SWSLHD and Bowral's Health - 69

After-hours care falls short

BY ISABELL PETRINIC

17 Apr, 2012 12:00 AM

IF you need a doctor between 11pm and 7am you must go to an emergency room at Blacktown, Hornsby or Hawkesbury public hospital and join the queue.
There's always the phone (nurses and GPs give advice on the National After Hours GP Helpline) or you can visit Norwest Private's emergency department, where fees are not reimbursable — even for those who are privately insured.

There are only 55 general practices open for 10 or more hours a week during the after-hours period but that is across all western Sydney (264 of a total of 303 practices were contacted) — nowhere near enough, according to medical educators WentWest.

WentWest have found through careful analysis of western Sydney's health needs that in Rouse Hill there are no practices open after-hours and in the semi-rural area above Glenorie even a registered home-visiting is not available.

Parramatta's north-east is serviced by only one practice providing after-hours service — at Epping — and Baulkham Hills North could do with chemists that open longer.
But the real problem is finding GPs to work outside normal hours.

The five doctors' rooms at Round Corner Medical Centre in Dural operate at 95 per cent capacity with 12 GPs on rotation, but doctors find it difficult to cope with demand after hours, even turning people away on Sundays.
The centre began operating after hours three years ago with financial assistance from the federal government.

Peter Szekely, the centre's financial officer, said they aim to stay open until 9pm weekdays and 5pm on Saturday and Sunday.
The ideal, he said, would be to stay open till 10pm every night.

"But we don't always have doctors available to do these hours," Mr Szekely said.

"At the moment the only weeknights we can do are Monday and Thursday.

"If we could expand the premises we would, but we can't, so the only thing we can do is expand the hours."

Mr Szekely praised the GP placement program, saying two junior doctors had stayed on at his centre, and saw this as encouraging.

Dural is among the many suburbs in The Hills identified by the Department of Health and Ageing as being in a district of workforce shortage, defined as an area of Australia in which the population's need for healthcare has not been met.

The others are Annangrove, Beaumont Hills, Bella Vista, Kenthurst, Oatlands and Rouse Hill.

Beaumont Hills and Rouse Hill are also among the growth suburbs in The Hills, which is of major concern given The Hills population is expected to rise 1.94 per cent every year until 2031, bringing the total population from 177,245 to 255,270 people - a rise of 44.02 per cent — over the next 19 years.

WentWest will submit its first after-hours plan to the Department of Health and Ageing in May, highlighting these and other service gaps in the Western Sydney Local Health District, which stretches from Auburn in the east to Blacktown in the west and to The Hills in the north.

 

Medicare Local defines after-hours as:

1. before 8am and after 6pm weekdays;
2. before 8am and after noon Saturdays;
3. all day Sundays and public holidays.

After-hours is further divided into:

1. the unsociable after-hours period of 11pm to 7pm; and
2. the sociable after-hours period which is all other after-hours times.
   A map showing the current District of Workforce Shortage areas is available at: http://www.doctorconnect.gov.au/i nternet/otd/Publishing.nsf/Conten t/locator
   
   
   Socrates says: While this article details the issues for the north-west of Sydney it can be replicated even more so for  rural and regional areas like the Southern Highlands.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 71

Medicare Locals will be healthcare Polyfilla: Roxon

• By Michael Woodhead on  18 November 2011 - 6Minutes

Divisions selected to be Medicare Locals must lose their doctor focus and prepare to be like Polyfilla to “fill in the gaps” of local health services, health minister Nicola Roxon says.


Speaking to the GP divisions’ annual conference in Melbourne today, the minister said the first priority of the new organisations will be to identify gaps in local services and integrate care.

“You are no longer organisations for a particular group of professionals – you are responsible for overseeing the primary health care needs of your entire community,” she told the AGPN’s GP Network Forum.

“You will need to work together to address these gaps – with an initial priority of addressing gaps in after hours services when you are first established.

Nicola Roxon said Medicare Locals will be tasked with  supporting all health professionals in primary care,  to “improve the quality and responsiveness of local care services, including in safety, performance and accountability”.

She said it was also important for Medicare Locals to go out into the local community and “tell and re-tell the story” of how they will improve local health services and how they will work with patients, professionals, other organisations, and hospitals.

The minister told the five divisions yet to be announced as Medicare Locals “not to be too disappointed” but to listen to the constructive feedback and “work cooperatively” with the Department of Health and Ageing

“Likewise, I would encourage applicants in areas where another organisation is to become the Medicare Local to contribute constructively to the process. The interests of the patients and providers in your area are best served by a smooth transition.”

