA PHN commissioned the University of South Australia’s Department of Rural Health to evaluate the service.

Official Launch

It found that the service model is closely aligned with good practice in suicide prevention in Aboriginal communities including: being provided by an Aboriginal Community Controlled Health Organisation; responding quickly to referrals; comprehensive engagement with clients; inclusion of kinships; involvement of traditional healers in clients care; and help with clients’ practical problems such as assistance with housing and vocation. As well as the Aboriginal Aftercare Service being well received in the community, it was recently recognised as a promising and emerging crisis suicide prevention program by the

Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention.

The UniSA evaluation report was formally launched on World Suicide Prevention Day during the National Suicide Prevention Trial Evaluation Webinar in September 2021. Country SA PHN and the University of South Australia jointly hosted this online event to celebrate the NSPT’s achievements and reflect on the outcomes from the trial strategies and activities. National Evaluation

In addition to the local evaluation of the trial the Australian Government also funded the University of Melbourne to undertake an evaluation of the 12 National trial sites, focusing on planning, implementation, impacts and outcomes. The final National report can be viewed here.

Mental Health

Grant Activity Whyalla Suicide Prevention Network 1. World’s Biggest Comic 15-part, large scale, visual narrative promoting mental health and wellbeing in the community spanning over 600 square meters.

2. First Responders Wellness Dinner Dinner event to provide information and resources about PTSD to first responders, promote positive mental health and reduce the stigma that prevents people from seeking help. The event was attended by over 60 First Responders from South Australian Police, South Australian Metropolitan Fire Service and South Australian Ambulance Service. 3. Step into My Shoes Campaign Development of short films to promote recognition, understanding and empathy for the role first responders play in the local community. 4. Roses in the Ocean Walk Community walk attended by over 250 people to remember those we have lost to suicide and their loved ones, those who have attempted suicide and those with thoughts of suicide.

Empowering Lower Eyre 5. Great Flinders Mental Health Round Engaging local Football and Netball clubs in conversations to reduce stigma of suicide and promote help-seeking behaviours. 6. Women’s Health Night Women’s Health Night - Focusing on that “M” Word. With guest speakers from Motion Physiotherapy EP, Lower Eyre Family Practice and Zest Holistic Healing.

Country SA PHN Annual Report 20/21

MATES in Construction 7. MATES in Construction Suicide Prevention Training MATES in Construction provided training to construction employees in suicide prevention to know how to look out for, support and talk to a work mate about mental health and suicide. The training seeks to raise awareness about mental health and wellness in an industry overrepresented by suicide. 8.

Port Augusta Suicide Intervention & Life Promotion Action Group (SILPAG) 8. Mental Health Awareness Coasters Drink coasters produced with images of local men accompanied with messages to reduce stigma and encourage help seeking.

Mental Health

Mentally Fit EP

Australian Red Cross

9. Everyone has a Story Documentary Development of six artistic short films to empower community members to be mentally healthy, encouraging them to reach out for support.

12. Safe use of Social Media Workshops Delivery of workshops to educate students from schools across the Port Pirie and Mid North region on the impacts of online bullying, positive social media use and introduction of the My Team (Mental Health & Wellbeing App)

Lincoln Alive

10.

10. Community Suicide Reflection Seat Workshops to develop a seat that will be a place for quiet reflection, starting lifesaving conversations and bringing people together.

Mission Australia 11. We stand together in Whyalla Development of an information and resource guide to support discussions about suicide for Whyalla businesses and organisations.

SOS Yorkes 13. 2021 Mental Health Awareness Calendar A calendar which showcases a suite of mental health and help-seeking stories of local champions. The personal narratives and images foster relatable experiences that breakdown stigma and facilitate conversations about mental health in the community.

13.

Country SA PHN Annual Report 20/21

Population Health Supporting Access to After-Hours Healthcare The Country SA PHN After-Hours Program has provided increased access to primary health care for country South Australians by supporting the delivery of a wide range of high quality, innovative and locally responsive after-hours services across rural and remote South Australia.

