Leanne Wells (Facilitator)
Welcome to the third session in the General Practice in Aged Care Incentive series, where our expert panellists continue the conversation about the introduction of the incentive.
I'm sure you'll appreciate there is much variation amongst general practices across the country - be it differences in their geographic location, workforce and resource availability, the communities they serve or their business model.
Here, panellists discuss these variations and how they can be catered for by the incentive.
This incentive has defined eligibility criteria and servicing requirements, which are detailed in the incentive guidelines available online.
However, there's still an opportunity for lateral thinking, in line with the incentive guidelines, to ensure care provided under this incentive meets the needs of diverse care teams and diverse communities.
Paresh, let's start with you. How do you think the incentive is catering for variations in practice?
Paresh Dawda (GP)
So I think, you know, as, as much as is possible in a, in a sort of national program, there has been some contextualisation and acknowledgement that, umm, you know, the one size fits all approach doesn't always work. When we look at the General Practice in Aged Care Incentive, it is one of a number of, umm, you know, dif, different initiatives being taken by the department, umm, to, to support improving care in this space.
Within the incentive itself, within the General Practice in Aged Care Incentive itself, umm, there have been, ahmm, ahh, there's been an appreciation of different contexts and there's been an appreciation of, ahhm, you know the variation, particularly when we look at, ahhm, metro, regional, rural, for example, there's, umm, a scaling up of the incentive based on, ahmm, the Modified Monash Model, ahmm, which categorises the degree of remoteness, ahmm, as, as an example.
There's been, ahmm, again appreciation and acknowledgement, for example, that in perhaps, ahmm, more rural and remote places, ahmm, those eligibility requirements may not be met, not be able to be met in a face-to-face way, and so there's been an allowance for some of them, to you know 50% of them, to be virtual care, telehealth.
Leanne Wells (Facilitator)
Yes, rurality is definitely one very important consideration. There are also many different models of general practice that may enrol in this incentive: from solo GP, small family practice, to larger corporate practices. Kate over to you, and then Karen, what are your thoughts on how these different practice arrangements can fulfil the requirements of this incentive?
Kate Tye (PHN)
I think you're right and, umm, there is great variability, as we said earlier, in aged care homes, but there also is in general practice. And a number of GPs who provide care in residential aged care homes are actually solo GPs in many cases as well. And so this, umm, in some cases people might think, well, how does this work in a solo GP practice, umm, where you have a solo GP, they’re they have a […], they have a practice manager or a receptionist, but they may not have a nurse. And how does that work in that case as well? And I think that, umm, it's important to note that the average GP visit in metropolitan areas is 17 times a year for a resident. And in rural areas 15 times a year. So what we're asking is more planned, proactive care, not necessarily visiting more often. Umm, so it'll be very interesting to see what that looks like down the track through this implementation. And I think for a solo GP this is a great opportunity for them to be able to embrace an extended care team as part of that care and being able to support them to do so.
When we're thinking about, umm, how, how this can be delivered in a way that, umm, that supports the nuances of general practice, I think what's really important is that GPs understand, umm, their team, so general practices have a clear understanding of the team and particularly in, umm, in practices that have quite a big team is understanding, umm, and being committed, to what that commitment is. So whilst the structure may feel like it's, umm, it’s more, there might be more visits or it's and it’s more structured, and it is more structured for a purpose, umm, it's not necessarily about being more, it's about, umm, proactive, planned care that's comprehensive and, umm, and has that team approach in that.
Karen Both (Nurse)
Umm, a couple of things, I think for, for, for solo GPs , umm, to maybe think outside of the box for them and the possibility that they could contract a nurse that might be able to do some of those, umm, health assessments for them. And, ahh, and look at, ahh, supporting care planning and other, umm, aged care activities.
And a contracted nurse hours also count towards, ahh, other incentive payments that help support employment. So there is an opportunity there for, umm, that, to maybe some funding to help support employing or even contracting a nurse.