It would seem that Nicola Roxon is making it quite clear that the dominance of the Division of General Practice is over when it comes to determining the delivery of clinical services provided in the jurisdiction of the new Medicare Locals. This is something about which the Board of the Southern Highlands Division of General Practice needs to take note. Recent declarations in the 'Highland's Doctor' by the Chairman of the SHDGP Board were:

"............. this was softened with the recognition that there was a real need to bring GPs from the Divisions into cooperation and participation as leaders in the new MLs, and that experience serving in Divisions over the previous 18 years had created skills in governance, service delivery and population health that few other potential ML Board members drawn from other branches of healthcare would have in the short term."

Drs Roche and Ruscoe had better reconsider their view in light of this recent advice from the Minister for Health and Ageing in which their role is to be collaborators and not as "leaders".

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 62

 The big sell(out)! - SSWGP Link + SHDGP

At various times, and in previous posts, Socrates has made reference to the relationship formed between the Macarthur Division of General Practice (now the Sydney South West GP Link) and the Southern Highlands Division of General Practice. For the former, the collaboration is about its further expansionist aims. For the latter, it is all about making sure that some people remain employed. 

But....... does it mean that people in the Southern Highlands will get an improved health service? This is the crucial question to which we have not had an answer simply because we have not had the level of community consultation and public meetings - or the involvement of all the non-government organisations, or the local private and public healthcare providers, or the health consumers in our local community - that the Federal Department of Health and Ageing (DoHA) had required prior to the lodgement of any application by the Macarthur-Southern Highlands consortium. 

It is little point in suggesting that the Southern Highland's meek and mild health consumers and health practitioners and NGOs should be happy that the consortium would inform everyone of the details after the event. That still does not comply in any way with the DoHA mandated requirements prescribed in the documentation for submitting for funding of a Medicare Local.

Is BIGGER simply the BEST? How can a consortium, which will control some 700+  GPs over some 320+ practices, possibly provide, or even broker, the most effective and efficient health service to the 40,000+ people of the Southern Highlands?

From its own website description, the Sydney South West GP Link demonstrates and boasts that it is a business seeking "to trade nationally and internationally" and has expansionist aims. 

Do the health consumers in the Southern Highlands really want to compete with other health consumers in the national or international arena?  I think not!

 

History of the Division

"Macarthur Division of General Practice (MDGP) was established in August 1993 as an unincorporated association known at that time as Campbelltown Division of General Practice.

"MDGP was incorporated in 1994 as Macarthur Division of General Practice Inc.

"MDGP's first premises were in Campbelltown Hospital where the Division functioned essentially as part of the Campbelltown Health Service.

"In 1995, MDGP moved to office premises in the Campbelltown CBD area and to the present building in 1996.

"MDGP was also preceded by the unincorporated Macarthur General Practice Association (MGPA) whose main purpose was to provide an educational service for local GPs.

This body continued until 1998 when its role was formally taken over by MDGP.

"MDGP became a registered Company Limited by Guarantee as of 27th June 2005.

This enables the business to trade nationally and internationally as the company evolves.

"As of 1^st July 2009, MDGP was successful in an open tender process, to run General Practice support services in the Liverpool and Fairfield regions. This effectively expanded the business of our support services to the Local Government Areas (LGAs) of Liverpool, Fairfield, Campbelltown, Camden and Wollondilly. Our catchment now includes some 600 General Practitioners working in over 280 practices across this large region.

"With our expansion, our members and stakeholders suggested a name change to better reflect the geographical regions we covered. 

"Also in late 2010 the Southern Highlands Division of General Practice (SHDGP) expressed a wish to merge with us in recognition that both organisations could better serve their members under one umbrella. 

"With these issues in mind, at an extra ordinary general meeting held on 30th June 2011, our Division changed its name to Sydney South West GP Link effective from 1st July 2011. 

"We continue to work with SHDGP to progress the merger."

Does the Southern Highlands Division of General Practice deliver the "optimal service" to the people of the Southern Highlands?

Does the Southern Highlands Division of General Practice deliver the "optimal service" to the people of the Southern Highlands as it states on its website? Or is it merely a subservient tool for the Imperial SSWAHS? The local Division seems to be more intent on acquisitions rather than delivering a service to their GPs.

