Leanne Wells (Facilitator)
Welcome to a 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.
Introducing new incentives into busy service settings like general practices and residential aged care homes, can be complex. In this discussion, I asked panellists about key implementation considerations for the General Practice in Aged Care Incentive, and activities, many of which are already typical practice in primary care, that can facilitate smooth adoption.
Each of our panel members represent a different perspective of the team involved in implementing this initiative. Panellists, let's go around the room, please highlight one or two system enablers that can be leveraged to support successful implementation of the incentive.
Sophie Piron (Practice Manager)
I think there are some real opportunities here in, in relation to the incentive to really look at our, our processes and our practices within the general practice setting. Umm, and that starts, you know, right from the, the beginning of, umm, how you actually register, umm, new patients to the practice or new residents to, umm, the aged care facilities that you're visiting. So, it's really about ensuring, as I said, that you have some practices in place so you don't miss people. Umm, and that, you know, speaks to how, umm, you might code new patients as being, umm, residents of an aged care facility.
Umm, the other aspect to that is also making sure that you put in place some fairly stringent processes for ensuring that, umm, you're recording how you're meeting the various requirements of that incentive. Now, that might look very different from one practice to the next because you might only have a handful of people, umm, in residential aged care, which would make that quite an easy process, or you might have, you know, a few 100, in which case you'll need a, you're needing a much more robust process. But you do need to make sure that you put something in, in place for that. And that speaks to what we have spoken about before, which is, umm, consistency, umm, and timeliness of the care that you're providing people.
I see a real opportunity here, umm, and it speaks to something that was mentioned before about how you might engage new general practitioners into this space. Umm, and that's the involvement of registrars. Umm, certainly in the practice ah where I work, umm, general practice registrars are always given the opportunity to engage in, umm, the services we provide to aged care facilities. Umm, for some of them it's not their thing and they decide not to go on with it, but the very vast majority of them, umm, absolutely love it. Umm, they engage very, very, umm, positively with it. They are often our backup person when the regular g[eneral practitioner], they, they will visit in tandem with the general practitioner, and if the general practitioner is on leave, they are then our go to person. Umm, and it also means that when, umm, when they Fellow, they have, umm, some experience in that space. Umm, so I think that's a real opportunity for, for general practices who, who take on registrars and are also working in the aged care space to, to look at how, umm, they might involve those registrars in, in that space.
Leanne Wells (Facilitator)
Enthusing the emerging general practice workforce around this, it’s going to be such an important area of future care. Umm, but it gives the incentive, umm, a longevity as well, with, with the workforce coming on stream.
Kate Tye (PHN)
I think there are a few challenges that are, umm, certainly being experienced, umm, by primary healthcare practitioners and one of those is access to medical records when they are working within an aged care home. There's a range of different products, umm, and each of those products, umm, have different functionality and that also makes it very challenging to be able to, umm, interface with, umm, with ge, with general practice software, and many don't at all, umm, and also for GPs to have access to that. Umm, so what that requires then is for the GP and the residential aged care home to have an agreement as to how the GP will be able to access those medical records. And also then how do those medical records, umm, that are, are recorded in the aged care home, how does that then come back to their general practice and what does that look like. Making sure that that's a secure method to be able to do that.
So it is very much about, umm, setting that communication base and understanding those challenges and then looking at ways that that can actually be, umm, be adapted and, umm, for there to be reasonable work arounds because that can be quite time consuming. And My Health Record plays a critical role in being able to support the system as an enabler, as an enabler for general practice and, umm, and the team, but also for residential aged care.
I think one of the other key components, umm, is having GPs understand, umm, the home and understanding components of that home, and that's really important because that enables access. And being able to be clear about where they can find, umm, different things within the home. But also who do they contact when they need support? Because we often hear from GPs that “I will enter a home and there won't be a nurse around. I can't find anyone on the floor”, and that's because they're busy and they're doing, and they’re doing the work. But it's really important for a GP to know how to actually contact those people if they need them when they're entering that home. And looking at the scheduled visits, making sure there's agreement around those and when they happen, if they are a scheduled visit and a planned visit, it's really important between both parties as well.
