Brooke Street Medical Centre
Brooke Street Medical Centre has provided health services to the Woodend community for over thirty years, opening in 1985. A key feature of this general practice is its focus on utilising the skills and services of a broad range of health care professionals to deliver a comprehensive, multi-disciplinary health service.
This large, purpose built practice hosts 12 general practitioners who have a broad range of clinical skills and special interests. The practice has up to six GP registrars and four medical students. In addition, the practice includes the services of a physiotherapist, exercise physiologist, chronic disease nurses, diabetes nurse educator, mental health nurse, a respiratory nurse, dietitian and two psychologists.
The practice hosts visiting podiatrist, audiologist, cardiologist, urologist, ear nose & throat specialist and orthopaedic surgeon.
“We think you provide better care if you utilise other people and their health disciplines to assist you in providing health care.” said Dr Richard Bills.
The practice has a dedicated treatment room and acts as the urgent care clinic for emergency presentations during business hours. On weekends, the practice provides a GP clinic on Saturday and Sunday, registrars are part of this roster with Supervisor back up as required.
Kyneton District Health (20km north) is the nearest acute service and the major referral networks are Melbourne and Bendigo based.
Woodend is one of a group of small towns and villages within the Shire of the Macedon Ranges, 70km northwest of Melbourne, 80km south of Bendigo.
EDUCATION AND TRAINING
Brooke Street Medical Centre is a dedicated teaching practice with a long history of hosting AGPT Registrars. It is a training hub for Monash Bendigo Rural Clinical School 4th year medical students and provides training placements for nursing and allied health students.
AGPT Registrars are allocated a primary supervisor, but are supported by five accredited senior GPs who share the roles and responsibilities of supervision. The registrars can draw on the knowledge and skill sets of all of the doctors, and in turn, play their part in teaching and mentoring the medical students.
“The registrars have opportunities to draw on various skill sets with all our supervisors and can ‘cherry pick’ depending on their requirements. We encourage them to also have time with the various health team members, to open their eyes to what the allied health and nursing practitioners can provide”. said Dr Richard Bills.
In addition to dedicated face to face teaching, further training opportunities are available via clinical meetings and case presentations, monthly doctors meeting, working alongside visiting specialists, consulting jointly with allied health practitioners and nursing staff and covering urgent care presentations to the treatment room. Registrars who have specific discipline interests or have already developed extended skills, are encouraged to engage in and develop those opportunities.
AGED CARE SERVICES
Unique to Brooke Street Medical Centre is the opportunity for registrars to develop extended skills in the area of aged care medicine and palliative care.
The practice created and manages the ‘New Aged Care’ GP Service. This service provides ongoing, regular visits to patients in residential aged care facilities by the practice team. The team, led by an aged care nurse practitioner, includes a GP, geriatrician and diabetes educator and other allied health or various specialists as required.
Senior partner with the practice, Dr Richard Bills explained New Aged Care was born out of their frustrations around the challenges of managing aged care patients across multiple facilities. The group recognised that traditionally, GPs are often constrained by time pressures in meeting the needs of their nursing home patients. The group developed this multidisciplinary model, where an experienced aged care nurse can assist the practice to meet nursing home patients needs and deliver a comprehensive service to them and their families.
“The registrar will visit with the aged care nurse…. Valuable for them to see the issues around health of aged people, but also important to experience the situation where a doctor is being led by a nurse, or an allied health practitioner, as part of their clinical experience. That respect for another person’s qualification is really important learning”. said Dr Richard Bills.
DR RICHARD BILLS Royal Australian College of Physicians: Clinical Diploma of Palliative Medicine
Dr Richard Bills joined the practice in 1991. He explained that in the early 1990’s he, with partners Drs Peter Ferguson and Alison Killoh, committed to developing Brooke Street Medical Centre as a multi-disciplined service. Dr Bills emphasised the key message to their registrars is the focus on a multi-disciplinary approach and the importance of working with and utilising the skill sets of the varied practitioners within the practice care team.
“We think you provide better care if you actually utilise other people and their health disciplines to assist you in providing health care. This multi disciplinary approach identifies the pivotal role of the GP in identifying and valuing the patient benefit from assistance from another discipline ….. then adjusting things accordingly in response to that contribution.” said Dr Richard Bills.
Dr Bills explained the practice is philosophically committed to education and training, even if in some instances it may not be financially viable for them to do so.
The practice took on their first registrars in the early 1990’s and today a number of those registrars are still with the practice. This year saw the first of their medical students from the Monash Bendigo Rural Clinical School program come through the practice as a registrar.
For Dr Bills, after 30 years he still finds general practice “intrinsically appealing”. He described knowing at age 12 or 13 that he wanted to do medicine and is happy doing it.
Dr Bills enjoys the journey, being part of a team of health professionals who have focused on sustaining each other and working continuously to improve and innovate their practice to meet the ongoing health needs of their community.
“To me – it is where I want to be. I would turn up anyway, general practice is something I genuinely enjoy.” said Dr Bills.
Dr GORGEE DYER
Dr Dyer moved to Australia from India to undertake medical training. She obtained her MBBS at Melbourne University in 2011.
Completing her intern year and HMO 2 and 3 rotations at both Northern & Western Health, Dr Dyer has obtained the RANZOG Diploma and the Diploma from The Sydney Child Health Program – The Children’s Hospital Westmead (SCHP).
She commenced her GP training doing an Extended Skills term in palliative medicine (RACP Clinical Diploma of Palliative Medicine) at Bendigo Hospital. In 2018 she commenced GPT1. Dr Dyer has put her medical training into practice on a very personal level, having had double ‘rotations’ of maternity leave and graduating as a mother of two along the way.
Dr Dyer had not been exposed to rural practice until, as a medical student, she completed a rural GP placement in Maryborough. She hopes to remain in regional Victoria with the opportunity to have a broad scope of practice. Dr Dyer explained she was attracted to Brooke Street Medical Centre because as a multidisciplinary practice in a small regional town, it provided opportunities for clinical experience across the spectrum of general practice.
Dr Dyer recognises utilising the various skills and knowledge of the health team provides a great learning opportunity for registrars. Shared consultations or linked appointments are available, plus allied health and nursing staff are available for input and advice at all times.
“The wide variety of allied health and nursing staff here is so good for a registrar – you have a broader understanding of the various staffs’ skill set and knowledge. We discuss the patients together – the communication lines are so open, the patient does receive better care as a result.” said Dr Gorgee Dyer.
In addition to her general practice sessions, Dr Dyer has the opportunity to participate in regular visits to various aged care facilities as part of the New Aged Care GP Service provided by the practice. Having completed the Clinical Diploma in Palliative Medicine, she is glad to practice her clinical skills in this regard.
Dr Dyer enjoys the relationships you build with patients and feels rural people, in general, “(they) let you into their lives, want to know you and know more about you”.
The broad spectrum of practice a rural GP encounters and the challenges presented are what appeals to Dr Dyer. For her, rural training and the opportunities available, are the platform to equip herself to meet those challenges.
“I think rural training definitely throws you in the deep end, but it prepares you to meet the challenges as they present. I guess I just wanted to be challenged as a GP….. I wanted to be a GP with a wide set of skills – being appropriately able to deal with anything that walks through the door.” said Dr Dyer.