"We have been measuring our patients' blood pressure, waist circumference, body mass index (BMI), recording their smoking, alcohol and physical activity status to identify and deal with their risk factors.

I find the data feedback we get from our Division very motivating. In fact, we have just employed another practice nurse just to do care plans. This has really helped us with our improvements.

Our practice is very much into prevention. We're currently concentrating on smoking cessation. We have placed laminated sheets on the seats in the waiting room with smoking related information: "Are you a smoker? Do you want to give up and need help? Ask your Doctor today." We then illustrate the daily, weekly and annual cost of smoking a pack a day ($4,927 annually). We also monitor how many patients are prescribed anti-smoking medication.

Another area we have just started pushing strongly is home health assessments, which I believe is essential for our older patients. We are targeting patients over 75 - especially husbands and wives. The home health assessments are filling a real need in the community. We get to find out how the way the patient is living is impacting on their health. It makes them feel very special. A typical response from the patient is: "My doctor cared enough about me to send out a nurse to see how I was living and if I was ok."

To me family practice is where a patient is part of the family and the home health assessments are perfect vehicle to help achieve this.

Overall, I have found our involvement in the Collaboratives inspiring. Yes, we commit to making improvements in certain areas. However, the program is not prescriptive. The areas are broad and we can choose exactly how we go about improving the health of our patients.

The Learning Workshops give us time to stop and reflect about exactly what we are doing in caring for your chronic disease patients.  We get to interact with people experiencing similar problems in general practice. We know we don't have to reinvent the wheel, as everyone is happy to share what they are doing."

"I arrived in Australia in April 2009, having left the UK where I had been working in General Practice as a Practice Nurse for 3 years.

I was and still am feeling confident and enthusiastic about carrying on in this role. I joined a busy GP surgery in May 2009, with a practice population of over 10,000.

Being involved in the APCC personally has really motivated me and fostered my enthusiasm to improve best practice delivering better patient care.

It has enabled me to network with lots of different people working in lots of different practices throughout Australia, a fantastic opportunity for someone like myself arriving in a new country, knowing very few people.

My work colleagues and I have really begun to develop the characteristics of a successful practice, working together, building our team, committed to making changes.

I really enjoyed representing our practice at the last learning workshop and catching up with everyone again. It was great to hear the Patients Journey creating a better understanding of the burden of chronic disease and how they cope with the challenges faced.

Since the last learning workshop, the practice as a whole is aiming to increase the identification of those with risk factors for chronic disease, utilising the AUSDRISK and the Absolute Cardiovascular Disease Risk Assessment tools. We are in the process of developing systems to monitor and review these patients.

All staff eagerly await our monthly data measures, with various PDSAs being generated on our staff notice board as well. It is great to see every one engaged in implementing improvements and change. Well Done Maddington."

"The Learning Workshops are terrific opportunities to share ideas, fast track rapid sustainable improvements on how we were going to improve outcomes in COPD and chronic disease self management.

Being involved in the Collaboratives motivated key staff members to engage others in the team to understand the main aim on these two topics and make small steps to improve outcomes for our patients.  It was wonderful to listen to the problems of health care from the consumer perspective, by listening to patients who had chronic diseases and telling us what worked and what did not work for them."

"I feel honoured that I have been able to contribute a patient’s perspective at the Learning Workshops and help doctors understand what patients go through. Clive, Mabel and I have been acting as a sounding board to see how well changes suggested by the practice may be received by patients.

The workshops have been very interesting and worthwhile for us personally as well. We have learnt how the GPs coordinate all the different health professionals that are involved in the care of patients – like the practice nurse, allied health professionals, specialists and various programs that the Division offers like HeartBeat.

I especially recommend programs like HeartBeat to patients. I have found it to be very important for my self esteem and my outlook on life. Now I know that people out there do care. It makes us feel like there is hope for us. We are not alone. There is help out there. "

"When all the patients got together, we learnt a lot from each other. We had brainstorming sessions to solve the problems of participating patients. I found that part particularly helpful. It was great to hear how different patients coped with the same problem.

I found out about a Webster pack that I am considering using now. And I will request from my GP to have a home medication review. I am sure that these changes will help me manage my condition better and improve my quality of life. I very much look forward to the next Learning Workshop. "