Owned and operated by Swan Hill District Health and located within the hospital precinct, Swan Hill Primary Health Medical Centre is one of three general practices in the town, and recently celebrated its second anniversary. The centre’s nursing and admin staff are employees of the Health Service with the four general practitioners acting as fee for service, independent contractors.
Swan Hill with a population of around 10,000, but servicing a community of around 25,000, is surrounded by lakes, rivers and creeks and is a very popular tourism destination.
The Murray River through Swan Hill is lined with a number of parks including Riverside Park on Monash Drive which has picnic areas, BBQ facilities, a playground and a sound shell. One of the most popular tourist attractions in town is the Pioneer Settlement, situated at the junction of the Murray and Little Murray Rivers. This settlement recreates the atmosphere of a pioneer river port town and it offers paddlesteamer cruises along the Murray River aboard the P.S. Pyap which was built in 1896 and has been restored.
It has a variety of festivals held through the year such as Harmony Day, Food and Wine Festival and the Heart Beat of the Murray Laser show. There are also great options for food and wine, with the region producing grapes and fresh vegetables for both the domestic and export markets.
About the clinic
Swan Hill District Health Senior Medical Officer, Dr Ernan Hession heads the Medical Centre and with practice manager, Gail Kenyon worked to establish the hospital clinic which opened in 2016.The practice hosts up to three AGPT registrars, Monash University medical and La Trobe University nursing students.
Staff includes the practice manager and administration staff, nursing staff, diabetic educator and medical student coordinator.
The medical centre covers all areas of general practice and utilises services provided by the allied health and community health departments within the hospital.
Practice manager, Gail Kenyon has worked in general practice in Swan Hill for 32 years and has a deep understanding of the complexities of health service provision, medical workforce retention and the issues around rural isolation and limited access to health services.
Recognising gaps in mental health services for the region, Gail, as part of a consortium auspiced by the local PHN, was successful in gaining Primary Mental Health Co-ordination funding for a Mental Health Nurse to co-ordinate and deliver services within the town.
“I saw the funding program in the tenders and thought – we are going to have a go at this! We now have our first time ever mental health nurse.” said Gail Kenyon.
Swan Hill District Health
The organisation services a catchment area with a population of around 40,000. The 79 bed hospital comprises emergency department (4 bed), acute care ward, midwifery unit, operating theatre, day procedure unit, renal dialysis, chemotherapy, palliative care and radiology services. Two residential aged care facilities provide 75 beds. Various allied health and community health services are provided including headspace, cancer resource centre and rehabilitation facilities.
Specialist and visiting consultant cover includes orthopaedic surgeon, vascular surgeon with surgical registrars on rotation from Bendigo. In addition, cardiologist, rheumatologist and anaesthetists are available. The Health Service has coordinated fly in fly out obstetric cover. The emergency department is covered by senior HMO staff and supported by anaesthetist and surgical backup. The major referral centres are Bendigo and Melbourne.
Telehealth is utilised extensively across various specialties. Geri-Connect and a tele- fracture clinic are also available.
The registrar experience
In welcoming registrars Swan Hill Primary Health provides a comprehensive orientation for the practice and the hospital. Registrars have time with practice manager and nursing staff then commence wave consulting with their supervisor, gradually moving towards independence.
Under their supervisor, Registrars are included in the on call roster as back up cover for the emergency department (generally one night per week) and have VMO admitting rights at the hospital. The after hours support includes surgical, anaesthetic and obstetric cover and complex or acute presentations are generally transferred out.
Opportunities for ongoing education and training
One on one teaching and general discussion around cases from the practice and the hospital are standard. Other opportunities for skill development and ongoing learning include participation in the hospital program which incorporates tutorials, case conferences, visiting speakers and various workshops. Emergency scenario lectures occur weekly.
Registrars may be involved in GP Clinics in outlying towns, advanced care planning, nursing home care, palliative care and end of life planning, telehealth consulting, fracture clinic, stress echos, treatment of skin cancer and minor surgical procedures.
Practice Manager, Gail Kenyon explained the Swan Hill medical community has a long history of supporting GP training and education. She advised the town hosts a varied cohort of health personnel including medical students, registrars, HMOs, VMOs, allied health and nursing trainees.
“The exciting thing is the vibe – it is such an open environment, a great learning environment. The young people are open to ideas, they are fresh and enthusiastic. The senior doctors enjoy having them and the community have been fantastic.. they take it on board that we are a training facility.” said Gail Kenyon, Practice Manager.
Mr Ted Rayment CEO
Implementing strategies to address the diminishing number of GPs and GP Proceduralists available to service the community is a major challenge for regional centres. As CEO for Swan Hill District Health, Mr Ted Rayment is particularly aware of the health needs of the region and utilises multiple approaches to address workforce shortage issues.