Leanne Wells (Facilitator)
Umm, Laila, your thoughts on implementation considerations, where we can learn and rapidly continuously improve and your top two or three facilitator or enabler thoughts.
Laila Hallam (Consumer)
One of the biggest areas from an implementation perspective, or the biggest change, is really going to be, ah, a bit of cultural change. A bit of cultural change about the way we interact. And I think it's really easy for us to say that now that we have these incentives in place that we will just automatically do it and do it well. Umm, and I think that's not necessarily just on the general practice side, but I think it's on the patient side as well. I think, you know, learning how to interact in a team base when a patient is only used to dealing maybe with one person. I think we’ll start to sort of see, umm, you know it's, they won't, not all patients will necessarily want to do that, or be able to do that. And I think that there is a bit of cultural change that needs to go and maybe adapting.
Umm, so there's a bit of gentleness that's going to go into moulding this relationship. And extending it out beyond necessarily the way that we've done it before. And that of course is also about relation, it's back to relational management, isn't it? It's back to going back and if I was to think, umm, about from an enabler perspective, I think about something as basic as scheduling. So when we do start to work these things out, making sure that, you know, the patients and their families have plenty of time to get themselves involved, umm, particularly the families who often miss out on the visits when they come in. And if we're going to be more regular about it, then it's even more important that they're part of the rhythm of how these, umm, interactions actually go through. And that might incur, include things like My Health Record and their access to the information.
But I think, umm, there's a lot of enablers, but I think there are things that we just need to, umm, we can't assume that things are just going to slot in because we say so. So I think there's a bit of work to do on both sides to sort of get it to sing.
Leanne Wells (Facilitator)
And that's proactive implementation, isn't it? Around multidisciplinary team ethos and practice and consumer and carer participation, yeah. Anthony, your thoughts on implementation considerations, the key ones, and for the […] facilitators and enablers of those.
Anthony Marinucci (GP)
So I, I think one of the, ahh, really positive things that's coming out of this incentive is it's, it’s actually compelling, ahm, the care teams, or the medical care teams, to really engage with aged care facilities and aged care providers. Umm, I think one of the, ahh, sort of umm, ahh, issues has been in the past, in, in aged care, as given the complexity of care, there's a lot of different stakeholders and they’re perhaps not talking to each other. But I think now we're, as I said, we're being compelled to start talking with each other to actually, will want of a better word, enable, umm, this system to start working smoothly.
Ah, I know myself anecdotally with my own personal practice, umm, and my team that works with me, we have been actively, umm, engaged with our aged care facilities, umm, to see where their challenges are, to see how we can help each other. So I think for me, the, the big enabler here has been communication and open lines of communication.
Umm, external to that, engaging other people, not just clinical, in my practice, the administrative staff, umm, to have a role in, in delivery of care. I think it's also been a very powerful thing from a practice point of view, umm, they've really engaged in that. So, I think again another, umm, positive thing that's coming out of this incentive is enabling not just the clinical staff but the non-clinical staff. And I think we've heard before from Sophie about how, from a practice point of view, it's important to ensure that these patients feel like they are part of the practice and not just an external afterthought.
So, they, they would be my really my sort of primary thoughts on, on enablers and I, and I think it's actually a very, very powerful, powerful variable that's happened with this.
Andrew Hayward (Aged & Community Care Providers)
There's an opportunity here, umm, for streamlined, ahmm, processes. And I think what this gives us an opportunity to do is look at user friendly registration. Ahmm, I think a, a massive enabler in all of this is the PHN. Ahmm, umm, with the, ahmm, you already mentioned before Kate, around the, umm, the IT, umm, connectivity, digital literacy, ahh, and I think there's a position here where we need to upskill, umm, the, the sector.
Umm ah, and that is to, umm, really enable the, the residents to ah, understand how MyMedicare can, umm, enhance their care, umm, ability as well. So, ahmm ah, and I think that comes through supportive guidance, ahmm, comprehensive resources, and visibility of resources. Ahmm, there are a number of resources available, ahh, on the, the websites as we know and it's just, umm, ensuring that the visibility of ah those, umm, those resources are, are understood and known.