For example, the SH Division employs staff to provide services that are already delivered by private allied health service providers in the community. Yet, because of its influence over the general practitioners it is meant to support, it exercises a monopoly. That is, it recommends GPs to preferentially refer their patients to the member of staff employed by the Division rather than to the private practitioners in the community. Where is the right to choose their practitioner for the patient?

Socrates is aware from personal experience that the general practitioners he has had to see over his long years (treatment for hemlock poisoning, etc), that the majority of GPs do have a mind to treat their patients with respect and provide them with options. This dialogue of mine today is not about the GPs in the Southern Highlands but about their Division and its Chief Executive. Their Chief Executive has openly stated that he will fight to market the Divisional staff to the area's GPs simply to be able to continue to employ them. Who has employed them - well the Chief Executive. But what processes does he follow in employing the staff, and what qualities and skills do they bring to ensure the provision of "optimal care" is delivered by them?

And can the staff employed by the Chief Executive deliver all the programs that he says (in the website) the Division can deliver to the people of the Southern Highlands. There is no doubt that the Aged Care and the Diabetes Coordinators are well experienced in their clinical fields and the services they deliver are well used. But what about the other services that the Division touts on the website? Mental health services delivered to the aged care facilities in the Highlands, the non-directive pregnancy support counselling, the better outcomes in mental health program, the better access mental health program, the mental health nurse incentive program - who delivers these?

These programs are all funded by the federal government through Department of Health and Aging or Medicare Australia. The qualifications of the practitioners used for these programs are dictated by the Medicare Australia and/or the relevant professional college or association. The Division, however uses its own set of hoops to select who it should anoint to do the work. I wonder what Medicare Australia or the Department of Health and Aging would think about the Southern Highlands Division of General Practice? In particular its Chief Executive and its Board.

Socrates is already aware from his reading of the scroll called "The Highlands Doctor" that, for example, GPs are being encouraged to refer their patients to a person for the "Better Access" program when they could be doing some of the "Better Outcomes" program which is funded by the federal government and the Division is the fundholder. Why use a Medicare funded program to keep their staff member employed? Perhaps it has something to do with running out of the funds for "Better Outcomes" because the funds were used for something better - like employing staff rather than providing a service to the patients referred to it.

The other program that seems to have disappeared off the scroll appears to be the Mental Health Nurse Incentive program - another of the Medicare funded programs. From the more ancient scrolls on the Division's website it would appear that the Chief Executive was employing someone who was hoping to be a Credentialed Mental Health Nurse, the only people (besides GPs and psychiatrists) who Medicare allows to participate in the program's delivery. It appears to be a good program (perhaps even a great one) which allows vulnerable people with a severe mental illness to have care coordination by a credentialed mental health nurse so that they might remain out of hospital and be cared for in their own community.

It would seem that the person employed by the Division was not successful in obtaining the credentialed mental health nurse qualification so the Division could no longer use them. From the official website of the Australian College of Mental Health Nurses the list of Credentialed Mental Health Nurses shows that there are three qualified and approved CMHNs in the Southern Highlands, which is not bad considering there are only about 800 nation-wide. However, the Division, for reasons unknown, is not supportive of the existing CMHNs and appears to have gone secretive as to their reasons why. The information about the MHNIP is no longer public on the website having been placed in the log-in "doctor's secret business" section on their website.

In the meantime, patients who could or should be referred to this program are not able to be referred because the only two CMHN in the Highland currently being used by GPs are unable to take on any more patients, and the other although credentialed since August 2009 has never received any referrals at all possibly due to misinformation provided by the Division to the local general practitioners.

Hmmm! Socrates has to then wonder at the Division's claim:

"Southern Highlands Division of General Practice (SHDGP) is a federally funded not for profit organisation which assists general practitioners and the Health Service to deliver health services to people in the Southern Highlands.

The Division acknowledges the support of the Commonwealth Department of Health and Ageing in respect of funding the Division's activities."

And:

"The mission of the Southern Highlands Division of General Practice is to assist local general practitioners in providing optimum care to health consumers in the Southern Highlands area."

Does it really, Chief Executive, or is the Division just as money grabbing as the so-called "for profit" organisations? Perhaps it is now time for the merger with the Macarthur Division of General Practice where they don't seem to run out of funds for their funded programs, and they employ people but they still seem to manage to work collaboratively with their general practitioners and with the private sector, especially the allied health and mental health nurses, without having to prostitute themselves to the empire of SSWAHS.