Improving access to after-hours primary care continues to be an important area of health policy. Significant challenges include after-hours primary care workforce shortages; the occasional tendency to unnecessarily direct consumers to emergency departments; and a lack of engagement of hard-to-reach communities such as those experiencing financial vulnerability or culturally diverse communities who can’t easily access information about after hours care options. There are also significant differences between communities – some have their after-hours services system relatively well organised, while in others there are significant access gaps or over-reliance on urgent care services. GPs in rural communities seeking a better work-life balance and pulling back from being available for all community members after hours has been a trend for many years, prompting planners to ensure there are alternative options.
Primary Health Networks (PHN) receive Commonwealth funding to work with key local stakeholders to plan, coordinate and support population based after-hours health services.
Effective planning needs to enable improved sector capacity and empowerment, improved community and provider health literacy, and better quality care while also acknowledging when local arrangements are working. A ‘one size fits all’ approach for after-hours primary care delivery does not work.
While state-funded services have a core role in urgent care, the private sector (GPs, general practice, pharmacy and Nurse Practitioners) are also central to the effective delivery of after-hours primary care. PHNs use a commissioning approach to address local gaps and regional needs.
Larter provides consulting services for co-designing innovative models for after-hours primary care delivery across Australia. The process usually includes mapping regional after-hours services (including the production of visual maps) and undertaking needs assessments to identify opportunities for improvement.
There are now many examples of innovative co-designed after-hours services throughout Australia.
- the ‘After Hours Medical Neighbourhood‘ funded by Eastern Melbourne Primary Health Network (EMPHN) and delivered by Nexus Primary Health, which includes outreach visits targeted to reach vulnerable communities
- a digital consumer portal funded by Murray PHN to help improve health literacy and provide the local community with options for accessing health services outside of traditional business hours
- the SPOT ON pilot in Queensland through which those who call 000 can be connected to a local GP skilled in acute care when appropriate rather than being directed to emergency departments (‘Supporting Patient Outcomes through Organised Networks’)
- palliative care pathways and outreach services to provide acute health care for residential aged care facilities funded by Brisbane North PHN
- free access to the My Emergency Doctor telephone app funded by EMPHN for people living in Melbourne’s east and north east. This app allows the user to speak with a specialist emergency doctor and to share video and pictures to with the doctor
- a patient streaming service, which links callers to NURSE-ON-CALL to a phone-based GP and then to local services, originating in the Hunter Valley and now available through Safety Link in parts of Victoria
- a number of locally targeted telehealth projects, including an after-hours telehealth service with a regional emergency department funded by Gippsland PHN; geriatric medicine services delivered via telehealth funded by Murray PHN; and a telehealth component of the ‘Medical Neighbourhood’ program funded by EMPHN
- Brisbane South PHN’s ‘Homeless to Home Healthcare After Hours Service’ that has commissioned Micah Projects to provide health and housing support to people experiencing homelessness, after hours
- a shared electronic medication management system established across 12 health services in the Western Victoria PHN.
We know effective delivery of after-hours primary health for all Australians will require further innovation, service integration and collaboration. Solutions will need to be targeted to meet regional needs and both established and emerging systems will need to be leveraged. This will significantly impact the health outcomes of vulnerable populations.
Contact us if you would like to learn more about innovative models for after-hours primary care delivery.
Further information about the 2015 Commonwealth review of after hours primary health care is available in the report.