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)

Team Care Arrangements and Flinders QUEST

Recently a QUEST participant contacted us with a query about his gap fees for an Allied Health visit which had occurred through a Team Care Arrangement (TCA). The gentleman believed that because he was participating in Flinders QUEST there would not be any additional charges (or ‘gap fees’) for his health care; including visits to Allied Health providers.

This misunderstanding seems to have occurred because in our trial materials we have stated to participants that there are no extra charges for taking part in Flinders QUEST. By this we meant the enhanced services that Intervention group practices are providing to their participants. We did not mean that that other health services the participant receives will be covered by us.

Can we ask that practices are careful with their Flinders QUEST participants when making referrals to other health care providers to ensure that they understand they may incur out of pocket expenses for these and that these are not a part of the Flinders QUEST enhanced services.

Flinders QUEST in 2019

Welcome to 2019!

During 2019 we will provide blog entries here to keep everyone up to date with progress on the trial and as a forum to address any of your questions or issues.

To briefly recap – Flinders QUEST has 20 participating practices, 92 GPs and 1044 patients. Practices were randomised to Control / Intervention groups and the Intervention practices are currently delivering the enhanced general practice services to their trial participants.

Last week Richard, Heilie and Leigh travelled to Melbourne to meet with members from the RACGP sister trial being conducted in NSW, Victoria and Tasmania (called ‘EQuIP-GP’), and officials from the RACGP and the Department of Health.

Flinders QUEST is leading the pack in terms of practice and participant recruitment and meeting timelines. This is a great result for everyone’s hard work in 2018 and we have proved that SA can implement a nationally significant general practice trial to very high standards.

As many of you would be aware, the Federal Government has extended the Health Care Home trial through to June 2021 and the implications of this for the two RACGP trials was discussed. More work on this needs to occur and we will keep you posted on any updates.

During March members of the QUEST team (Richard, Leigh, Heilie, and Toni) will visit as many of the Intervention practices as we can. We need to hear from the practices as to how we can best help each practice to deliver the enhanced services to trial participants. And everyone is always interested in what everyone else is doing in the trial and so it is a good opportunity for us to share information.

The 6 monthly data collection from all participants in both the Control and Intervention practices will take place in April which is a big logistical job here.

We are expecting Medicare (MBS / PBS) item level data (for participants in the 12 months prior to joining Flinders QUEST) to arrive from Canberra any day now. This will provide baseline insights into two key components in our trial – a measure of continuity of care (what proportion of GP visits people make to their preferred GP) and the distribution of appointment time lengths.

Thank you for your ongoing support of Flinders QUEST. Please get in touch if you have any items you would like us to post about on this blog.