The future role and function of General Practice Units in t - PowerPoint Presentation

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The future role and function of General Practice Units in the National Health Reform environment

D Jennifer AndersonDr David IsaacDr Ines RioDr Clare SeligmannSlide2

History GP Liaison in VictoriaSince the 1990. 2 major issues to start withDeclining communication b/w GPs and hospitalsShared maternity care1991: In 7 hospitals2000/2002: Hospital Demand Strategy - Hospital Admission Risk Program A number estab with this $ to do work requiredNational email network

Informal support GPV2006: In 16 hospitalsLenora Lippmann from GPV publishes many achievementsAuditor General’s

report in 2006 noted dramatic increase in o/p attendances: “up to 80% of patients… for review appts”A number of recommendations areas GPL working onDHS commissioned review of GP Liaison ProgramSlide3

Report findingsFunding varied: DH/Hospitals/DivisionsConsequently governance variedUsually small team: all had a GP in them and most other staff clinicalGP 2-25 hours (average 10)High connections in hospitals Highly valued by hospital/ GPs/Divisions/DH/PCPs

High degree of consistency re. broad functions and significant range achievementsInformation flow and processesRelationships /communication b/w health servicesEnhancing skills and capacity for GPs to care for patients in the community who might otherwise require hospital care

Enhancing skills and capacity of health services staff to better understand and respond to GPsSlide4

Core functions nominated by GPL at that time:Improve GP/patient access to health serviceLiaison b/w health service and GP DivisionsProvide clinical adviceContact point for consultation/liaison/advice for health service in communication with GPsOversight shared maternity careDesign GP friendly hospital systemsFoster partnerships with community providersProvide central point of contact for GPsEnormous range of specific activities according to needSlide5

Framework Victoria GP Liaison Program2007: DH acknowledgment “Achieved significant changes in areas of information flow, processes of care and relationships and communications”Saw it as enabling arm of various DH policiesSupport program: Funded all metro programs to start with then extended to 2 large rural units with GPV advocacy Defined role/structure/strategic directions/reporting.

Stipulated:In hospitalTeam structure with a GPHigh level executive support/reportingFormal linkages with relevant DivisionsParticipate in systematic planning at state & health service levelAnnual reporting DHSlide6

Funded GPV:Coordinate and support GPL UnitsAssist with audits etc.Provide/facilitate cpdFacilitate strategic development, planning and reporting(Also provided advocacy)2010: Funding moved to general pot of outpatient funding 2011/2: MLs established. GPV defunded

2012: Few health services in the redOne

of these has dismantled GPLOne has cut back to 1/2Slide7

What are some of the things we doCore: Monitor/report DC summary ratesGP details data improvementAudits for info quality in and out: work on outcomesEducation hospital staff: needs GPCpd for GPs: sessions/upskilling outpatientsTake direct calls GPs: advice/complaints/service utilisation/information: work on issuesDirect contact for hospital staff re GP issuesStrategies for patients to be linked to GPsWork cross hospital develop info for GPs/HP

Involved in pushing electronic notification Slide8

Some specifics: RWHCurrent work includes:Shared Maternity Care programManage programCross health sector structures Breast cancer survivorship project Redoing the website Health Professionals Involved in development of parenting bookDev policy on notification to AHPRAArticle b/w GP and 2 psychiatrists in press on perinatal mental health identification and supportTriaged who gets an Dept USPre-referral guidelinesSlide9

Some specifics: RCHFree community health provider educationEstablishing tele-health as routine practiceSecure sending of outpatient lettersGP notification of receipt of referral letterPre referral guidelines Clinical Services DirectoryTop TipsSlide10

Some specifics: St Vincent'sThe standard, generic activities to simplify GP navigation of the complex hospital system summarised in a “For GP” website.Discharge summary completion program.(QI) - junior doc education - real-time online completion data - monthly email to Heads of UnitsSecure Messaging - project now underwaySlide11

Some specifics: St Vincent's (cont’d)Piloting a “VFSA” model for patients referred to Headache ClinicOutpatient Clinic improvement work –Referral guidelines, GP Outpatient referral audit, Vic Dept of Health Advisory Committee