The After-Hours Primary Health Care Program is a key initiative of the Australian Department of Health to improve the health system and provide the best possible access to after-hours primary care services to members of the community - particularly those living in locations with limited access to health services and where there are identified service gaps. “The COVID-19 restrictions and lockdowns has seen a rapid rise in innovations in tele-health, teledentistry and extended after-hours services that has proved to be a real benefit for rural and remote South Australians,” said Country SA PHN Chief Executive Officer Kim Hosking. “Emergencies don’t only happen on week-days between 9am and 5pm. Incidents can occur at any time and the after-hours program allows rural and remote country South Australians to access primary health care when they need it.” After-Hours General Practice Program

Country SA PHN is working with general practices located in Gawler, Mount Pleasant, Yorke Peninsula and surrounding regions to offer face-to-face after-hours services by supporting extended operating hours and increased after hours general practitioner and practice nurse staffing capacity. Gawler GP Inc is co-located with the Gawler Hospital Emergency Department (ED). The introduction of additional registered nurse staffing on weeknights and weekends has resulted in reduction in the time patients wait or leave a service without being seen.

Nurses are actively triaging patient in the clinic and ED. Nurses are completing observations, pathology and radiology requests where required to streamline the visit and prior to the patient being seen by the general practitioner. The service was expanded in April 2021 to meet increasing need for after-hours services from both the community and local primary health care services, ensuring community members continue to receive the right care, in the right place, at the right time. Mount Pleasant’s Talunga Clinic has expanded after-hours services to address increasing community need following the closure of the Mount Pleasant Hospital ED. Talunga Clinic has been meeting regional service gaps through the successful triage, management, referral and hospital admission of urgent and semi-urgent health care needs arising from patients that walk-in to the service. Community need continues to increase with residents from as far away as Mannum and Murray Bridge attending the clinic for after-hours healthcare. Medical HQ works in close partnership with the Ardrossan and Maitland Hospital EDs and local health services to provide a full range of after-hours primary care services, including Sundays and public holidays. Weeknight and weekend service need is regularly monitored by Medical HQ to schedule clinics across both locations to maximise services provided to each community. Yorke Peninsula is a popular South Australian tourist destination with community numbers significantly increasing on weekends and during school holidays. Patient feedback has been extremely positive.

Population Health

Number of Patients, March - June 2021

Apr -Jun 2021

Jan-Mar 2021

1500 1413

1200 900 600 518

300 0

Medical HQ

622

321

Talunga Clinic Mt Pleasant

Gawler GP Inc

Patient Outcomes 1,550 No further treatment required 802 Advised to make an appointment with usual GP or other persons involved in their health care (non-practice patients) 313 Follow up appointment (practice patients) 171 Referred to ED (Pre or Post Encounter) 55 Referred to other Health Professional (New Referral) 41 Other 22 Referred to other Health Service (New Referral)

Country SA PHN Annual Report 20/21

Extended Access to Dental Service

As reported in the SA Oral Health Plan 2019-2026, dental problems are common in the Australian population, with more than a quarter of children aged five to ten years (27%) and adults (26%) having untreated dental decay. Nationally, dental decay is the third highest cause of Potentially Preventable Hospital Admissions (PPHA) which could be avoided if timely and adequate primary care is provided. Dental problems are the most common acute condition causing PPHAs in South Australia according to The Chief Public Health Officer’s Report 2016 – 2018. However, the national trend of fewer dental professionals practising in rural and remote areas holds true for South Australia, making access to care challenging in these areas.

