The future role and function of General
Practice Units in the National Health
Reform environment
D Jennifer Anderson
Dr David Isaac
Dr Ines Rio
Dr Clare Seligmann
History GP Liaison in Victoria
• Since the 1990. 2 major issues to start with
– Declining communication b/w GPs and hospitals
– Shared maternity care
• 1991: In 7 hospitals
• 2000/2002: Hospital Demand Strategy - Hospital Admission Risk
Program
– A number estab with this $ to do work required
– National email network
– Informal support GPV
• 2006:
– In 16 hospitals
– Lenora Lippmann from GPV publishes many achievements
– Auditor 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 on
– DHS commissioned review of GP Liaison Program
Report findings
• Funding varied: DH/Hospitals/Divisions
• Consequently governance varied
• Usually small team:
– all had a GP in them and most other staff clinical
– GP 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 achievements
– Information flow and processes
– Relationships /communication b/w health services
– Enhancing 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 GPs
• Core functions nominated by GPL at that time:
– Improve GP/patient access to health service
– Liaison b/w health service and GP Divisions
– Provide clinical advice
– Contact point for consultation/liaison/advice for health
service in communication with GPs
– Oversight shared maternity care
– Design GP friendly hospital systems
– Foster partnerships with community providers
– Provide central point of contact for GPs
• Enormous range of specific activities according to need
Framework Victoria GP Liaison Program
• 2007: 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 policies
• Support 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 hospital
– Team structure with a GP
– High level executive support/reporting
– Formal linkages with relevant Divisions
– Participate in systematic planning at state & health service level
– Annual reporting DH
• Funded GPV:
– Coordinate and support GPL Units
– Assist with audits etc.
– Provide/facilitate cpd
– Facilitate 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 red
― One of these has dismantled GPL
― One has cut back to 1/2
What are some of the things we do
• Core:
–
–
–
–
–
–
–
–
–
–
Monitor/report DC summary rates
GP details data improvement
Audits for info quality in and out: work on outcomes
Education hospital staff: needs GP
Cpd for GPs: sessions/upskilling outpatients
Take direct calls GPs: advice/complaints/service
utilisation/information: work on issues
Direct contact for hospital staff re GP issues
Strategies for patients to be linked to GPs
Work cross hospital develop info for GPs/HP
Involved in pushing electronic notification
Some specifics: RWH
Current work includes:
• Shared Maternity Care program
– Manage program
– Cross health sector structures
•
•
•
•
•
Breast cancer survivorship project
Redoing the website Health Professionals
Involved in development of parenting book
Dev policy on notification to AHPRA
Article b/w GP and 2 psychiatrists in press on perinatal
mental health identification and support
• Triaged who gets an Dept US
• Pre-referral guidelines
Some specifics: RCH
•
•
•
•
•
•
•
Free community health provider education
Establishing tele-health as routine practice
Secure sending of outpatient letters
GP notification of receipt of referral letter
Pre referral guidelines
Clinical Services Directory
Top Tips
Some specifics: St Vincent's
 The 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 Units
 Secure Messaging - project now underway
Some specifics: St Vincent's (cont’d)
• Piloting a “VFSA” model for patients referred
to Headache Clinic
• Outpatient 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.
History GP Liaison in QLD
• 2008 – GPLO appointed with joint Division and
QH funding. Work with Aged referrals project in
orthopaedics.
– Subsequently this position continued to be funded
• 2009 – 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 model
• GPs who have done these roles have often been
asked to participate in other committees or
advise on interface issues
GP Liaison now in QLD
• 2010 – 2012 – localised roles funded a few
hours per month by Divisions/MLs to improve
integration. No consistency
• Newman Government announces 20 GPLO
positions in 20 biggest hospitals.
– No funding details
– No job description
• GPQ is working with QH on positions
description and funding models for these
Core elements of success
• Knowledge of health care delivery/clinical perspective
• Positioning in system
•
•
See the inside the hospital and outside the hospital
See what each think of each other and the “problems”
• Relationships
•
•
•
•
High level Relationships in hospital and community
Identify 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 sides
Core elements of success
• AND Work on systems
• Work on core issues
– Communication, quality, shared care, clinical handover,
gaps in knowledge etc.
• AND Being opportunistic:
– Work with where there is momentum or concerns in
hospitals or with individuals
– Scuttle your way into things
– Identify synergies and work with them
• Being around
So…..GP Liaison & Medicare Locals?
Objectives of Medicare Locals
1. Identify the local health needs and develop locally focused and
responsive services
2. Improve the patient journey through developing integrated and
coordinated services
3. Provide support to clinicians and service providers to improve
patient care
4. Facilitate the implementation and successful performance of
primary health care initiatives & programs
5. Be efficient and accountable with strong governance and
effective management
Performance Indicators: NHPA
• 31 healthy communities reports: 17 hospital performance reports
• Safety, 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!
So?
• GPL Unit and MLs goals are aligned
• MLs/Hospitals need close strategic relationships to achieve
• MLs/LHN will and should have high level CEO/executive
relationships & planning
• But MLs also need people that think the same way /similar
objective working in the hospital system
– On the ground with departments
– Being able to see all the hospital laundry
– Opportunities/blockers/synergies
• Natural connection for that is GPL Units
• MLs 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 replaced
• There are threats
– Funding
• Whose 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 impact
– Lack of coordinated research outputs from units
– Already seen the emergence of this in Victoria
Role Medicare Locals?
• Probable necessarily flexible
• Work together with GPL Units on NHPA Indicators and Healthy
community report
• Aligned and complementary work plans
• MLs work with SBOs to provide:
– Ongoing support and development/Advocacy
– Strategic development
– Reporting
• Work 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 this
Big one is the funding??
Health systems do not partner naturally
Improving the patient journey across health care
sectors requires collaboration and is built on four
main building blocks:
• Relationship-building between hospitals and
GP/Primary Care
• Complementary planning and implementation:
Incorporating the needs of the other in system
design
• Identifying system problems or road-blocks
• Practical problem solving
Identify local health system needs and opportunities to
address these & work on locally focused & responsive
responses
The 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 journey
GP Liaison Units are change agents – working for the
needs of primary care and integrated care from within the
hospital
Thankyou
Questions?