We’ve all been there – cutting a finger badly while slicing vegetables for dinner late on a Sunday night; or your child waking up in the middle of the night with a barking cough and in distress.  Seeing a GP would be ideal, we are not sure if there is one open. Going to an emergency department (ED) or rural equivalent is a safe and reliable choice, but can also mean a potentially long wait.

Around 35% of ED presentations across Australia are for lower urgency presentations not leading to hospital admission[1]. There is strong evidence from Australia and internationally that improved access to primary health care after hours[2] can reduce non-urgent emergency department (ED) presentations. It has been estimated that if clients were seen by a GP after hours, we could save $1.5 billion[3], which could be invested into other health services.  

Primary Health Networks (PHNs) have a mandate to enhance access to and improve the efficiency, effectiveness, and coordination of health services. They are uniquely positioned to address after hours care issues, especially for people most at risk of poor health outcomes. PHNs have been funded by the Australian Government since 2015 for this task through the PHN After Hours Program (the Program).

An evaluation of this Program[4], commissioned by the Australian Government and published in May 2021, found that while the Program is aligned with national policy objectives, it has not enabled PHNs to address the root causes that hold back after hours service delivery systems, such as:

1. An inability to resolve national and state health system complexities due to limited mandate
2. Workforce challenges, in particular GP shortages that are becoming more evident in many areas
3. Service gaps during the day that increase after-hours demand, and
4. Multiple and confusing system entry points.

Having had the privilege to undertake three PHN after-hours program reviews, we would suggest a further six key issues:

• high public awareness of accessing hospital, ambulance, and 000 services; yet relatively poor awareness of non-hospital after-hours services, including the after hours GP helpline and telehealth options
• inadequate transport to non-ED after hours services for those who cannot drive, do not have access to a vehicle, are carers, or for whom driving at night in rural areas is impractical
• no physical alternative to hospital care after 6pm and particularly after 8pm in many rural towns
• lack of investment in providers such as pharmacists, physiotherapists and nurse practitioners
• lack of dedicated non-acute mental health services after hours
• national and state telephone triage services that often direct consumers to hospital rather than to local after hours primary health (including general practice) services.

At Larter, we have built an extensive knowledge base of innovative approaches to after hours primary care service delivery through our work with PHNs and other partners. A recent example is the After Hours Pharmacy Literature Review for Primary Health Tasmania. In 2019-20 we also worked with a PHN in Queensland, recommending an after-hours co-design and investment strategy (commissioning support) following consumer/stakeholder consultation and service mapping; and assisting a rural Victorian PHN to evaluating some of their investments against the Quadruple Aim.

Talk to us if you would like to explore how we can support your PHN to improve population health through innovative approaches (including in the after hours space) to primary care delivery.

---

[1] Emergency department care – Australian Institute of Health and Welfare (aihw.gov.au)

[2] The after hours period is defined as: Weekdays before 8am and after 6pm, Saturdays before 8am and after 12pm, Sunday and public holidays.

[3] RACGP – Why do patients go to emergency rather than to their GP?

[4] https://www1.health.gov.au/internet/main/publishing.nsf/Content/phn-after-hours-reports