RACGP calling for increased GP funding in 2019-20 Budget

More funding for longer GP consultations is just one of the recommendations put forward by the RACGP ahead of next week’s Federal Budget.

In their Pre-Budget Submission, the RACGP advocated for a range of improvements including:

  • providing an increase of at least 18.5% in funding for level C and D consultations to reduce patient out-of-pocket costs and enable GPs to continue to deliver high quality care to patients with complex needs
  • introducing a level E consultation (i.e., over 60 minutes)
  • aligning GP rebates with those of other medical specialists (accounting for years of training)
  • enabling greater recognition for practice nurse time
  • amending MBS requirements that consultations must be face-to-face, to allow for communication via electronic methods where appropriate
  • introducing funding for longer mental health consultations.

As all of our QUEST practices are aware, offering longer consultations is one of the key enhanced services targeted in the trial. Our baseline data suggest that in the 12 months prior to the trial, 65.4% of appointments between QUEST participants and their preferred GPs were level B, 28.3% level C and 3.7% level D consultations. We are hoping to see a shift in these rates over the course of the trial.triangle-3145433_960_720

Longer appointments have been linked with higher patient satisfaction, better quality prescribing, ability to adequately address multiple health and psychosocial issues and opportunities for preventive activities. Our upcoming 6-month survey will help us to see how this is going for the practices and patients involved in Flinders QUEST.

With the Budget due for release next Tuesday 2 April we look forward to seeing how the Government has addressed the RACGP’s recommendations and the resulting implications for general practice!

March 2019 Practice visits: Chandlers Hill Surgery

On Tuesday 19 March the Flinders QUEST team comprising of Richard Reed, Leigh Roeger and Toni Chappel visited Chandlers Hill Surgery for a progress meeting. The meeting was very well attended with the majority of practice staff present.

Chandlers Hill Surgery is situated in Happy Valley and has been providing care for patients in this catchment area since 1985. Chandlers is our largest QUEST practice with 9 GPs and 100 patients taking part. This means that Chandlers has approximately 20% of our Intervention participants.

Being a larger practice meant that the first key task for Chandlers’ indomitable Practice Manager (Jacky Genesin) was to get a very large group of staff working together “on the same page” for Flinders QUEST, to ensure that there was consistent delivery of the enhanced services across the team.

Jacky has flagged participants in their Best Practice software system by recording them as Health Care Homes (HCH) trial participants. She is currently experimenting with using the HCH reports programmed within the software, for our participants.

At Chandlers each QUEST participant is allocated into a ‘Pod’ which contains his or her preferred GP, a Practice Nurse and an Administration staff member. Each participant was informed (by letter) explaining how Chandlers was going to implement the trial. In the introductory letter participants were also encouraged to phone the practice to advise their ‘Pod’ of any Emergency Department presentation or hospital admission. As we all know, the discharge summary is not 100% reliable and so this will help prevent participants from falling through the cracks.

As in other practices GPs are blocking out reserved appointment slots for QUEST participants. It is thought that this will significantly improve the ability of participants to see their preferred GP (continuity of care). Longer appointments are being offered but Chandlers also reviewed the appointment frequency of participants and used this information to schedule a ‘course’ of planned longer appointments for the 12 months of the trial.

In addition (and we don’t know how they found the time to do this!) they ran a focus group for participants where they gathered lots of useful feedback not just about the trial but also the services they provide generally.

With a real ‘Pod’ team approach, Chandlers has been able to ensure that nearly all QUEST participants have a Care Plan and have been screened (where appropriate) for preventative health requirements e.g., BMD and Home Medicine Reviews.

Chandlers staff always ask very good questions and GPs had two curly ones for us. The first question was whether GP participation in Flinders QUEST could be used for CPD purposes. The answer is yes and we will post a blog next week on the specific details.

The second question (which was also raised at WOWS) was around our measure of continuity of care when GPs have a ‘buddy’ GP. We will do some investigations into this and present the data at our planned 6 month workshop for Intervention practices.

