Pilot program demonstrates GPs can help to reduce hospital waitlists

Edwin Kruys

11/09/2019 2:15:28 PM

Using GPs with special interests offers a promising new way to tackle hospital waiting times, writes Dr Edwin Kruys.

Busy waiting room
The pilot program was found to improve collaboration and integration between general practice and hospitals by facilitating collegiate contact and inter-professional learning.

Good news: GPs with a special interest (GPSIs) can help reduce public hospital waiting lists and increase our health system’s capacity.
Our team’s recent pilot in Queensland found that the proportion of long waitlists were reduced in 66% of the specialties measured. For example, orthopaedic waitlists dropped by 42% and general surgery by 39%.
Long waits are defined as exceeding the clinically recommended waiting time, ie more than:

  • 30 days for Category 1
  • 90 days for Category 2
  • 365 days for Category 3.
The 24 experienced GPSIs – equivalent to three full-time equivalent (FTE) GPs – were responsible for 5000 extra episodes of care per year.
We found the pilot program improved collaboration and integration between general practice and hospitals by facilitating collegiate contact and inter-professional learning between GPs and specialty teams.
The UK has been experimenting with this model since 2000, defining GPSIs as GPs who continue with their core role, but who develop additional skills and knowledge in specific clinical areas.
In Australia, RACGP Specific Interests now has more than 5000 members and almost 30 individual networks.
So it appears there is no shortage of specific interests.
How did the trial come about?
The Queensland Specialist Outpatient Strategy set aside 361.2 million in 2016 to improve Queensland Health’s specialist outpatient appointments. This included an investment in new models of care.
In 2017, the Queensland Healthcare Improvement Unit selected the Sunshine Coast Hospital and Health Service (SCHHS) as a pilot site.
The GPSIs were recruited on a part-time basis and allocated to 12 specialties within the health service. GPs were required to hold vocational registration with the RACGP or the Australian College of Rural and Remote Medicine (ACRRM) and have a minimum of five years’ general practice experience.
Specialties such as paediatrics and dermatology required GPSIs with additional qualifications, while other specialties provided on-the-job training.
The project was managed by the hospital’s General Practice Liaison Unit (GPLU), where I work with my co-authors, Dr Michelle Johnston and Dr Marlene Pearce work. The hospital’s Executive Director of Medical Services was executive sponsor.
The GPLU was responsible for advertising, promoting and recruiting the GPSI positions.
Role planning, selection and interviews were done collaboratively between the GPLU and the medical directors of each specialty. Consultants provided supervision.
GPSIs worked up to two clinic sessions per week, in addition to their work as community GPs.
Interestingly, discharge rates from GPSI clinics were higher on average than regular outpatient clinics. In combination with GPSI-facilitated follow-up plans for further care by the regular GP, this is an important strategy to reduce waitlists.
Three specialties saw an increase in waitlists, which was attributed to confounding factors such as the loss of consultants and the introduction of the new cervical screening program, which saw a significant increase in demand.
Feedback from GPSIs, consultants and patients demonstrated high levels of satisfaction. Common feedback themes included value gained from bidirectional inter-professional learning and co-design of new discharge planning models.
GPSIs can help build hospital team confidence in primary care handover and identify which patients can be appropriately transferred back to the regular GP, facilitating continuity of care.
Local upskilling opportunities support GPSIs to more confidently manage patients in primary care and may help horizontal referrals between GPs in the future, reducing hospital referrals and demand for specialist outpatient services.
We believe it is vital that GPSIs continue to actively work as community GPs, in order to avoid subspecialising and to improve integration between general practice and hospital care.
It is important to continue to develop and invest in integrated models of care, as they can be part of the solution to the ever-growing demand on Australia’s health services.

hospitals specific interests sub-specialties waitlists

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Dr Arshad Merchant   12/09/2019 7:35:55 AM

The study actually shows the incompetent specialist led hospital clinic and need for better training in these specialist care areas. Please don't dump another responsibility on GPs as we are already overstretched

Dr Geoff Harding   12/09/2019 8:02:40 AM

GPs with special interests certainly do decrease waiting times – this has been proven in trials all over the world.
Their effectiveness could be enhanced significant by increasing the training/recognition of these GPs within their own practices. The more GPs in primary care, dealing is patients at the coalface, means fewer ( and more appropriate) referrals to the Hospital outpatients.
Naturally, to bring this about, governments would have to increase funding for GPs to be able to afford to give longer consultations. My special interest area is musculoskeletal medicine, and even if I refer a patient who obviously will need surgery, to Ortho OPD, they are screened by Physio gatekeepers who send the patient back to the community for more physiotherapy.
Thousands of GPs having the time (and funding) to tackle these problems would be much more effective than having small numbers of GPs as gatekeepers working in hospitals (the current system).
Will governments/bureaucrats listen?

Joe   12/09/2019 3:56:02 PM

It will reduce hospital waiting times and also my hip pocket. I already under bill due to fear of medicare and if I am spending such long amount of time on one pt and charge peanuts I better become a tradie.

Dr Neil Warren Donovan   14/09/2019 5:24:06 PM

Yes, this has huge potential to see GP's using their broad skills and demonstrate we can manage these patients. It could be empowering for Gp's,, provide a respite from the day to day care and another income stream. Patients will be able to recognize the skills we can transfer to a hospital setting. The most exciting thing may be a change in culture , where finally Hospital and and state based organisation, might" get" what we do, understand primary health care and how cost effective we are everyday.
In my experience with" hospital in the home" and every other time I brush up against NSW Health, there exists a culture of ignorance and disrespect.
Would love to see a fresh go at changing the current hospital model : Specialist :RN spoke and wheel, where we seem to have a role providing scripts and referrals.
Would love to have a go. Just pay me a reasonable wage.