Lindsay Mackay/Jenny Carter Urgent Care Access and Demand Management Integration: Improving the utilisation of available afterhours GP services NOT! Lindsay Mackay/Jenny Carter From concept to reality has been interesting to say the least….. We realised early our concept was C.R.A.P. i.e. Couldn’t Really Address the Problem-had attempted to blend two completely disparate problems into one We realised later just how complex even working through the process of defining the concept could be Are we there yet? Well we have modified the title to better reflect what is ‘achievable’ and realistic

Rationale for Change Integration: ‘The coming together of already developed although disparate systems and services to create a unified approach to achieve better health outcomes through patient centred care’. Rationale for Change redefined to: Currently patients are ‘waiting’ in EDs whilst 20% of appointments in co-located GP afterhours services remain available. As we said our original problem statement and rationale actually didn’t make much sense and was looking at 2 problems with 2 disparate unlinked models. Just to refresh what we had said: Currently, access to urgent care for patients in the HNE region is managed via many disparate models of care, which have been developed over time and funded from many sources. This results in duplication of effort, resources and pathways, which creates confusion and has resulted in a lack of coordination. There is no visibility of the demand and access needs across all services, including HNE Patient Flow Unit , after hours GP services, Aged Care Emergency Service and NSW Ambulance. The project aims to bring together the disparate models under one system, which is monitored by multiple parties. The target population initially are those patients whose presenting condition can be optimally treated by General Practitioners or with specialist medical advice via telehealth. Revised to align with our understanding of the definition of Integration: ‘The coming together of already developed although disparate systems to create a unified approach to achieve better health outcomes through patient centred care’ Rationale for Change now been redefined to: Currently patients are ‘waiting’ in EDs whilst 20% of appointments in co-located GP afterhours services remain available. The impact aside from the patient is borne by emergency department staff, NSW Ambulance, those other community members waiting access to ED and the GPAAH service ‘Right patient, Right place Right Time’………………….

Overarching Aims and Objectives Reduce the time patients wait to access afterhours treatment/care. Identify those structures, processes and behaviours within the system that are a barrier to the maximal utilisation of available GPAAH appointments (20% not used). Improved visibility of available GP clinic appointments Improved the awareness of GPAAH model Improved compliance to prompting and referring appropriate patients to GPAAH Ultimately Right patient Right place right time……………'Reduce the time patients wait to access afterhours treatment/care’. GPAAH improved utilisation ED reduced lower acuity presentations requiring treatment NSWA reduced call outs/transfers Could mean those appropriate patients waiting and those needing to access ED (not appropriate for GPAAH)

Diagnosis results ‘Herding’ all the information via data/stories/tag a longs/process mapping paints a comprehensive picture of what is happening and the impact from patients and staff perspective Needs assessment: Current data from ED, GPAAH and NSWA Situational Awareness Internal Health staff-Focus groups to identify barriers to referring NSWA and ED triage staff Community-Survey-Peoplebank/Community advisory/social media

Analysis and Design Results In the beginning……. 5 whys-really teased out the problem and potential underlying root causes Why do we have to improve the utilisation of afterhours GP appointments? -increasing numbers of patients presenting to Eds Why is that? -community health literacy-education -ED triage not identifying suitable patients-skillset/education/awareness/unable to monitor -NSW Ambulance crews not prompting a referral-skillset/awareness/unable to monitor -Lack of visibility of what is available in GPAAH-non integrated IT Logic Map

Mission Statement ‘To address the barriers that impede timely access to care after hours by enabling the patients and staff to more optimally navigate journeys to the right place’ Mission Statement Align with our definition of integration: The coming together of already developed although disparate systems and services to create a unified approach to achieve better health outcomes through patient centred care’ Align with the values of the organisations CORE Collaboration Openess Respect Empowerment and Healthy People Healthy Communities

Action Plan with Timescales Actions Description Timeframe Finalise project concept Review to align with principles of integration DRAFT outcome measures (reduced patient times to access) 2 weeks Progress Concept Present to Alliance Governance Group -endorsement 1 month Identify project leads LHD and PHN Identify internal/external stakeholders Steering group formalised Stakeholder engagement event with community representation 2-3 months Situational Analysis Further data sourced/reviewed Focus groups Surveys Process mapping Ref: Peoplebank 5 months Communication Strategy (project) Community NSW Ambulance Emergency Department General Practice 2-12 months Education Strategy Identify what exists what needs revamp and delivery modalities 6-10 months IT/Reporting platforms Investigate existing platforms and messaging capabilities of GPAAH data systems Automated reported systems (RAP/ClikView) Ref: Northwest London Toolkit 6-8 months Evaluation Data review Survey Staff/Patient Experience and awareness 10-12 months