Providing training opportunities and career pathways for medical students, interns, registrars and General Practice Registrars is a core focus of the organisation and a major long term strategy in ensuring work force security. The health service continues its partnership with the Monash University Clinical School Rural Hub program and works closely with various stakeholders to provide education and training opportunities across all health sectors.
Mr Rayment explained Swan Hill District Health offers the AGPT Registrar a broad scope of experience in all facets of the health care system.
“We provide the Registrars with general practice experience – not only in the clinic, but also across our health service, which includes the hospital and all the community services under the one umbrella – including headspace, aged care, allied health and community health – there is a broad exposure to all our services.” said Mr Ted Rayment.
Dr Ernan Hession
Obtaining his medical degree at Dublin University in 1983, Dr Ernan Hession completed his general hospital and GP training in the UK and moved to Australia in 1989. At the time, many UK doctors were emigrating to Australia and Canada. Swan Hill was looking to recruit GPs. Via an introduction from a friend in Echuca, Swan Hill wrote and offered Dr Hession a position.
Coming up to his 30 year anniversary in the region, Dr Hession explained he enjoys the scope of practice in Swan Hill. He has practiced as a GP generalist and GP obstetrician. In recent years he has ceased his obstetric practice. He continues to provide a broad range of general practice services in the clinic, works in emergency, palliative care and geriatric medicine but more particularly has focused on medical education and health service delivery and workforce planning in his role as Chief Medical Officer with Swan Hill District Health.
Dr Hession has been clinical supervisor for medical students, HMO’s and Registrars at the Swan Hill hospital for the past 25 years. He is Hub Director with the Monash Medical School, supervises international medical graduate training and is an accredited supervisor with the RACGP Registrar training program. He explained this focus on and commitment to education is driven by the understanding of the need to ensure a skilled proceduralist GP workforce for rural areas.
As part of his role as Chief Medical Officer with the Health Service, Dr Hession values his involvement in planning for the future and developing strategies to implement various initiatives including:
- Further development of medical student training programs in conjunction with Monash University Rural Medical School, as part of the Federal government Department of Health, Murray–Darling Medical Schools Network
- Development of academic research positions in medical education and training
- Planning and lobbying for funding to upgrade health facilities in Swan Hill
- Developing initiatives around providing satellite GP services to outlying towns where declining GP numbers mean small towns are without cover.
“We are at a time of change in Swan Hill. Like many country towns we are trying to define a new role – the new direction for the hospital and general practice in the town… to address how we can service the small towns around us, like Moulamein, Sea Lake and Balranald.” said Dr Ernan Hession.
“In my medical career, I’ve been able to deliver babies, manage heart attacks, manage major emergencies… I’ve been part of a much bigger organisation.. I’ve been able to get involved. You know you are needed in country practice. A country GP is a jack of all trades a master of none, but oft times better than a master of one.” said Dr Hession.
For Dr Hession, the personal satisfaction of general practice comes from the diversity it provides and the role it enables him to play in his community. He values the opportunity working in Swan Hill provides him to utilise his procedural skills and to facilitate the attainment of those skills in the GPs of the future.
Swan Hill has a population of around 10,000 and is located between Bendigo and Mildura, 340km NNW of Melbourne.
DR ERNAN HESSION
BAMB. Dublin University 1983
BC H., BAO., DCH., Dip.Obs.
Chief Medical Officer, Swan Hill District Hospital
Swan Hill Rural City Council: https://www.swanhill.vic.gov.au/
Swan Hill Regional Guide: https://www.visitswanhill.com.au/swan-hill-region-official-visitor-guide-2018
Swan Hill Primary Health Medical Centre: http://www.shdh.org.au/medical-centre/
Swan Hill District Hospital: http://www.shdh.org.au/
Geri-Connect Better Care Victoria: https://www.bettercare.vic.gov.au/innovation-projects/browse-all-projects-listing/Geri-Connect
Monash University – Medical School Regional Training Hubs https://www.monash.edu/medicine/srh/regional-training-hubs
Department of Health Marry Darling Medical Schools Network http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2018-factsheet22.htm
Royal Australian College of Medical Administrators, Associate Fellowship In Medical Administration: http://www.racma.edu.au/index.php?option=com_content&task=view&id=385&Itemid=159
Melbourne University Faculty of Medicine Grad Cert in Clinical Teaching / Grad Diploma in Clinical Education / Masters in Clinical Education. http://mdhs-study.unimelb.edu.au/degrees/graduate-certificate-clinical-teaching/overview