1. For our patients and our population South Australian Clinical Genetics Unit A Review of the Organisational and Management Structure Recommendations presented 15 April 2015 (Site Visit – 5-6 February)

2. For our patients and our population Background With the resignation of Graeme Suthers, an opportunity to review processes including structure and provision of services Review conducted by: o Professor Martin Delatycki, Director of the Clinical Genetics Service, Austin Health, Melbourne; o Ms Mary-Anne Young, Senior Genetic Counsellor, Familial Cancer Centre, Peter McCallum, Melbourne Terms of references available to staff prior to site visit and all staff were invited to participated in the review Reviews, Audits or assessments are not uncommon

3. For our patients and our population Aims 1.Identify strengths and weaknesses under the current model 2.Make recommendations about the appropriate model of care of each unit 3.Make recommendations about optimal staffing mix, given a fixed budget

4. For our patients and our population Aims (cont’d) 4. Make recommendations whether resources should be transferred between Units to maximise efficiencies 5. Make recommendations for best practice organisational and governance structure

5. For our patients and our population Terms of Reference 1.Make recommendations for an organisational structure/structures in the short/medium term that supports best practice in the provision of genetic services in SA 2.Examine and review staffing and the FTE of the units and the distribution across units for optimal service delivery 3.Examine and review model of service provision and patient care 4.Provide a report with a list recommendations

6. For our patients and our population GENETICS AND MOLECULAR PATHOLOGY DIRECTORATE SOUTH AUSTRALIAN CLINICAL GENETICS SERVICE EXISTING SOUTH AUSTRALIAN CLINICAL GENETICS SERVICE Dept Head GKS SOUTH AUSTRALIAN CLINICAL GENETICS SERVICE Dept Head GKS CLINICAL DIRECTOR 0.8 x MD2 DIRECTORATE MANAGER 1.0 x MeS5 Adult Genetics Unit Unit Head Metabolic Clinic Unit Head Paediatric & Reproductive Genetics Unit Unit Head Registry Manager 1 x ASO3 Admin 0.9 x ASO3 5.5 x ASO2 0.8 ASO2^ 1.6 MD2 0.6 MD2* 1.0 x AHP3 4 x AHP2 1.0 x MD2* 2.0 x MD2 1 x AHP3 3x AHP2 1.1 x MD2 1x MDP2 0.5 x AHP2 0.7 x RN3 *employed by CYWHS ^ funded by SAMHRI Quality Coordinator 1.0 x MeS2 1 x MPD2

7. For our patients and our population Areas for Review Service Model Governance Improving Efficiencies * Presenter's comment – all sides are the recommendations from the reviewers and not my own views or that of the management

8. For our patients and our population Service Model Recommendations The reviewers are of the view that the best model for SACGS is for the Adult Genetic Service (including familial cancer) to be based in an Adult Hospital The reviewers are of the view that the best model for SACGS is for the Paediatric and Reproductive Genetics Unit to based in a Children’s Hospital

9. For our patients and our population Reviewer Commentary- Service Model There was essentially no support from staff that the best model is to maintain the current service model Reviewers commented that while there are aspirations to interact that there is very little interaction between AGU and PRGU There are advantages of having onsite presence and to be based where the major referral outweighs the disadvantage of not located with colleagues

10. For our patients and our population Governance The reviewers have recommended an overarching Genetics Services Advisory Committee Independent chair and membership from Government, LHNs and Genetics Units

11. For our patients and our population Governance Structure

12. For our patients and our population Reviewer Commentary There was greater support for having an overriding single genetics service for SA This new model of governance will facilitate engagement between senior levels of government and relevant stakeholders

13. For our patients and our population Governance Structure

14. For our patients and our population Efficiency Recommendations

15. For our patients and our population Efficiency Recommendations (10) Note: The reviewers acknowledge that there is a understaffing of clinical genetics services in South Australia 1.When the new Adult Geneticist is appointed it is strongly recommended that they have a full clinical load commensurate with HGSA standards 2.The reviewers note that that more than a 1/3 of the consults in PRGU are co-counselling – recommendation of less co-counselling

16. For our patients and our population Efficiency Recommendations 3. The depth of pre-clinic interaction between PRGU genetic counsellors and families to be reduced 4. All new patient appointments be 60 minutes and review patient appointments 30 minutes

17. For our patients and our population Efficiency Recommendations 5.Review of administrative tasks performed by clinical staff to free up time to see more patients 6. Systems to utilise telephone genetic counselling and tele-health that could be utilised for rural patients.

18. For our patients and our population Efficiency Recommendations 7. Staff be located in one unit with secondment from one Unit to another minimised 8.Once the staff that deliver Huntington disease predictive testing services at FMC move on, this be incorporated into the Adult Service

19. For our patients and our population Efficiency Recommendations 9. Systems around preparation and correspondence is standardised between services 10. To raise the profile of the Genetics Services that locating clinical staff at other metropolitan hospitals be considered

20. For our patients and our population Reviewers Final Note All staff are passionate about and committed to their work Evident that staff take great pride in the delivery of genetic services to families

21. For our patients and our population Where to next? This presentation will be provided by email today to all staff for consideration and Union representatives Feedback by staff to be provided in writing by 6 May 2015 Staff unable to attend, a time can be made available for one on one or group sessions

22. For our patients and our population Contact List Janice Fletcher – Clinical Director janice.fletcher@health.sa.gov.au Sharon Bain - Directorate Manager sharon.bain@health.sa.gov.au phone 0481 437 729 Linda Sykes – Human Resources linda.sykes@health.sa.gov.au Your Union Representative