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RC proposes medical response teams to improve health care


The aged care system needs a national network of government-funded multi-disciplinary hospital outreach services to support aged care recipients in their care facility or home, this week’s inquiry hears.

This week’s hearing of the Royal Commission into Aged Care Quality and Safety is focusing on the interfaces between aged care and all levels of the health care systems.

Senior Counsel Assisting Peter Gray said all aged care recipients deserved access to the primary, acute and specialist health services they needed, however, “the evidence is clear that this is not happening”.

He said the commission would present several solutions throughout the week that required ingovernmental cooperation, including joint action between the Australian and state and territory governments to improve access to secondary health care services such as acute and emergency care.

“These services, we suggest, should reach into residential aged care facilities or people’s homes and provide services in situ, wherever possible,” Mr Gray said in his opening address on Monday.

Peter Gray

“Our proposition is that recurrent funding should be provided for the system-wide implementation of multi-disciplinary outreach health services for people with high care needs in aged care.

“These would include 24 by seven advice and triage services, and teams of registered nurses and nurse practitioners and others, specialising in acute care of older people, with access to a core team of specialists,” Mr Gray said.

He said the approach was consistent with recommendations of the 2011 Productivity Commission report Caring for Older Australians and noted some progress.

“In the years since 2011, there have been hopeful developments along these lines in some jurisdictions and within some Local Hospital Networks, but nothing that is specifically funded by the Australian Government to be implemented on a system-wide basis across the country.”

He said the National Health Reform Agreement could be used to cover these services and determine contributions of the Commonwealth and relevant state or territory governments.

Providers highlight difficulties

Gray said the royal commission has received more than 500 public submissions about inadequate access to health care services as of 2 December 2019.

“They raise concerns about access to primary health care services, specialist services, allied health care, state and territory funded rehabilitation and restorative care, and palliative care services as well as transitions between hospitals and aged care,” he said.

Similar concerns were raised by many of the 500 providers who responded to the royal commission’s provider survey questions on the difficulties of accessing health care for aged care clients, Mr Gray said.

He said providers identified the following:

  • a lack of access to health services, including GPs, specialists, in-reach clinical support, and telehealth
  • poor service integration, information sharing, record keeping and communication processes between various professionals, including GPs, residential aged care providers, registered nurses, hospitals and ambulance services
  • poor hospital transfer, discharge practices and follow-up care.

GP’s raise pay, access issues

Elsewhere at the hearing doctors raised issues related to inadequate remuneration.

Australian Medical Association president Dr Anthony Bartone said the model for paying GPs needed to include the full amount of work they did, which was more than just the face-to-face time they spent with aged care recipients.

Dr Anthony Bartone

“If we look at how primary care is to be funded into the future, what we’re seeing now is an increased movement or an increased understanding that fee for service alone will not support the increase in chronicity of care, the increased complexity of care and the increase in non-face-to-face care,” Dr Bartone told the hearing.

He said non-contact time was rarely remunerated.

“We already have an ineffectual blended payment model between the Medicare Benefits Scheme and the Practice Incentives Program, which is an incentive grant… for the amount of work that you might do in an aged care facility but not directly rewarding face-to-face time, those two components together largely do not reward or completely remunerate in any way, shape or form the activity required,” Dr Bartone said.

“What we’re saying is the principles are sound, the funding is woefully inadequate and needs to be reviewed and not only augmented but also improved in that relationship between the amount of work that really goes on,” he said.

Dr Troye Wallett

GP Dr Troye Wallett also told the hearing that remuneration was a barrier to attracting GPs to work in aged care during a panel discussion.

Dr Wallett co-founded mobile general practice service GenWise in 2013 to improve and specialise in GP services for residential aged care (read more here).

Mr Gray asked Dr Wallett how aged care providers could better support GPs visiting residents at their facilities.

“Basic internet access, basic access to printers, [and] access to the facility’s notes to continue on with the clinical communication between the residents… those are generally sort of minimum requirements that my GPs that I work with need,” Dr Wallett told the hearing.

Without them, the GP’s life is difficult, said Dr Wallett.

He pointed to the Royal Australian College of General Practitioners recently released draft minimum standards aimed at facilities to support GPs working in residential aged care (read more here).

Dr Wallett acknowledged that each facility and GP operated differently, but said some guidelines or minimum requirements for facilities would be help GP’s working in residential aged care.

Susan Irvine

Fellow panelist Susan Irvine, who is general manager of aged care nurse practitioner group Home Nurse Services, said a formal agreement between providers and health professionals could improve each party’ understanding of what is expected.

“A service agreement requirement between general practitioners and any other health professionals going in where it outlines mutual responsibility and accountability… will go a long way to assuaging some of the concerns of GPs visiting but also concerns of aged care providers,” said Ms Irvine.

Dr Wallett agreed such an agreement could help.

“Having a service agreement which we may discuss further would allow us to formalise that arrangement to say these would be the expectations that the aged care facility requires from me, and these are the expectations that I as a GP would require from the facility,” he said.

The Royal Commission into Aged Care Quality and Safety continues this week before wrapping up for the year on 13 December.

To stay up to date on the latest about the Royal Commission into Aged Care Quality and Safety go to our special coverage. 

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One Response to RC proposes medical response teams to improve health care

  1. District Nurse December 12, 2019 at 1:09 pm #

    In Victoria we have a program Called Residential in Reach, it is experienced ICU/A&E trained nurses who are available to visit residents in Aged Care Facilities assess residents, liaise with the residents GP or specialist providers, organise tests, commence treatments and monitor the clients progress. If required the Residential in Reach nurse will liaise with the local hospital, streamline the residents admission and ensure the resident doesn’t spend long hours in A&E. This service costs the resident and the facility nothing (yes it is free)

    The Residential in Reach nurse can also support the Aged Care Facility Registered Nurses to commence IV’s, run infusions including blood and assist in the up skilling of the Registered Nurses at the Aged Care Facilities.

    Some of the Residential in Reach Nurses are Nurse Practitioners or are studying to become Nurse Practitioners which allows them to order some tests and commence some medications with out a doctors order.

    As a District Nurse I have worked beside Residential in Reach nurses for a number of years and have seen the transfers of residents to A&E or Acute Care fall to almost zero from the services they support.

    This program can be replicated all over Australia if someone in Government had a little drive and was prepared to learn from what is currently working well.

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