As reported in the SA Oral Health Plan 2019-2026

Country SA PHN’s Needs Assessment identified increasing rates of poor oral health across the Country SA PHN region, particularly in areas of socio-economic disadvantage. This is compounded by distance and low rates of accessible dental practitioners especially in very remote locations. In May 2020 Country SA PHN commissioned the establishment of Extended Access to Dental Services programs, to improve access to necessary dental services in the after-hours period, with a view to preventing avoidable emergency attendance and hospital admissions, improving oral and general health outcomes for members of the community, and providing a better patient experience.

27% of children (5-10 years) have untreated dental decay

Australian Dental Foundation

The Australian Dental Foundation (ADF) delivers after-hours telehealth services in the Murray Mallee and Outback regions and provides education and training to ensure health professionals providing the service are appropriately qualified. The ADF also provides education to rural GP’s and nurses on the diagnosis and management of dental pain in a primary care setting. Services were further expanded between March and June 2021 due to increased demand in both regions including additional training and support to dental/clinical community members. Community need for the triage hotline and teledental services continues to increase, particularly in the Murray Mallee region, additional services are being offered to this region over 2021-2022 to meet the on-going higher health care needs.

26% of adults have untreated dental decay Dental decay is the third highest cause of Potentially Preventable Hospital Admissions (PPHA)

Population Health

Australian Dental Foundation - Trauma/Infection

Option A Patient proceeds to the nearest hospital for assistance

Patient Journey

Option B Patient calls the nearest hospital for assistance

Patient proceeds to ADF after hours emergency dental clinic

Option C Patient calls promoted ADF oral health emergency hotline

Dental Trauma/Infection

Dental Emergency Service

Option A On arrival at the ED, patient assessed and triaged immediately to ADF emergency service

Outcome Patient is promptly assessed and treated in the most appropriate manner. Lower cost to public system, less congestion of ED. Happy patient, medical staff and taxpayers.

Option B Patient is triaged over the phone service straight to the hospital or ADF Patient assessed by a dentist and treated accordingly. If required, referral for further treatment Cost is equivalent to ED costs for nonadmitted patient i.e. $545 at present

Country SA PHN Annual Report 20/21

Australian Dental Foundation Extended Dental Case Studies Dental Outreach

Country SA PHN has commissioned Dental Outreach in the same period for the delivery of after-hours dental services to community members residing in the Limestone Coast, Eyre, Flinders & Far West, Kangaroo Island and Mid-North and Yorke Peninsula regions. The service was expanded between March and June 2021 to meet increased community demand, including an additional location of the Riverland Mallee Coorong. Community demand in Yorke Peninsula continues to remain high, expanded services for this region will continue to be provided over 2021-2022.

Royal Flying Doctor Service

The Royal Flying Doctor Service Central Operations (RFDSCO) Oral Health Program operates a portable two-chair dental operatory in multiple remote locations in South Australia and Northern Territory. do not receive services from private or public dental health service providers. Service sites include Marla, Marree, Andamooka, Kingoonya, Oodnadatta and Leigh Creek (with a catchment of Copley, Nepabunna and Beltana). These locations do not receive services from private or public dental health service providers. RFDS Oral Health Program services are provided in conjunction with RFDS Integrated Primary Health Services, with a strong focus on preventive care. This evidence-based health

service aims to minimise adverse oral health and general health outcomes for community members through face-to-face and tele-health afterhours care, comprehensive preventive management and additional afterhours services provided through other innovative activities. Services have been expanded in 2021-2022 and include the use of intraoral cameras for tele-health consultations as an addition to existing RFDSCO Visionflex system capabilities established in remote community clinics, which allow an in-depth examination in real time by a clinician. The RFDS has also developed training packages for health professionals to provide tele-health triage for dental emergencies.

Population Health

Outback

Murray Mallee

26-year-old Joel fractured front teeth while working on a station Joel was working on a water pump when the crank handle spun around and struck him in the mouth, breaking his two front teeth. He took a photo and contacted the Australian Dental Foundation Emergency Dental Triage Service. He was triaged to a partner clinic, advised to keep on a soft food diet and received treatment with two restorations placed upon his upper central incisors. He was advised that they may require endodontic (root canal) treatment in the future.

