Romancing GPs in aged care
Bupa Care Services believes it can solve one of the great vexing issues in aged care – getting access to a GP. They hope their initiative will transform the industry and set a new benchmark in bridging the nexus between primary care and aged care.
Above: L-R Minister for Ageing, Senator Jacinta Collins with Bupa Managing Director, Louis Dudley and a resident of Bupa Berwick at the offical launch of Bupa’s Integrated Health Care Program in Melbourne this week.
By Keryn Curtis
Bupa Care Services believes it is poised to solve at least one of the great challenges in aged care – getting a GP to make a timely visit.
On the election trail this week, Minister for Ageing, Senator Jacinta Collins formally launched Bupa’s “Integrated Health Care Program” – an initiative that will eventually see a GP employed in-house at each of Bupa’s 61 residential aged care homes in Australia.
The initiative has already commenced roll-out in six Bupa aged care homes, including Bupa Berwick in Melbourne’s south east where the official launch took place on Tuesday.
Berwick was the first of the Bupa homes to have a GP on site under their program. In addition to the six homes currently under implementation, a further nine facilities will have an in-house GP by August 2014.
In a statement issued by the Australian Labor Party, Minister Collins said she applauded Bupa’s ambition to have an onsite GP in all their 61 homes across the country.
“Aged care residents will have access to regular consultations with the same GP,” she said.
“The aim is to improve health outcomes for residents and it is expected this will decrease their need for hospital visits and the need to leave the home for simple procedures.”
She said the GP initiative would also be a boost for the nursing and care teams in each home, which would receive training and mentoring support from the GP.
A considered plan
The GP initiative, first announced by Bupa in early July, is a carefully planned and informed attempt to address the persistently vexing issue in aged care of getting access to a GP.
Bupa Care Services Australia Managing Director, Louis Dudley, said the decision to bring GPs in house was made in the context of trying to improve healthcare access and outcomes for residents, one of the planks of the government’s Living Longer Living Better reforms.
Mr Dudley said the organisation had approached the issue in a holistic way by trying to understand the problems experienced by aged care homes in getting access to a GP from both the home’s and the GP’s perspectives and then how the barriers might be overcome.
“In making the in-house roles attractive to GPs we looked at all the difficulties and inefficiencies cited by GPs in working in aged care homes.
“One of the key issues was having a space to work from with access to equipment and a computer and the right software, so we created an office and consulting room with all the proper equipment and the computer and software etc,” said Mr Dudley.
“Other challenges from the GPs’ point of view included sometimes not having enough nursing support during the visit.”
Mr Dudley said an integral part of the initiative was the creation of a new, dedicated clinical support role in each home called a clinical care manager.
While the central component of the role is providing regular consultations, bulk-billed through Medicare, to residents who choose to see the Bupa GP, the salaried positions have a wider role within the aged care service including clinical leadership and skills development for other staff.
“The new model of care will also create opportunities to develop the clinical capability of our nurses, enabling them to deliver more complex health care within the residential age care setting.
“There are great benefits in receiving continuity of care from a GP who knows the resident and their family,” said Mr Dudley. “And residents will benefit from improved access to complex medical care, early referral to specialists, and prevention and early intervention for new and evolving conditions.”
He says the model will also provide access to telehealth specialist consultations when required, as well as the opportunity for residents’ data to be digitally shared securely with local clinicians, specialists and hospital staff for more integrated health care.
Reduced hospital admissions
But one of the key outcomes expected from the program is a reduction in hospital admissions.
“Currently one in four of all aged care residents is admitted to hospital every year and around 30 per cent of these admissions could have been avoided if a GP or other primary health carer was available to assess the resident before a transfer was needed,” said Mr Dudley.
“Accessing consistent, quality GP services for residents in aged care homes has been a real challenge for aged care providers, and addressing this was central to our plan to help our residents live longer, healthier, happier lives.”
The model is being formally evaluated by the University of Tasmania’s Wicking Institute. The study, under the leadership of Professor Andrew Robinson, will assess the impact of the model on key clinical outcomes over three years to demonstrate the clinical and financial benefits of operating a proactive Integrated Health Care model within residential aged care.
Australian Ageing Agenda has an in-depth look at this model in a feature article in the forthcoming September October issue of our print magazine.
I look forward to reading more about this. Rural areas will be harder, I suspect, as there is no surplus of GPs there (may not impact Bupa)but this looks like a promising move on a previously intractable problem.
Good initiative and model for metropolitan areas.There are other initiatives/models with GP’s and Nurse practicioners working together to have a viable and sustainable model for Residential Aged care that pull on the MBS.But where there are not the numbers or travel has to be included it is not sustainable.
What a great initiative as long as the GP practices holistic wellbeing medicine and not just acts as a pill dispenser.
Seven years ago I established daily GP clinics in each RACF in a large area of Queensland. It certainly reduced avoidable admissions. But what will we do when we are short > 4000 GPs by 2025 and some 20,000 nurses. Don’t say we’ll train more – there won’t be enough warm bodies able to be trained. We need new paradigms of healthcare, not simply trying to reallocate what will be an inadequate workforce.
An interesting initiative. Timely GP response could mean improved quality of life with appropriate individualized care planning.
This model of care is clearly the answer to better outcomes in ACFs. However the issue in any successful venture is financial viability to sustain the costs that accompany such ideal care. Unfortunately the current bulk billing Medicare invoicing schedules for such care do not cover the costs so where does the shortfall come from if Medicare bulk billing legislation doesn’t allow for separate supplementary invoicing of ACF residents for services rendered.
I understand the importance of this in rural areas where GP’s are very hard to get a hold of and waiting times for home visits are long and frustrating but where I work our GP’s are amazing, they come when requested and do all the documentation as required. I just wonder however…. what happens to the residents right to choose? This is part of the residents rights act. If they are forced to give up the GP they have been seeing for the past 10+ years for the facility GP. Just food for thought.
Shirley, as editor and author of that story, I regret that I didn’t clarify that residents do have the choice to see the in house GP or see their own GP. Bupa’s original press release said that “only 30 per cent of residents retain their family GP when they enter residential care, leaving the remaining 70 per cent without a GP at this critical point in their lives.” But every resident can choose to stay with their own GP or any GP of their choice. I imagine (though I didn’t ask) that residents can probably choose to have the Bupa GP see them in certain circumstances such as when their own GP was unavailable or in an emergency. Keryn Curtis