Umm, I think that digital integration is really important, ahmm, linking the patient and, or the sorry the residents’, and providers’ registration systems, ah and um, existing, ahh, health records, ahmm, which would then enhance the efficiency and accuracy of medical records, ahh, in care consultation.
Umm ah, in terms of enablers, I, I think the increased collaboration with the ah, the, the providers so umm, the aged care providers, ahh, is always a positive. I think coordination between the facilities and the GPs will ensure, ahmm, that person-centred, driven, umm, care and also timely resident, ahmm, registration and, ahmm, and, and care provision.
Ahmm, flexibility, I think there's some flexibility in, in this incentive, in the incentive. Ahmm, but it's also having the, ahmm, understanding of how the flexibility can support the care provision. And again, that comes back to visibility of the resources and understanding of the, ah the, the incentive itself.
Ahmm, and that comes back to, umm, incentive awareness. So clear communication about the benefits of the incentive, […] how it motivates participation from both the patient and the providers perspective. Ahmm, and as I've said before, ahmm, communication, relationships and all those other things that really are beneficial and crucial to the incentive, ahmm, being positively, ahmm, implemented.
Ah and umm I, I think, umm, Laila mentioned cultural and social impacts as well. Err, I think it's really important that we build a culture of respect, err, and that person-centred, or person-driven care, umm, is actually enhanced through the represent, reputation of the aged care providers and, and aged care services.
Ann Davies (Consumer)
I think that orientation at the residential aged care facility that they will be visiting, and the option of working alongside, ahh, aged care staff for a short period of time, ahh, just to, see how the facility operates. Each, each aged care facility is different, and they need to be involved in a shared trust and understanding, ahh, required to build the necessary confidence as a team.
Karen Booth (Nurse)
One of the things I think we do need to work on will be, umm, how we get the patient and the family on board. So we have had quite a bit of education for the general practice team, but I think looking at how we bring in the aged care team, but the patient and the family. What's the benefits to them? And we know from lots of activities in the past, ahh, with things like health assessments, if patients want them they'll drive that activity. And so making sure they know, so that they will drive that activity and they'll be asking us to sign up, not just, umm, us chasing them to sign up.
Paresh Dawda (GP)
It's a really well-intentioned incentive, trying to nudge us that work in the system towards a more proactive, planned approach to comprehensive general practice. It's different to what we've been used to in the past, so really understanding the why and its intent is important and within the resources there are, you know, patient stories that kind of point to the why.
The second thing I think then is, ah, and you know we've heard about the importance of people being aware as to the why, the consenting process, the registration with MyMedicare. There's a whole bunch of tools already out there, resources available, umm, and, and so to look at that.
I very much urge people to take a continuous quality improvement approach to this, so don't try and get everyone registered straight up. Start with a few, use the tools, look at what's working for you, learn the process and design the process using that continuous quality improvement approach.
I think once we get comfortable with the registration process, ahmm, the conversations to have around consent, ahmm, then it's about delivering the, ahmm, the requirements of the incentive. The delivery of the incen, the requirements of the incentive really does require a little bit of planning, ah, monitoring, tracking and again there are tools available to do that. It's about looking at the tools that are available, and adapting them to individual circumstances in individual practices, and actually starting to use those tools. Again, using that continuous quality improvement approach, ahmm, learn from them and adapt them and you know eventually in the fullness of time, maybe, you know, it will, it will become an automated process around the tracking and monitoring.
But what really, really excites me about this incentive is the potential for team-based care. Ahmm, so part of the enabler I think is to have conversations in your practice. How can the practice nurse help? You know, if you have a practice pharmacist how can that person help? Can you work with nurse practitioners around this? How will communication look like? How will you decide who does what and when? Ahmm, I think those conversations are really important. They're really exciting.
Ahmm, putting together a pathway of how you deliver care to this population of people residing in residential aged care homes, ahmm, it’s a, it’s a wonderful way to sort of start thinking about the implementation of this. And like I say, it won't happen overnight. Using that mindset of continuous quality improvement, is the way to do this. And, you know, if, if you're a clinician, if you're a GP, you can also document this and put it towards your continuous professional development, which is a sort of added bonus. So, ahmm, you know that, that's what I'd like to encourage people to do is focus on, on, on, you know, tools that are there, use the supports that have been talked about, be using incremental continuous quality improvement approach.