38-year-old John failed wisdom tooth extraction John was triaged and seen following contact from a regional clinician who had attempted an extraction on the lower right wisdom tooth which was causing pain due to pericoronitis (inflammation of the gum overlying the wisdom tooth). Unfortunately, the extraction had not gone as planned and while the crown of the tooth had been removed, the roots remained unyielding, ensconced within the bone. Arrangements were made for John to be seen by an experienced surgeon that evening, who removed the tooth. Thanks were given by the patient and the original clinician and healing was apparently uneventful.

Outback Nine-year-old Edward Trauma to Upper Front Teeth Edward was struck in the mouth with a cricket bat playing with his brothers, fracturing his four upper incisors. The family contacted the emergency phone number and Edward was triaged to a partner clinic the following day for an endodontic (root canal) specialist assessment. Edward then received the desired treatment. The immediate results were extremely positive. Edward and his parents have been advised there may be a need for further endodontic treatment in the future. Edward’s parents have since invested in a cricket helmet!

Country SA PHN Annual Report 20/21

Workforce Responding to COVID-19 Country SA PHN demonstrated effective system coordination and integration in response to the COVID-19 pandemic. A PHN integrated Central Command Centre was established in March 2020 to ensure systems and processes were developed to support the community and primary care in an uncertain environment.

Country SA PHN quickly mobilised resources to support over 80 practices to adapt to telehealth services that enabled business continuity in an environment where face to face care was not an option. Six GP Led Respiratory Clinics and eight homebased testing services were rapidly established in areas of high need supporting the community with testing and tracing. Practices were supported in the provision of Personal Protective Equipment to maintain safety in an evolving pandemic. Isolated communities through COVID restrictions were supported with mental health care. This initial response was followed by COVID-19 vaccination support through GP Led Respiratory Clinics, known in their joint role as Commonwealth Vaccination Clinics, and general practices to provide vaccinations to the majority of country South Australians. Country SA PHN has led the coordination, scheduling and vaccination of the most vulnerable communities in Residential Aged Care Facilities and ensured options were available for staff in these facilities to meet their mandatory vaccination requirements. As South Australia heads towards opening our domestic borders and

potentially easing restrictions and adapting to ‘living with COVID-19’ Country SA PHN is continuing to work collaboratively with multiple stakeholders at a Federal and State level to ensure that country South Australian primary health care providers will be fully prepared. This includes representing primary care in country South Australia – ensuring the rural primary health care voice is heard, supporting vulnerable populations and primary health care providers for their ongoing and unfolding role. “While COVID-19 has provided primary health care with many challenges, it has also provided the opportunity to strengthen multiple integrated models across sectors such as aged care, social care, disability and housing in a way that had previously not been experienced” said Bernie Cummins, Country SA PHN Executive Manager, Health Integration and Coordination. “It has given Country SA PHN the ability to work directly and collaboratively with other organisations to provide support and influence across the sector. These relationships have resulted in better outcomes for primary health care providers in country South Australia and their communities.”

Workforce

Country SA PHN Annual Report 20/21

Response Presence in the Central Command Centre

A multi-agency State Control Centre – Health (SCC-H) within SA Health headquarters is part of a wholeof-government response to the COVID-19 pandemic. The SCC-H provided the opportunity for agencies to work together in a comprehensive and coordinated statewide response. Country SA PHN has represented the Commonwealth’s primary care response at the SCC-H, along with Adelaide PHN since March 2020. The opportunity to collaborate with our colleagues across the PHNs and the operational leads of various agencies such as Communicable Disease Control Branch, South Australian Ambulance Service, Australian Defence Force, etc. has been rich and valuable and meant that rapid solutions could be found in an emerging pandemic response in SA. Communication

Country SA PHN provided timely information to rural and remote South Australian primary health care providers through the COVID-19 Updates and has become a trusted resource throughout this pandemic.

