Evaluation of after hours primary health care programme – phase one
Centre for Health Policy, Programmes and Economics
28 March 2013
After hours activity undertaken by T1 – Known Gap Filling (KGF).
Eight categories of activity:
Awareness raising about after hours service availability;
Maintenance or extension of existing after hours service;
Establishing new after hours services;
Support for residential aged care facilities and community elderly in accessing after hours care;
Improving service coordination and continuity of care; and
Improving after hours access to medication.
KGF activities provided a symbolic starting point for after hours service development in Medicare Locals (MLs).
Overall effectiveness of KGF activities cannot be assessed at this point.
Activity built foundations for the continued development of after hours and provided valuable learnings about the factors affecting change in the after hours care environment.
Evaluation of after hours primary health care programme
Centre for Health Policy, Programs and Economics
September 2013
Strong regulatory frameworks are required to assure quality of after hours services.
Consumer use of after hours services is influenced by media campaigns. Care must be exercised to ensure increased demand can be met.
Rural General Practitioners (GPs) may still experience unscheduled after hours demand even when new arrangements are in place.
The evidence on the costs of after hours services is limited and inconclusive.
Intangible effects (peace of mind, value of retention etc) should be factored into after hours cost effectiveness assessment.
After hours Medicare Benefits Schedule (MBS) has increased nationally over a four year period – item 5020 is the main driver of the increase – most pronounced in Eastern and South Eastern metropolitan regions.
ACT, NT and Tasmania mostly static in after hours MBS items.
No discernible effect of the after hours GP helpline or Medicare Locals After Hours (MLAH) programme on national MBS utilisation.
Emergency Department (ED) Category 4 and 5 presentations have increased over an 8 year period (except in ACT).
Hunter – lower rate of increase in ED primary care type presentations compared to rest of NSW.
No discernable effect of the after hours GP helpline or MLAH programme on primary care type presentations to emergency departments.
254 approved ML stage one activities – predominantly social after hours period; a third of activities involved other settings in health care and the community.
Strengths – leadership, staff, planning, involvement of non-medical primary care stakeholders.
Weaknesses – time to build new organisations governance structures, GP resistance, costs and time commissioning, slow plan approval, reporting processes, low community awareness.
Opportunities – engagement with non-medical and community sector, localised innovation, integration with other programs, cross ML collaboration.
Threats – uncertain funding environment, loss of GP trust, financial viability in low population areas, workforce issues, duplication of costly administrative and commissioning arrangements.
Funding more geographically equitable in ML period – all MLs received funding.
Some MLs were disadvantaged because regions did not receive funding for General Practice After Hours Programme in pre ML period.
There is a greater diversity of projects including ones more broadly related to primary care and not directly related to general practice.
The majority of providers feel they are currently meeting consumer after hours needs but feel less confident about meeting them in the future.
Some providers feel undervalued in the role they play in after hours especially in rural areas.
There is a high level of dissatisfaction with funding changes in after hours care provision.
MLs are not widely seen as adding value to the after hours primary care environment – some non-medical providers welcome involvement in local planning.
Barriers to consumers – lack of knowledge of available services, perceptions needs not urgent enough, concern about cost and transport/travel times. Using after hours services provides peace of mind to consumers.
MLAH Programme implemented in an uncertain environment – external factors and organisational development influencing progress.
Lessons from existing regional models – solutions work but require time, trust, cooperation and financial support.
Overall, reform process to achieve accessible, equitable and appropriate after hours primary care system is well underway.
Recommendations:
MLs should incorporate the after hours GP helpline as a ‘first line’ option in plans for unsociable hours.
MLs should be encouraged to work collaboratively to address issues of regional or national importance in after hours care delivery.
The Department of Health and the Australian Medicare Local Alliance should work with MLs to facilitate access to regional, state and national demographic and health services utilisation data.
MLs should monitor closely the impact of new after hours activities and funding steams on the financial viability of existing providers, particularly in rural areas.
Opportunities for the reduction of duplication in financial, administrative and legal arrangements for after hours services should be sought. The role of the Australian Medicare Local Alliance in the provision of common corporate services could be further strengthened.