Leanne Wells (Facilitator)
To conclude this session, as we've spoken about before, Primary Health Networks have an important role in providing system level support to primary care, including the implementation of this incentive. Can you please remind us of the broader PHN support opportunities that can be tapped into by all stakeholders?
Kate Tye (PHN)
I think there's certainly a number of, ahh, facilitators and enablers that PHNs support at a system level because PHNs provide that system level support and that, as I've talked about before, that connection, ahmm, of the system and across the system to support that patient journey and the resident’s journey in this case.
Definitely education is a role, ahmm, of PHNs. PHNs have three distinct roles, one being capacity building, and that certainly is working with residential aged care teams, in building capacity in those teams, to be able to support primary healthcare access, and that includes, as I said earlier, around supporting digital health and telehealth.
But the other part of it is also educating and supporting general practice teams. And supporting them to work differently and considering how they do need to work differently in order to manage the change that this particular incentive is bringing as well. And that's really important.
Um, supporting and facilitating the development of those relationships as I've talked about earlier and helping the two parties to agree upon what those working relationships will be, and how a GP or their team will be supported when they are on site at a residential aged care home and what that actually looks like.
And also opportunities for the GP and the team to be involved in the residential aged care home as well. Some residential aged care homes have medication management committees and they have GPs represented on those committees and that provides a great opportunity for GPs to be able to understand how the, how the prac, how the, umm, home works. But also to understand, umm, and to contribute to some of those decisions that need to be made at a clinical governance level, and support the role of the GP in that home as well and, most importantly, the safety of that resident. And there's ways that, umm, PHN's can support that because they have an understanding of the general practices, they’ve also got an understanding of the residential aged care homes.
Another enabler of PHNs is being able to support residential aged care homes who cannot find a GP and are really struggling to be able to access a GP and we know that that's very variable across, across Australia. And certainly that is a key role of PHNs in this. So one of the key things that PHNs can do is work with the res, residential aged care care manager to support them to be able to access GPs who provide care in their local area to residential aged care homes and to […] to support that connection. They don't do it at the individual patient level, but they do do it at the residential aged care home level. And they will support that care manager to support that connection as well. And if there isn't a GP that's available, then they will look at what other options are available and they might be able to actually fund a particular model that will work in that area to support that.
Leanne Wells (Facilitator)
This brings us to the end of our discussions with expert consumers and health leaders on the implementation of the General Practice in Aged Care Incentive. In this fourth and final conversation our panellists have -
- Stressed the benefit of planning, change management, and a continuous improvement mindset around the incentive’s implementation. And they've offered practical actions such as making good use of My Health Record and other digital tools.
- Embracing MyMedicare voluntary patient registration as a mechanism to ensure GPs and practices understand they have an accountability for their registered population of people living in aged care.
- Ensuring personalised cycles of care that are proactively managed with a sense of common goal and a clarity of roles across the integrated practice and aged care team, including the future workforce such as registrars.
- And finally, tapping into the local assistance and support available through Primary Health Networks.
We hope during the General Practice in Aged Care Incentive series our panellists have provided some useful insights into why it's important and what the incentive aims to achieve.
We recognise that there are no standard one size fits all approach to the adoption of the incentive. Ideas offered on how it can be implemented in general practice are reflective of our panellist views. Clearly every participating GP and practice, working with local aged care home partners, will need to establish their own implementation pathways.
Our word of advice, is to reach out to your local Primary Health Network for guidance or support if needed.
Finally, I'd like to close by reiterating that the incentive aims to promote access to high quality, proactive, planned and continuous care for all people living in residential aged care homes.
If you'd like more information to support implementation of the General Practice in Aged Care Incentive, there are several resources available from the Department of Health and Aged Care's website. They include fact sheets, program guidelines, patient journeys and information kits for GPs and practices, aged care residents, their families and carers, residential aged care providers and peak bodies.
Services Australia, MyMedicare and individual PHN websites are also sources of further information.