Development of regional approaches to after hours primary care

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Larter supported Murrumbidgee PHN to improve consumer access to after hours primary health care in three communities – Griffith, Leeton and Berrigan. Larter has specialist knowledge and significant experience assisting PHNs to improve the accessibility, efficiency and integration of after hours primary health care, built over many years.

Murrumbidgee PHN works to strengthen primary healthcare delivery and address healthcare inequalities across its region, in partnership with communities, clinicians and organisations. The PHN works across a vast and diverse geographical area that encompasses regional cities, small towns and sparsely populated rural areas.

The challenge

In 2019, Murrumbidgee PHN developed an After Hours Regional Plan collaboratively with stakeholders which contained number of recommended strategies. Two of the strategies included:

  1. Identifying local solutions to improve access to after hours primary care services in three rural communities for piloting – Griffith (570km west of Sydney), Leeton, and Berrigan/Finley/Deniliquin (adjacent towns, just north of the NSW-Victorian border)
  2. Codesigning the selected solutions with consumers, providers and regional leaders

Larter worked with Murrumbidgee PHN to action these two.

Following desktop analysis and documentation of after hours service availability, we consulted with community members and providers across the five locations. While the insights on barriers and opportunities were very local and place-based, we also heard some common themes from community:

  • People usually go to their local hospital or call an ambulance to access medical services in the after-hours period, as access to primary care is limited. This was particularly true for refugees and new migrants. Transport can also be a barrier for many.
  • Many people had limited knowledge of other kinds of services available to them and how to best access after-hours care. They would like clear and simple information about access points and cost of services.
  • People are generally willing to try new models of care or new delivery methods such as telehealth, if they are appropriately informed and supported to do so.
  • In the smaller towns close to the border, GP books are full and the only local alternative is ED. Pharmacies are also closed all weekends after midday Saturday.

Some common themes from service providers on issues and solutions included:

  • Shortages of GPs and of pharmacist locums across all regions leads to wait lists during business hours and a lack of face-to-face care availability after hours.
  • Only two services indicated they may consider extending existing service hours if offered incentives. For others, workforce was a key barrier.
  • Providers were open to alternative workforces that could complement them after hours, though they wanted to make sure they were involved in solution design.

Providers were generally unsure whether consumers used healthdirect and direct-to-consumer GP videoconferencing services – though some knew that itinerant people did, such as truck drivers.

Our response

Based on the initial insights gathered through the scanning phase, Larter collated the opportunities for place-based solutions for each of the three locations. We did this by:

  • undertaking a thematic analysis of local consultations
  • updating an after hours literature review
  • documenting a list of initiatives funded or facilitated by other PHNs around Australia, and highlighted those running in rural towns of similar sizes.

We facilitated a prioritisation workshop with key stakeholders and PHN representatives, at which 10 potential ideas to take to communities for codesign were identified. These were further prioritised to 7 ideas using Larter’s prioritisation matrix.

While stakeholders’ key priorities were to attract more GPs and pharmacists, this received low feasibility scores based on timelines available for piloting (as well as being seen as a critical broader workforce issue).

The top two priorities agreed for codesign were:

  1. Planning and undertaking a contemporary consumer marketing campaign promoting available after hours services
  2. Planning and rolling out an out-of-hours GP care and advice telehealth service.

Priority 1 was absorbed by Murrumbidgee PHN’s communications team who would engage marketing experts to deliver.

Priority 2 was selected to be taken to local codesign.

Larter undertook face-to-face codesign workshops in Griffith, Leeton, and Berrigan/Finley/Deniliquin and an online workshop for residential aged care facilities.

The workshops used our codesign framework to collaboratively design the scope, service specifications and marketing of the proposed services to ensure they were locally-appropriate and fit-for-purpose. For example,

  • People with a UTI or ear infection may use the service and then need a script, so the service will need to know which pharmacies are open and when, to help the caller navigate the service system.
  • People with high needs, such as for moderate to severe mental illness, may be better served through other services, so marketing will need to be tailored and triage will need to consider what is in scope and what is not.
  • Some people in larger towns will be able to afford fees, while smaller rural communities near the border will generally struggle to pay – so services will need either need tiered fees or no fees.

The outcome

The PHN has commissioned an out of hours GP care and advice telehealth service for the communities of Griffith (and surrounding Murrumbidgee and Carrathool Shires), Leeton Shire, Finley, Berrigan, and Deniliquin (and surrounding Edward River Shire). The service has no out of pocket expense and operates.

  • Monday – Friday: 6pm-10pm
  • Weekends and public holidays: Midday-4pm.

Larter has delivered After Hours program needs assessments and commissioning support for four Primary Health Networks. This includes codesigning fit-for-purpose local solutions with communities and stakeholders. We understand this difficult space, and we love helping PHNs work with others to improve access to care for communities. 

We would love to have a discussion about supporting After Hours program needs assessment and planning – feel free to reach out to us.