Supporting Priority Populations

This was integrated through the collaborative work with SA Health, Wellbeing SA and Adelaide PHN on HealthPathways SA. HPSA experienced an increase of more than 35 percent in use and a 24 per cent increase in new users from April to June 2020, with COVID-19 accounting for 86% of the site’s primary hits. GP Led Respiratory Clinics

The Australian Government established GP Led Respiratory Clinics around the country to support the assessment, testing and diagnosis of community members experiencing mild to moderate respiratory symptoms. Commonwealth funded respiratory clinics, supported by Country SA PHN, were established at six sites across country SA in Clare, Murray Bridge, Angaston, Kadina, Naracoorte and in Port Augusta at Pika Wiya Health Centre. Commonwealth Vaccination Clinics

Six Respiratory Clinics continued to operate as testing centres and in March 2021 began operating as Vaccination Clinics as well – administering the Astra Zeneca vaccine and the Pfizer vaccine in July 2021.

Aged and disability care workers

People with disability

Supporting Primary Health Care with PPE distribution

Country SA PHN distributed surgical masks and P2/N95 respirators to GP Respiratory Clinics, general practices, including Aboriginal Community Controlled Health Services (ACCHS), allied health professionals and community pharmacies with demonstrated need. My Health POCiTT Expansion

Country SA PHN expanded the My Health POCiTT (Point of Care Testing) program to further support integrated care and the community. Providing Mental Health support

Country SA PHN supported the Australian Government’s mental health response to the COVID-19 pandemic and focused on: assisting vulnerable people; including frontline health workers; older people; Aboriginal and Torres Strait Islander peoples; people from a culturally and linguistically diverse background and those that are socially isolated or financially impacted by the COVID-19 pandemic to access mental health services and support.

Aboriginal and Torres Strait Islander People

Workforce

Supporting GPs – Emergency Response Planning Tool (ERPT)

Country SA PHN is providing funding for general practices within country South Australia to access the Emergency Response Planning Tool (ERPT). The Tool is an up-to-date cloud-based plan, developed in collaboration with the Royal Australian College of General Practitioners. It provides general practices with individually tailored information to appropriately prepare for, respond to and recover from, the impacts of emergencies and pandemics in their community – ensuring their staff safety, reducing the risk of financial loss and assisting with the smooth recovery of their practice.

Vaccinations Supporting Residential Aged Care Facilities Workers Mandatory Vaccinations

Country SA PHN supported 64 Residential Aged Care Facilities in country South Australia to ensure their approximately 1,010 workers had received at least one dose of a COVID-19 vaccine prior to the Federal Government’s mandated September 17,2021 deadline for RACF workers.

People who are pregnant

People with underlying medical conditions

Country SA PHN Annual Report 20/21

Opening Up Preparation Supporting Primary Health Care providers

Country SA PHN is working with multiple stakeholders at a Federal and State level to ensure that country South Australian primary health care providers will be fully prepared when South Australia opens domestic borders. Country SA PHN is representing rural and remote primary health care providers on the Primary Care Taskforce, the Rural Health System Preparedness Roundtable, the SA Living with COVID-19 Mental Health Support and assisting with COVID-19 Vaccination of our most vulnerable populations. An important element in Country SA PHN’s participation is planning for the sustainability of general practice as a critical element of the primary health infrastructure of small rural communities. Country SA PHN’s role in this preparation ensures the country voice is heard and that the unique challenges facing our rural and

remote primary health care providers and their communities are planned for as we move into this next phase of the pandemic. Supporting Vulnerable Populations

Country SA PHN is providing funding and support to six local organisations with direct relationships to support innovative, local, short-term activities tailored to the individual needs of their communities. These include four pop up clinics, an out-reach clinic and a motorhome and a mobile vaccination clinic supporting our most vulnerable communities. Country SA PHN recognises that there are many vulnerable population groups within our community who may be finding it difficult to access COVID-19 vaccinations and the importance of ensuring equity of access where possible. These may include those impacted by:

Working with Local Health Clusters Country SA PHN, working with our Local Health Clusters, has been able to hear the community voice and find local solutions to vaccine availability, workforce support and community vaccine hesitancy. Local Health Clusters have been integral to nominating community members to work with Country SA PHN to provide trusted advice and reduce hesitancy in the community. The Local Health Clusters have been able to inform the development of vaccine solutions and source venues that are most appropriate for the community and provide the best opportunity to maximise vaccinations.