There are whole country towns with no GPs out there, that have small aged care facilities that are basically run by nurses. So, looking at how, umm, how they can connect, make sure they've got GP access, support GP access there. Telehealth is wonderful, particularly when you've got a nurse at the patient end that can help with clinical assessment. And then look at how we actually then support some sort of face-to-face visit for patients, ahh, with the doctor, whether it be through a roaming GP like some country areas have got a hub and spoke model. The collaborative care program in Southern South Western New South Wales, they've got a roaming GP. Umm, yeah, to sort of, time to be innovative in thinking of how, how can we do this?
Leanne Wells (Facilitator)
We live in vibrant, multicultural communities. Andrew to you first and then Sophie - What are some of the opportunities to provide culturally appropriate care under this incentive?
Andrew Hayward (Aged & Community Care Providers)
We need tailored care approaches, ahmm, that recognises the importance of cultural safety and inclusive care, ahmm, that I see also focuses on meeting the needs of the residents from diverse backgrounds. Ahmm, and cultural training, um, I think, um, you know not only in the residential aged care but in the GP, umm, services and practices and beyond. You know there's wrap around services, they’re encouraging practices to undertake training that improves understanding and responsiveness to cultural and, umm, er and, ling-linguistically diverse, umm, ah, residents is really critical.
Sophie Piron (Practice Manager)
There are already, ah, in many practices, umm, established practices that they have for dealing with various, umm, patients, cohorts or, or situations and that's something that they can then take into the aged care facility. So, the practice I work at has, has a huge cohort of patients who are refugees and asylum seekers, so we are well versed in, umm, organising on site interpreters, phone interpreters, and we can do that for a home visit. We can do that for, ahmm, a visit to an aged care facility. So, you know, these things don't necessarily need to be something new. They are really about thinking what is it that we already do for the patients that step into the practice that we can, ahmm, perhaps modify or just also apply to those patients who are in an aged care facility.
Of course there are issues of, again as there are with every single patient, there's issues of consent, ahmm, and you know of, of, umm, informing the aged care facility of, umm, having scheduled visits rather than, you know, the patient and the family knows what's happening and who's coming, but there's certainly a lot happening already in general practices, that, umm, if we think a little bit laterally can, can be carried into the aged care facility.
Leanne Wells (Facilitator)
Thank you both for those important points. Ultimately, this incentive is for and about people living in aged care homes. Laila, I'll end with you for your consumer perspective of variations of practice under the incentive.
Laila Hallam (Consumer)
Where the GP services are scarce and whether they're small GPs, umm, finding ways to be innovative and bringing them together to work out how they might be able to service the community that they're in, in a different way, I think is really important.
And I think we should, umm, also think about what it's like when it doesn't work for the resident. So if we do have, umm, ah when we do have GP services and they don't fit right for the, for the resident, how in fact we work through those so that it actually works for both, the, the, umm, whether it's that service or another. But how it works. So we don't want to move, we don’t want to lose resident choice.
Leanne Wells (Facilitator)
This brings us to the close of our third session on the General Practice in Aged Care Incentive series. Key takeaways from this conversation include -
- There are additional provisions, such as loadings for GPs and practices in Modified Monash Regions 3 to 7, and ability for rural and remote practices to provide 4 of the 8 regular visits by telehealth when they can't attend face to face.
- The suggestion that smaller or solo provider practices think creatively about how they could bolster their team by contracting or sharing a practice nurse, for example, with other practices rather than directly employing them.
- The value of building and leveraging relationships with local providers who can assist, such as aged care lifestyle coordinators or multilingual staff.
- And finally, the importance of engaging with Primary Health Networks who have various roles, including collaborating with residential aged care homes to connect residents with a GP where they don't have one.
Join us in our fourth and final discussion where our expert panellists will consider implementation enablers and other supports available to GPs, general practices and residential aged care homes to support the implementation of the General Practice in Aged Care Incentive.