AREVOLUTIONINGENERAL
PRACTICE
WesternSydneydoctorstryingtoimprovegeneralpracticefordoctorsandpatients
“Imagineasituationwhereachildmightpresentwithaspecifichealthcondition.Managingthe healthconditionmightbestraightforwardexceptthatbothparentsareunemployed,oneusing recreationaldrugs,theotherinjailThegrandparentsaretheprimarycarersTheylivewithdiabetes andheartdisease.It’sanexamplewherethere’sacombinationofmedicalandsocialcomplexity thatGPsstrugglewitheverydayThisiswhereHealthicarecomesin”
DrKean-SengLim,LocalGPandChairofHealthicare
BasedintheBlacktownExercise SportsandTechnologyHubin RootyHill,Healthicareopenedin January.Tenyearsinplanning, fiveyearsinthemaking,thehealth hubhastakenontheambitious taskofrevolutionisingprimary care
It'stheseeminglyintractable problemwhichisonlygrowing GP numbersaredwindlingaspatient needandcomplexitiesincrease.The issueisfeltmoreacutelyinareaslike westernSydneywhereGPsshutup shoponanalmostweeklybasis So, whatifyoucameupwithasolution thatwouldbothhelpthepatientsin greatestneed,andtakethepressure offGPs?Asolutionwhichmakesan areamoreattractiveforGPstowork while keepingpatientsout
ofthehospitalsystem?Western Sydneydoctorsareatthehelmofa groundbreakinglocallyled neighbourhoodhealthhubthat couldhelpaddressAustralia’sGP crisis.
HEALTHHUB
Healthicareisanewneighbourhood healthhubinSydney’swest,codesignedbylocaldoctorsandthe PHN,whichitscreatorssayisunlike anyotherinNSW Theresultofyears ofplanning,study[1]andresearch tripstocentresoverseas,ithasa growingteamofGPs,GPregistrars, nurses,apharmacist,dietician, exercisephysiologist,psychiatrist andsocialworker.Keytothemodel, ithasdedicatedpatientadvocates tosupportsurroundingpracticesto extendtheirserviceoffering,whilst
simultaneouslyhelpingpatients tonavigateeverystageoftheir healthjourney
“Healthicareaimstosolvethe problemoflackofaccessto generalpractice,particularlyin underservedareasinwestern Sydney Weknowthat40%of peopleinwesternSydneydon’t havearegularGP.Weknowalot ofpatientsaredischargedfrom EDswithouthavingaregularGP andthosepatientswillveryoften endupbackinhospital Wereach outtothosepatientsandbring themintooursystem,”Clinic DirectorDrJaspreetSainisaid It'snotjusttheprimaryhealth servicesofferedonsite,it’sthe hubandspokemodelthatis designedtosupportGPpractice throughoutthearea
participatingpracticesandisusing thattoidentifywhichpatientsare goingtobeatthehighestriskof hospitalisationinthenext12months. Thehubwon’tknowthenameofthe patientsbutoncethedataisanalysed Healthicarecangobacktothe practicesandsay“Thesearethe patientsmostatriskofcomplications fromheartfailure,diabetes,kidney disease”orwhatever Thepracticecan thencontactthatpatientandrefer themtoHealthicareorreceive assistancetoimprovetheirhealthand reducetheirrisk
“Healthicarewillbethefirsttimewe lookatpopulationdataandmobilise teamstoprovideproactiveoutreach caretopatientssothattheystaywell andhealthyandthoseoutofhospital” DrSainisaid,“Usingpredictive analyticsbasedontheCSIRO hospitalisationriskalgorithmwecan predictthepercentageprobabilityof unplannedhospitalisationforevery individualinthecohort.Fromthis
FEATURE
Co-designedandestablishedby WentWestinpartnershipwiththe MtDruittMedicalPractitioners Association,Healthicareisan independentnotforprofit organisation It’swhereoverrun localGPscanrefertheincreasing numberofpatientswhose complexmedicalissuestake hours,not15–20minuteslots
Healthicaretakeschargeof referredpatients,identifiesand separatesthedifferentelements ofcarerequired,thenseeksto addresseachindividually.
OUTREACH
Referralisnottheonlyway patientsarriveatHealthicare The centrereachesoutintothe communitytofindthepatients whoaregoingtoneedcare, beforetheyneedit
Throughacollaborationwith localhealthbodiesandthe consentoflocalpractices, Healthicarehasaggregatedthe deidentifiedclinicalinformationfor
Healthicare Health Hub, Blacktown Sports and Technology Centre NSW
Local GP and Chair of Healthicare Dr Kean-Seng Lim and Clinic Director Dr Jaspreet Saini
dataweknowthat11%ofthe populationhasagreaterthan20% probabilityofunplanned hospitalisationinthenext12months Wecanseewhothehighestrisk groupsandindividualsare Wecan seewhoislikelytohavehadan exacerbationofCOPDinthepast12 monthsandwhethertheir medicationscouldbeoptimised.We couldseewhichpatientswith diabetesanddecliningrenalfunction couldpotentiallybenefitfromnewly availablemedications.Wecan identifygapsandopportunitiesto influencetheircaredirectly, improvingtheirhealthandreducing theirriskofgoingtohospital.”DrLim explained.
