GPs at the centre of Health Alliance process
Over the past nine months, a Health Alliance between Metro North Hospital and Health Service and Brisbane North PHN has undertaken targeted consultation with local GPs on their experience supporting three key population groups.
The Health Alliance is an approach to tackling health and healthcare problems that transcend the mandate of any one organisation or part of the health sector, and that can’t be fixed by existing approaches. The focus of the Health Alliance to 2020 is on improving the health and wellbeing of three population groups:
In May 2018, the Health Alliance brought together a group of GPs and specialist geriatricians practising in the Prince Charles Hospital (TPCH) catchment to workshop how care for frail elderly people living in their own homes or local Residential Aged Care Facilities (RACFs) could be improved.
There is an agreed need for a system-wide approach to the health and wellbeing of frail older people, and the Alliance has looked at the Prince Charles Hospital catchment as a starting point for this work, owing to existing projects in this region such as the Geriatric Outreach Assessment Service.
The workshop provided an opportunity for the 11 local GPs in attendance to discuss with hospital clinicians and representatives from the HHS, the PHN and the Health Alliance how care for older people could be improved, and how GPs could be supported more broadly in their work with this population group.
Health Alliance General Manager Professor Don Matheson said the workshop highlighted key challenges in the provision of care for residents of RACFs.
“GPs told us they have seen an increase in the complexity of healthcare needs of residents in RACFs coupled with the reduction in the registered nurse workforce over time,” Professor Matheson said.
“We heard that care in the RACF setting can be onerous and not well remunerated, and that sector standards don’t always encourage improvements in clinical care,” he said. “We know that it can be difficult for GPs to access support for older people who are living in their own home, and we recognise there is a need for improved communication back to GPs after a patient has been hospitalised.”
Focus groups unpack experiences providing healthcare for people with complex health and social needs.
In late 2017, two focus groups were undertaken with six GPs, three nurses and one physiotherapist who provide care to people with complex health and social needs in North Brisbane and inner-Brisbane.
People with complex health and social needs are likely to have experienced a prejudicial background, and are often homeless or at risk of homelessness or living in transitional or supported accommodation.
The GPs in attendance shared a number of challenges that exist when providing effective care for their clients, in particular those with severe and persistent mental illness. They noted time constraints and the challenge of continuity of care and follow up, as well as limitations around remuneration for necessary patient advocacy.
One GP said, “It takes time and you’re not remunerated for it unless the patient is sitting opposite to you which is pretty rare.”
Health Alliance General Manager Professor Don Matheson said the willingness of all stakeholders to be involved was testament to their passion for supporting the most hard-toreach in our community.
“We recognise and acknowledge the improvements in health outcomes already achieved through local projects and the tireless work of individuals who go above and beyond to support people with complex health and social issues,” Professor Matheson said.
“What we’ve heard is that all parts of the sector share common challenges around health service provision, integration and communication between services and the same barriers to delivering holistic care.”
Meanwhile in mid-June, 10 local GPs from the Caboolture, Bribie Island and Morayfield region spoke with staff from the Health Alliance about their experience caring for women in the antenatal period and following birth, and for children in their early years of life.
Professor Don Matheson said the group cited health needs across the lifespan, from a mother’s needs pre-conception, though to childhood. “GPs told us the Caboolture region is an area of enormous needs – they told us about financial disadvantage, poor access to transport, high rates of child abuse and neglect, and high rates of domestic violence including during pregnancy,” Professor Matheson said.
“We heard that pregnant women are sometimes visiting their GP late in the pregnancy and this compromised the GPs’ opportunity to get to know the patient. It also means often mothers are missing out on early scans, and the opportunity to receive education regarding drug and alcohol use during pregnancy,” he said.
One GP reflected on the changing and decreasing role of GPs in antenatal care, “In the old days, we used to see patients every four weeks up to 30 weeks, every two weeks up to 36 weeks”.
Participants spoke of the challenge of waiting to access paediatric services and the pressure to provide children with a formal diagnosis.
The Health Alliance is interested in continuing to work with GPs, practice nurses and other primary care providers to understand the current challenges in the system and design new models of care for these three population groups. If you are interested in being involved in this work, please email firstname.lastname@example.org.