An interesting question raised by seeing all the ‘extra’ activities being undertaken by Chandlers is how does this fit into the idea of our clinical trial which is designed to test the impact of specific enhanced services. Flinders QUEST is a pragmatic trial. This means it is being conducted in the real world of practices and not a laboratory or university setting. Taking part in Flinders QUEST did not mean that practices (either Intervention/Control group) had to stand still with their quality improvement efforts. Chandlers (like all the practices in QUEST who self-selected to join our trial) were engaging in quality improvement activities long before we came along and will do so after the trial is complete. According to Jacky, Flinders QUEST enabled Chandlers to put additional focused effort into quality improvement areas that they had wanted to do for some time.

From our perspective, better quality general practice services have the potential to produce better patient outcomes. And that’s something that everyone involved in Flinders QUEST can be on the same page about.

So well done to Jacky, Meera, Casey and the whole team at Chandlers for their very proactive approach to implementing Flinders QUEST.

Next practice visit we are looking forward to is Hallett Cove.

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Left to right (standing): Dr Natasha Alexandrides (GP), Dr Moira Gallagher (GP), Dr Dan Nolan (GP), Dr Laura Turnbull (GP), Dr Paul Muffet (GP/Partner), Dr Leigh Roeger (QUEST Manager), Ms Jacky Genesin (Business Manager), Dr Kerry Hancock (GP/Partner), Ms Stacey Jennings (Practice Nurse)
Left to right (seated): Prof Richard Reed (Chief Investigator), Dr Daniel Byrne (GP/Partner), Ms Casey Franchi (Practice Nurse)

 

March 2019 Practice visits: Wirreanda on Wheatsheaf Surgery

On Thursday 14 March the Flinders QUEST team of Richard Reed, Leigh Roeger and Heilie Kwok visited Wirreanda on Wheatsheaf Surgery (WOWS) for our first on-site progress meeting.

Since the trial has begun, WOWS has grown in size and has welcomed two additional doctors on board. WOWS is located in Morphett Vale and is one of our medium size practices with 38 participants (child/young people: 4; adults aged 18-64: 18; adults aged over 65: 16).

At the progress meeting representing WOWS were the Practice Manager (Ms Kerrie Payten), Practice Nurse (Ms Marta Zan), Medical Receptionist (Ms Donna Kammermann) and Drs Lou Christodoulou, Charmaine Sargent and Michael Ludlow.

So that was the first highlight of our visit to WOWS. Meeting with the full team (Reception, PM, PNs and GPs) at the practice and seeing how well everyone has got on the same page about Flinders QUEST.

Like the other Intervention practices we have visited, WOWS haven’t experienced any difficulties incorporating the enhanced services into their routine system of care for QUEST participants.

We did learn a couple of things we hadn’t been aware of previously.

Apparently, on occasions, Flinders Medical Centre staff ring through to WOWS and make appointments for patients being discharged who require a follow-up GP appointment. This is a great service which could really make a difference to the critical transition from secondary to primary care. We will try and dig further into this to better understand how it is being implemented.

The other thing we learned was the difficulty that practices can experience achieving very high levels of appointments with preferred GPs when GPs in the clinic may work part-time. As a result of the discussion with WOWS we will tweak our measures to also look at proportion of appointments made to GPs in the practice.

We enjoyed an interesting discussion with practice staff about the potential benefits of the longer appointments and the follow-up appointments after discharge from hospital. The GPs gave us some food for thought about providing guidance materials for how we think these enhanced services could best be maximised for patient benefit.

The final highlight for us was the group photo. This was taken with a background of several paintings in the WOWS waiting room which had been painted by their GPs. We were subjected to a tough guessing game where we had to try and match the painting to the GP – naturally we got this entirely wrong!

Thanks to WOWS for a very enjoyable visit. Next visit (Tuesday 19 March) is to Chandlers Hill – we know that many of our Intervention group practices have been very interested to learn about how Chandlers have gone about implementing Flinders QUEST so look forward to providing an update next week.

WOW
Left to right: Dr Heilie Kwok (QUEST Coordinator), Prof Richard Reed (Chief Investigator), Ms Donna Kammermann (Medical Receptionist), Dr Lou Christodoulou (GP), Ms Kerrie Payten (Practice Manager), Dr Charmaine Sargent (GP), Ms Marta Zan (Practice Nurse), Dr Leigh Roeger (QUEST Manager), Dr Michael Ludlow (GP)

March 2019 Practice visits: Hackham Medical Centre

On Wednesday 13 March the Flinders QUEST team of Leigh Roeger and Heilie Kwok visited Hackham Medical Centre for our first on-site progress meeting.