SUPPORTFORGPs
“AsaGP,youmightspendalotof timeonphoneswhichisofcoursenot remuneratedunderMedicareandit canbeavery,verytrickythingtojoin allthedifferentaspectsofcare together.ThisisoverwhelmingforGPs andit’sonlygoingtogetworse”Dr Limsaid
“Werecognisethatattracting clinicians,whetheritsnursesorGPs intoareaslikewesternSydneyis quitedifficultbecausethecasesare morecomplexandnotnecessarily remuneratedinthesamewayasin moreaffluentareas.”DrSainiadded.
FEATURE
“Ourpopulationovertheageof65 issettotripleoverthenextdecade, thecurrentwayweprovidehealth careisnotgoingtobesustainableor reallyservetheneedsofour demographic”DrSainisaid
DrLimsaid“TheHealthicarehub becomesthecoordinatingcentrefor thiscarebutalwayswiththe intentionofreturningthecareofthe patienttotheirusualgeneral practice Thisisbasedonverygood evidencethatregularqualityGPcare doesreducehospitalisation,does reducetotalcostofcare,does improvelifespananddoesimprove patientwell-being.So,partofthisis tryingtoestablishanongoing connectionbetweenpatientsand theirGP Thehopeisthatby
augmentingorsupportingtheusual generalpracticetoprovidebetter qualitycare,sayinfiveyearsthis makeswesternSydneyabetter placetobeaGPandisexactlythe sortofplaceyouwanttobeaGP becauseyoucanprovidethatcare thatyouwanttoprovideandyou’re wellsupportedtodothat”
“MostGPsaresobusy,so overworked,sostuckintheir day-to-daygrindthattosee somethingdifferentishard Thisis partofourgoalhere,toshowthat youdon'thavetodothings inthesamewayandthatyou canhaveadifferentlifeasaGP”
NEWFUNDINGMODEL
Healthicareensuresitsdoctorsare appropriatelyremunerated Some areonsalaryandsomeon independentservicesgrants
“ThismeansGPsdon’thavethe concernsofneedingtoseelarge numbersofpatientsinorderto makeendsmeet Thatpressureis
takenoffthem WhiletheFederal Governmenthasmadesignificant investmentinMedicareitstillfalls wellshortofwhatgeneralpractice needstoprovideadequate servicestopatients”DrLimsaid Healthicareisfillingthefunding shortfallininnovativeways,while theMBScoversaround70%, alternativesourcesoffunding comefromgrants,research fundingandothernon-MBS sources.Itisalsocontinuingtolook atpartnershipsandnewwaysto ensureongoingsustainable funding
“Asapercentageoftotalhealth expenditure,theamountspenton GeneralPracticehascontinuedto fallfromover7%tenyearsagoto nowlessthan5.7%[2].AMApolicy andinternationally,wethinkthis needstobeatleast10% At Healthicarewearewantingtodo GeneralPracticeasitshouldbe doneanditlooksliketherewill needtobeatleast30%topup fundingtomakethishappen”
Patient Barbara Blissett with Medical Practice Assistant Camelia Najjar
“We’renotafraidofdoingthings differentlyandbeing collaborativeandholistic The practicehasaWednesday walkinggroupwhichpatientsare invitedtoattend Peoplewho haven’texercisedforalongtime arenowparticipating Asaresult, manyhavestartedtoincrease thelevelofactivitytheydoon theirown”
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FEATURE
INNOVATIVECARE
AtHealthicareDrSainiisjustas likelytoprovideyouwitha prescriptionforexerciseasheis formedication
“Soonwe’llberunningmore specificprograms We’vegota COPDprogramandanobesity cliniclinedup.Theobesityclinicis apartnershipwiththelocalhealth districtwhereserviceswithin hospitalsettingshavebeen unabletohandlethelargevolume ofpatientsthatarereferred Similartowhatwedowithwestern SydneyDiabetes,we’llhave specialistendocrinologistscome intoHealthicareonasix-weekly basis,providemoreintensive
supportandtrainuptheGPs internalpracticeteamtoprovide supporttoourstations.Weare workingoninnovativehealth coachingapproachesaimingto improvepatientactivationwiththe WesternSydneyDiabetesteam.The otherthingwe’relookingatthe momentisanInflammatorybowel diseaseclinic”
AROLEMODEL
“WehopethatHealthicarewillbe thefirstofmany.It’sourhopeto inspirepeoplearoundthecountry tosetupsimilarservicesinsimilar clinics”DrSainisaid“Thisiswhat generalpracticeofthefuturecould looklike,”addedDrLim
AsanAMA(NSW)member,foreverynewmemberyourefer,we’llrewardyouwithagift card Themorepeopleyourefer,themoregiftcardsyou’llreceive!Findoutmoreatthe QRcode
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Innovative practice rooms include Tv for kids to watch and music to make patients feel comfortable. Here is patient Erin Clark with Dr Hani Bittar
Patient Simone Fisher with baby Brooklyn