HCCA Submission to the GP Task Force

HCCA has made a submission to the GP Task Force. It is available online (290 kb Pdf)

Our community needs primary health care that is accessible, clinically and culturally appropriate, timely and affordable. We based our submission on our research and analysis of consumer experiences and expectations of general practice in the ACT.

We would like thank the hundreds of people who took the time to complete the GP Snapshot online survey and share their experiences and expectations of general practice in the ACT. There is a strong level of interest in the community about access to quality health services.

We would also like to thank the many people in our membership and wider networks who shared their experiences and perspectives with us.

A quick summary:

In our consultations we found that consumers’ experiences of primary health care were varied. Some consumers are very well placed with a regular GP who they can see when the need arises. Other consumers reported that the inadequate supply of GPs presents them with significant difficulties in accessing satisfactory care, including for urgent appointments, referrals, scripts or renewals of prescriptions.

Consumers also reported a level of disruption to their health care with the closure of general practices and move to larger corporate medical centres. The impact of closures of practices on consumers is amplified as many existing GP practices have closed their books to new patients.

One of the strategies consumers have developed to deal with the GP shortage is to have a number of general practices they access. A respondent to the GP Snapshot 2009 said that they had “2-3 GPs because we cannot always get to see the same GP due to difficulties getting an appointment” (Respondent 130).

The extension of “corporate” GP practices with a strong profit emphasis is a cause of dissatisfaction for many health consumers in the ACT; reasons given are reduced geographic access, especially if relying on public transport, no doctor of choice and a ‘production line’ consultation process – a particular concern for consumers with chronic and complex conditions.

The majority (81.2%) of respondents have a regular GP. Respondents were asked to provide reasons for not having a GP. The main reasons given for not having a GP were that the consumers can never get into their preferred GP (17.5%) and that GP Clinics are not taking new patients (16.7%).

The GP Snapshot 2009 was designed to capture a snapshot consumer experiences and expectations of general practice in the ACT.

The survey was developed based on discussions with consumer representatives and members of HCCA. Secretariat to the GP Task Force had seen a draft of the survey before publication. The survey was piloted with a group of HCCA members. It included issues such as whether consumers have regular GPs, waiting times, the quality of the interaction and demographic material and included a number of questions that the GP Task Force had asked practicing GPs.

The survey ran from 15 June - 3 July 2009 and was publicised through HCCA members and networks, and media coverage in The Canberra Times, ABC Canberra and 2CC. There were 635 responses. We think that the number of responses demonstrated a strong interest in the community around this issue.

Our preliminary analysis is included throughout the submission to the GP Task Force. A summary of findings is available online (151kb Pdf). HCCA will continue to analyse the results of the survey and post this to the HCCA blog over time.

National health reform

The Prime Minister officially launched the report of the National Health and Hospitals Reform Commission at the Australian National University on Monday 27 July 2009. The full report is available online on the NHHRC website.

The report contains three main reform goals:

• Tackling major access and equity issues that affect health outcomes for people now

• Redesigning our health system so that it is better positioned to respond to emerging challenges

• Creating an agile and self-improving health system for longer-term sustainability.

A few points of interest include:

• The Commonwealth should assume responsibility for all primary health care policy and funding. (States would continue to be owners and managers of public health services. Non government organisations and the private sector would continue to be providers of services).

• There is a strong to build a regional network focus in primary health care to provide better access to front line care through our GPs and related community care services. A part of this will be the development of Primary Health Care Organisations to improve population health planning and regional delivery of primary health care services, integrating closely with general practice. (It will be interesting to see how the Divisions of General Practice position themselves to take on this role.)

• Voluntary enrolment with a single primary health care service is recommended for youngfamilies, Aboriginal and Torres Strait Islander people and people with chronic and complex conditions (including people with a disability or long-term mental illness)
  

• A new universal scheme for access to basic dental services, ‘Denticare Australia’ which would provide for prevention, restoration and provision of dentures paid through either a private health insurance plan or through public dental services.
  

• A national e-health system be implemented with a personal electronic health record owned and controlled by the individual as a central measure

• Funding for residential aged care providers will be able to make arrangements with primary health care providers to provide visiting sessional and on-call medical care

HCCA will be assisting the Consumers Health Forum in preparing a more detailed analysis of the recommendations and findings of the NHHRC Final Report and will let members know once this is complete.

In the interim, we are interested in your thoughts.

Melton Health

Staff from HCCA were very impressed following a tour of the Melton Health Centre on the north west fringe of Melbourne last Wednesday (15 July). Melton Health is one of the sites of Djerriwarrh Health Services.


Melton Health represents a new benchmark for Integrated Primary Health Centres that are proposed in the ACT and also provides excellent ideas for consumer-centred design and refurbishment of Village Creek Centre for the Aged Care and Rehabilitation Services (Read FAQ online 55kb Pdf).

Melton Health is a SuperClinic and was established 3 years ago. Melton Health offers an extensive range of same day medical services, specialist clinics, pathology and radiology services to cater for the health and well being of a rapidly expanding community. It provides around 50,000 occasions of service per year and has greater capacity to provide up to 90,000 service provisions in the future. The figures have shown growth each year but whilst there has been an 8% growth in population, there has been a far greater growth is users of the Centre.

Services were decided on by using population, Emergency Dept, and Health Dept statistics. The highest demand services were chosen and other services were not provided if there was not a critical mass to support them. A Community Advisory Group provided input into what services were provided and the structure of these services. Community consultations were held. The Community was also involved in creating artworks for the Centre, including a large mural at the entrance.

The Centre provides a vast array of services within the one highly functional and attractive environment.