Leading the engagement of St V Execs to Medicare Locals. Slide12

History GP Liaison in QLD2008 – GPLO appointed with joint Division and QH funding. Work with Aged referrals project in orthopaedics. Subsequently this position continued to be funded2009 – roll out of multiple aged referrals projects based on the Townsville model. E.g. hepatology project at PAH. These projects had GPLO as part of the project modelGPs who have done these roles have often been asked to participate in other committees or advise on interface issuesSlide13

GP Liaison now in QLD2010 – 2012 – localised roles funded a few hours per month by Divisions/MLs to improve integration. No consistencyNewman Government announces 20 GPLO positions in 20 biggest hospitals. No funding detailsNo job descriptionGPQ is working with QH on positions description and funding models for these Slide14

Core elements of successKnowledge of health care delivery/clinical perspectivePositioning in systemSee the inside the hospital and outside the hospitalSee what each think of each other and the “problems”

Relationships High level Relationships in hospital and communityIdentify the champions/drivers and the blockers

Cross silo and vertical relationships in hospital an out: executive/clinicians/IT/junior staff/managers/clerical staff/project staff: Boundary crossers

Seen as a solver – go to person both sidesSlide15

Core elements of successAND Work on systemsWork on core issuesCommunication, quality, shared care, clinical handover, gaps in knowledge etc.AND Being opportunistic:Work with where there is momentum or concerns in

hospitals or with individualsScuttle your way into thingsIdentify synergies and work with themBeing aroundSlide16

So…..GP Liaison & Medicare Locals?Slide17

Objectives of Medicare LocalsIdentify the local health needs and develop locally focused and responsive servicesImprove the patient journey through developing integrated and coordinated services

Provide support to clinicians and service providers to improve patient care

Facilitate the implementation and successful performance of primary health care initiatives & programs

Be efficient and accountable with strong governance

and

effective managementSlide18

Performance Indicators: NHPA31 healthy communities reports: 17 hospital performance reportsSafety, Quality/Access and Efficiency/Financial Unplanned hospital readmission rates for patients following management selected conditions (LHN)

Selected potentially avoidable hospitalisations (ML)Rate community f/u w/i 7 days D/C from a psychiatric admission (LHN)

Measures of patient experience (ML and LHN)Specialist

service utilisation (ML)Number women with at least one antenatal visit in 1st trimester (ML)

Primary care-type Emergency Department attendances (ML

)

Clearly need to work together

Info is reliable, valid, consistent

Addressing the indictors!Slide19

So?GPL Unit and MLs goals are alignedMLs/Hospitals need close strategic relationships to achieve MLs/LHN will and should have high level CEO/executive relationships & planningBut MLs also need people that think the same way /similar objective working in the hospital system

On the ground with departmentsBeing able to see all the hospital laundryOpportunities/blockers/synergies

Natural connection for that is GPL UnitsMLs need them for meaningful hospital systems change

If GPL Units go – lots of the cross silo and vertical relationships will be lost to primary care and their functions will need to be

replacedSlide20

There are threatsFundingWhose role is it to fund?Not a clinical service (even though has a role in advice to keep people cared for by their GPs) – hard to measure impactLack of coordinated research outputs from unitsAlready seen the emergence of this in VictoriaSlide21

Role Medicare Locals?Probable necessarily flexibleWork together with GPL Units on NHPA Indicators and Healthy community report

Aligned and complementary work plansMLs work with SBOs to provide:Ongoing

support and development/AdvocacyStrategic development

ReportingWork together with GPL Units to

drive

hospitals interface and integration work

Develop “minimum expectations”

Things

better done in the community – often easier for GPL Units to identify and MLs to drive thisSlide22

Big one is the funding??Slide23

Health systems do not partner naturallyImproving the patient journey across health care sectors requires collaboration and is built on four main building blocks:Relationship-building between hospitals and GP/Primary CareComplementary planning and implementation: Incorporating the

needs of the other in system designIdentifying system problems or road-blocksPractical problem solving Slide24

Identify local health system needs and opportunities to address these & work on locally focused & responsive responsesThe GP Liaison program, although modest in size has been the “glue” and, in many cases the initiator, for many of the collaborations across the hospital / Primary Care interface that underpin improvements to cross sector access, efficiency, quality and the patient journeyGP Liaison Units are change agents – working for the needs of primary care and integrated care from within the hospitalSlide25

ThankyouQuestions?