Table 2 Themes, sub-themes and illustrative quotes

Local, rural context

Farming, weather

…but we are a traditional farming community…and you know people in these areas haven't been big in covering up as much as they would be expected, everyone expects people to do these days MGT3

Access to health services (distance, workforce shortages, waiting time)

…the barriers for people are just the general tyranny of distance… if they had to go to Ballarat it's a 300 km drive, it's an all day trip MGT3

Horsham has a long waiting list, because that area covers the area all around the Wimmera…Their waiting time could be one and a half months or two months GP

Burden-of-disease; later diagnosis; poorer outcomes; awareness of skin cancer risk; demand for skin cancer screening and treatment

Various cancers are one of our biggest burden-of-disease issues, or one of our most amenable [to intervention] burden of disease issues in our sub-region, particularly skin cancer screening HP

…cancer awareness and cancer prevention is very much part of that broader health promotion strategy looking at the burden of disease and the major environmental and structural factors MGT1

So a sense, a huge sense, of need and that actually people are increasingly aware now and if there's a clinic there they want to go. We haven't got to drag people along kicking and screaming MGT1

In our catchment area again, because we're fairly rural, remote and rural, we know, or the stats tell us that people who do get any type of cancer generally have worse outcomes than in the city. They have a higher chance of getting any types, most types of cancer than people in the city and if they do get it their survival rates aren't as great MGT3

So, we put out the advert (for skin cancer checks), and of course, we had 100 people ringing up, we filled the day of about 30 and then had 100 on the waiting list, we actually did deliver all those skin cancer checks over the course of a few months N2

Elements of the model

Promotion of the service

Now, for a large part, that [promotion of the service] really has relied over the last few months in getting information out on social media…. of course our staff is a pretty significant proportion of the general population, if we get them talking about it, hopefully the trickledown effects touches almost every household (HP)

Staff development. Getting the right people trained with optimal training and mentoring and ensuring a smooth path to solo practice

…but there is no way I would be confident to assess a spot, diagnose a spot and treat a spot with [just] that training… N1

… one that actually stayed with me and came two days [of scheduled skin cancer screening clinics]…said that was really good…to know what you were looking for… N1

I think that they would really need probably a full week…with me doing 50 consults a day…would be the bare minimum in order to maintain some sort of proficiency in dermoscopy N1

I think we had about 13 expressions of interest, but we only had funding for, originally, one position, but then management/exec decided that they'd extend this to offer it to five persons, ….we selected five staff that would cover a broad area in our nine sites N2

It (the dermoscopy training) was not really what I expected. So it was targeted very directly, very strongly towards GPs. So there were five of us nurses that all went from West Wimmera Health Services and they were the only nurses in the entire room. I feel probably like it wasn't the best option in terms of courses that we could have done because they would give us sort of the basic knowledge but then they would just flash all these pictures on the screen and say would you excise this or not excise this?…we can't excise…Of the five of us that completed the course, only two of us actually passed the exam N3

Making it happen

Governance (billing, referral pathways, data management)

Efficiency and the timeliness, well, the timeliness will be around that before we actually run one of these clinics, we need to have our referral pathway, everything needs to be sorted. So, when we start, we start properly. Because that's been my biggest concern that we are going to start—excuse the language—this half-arsed thing, that we haven't actually worked out what we're doing MGT2

Funding (stability and flexibility)

Yeah, well I think that was the other driver for being involved in the project, was that currently our funding model allows for it. So we get funded, block funded through Community and Women's Health and all our allied health and community health nursing is funded through that. So currently our community health nurses can claim—they'll take pathology and do consults and they can claim that time against this funding model. When we looked at it we really thought there's no reason why this would be any different MGT1

Partnership, collaboration, stakeholders

If our local GPs know that, what is the system, that will help them understand, that you know, we can all work as a team GP

I think probably the biggest internal factor that we have is motivating the person who is supposed to be implementing all of this sort of stuff to happen N3

Wimmera Primary Care Partnership, they had some funding to do a health literacy project in Hindmarsh  and Yarriambiack shires…we actually put out some surveys, about what residents in both those areas would like to see, what came to light, there was a particular need for men's health and skin checks N2