The services provided include:

Urgent Care, Renal Dialysis, Oncology, Haematology, Gastroenterology, Chronic Disease Management, Day Rehabilitation, Orthopaedic Clinic, Endocrinology and Diabetes Clinic, Chest Pain Clinic, Respiratory Clinic, Nephrology Clinic, Dermatology Program, Stomal Therapy, antenatal clinic and classes, Infant Settling and Feeding Clinic, Paediatric Clinic, and an Audiology Clinic.

The centre is open from 9am – 10.30 pm, 7 days a week. Most services are by referral, a few are self- referral.

Particularly noticeable was the absence of consumers waiting to be seen which according to the Executive Officer, David Grace, is due in part to the innovative electronic queueing system by Q-matic. The system allows nine out of ten consumers to be seen straight away by a Clinician, who is prompted upon their arrival by the system. They kiosk can scan the bar code on the consumer’s referral letter which then notifies the clinician that that consumer has arrived. David Grace believed that at first they had underestimated just how effective the queueing system would be. We think this has great potential in assisting consumers in our ongoing quest to tell our stories once and get to the right place and will be raising this for consideration in the Capital Asset Development Program and design and refurbishment of Village Creek.

The Urgent Care Stream is a walk- in service with no appointment required. It’s provided on a non on-going, one off basis where consumers are referred back to their GP for further treatment when required. Interestingly, the local area is similar to the ACT, in that there is a shortage of GP’s. Typically, consumers wait 3- 4 days to see their GP. Since the opening of the Melton Health Clinic, there has been a statistically significant reduction in Emergency Department presentations. The Urgent Care service is both Nurse Practitioner and GP led, with lots of part- time staff working side by side. Discharge summaries are provided in a written format whilst all other medical records are electronic. They are working toward discharge summaries being electronic but at present encrypting taking too long. David reported that they would have two or three code blue emergencies a month and 20% of patients referred to hospital go by ambulance.

The Ambulatory Care Stream is similar to an outpatient clinic except with a Multidisciplinary approach. At a planned appointment, consumers can get back to back appointments with a number of staff. Some staff work across the multidisciplinary team whilst others are part of a specific team. Most doctors are contracted but some are salaried or casual. 5% of doctors rent a room and have their own practice. Recruitment of staff had not been a problem as many professionals wanted to be part of the new and effective system.


The Reception area used glass surfaces and fixtures so as consumers could see the activity going on beyond the waiting area. Each module was secure with Clinicians using swipe cards to let consumers in and out. The secure doors are glass and add to the sense that you are in a welcoming environment rather than an institution.


Electronic records were kept using an electronic system which allowed for both handwritten and computer generated documents to be captured. Eyesoft is the electronic patient master system that sits above all others across the Djerriwarrh community to allow all clinicians to access all records. David Grace mentioned that no consumers have had an issue with privacy and confidentiality of records and so far all have consented to electronic records.

Some other features were pathology, ultrasound and x-ray, and dermatology facilities on site. Group meeting rooms were also provided for educational purposes. The paediatric consultation rooms were of a generous size to allow for the whole family to fit comfortably including an activity table for children.

We were very impressed with building and the sense of being built around consumer needs and also taking into account the needs of staff. HCCA would like to thank David Grace for his time in showing us the Melton Health facility.

Workshop: What do consumers need to effectively self-manage chronic conditions?

How patients and health professionals can learn from each other and share information about managing and self managing chronic conditions is one of the key areas of investigation by a collaborative research partnership that has recently been formed in the ACT. This research partnership is between the University of New South Wales, ANU College of Medicine, ACT Health and the ACT Division of General Practice.

While we know that self- management is important for those with chronic conditions, what information and support is needed to make it easier for both patients and health professionals to work together?

Darlene Cox, Executive Director of the Health Care Consumers Association says, “each person has their own unique experience of their condition and illness, which they manage on a daily basis”. But what would make this easier?

What works, what doesn’t work is the topic for conversation that Health Care Consumers' Association and the ACT Division of General Practice would like find out from people in the ACT at a seminar on August 11th. “This is an exciting opportunity for us to meet and hear from people in the ACT and share ideas and experiences of how they manage their chronic conditions”, she said.

To find out more about this seminar or to book a place, contact Health Care Consumers’ Association on ph 6290 1660.

Patient Centredness

A new essay by Don Berwick on the role of patient centredness as a dimension of quality in healthcare was published yesterday in the journal Health Affairs.

Abstract:“Patient-centeredness” is a dimension of health care quality in its own right, not just because of its connection with other desired aims, like safety and effectiveness. Its proper incorporation into new health care designs will involve some radical, unfamiliar, and disruptive shifts in control and power, out of the hands of those who give care and into the hands of those who receive it. Such a consumerist view of the quality of care, itself, has important differences from the more classical, professionally dominated definitions of “quality.”

Key issues discussed:
In Berwick's essay he argues that imposing a clinician view of what is best for a patient is a form of violence against patients. His proposed definition of “patient-centered care” is this: The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.

He goes on to propose that these principles should be applied to include the experience of family and loved ones of their choosing, becoming “patient- and family-centered care.” In this view, a patient- and family-centred health care system would be radically and uncomfortably different from the health systems we experience today.

Characteristics might include:

• Hospitals would have no restrictions on visitingPatients would determine what they eat and wear in hospital
• Patients and family members would participate in clinical rounds
• Patients and families would participate in the design of health care processes and services
• Medical records would belong to patients
• Shared decision-making technologies would be used universally
• Appointment schedules would conform to queuing theory designs rather than clinician convenience
• Patients physically capable of self-care would have the option to do it

Read the article online

Donald M. Berwick, What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist A seasoned clinician and expert fears the loss of his humanity if he should become a patient. Health Affairs, July/August 2009; 28(4): w555-w565.

Russell McGowan