After hours primary health care is a central tenant of a high quality health care system. This Review has highlighted opportunities to improve the efficacy and efficiency of after hours primary health care coverage across the country and better empower health consumers to utilise the most appropriate supports.
The following recommendations are presented for the Minister’s consideration.
The Commonwealth resumes responsibility for after hours funding of general practice from Medicare Locals from 1 July 2015.
A revised Practice Incentives Programme (PIP) After Hours incentive is accessible for accredited general practices from this date.
The revised PIP should:
appropriately remunerate general practices for after hours patient care;
utilise tools such as the Standardised Whole Patient Equivalent (SWPE) to weight practice size, age and rurality; and
reward practices providing telephone triage for their own patients.
Performance Indicators for this PIP should be outcome-focused and easily collectable.
The final design of the revised incentive should involve consultation as soon as possible with the PIP Advisory Group (PIPAG).
From 1 July 2015, Primary Health Networks (PHNs) receive funding to work with key local after hours stakeholders (including Local Hospital Networks (LHNs), Medical Deputising Services (MDSs), consumer groups, Aboriginal and Torres Strait Islander representatives, the private health sector and non-government organisations) to plan, coordinate and support population-based after hours health services. Their focus should be on gaps in after hours service provision, vulnerable groups and service integration.
The Commonwealth works with key stakeholders to urgently examine the rapid escalation in utilisation of after hours MBS items. The Department of Health should identify the relevant drivers responsible and work with PHNs and local stakeholders to develop optimal utilisation of this resource.
The adoption of an expanding variety of eHealth applications to support consumer self- management and improved links between providers and after hours service delivery is recommended. This should involve input from after hours stakeholders, proven technology leaders, state and territory government telehealth directorates and the National E-Health Transition Authority and include opportunities to facilitate the transfer of clinical summaries via an electronic health record.
Residential aged care after hours service needs and provision are complex, with a high and increasing service utilisation, particularly from MDSs. This Review recommends the Department of Health engage with key clinicians from primary and acute care, residential aged care organisations, MDS and other relevant stakeholders to identify innovative solutions, applicable locally and consider an appropriate role for PHNs.
Palliative care involves a similarly complex interplay between patients, carers, families and service providers both in and out of hours. Palliative care should be a special focus for local service planning.
Consumers are frequently unaware of the many after hours support options available to them. A clearly articulated pathway for consumers to access high quality after hours advice and support should be developed. This should identify the many support modalities available (quality web-based self-help sites, after hours support via the family general practice, after hours cooperatives, MDSs, ambulance services and emergency departments) and indicate those most appropriate for the care required.
This pathway should be provided to PHNs for local customisation and broad community dissemination.
MDS accreditation should include a requirement for deputising services and others providing after hours care outside the practice to return clinical summaries within 24 hours to the patient’s regular practice.
As state funded after hours support plays an important role in rural and remote settings, after hours service planning should be integrated as part of PHN/ LHN local service delivery mapping.
States and territories vary widely in their rural after hours models of care. Best practice approaches should be identified at state level and discussed with a view to broader implementation via the National Rural Health Standing Committee or the Council of Australian Governments’ Health Council.
MDSs play a critical role in after hours care. However, the rapid increase in deputising service utilisation of MBS items raises questions around the appropriateness of a purely fee-for-service funding model for the sector. Funding for MDSs should be considered to strike a better balance between infrastructure and activity based funding for a sector with unpredictable and uneven service demand.
MDSs are accredited deputising services and access to after hours should happen via a patient’s regular general practice, rather than through direct marketing.
The After Hours GP Helpline (AHGPH) was incepted to relieve after hours pressure on regional and rural General Practitioners (GPs) and support GP continuity of care. However there is limited evidence that this has occurred. Direct Commonwealth funding to the AHGPH should not continue in its current formbeyond the completion of the 30 June 2015 contract, with funding reallocated to support innovative after hours services delivery locally.
A need to relieve pressure on GPs in regional and rural areas and improve the continuity of care after hours remains a priority. Therefore population based after hours planning should identify the need for GP phone support, best linkages and application. Innovation funding for this purpose should be available for PHNs that submit appropriate applications, endorsed by local stakeholders.
Many stakeholders identified after hours care as only one component of high quality comprehensive general practice care. Other elements included in hours service flexibility, eHealth excellence, comprehensive chronic disease management and effective integration of care. This Review recommends the further development of the PIP to recognise and reward the practice infrastructure required to deliver to Australians high quality comprehensive primary care. This should be progressed by the PIPAG.
Executive Summary Attachment A