Hackham Medical Centre is in Huntfield Heights and is one of the largest practices in the trial. Hackham has 83 participants (child/young people: 7; adults aged 18-64: 32; adults aged over 65: 44). It is primarily a bulk billing practice serving a patient population in a disadvantaged area.

At the progress meeting representing Hackham were the Practice Managers (Mr Zeeshan Khan and Ms Sue Daglish), Practice Nurse (Ms Belinda Blackstock) and Drs Navtej Pal Singh Sandhu, Edwin Lapidario, Muhammad Durani, Mahbubul Alam and Blaceline Costelo-Sayo.

QUEST participants have been relatively healthy since the beginning of the trial but Hackham doctors are gearing for a difficult flu season during the winter months.

Hackham are implementing the enhanced services for Flinders QUEST participants with a direct approach. All QUEST participants have been flagged in the practice system and are routinely offered double appointments with their preferred GPs.

Anecdotally we heard that patients are very positive about the trial and are feeling that they are receiving “better” services. Participants are not using their QUEST ID card as much as when the trial started but do remind practice staff verbally that they are QUEST participants.

Since the start of the trial, it is estimated around 20 participants have experienced hospitalisations. In these cases, discharge summaries were forwarded to each participant’s preferred GP who conducted the follow-up phone call.

It was great for us to catch up with the team at Hackham Medical Centre and to see the interventions getting implemented. The next practice visit will be at Wirreanda on Wheatsheaf Surgery on Thursday 14 March.

Hackham

March 2019 Practice visits: Torrens Clinic

On Wednesday 6 March the Flinders QUEST team of Richard Reed, Leigh Roeger and Heilie Kwok visited one of our Intervention group practices – Torrens Clinic – for our first full team on-site progress meeting.

Torrens Clinic is located in Flinders Park and is one of the most northern practices in Flinders QUEST. Torrens has 45 participants (child/young people: 6; adults aged 18-64: 9; adults aged over 65: 30).

At the progress meeting representing Torrens were the Practice Manager (Ms Melissa Williams) and Drs Alan Forbes, John Tsavdaridis and Sheeper Ahmed. We heard that it was a particularly busy time for Torrens as they prepare for accreditation and coordinate renovations that are underway in their sister practice.

We mentioned to Melissa that we were happy to forward her a copy of the Flinders QUEST Ethics Approval for accreditation purposes (see indicator C3.6; 5th edition). If any other Practice Managers would like a copy of the Ethics Approval for Flinders QUEST please let us know by email to quest@flinders.edu.au.

Torrens Clinic are implementing the enhanced services for Flinders QUEST participants with a straightforward approach. Doctors are reserving a spare appointment each day for QUEST participants and staff are very confident participants will be able to see their preferred GP on the same/next day. According to Torrens staff patients need very little convincing of the benefits of seeing their preferred GP to promote continuity of care. This is very much patients’ strong preference.

Longer appointments are routinely offered for participants. Several participants with chronic conditions have pre-booked routine appointments (30 minutes) several months in advance so that their health conditions can be proactively managed.

Four participants have experienced hospitalisations since the start of Flinders QUEST. Melissa did the follow-up with them and none needed further GP follow-up. Torrens staff felt that generally QUEST patients had been remarkably healthy over summer, but they expect higher rates of health problems during the winter months.

GPs commented that the “QUEST ID card” has proved to be very popular with several participants reminding GPs of their new “special” status.

It was great for us to catch up with Torrens Clinic and very pleasing to see how the Flinders QUEST enhanced services have been able to be readily integrated into their systems of care. The next “cab off the rank” for a practice visit will be Hackham Medical Centre on Wednesday 13 March.

TorrensLeft to right: Dr Leigh Roeger (QUEST Manager), Dr John Tsavdaridis (GP), Prof Richard Reed (Chief Investigator), Dr Sheeper Ahmed (GP), Dr Heilie Kwok (QUEST Coordinator), Ms Melissa Williams (Practice Manager), Dr Alan Forbes (GP)