Alternative Models for General Practitioners

North East Valley Division of General Practice Aged Care GP Panels Initiative

Draft prepared 18/07/06 by Dr Alison Sands. Revised 21/11/06

Alternative models for General Practitioners servicing aged care home residents

A Discussion Paper

Prepared by North East Valley Division of General Practice Aged Care GP Panels Initiative as an extension to ideas presented in ADGP June 2006 discussion paper titled : Practicing in Residential Aged Care Facilities: Alternative models for general practitioners who predominantly or exclusively service residential aged care facilities

The above discussion paper outlines the issues currently existing in Australia around GP services to aged care homes. In particular the paper outlines concerns regarding the changing GP workforce demographic, including  Retirement of older GPs  Less younger GPs taking on aged care work  Increasing numbers of GPs choosing to work part-time  Few female GPs taking on aged care home work.

The alternative models described below are based on observation of how GPs within our Division manage their aged care home work.

Alternative Models for General Practitioners

1. General Practice Nurse 2. Group Practice ownership 3. Part-time GPs 4. Junior Doctors 5. Work Share

General Practice Nurse

Roles the practice nurse can take on that support the GP in aged care home work  Collect information for Comprehensive Medical Assessment  Co-ordinate EPC Items (CMA, RMMR, Care Plan Contribution & Case Conferencing) o Recalls & reminders (eg weekly lists for GP) o Familiarity with MBS item requirements o Identification of residents eligible for these items o Documentation (template supply)  Liaise with aged care home for weekly job list prior to GP visit  Organise Small Group Learning continuing education onsite at GP clinic with aged care topics., cases & speakers

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D:\Docs\2018-04-28\07767deda3f2e87c4cc33888e267e2f0.doc North East Valley Division of General Practice Aged Care GP Panels Initiative

Group Practice ownership

A group practice makes a commitment to service a particular group of aged care residents. The workload can be divided in various ways  One day each per week  Roster for regular visits  Roster for cover for phone calls & unscheduled visits  Cover for each other when on leave  Allows inclusion of part-time GPs without the concern of non-availability on days off (eg PT females)

This group approach would be assisted by:  A co-ordinator  Regular team meetings regarding clinical & other issues

Financial incentive to the practice could be by:  Extending PIP payments to reward practices taking on a significant residential aged care workload  This might include establishing a Residential Aged Care Register (like Diabetic Register)  Quality care could include the completion of an annual cycle of care including CMA, RMMR, Care Plan Contributions & Case Conferences (like Diabetic Annual Cycle of care)

Consent to medical care The residents, or their representative, would need to be asked to consent to medical care by the practice, rather than by an individual GP

Part-time GPs

There are far fewer female GPs working in residential aged care than male GPs. In the future the majority of our graduating GPs will be part-time females, and more & more so, part-time males. There need to be models that make aged care home work viable for part-time GP

1. Co-operative arrangement between part-time GPs to cover each other for days off & leave (this model is particularly applicable to GPs predominantly servicing aged care homes without attachment to a clinic as described in ADGP discussion paper) 2. sharing aged care home workload as part of a group practice (as above)

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Junior Doctors

Junior Doctors are often sent out to do aged care home visits when the regular GP cannot attend to an urgent request. This often results in an unsatisfying experience for the young doctor & may well put him/her off aged care home work altogether.

Ways in which the junior doctor might contribute to aged care home work in a positive way could be  join regular GP on regular aged care home visits & be given tasks or residents to see  alternate weekly visits with regular GP (and not make major changes to management without consulting regular GP)

As this role is likely to include an educational role for the regular GP it may help for a Mentor Grant to be available to that GP or the practice.

As for Group Practice model, resident or representative consent to shared care would be needed

Work Share

Two GPs within the same practice alternate weekly regular visits and cover each other for holidays.

Information Technology

If aged care home work is shared between GPs as in any of the models above, it is essential that clinical information be available to all. There is therefore a need for sophisticated, reliable & integrated electronic records & other IT infrastructure at both the GP clinic and the aged care home (and other health services interacting with these – eg pharmacists, acute hospitals)

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How might the above models be supported?

Residential Aged Care Model support

 Documentation of the above models  Clear explanations of how these models can be applied (practice protocols, organisational changes etc)  Facilitators to work with practices & GPs to implement a new model  Templates, software & other practical tools

In order to develop the above it would be necessary for the Commonwealth to support trials of each model at a small number of practices.

National resources could then be developed and rolled out via Divisions of General Practice given appropriate funding

Financial incentives would need to be include to support these models For example:  PIP practice payments linked in with aged care home work  Practice Nurse Grants for nurses to take on a specific role supporting aged care home work  Mentor Grants for supervisors of junior doctors  IT Grants to both aged care facilities and GP practices for infrastructure, training and co-ordination of IT systems

Practice Incentives Program Current situation  A GP must be working at an accredited practice in order to access PIPs & SIPs  Even if a GP works in an accredited practice the services s/he provides to aged care home residents do not qualify for SIPs eg annual cycle of care for diabetics

Proposal: (i) the PIP & SIP model should be extended to provide financial reward for GPs caring for the residents of aged care homes (ii) care provided for aged care home residents should attract SIP payments for diabetes, asthma & mental health as per patients living at home (iii) Practices caring for a higher number of aged care home residents would attract a higher PIP payment.

Note that that a whole patient equivalent (WPE) in a RACF is more labour intensive for a doctor than a WPE in the community. This has implications for PIP calculations.

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