Vulnerable Populations Homelessness

Disability

Living in remote location

Aboriginal and Torres Strait Islander People

Workforce

Working with Wellbeing SA to address Vaccine Hesitancy Country SA PHN is working with SA Health and Wellbeing SA to use evidence-based methods to reduce vaccine hesitancy in country South Australia. Approximately 30% of those living in rural and remote South Australia report some level of vaccine hesitancy. This hesitancy is higher in our vulnerable communities such as Aboriginal communities, the unemployed and those experiencing mental illness, psychological distress and disadvantage. Country SA PHN has also collaborated with SA Health and Wellbeing SA to provide training sessions to help primary health care professionals have conversations with the community. These sessions cover facts about the vaccine and effective ways to mis-spell common misperceptions and clearly communicate the benefits of increasing vaccination rates for community protection against COVID-19.

Aged care and disability workers

Those ineligible for Medicare

Older age groups

Culturally and linguistically diverse people, especially asylum seekers and refugees

Country SA PHN Annual Report 20/21

1. Goolwa Medical Centre

Goolwa Medical Centre (GMC) has been awarded the Royal Australian College of General Practitioners 2021 South Australian/Northern Territory General Practice of the year. GMC is a large, rural practice with six partners, five associates, several registered nurses and a varying number of registrars and students at any one time. Collectively, GMC has more than 35 years of experience in this practice.

GMC is a successful practice across all areas of primary health care delivery, including their well-orchestrated COVID-19 vaccination roll out. They started on March 23, 2021, completing 63 clinics, with more than 7,500 vaccinations and more than 3,700 patients fully vaccinated (to date). A detailed planning stage was the key to their vaccination clinic’s success. Planning included the mathematics of patient/doctor ratio, staff availability, social distancing requirements, costing and the impact on patients.

GMC purchased an online workshop through Scale My Clinic which included everything from cost to logistics. They established the ‘Grubicle’, model with five patients, booked every five minutes with two doctors vaccinating in two rooms. Their clinic numbers were 120 to 160 vaccinations in two to three hours on average. GMC was contacted by Business SA for the details of their method and their vaccination figures to use as an example to SA Health.

Workforce

2. Hawkins Clinic

Hawkins Clinic in Mount Gambier provides care to the Limestone Coast community and parts of Glenelg Shire in Victoria. The clinic currently has 23 consulting GPs, who also offer services to local nursing home residents, and provide obstetric care at the local hospital. Hawkins Clinic is dedicated to education and training, hosting registrars, medical students

and providing GP experience for interns employed at the local hospital. Hawkins Clinic has done a remarkable job performing its traditional role for the community as well as making a significant contribution as a General Practice Vaccination Clinic. To date, Hawkins Clinic has performed almost 4,000 COVID-19 vaccination services - including providing in reach clinics to nursing home staff, Astra Zeneca

vaccines to our patient population, and now Pfizer vaccines to eligible patients in our local community. This has been possible thanks to the hard work and dedication, of not only the clinic’s GPs, but also the nurses and administrative staff, who have given up their weekends to assist with planning to achieve our targets and support the provision of large vaccination clinics.

Country SA PHN 30 Tanunda Road, Nuriootpa SA 5355 PO Box 868 Nuriootpa SA 5355 Ph: 08 8565 8900 www.countrysaphn.com.au