Geographical Zoning A role for your Division?

Dr Doug Barrett, GP Julie Sutherland, Aged Care Program Officer

Central Victoria General Practice Network

(previously Bendigo & District Division of General Practice)

Central Victoria General Practice Network

Based in BendigoIncludes Heathcote, Dunolly, Maldon & parts of Castlemaine. 102 GPs (43 practices) 23 Residential Aged Care Facilities16 in Bendigo

Background to the issueCity Greater Bendigo pop. 98 300 (growth rate higher than the Vic. Average)Increasing workload pressures of GPs, ageing workforce.GP workforce shortage (currently 4-5 practices taking new patients).Approx. 90% of GPs visit residents in aged care facilities.Aged Care Work is not being undertaken by all GPs. Increasing requests for GPs to “take-on” new patients/residents.

What is Geographical Zoning?

Long term initiative.

Involves GPs nominating their availability to provide visiting services to residents of certain RACFs.

Primarily established for the Bendigo GPs of CVGPN.

Acknowledgement to Ballarat Division of General Practice

Three key components

    

1. Communication between GPs and patients/ families. Informing patients in advance about the RACFs the GP will attend.

2. Collaboration with social workers & ACAS to promote GP involvement in patient selection of RACF preferences.

3. Patients/Residents transferring to an RACF in Bendigo from surrounding areas (where usual GP will not be able to continue care).

Getting started…. GP Survey – detailed the concept and asked for expressions of interest.

Names of RACFs were listed. GPs were asked to indicate which RACFs they were prepared to see patients.

Received 16 responses to survey, 5 GPs indicated they were not interested.

11 GPs interested to meet and discuss further.

Survey Comments

“I think it is a good idea. Currently seeing single patients in nursing homes is time consuming in terms of travel”

“I am motivated to look after my own patients wherever possible”

“I am not willing to take over care of existing residents, only new admissions”

“I am not wanting large numbers of nursing home patients but would consider case by case”

“I am a solo practitioner, I am currently overwhelmed by my workload,this may change in the future”

The pilotPilot to be conducted Dec 07 – June 08Primarily for GPs to accept new patientsInitially we thought the RACFs would keep the list of GPs, however GPs were keen to see CVGPN have a key role in maintaining their list of preferences.CVGPN receive requests and make contact with the participating GPsGPs decide on case by case basis whether to accept or decline.GPs can opt out of the GZ initiative at any time

16 facilities in BendigoAverage number of GPs available per facility is 6. (However, this ranges from 2-10GPs per facility.)11 admissions from outside where CVGPN have been involved in “finding” a GP.20 existing residents have had care transferred from one GP to another as part of GZ.2 currently on waiting list for beds. (1 relocating from Mildura & 1 from Melbourne)

Initial Outcomes

Initial Outcomes

Currently 20 GPs participating(10 have been “active” since trial commenced).Pilot expanding, working closely with social workers for patients in rehab, acute.Template developed for GPs to inform of ACAS assessment and need for preferences for RACFs (Commenced this week).

Information required by GZ GPs

GPs accepting new residents will need:Medical SummaryCurrent Medication ListDates for MBS Claims for 712, 903, 731 as appropriate.

Case Studies

Phone call from stressed husband.Wife was originally going to 1 RACF so “usual GP” (who was participating in GZ) arranged for another GP to take over care within same practice.However, bed became available at 2nd preference RACF where neither GP visits.Spoke with husband and arranged for new GP. Past hx, medication list etc to be transferred to new GP ASAP.

Mr & Mrs A

Mr 52 & Mr 68

Social Worker from BHCG made contact regarding two patients currently in rehab being transferred to RACF (dementia specific unit).

Male 52yr alcohol related dementiano “usual GP”, been to see 1-2 different GPs (who are not prepared to take them on at RACF)

Male 68yr personality disorder. From outside of area so “usual GP” not wanting to travel into Bendigo.

2 phone calls to GZ GPs. First GP declined to “pick up”. Second GP agreed to both residents.

Mrs W Call from social worker on Wednesday

95yr resident in rehab from low care RACF being transferred to high care RACF on Friday/Monday.

Mrs W previously went to see GP at the clinic. “Usual GP” since left the practice, was seeing the practice nurse and any GP that was working.

Next of kin lives in Nagambie

Arranged for GZ GP to pick up at new “HC RACF”

Son to be sent “release of information form/s” for record transfer etc.

EvaluationOfficial review of pilot end June 08.Feedback from the participating GPsFeedback from social work re: template/form.

So far, anecdotal feedback has been positive both from GPs, social workers and aged care facilities.

Division role has been “perceived” as beneficial.

We have seen an increase in number of GPs coming on board.

???Further promotion / expansion Non-participating GPs and Other sites e.g. social work at private hospital.

Further information contact Chris Fishley & Julie Sutherland at CVGPN

Telephone 5441 7806

jsutherland@cvgpn.org.au

cfishley@cvgpn.org.au