We talk to Capital PHN CEO Stacy Leavens about the flow on effects of some of their most recent pilots on breathlessness and social workers in general practice.
In this edition of Spotlight on PHNs, Capital PHN CEO Stacy Leavens reveals how embedding social workers in GP clinics and helping people manage breathlessness at home is easing pressure on overworked GPs.
She also talks about how she’s reshaping the ACT’s health system from the ground up and what their next focus will be.
Q: How would you describe the biggest health challenges in your region right now? What makes your catchment unique?
Here in the ACT, there are a few main issues that we look at from a PHN perspective.
We know that there are massive cost barriers for care in the ACT, with high out-of-pocket costs and low bulk billing. That’s across general practice, specialist care and allied health as well.
We also know that in the ACT we have massive workforce issues, particularly around general practice. We have the lowest rate of GPs per population compared to other states and territories. We have a gap in access just because of pure workforce figures.
That leads on to issues in terms of being able to access care when you need it, but also that fragmentation of care in how we link up services across the system.
Q: Is there particular reason it’s worse in the ACT?
I think it’s part of the overall workforce shortages issues nationally. But it is a little hard to really understand why, specifically in the ACT, we have that shortage, especially compared to other metro and urban regions. It is quite low.
There’s not really one reason, there’s all sorts of bits and pieces that contribute to that. There’s a lot of work happening, both across Commonwealth and ACT Health that we’ll be working with them on trying to increase that pipeline of GPs in particular.
What we know is that if medical students and junior medical officers get early access to experience in general practice, that they’re more likely to choose it. So really thinking about how we engage across those earlier in the pipeline to encourage them into general practice, particularly in the ACT.
We recently held a really cool event called Explore GP that was aimed at engaging medical students, Junior medical officers and then international medical graduates around ‘what does a career in general practice in the ACT look like?’, and what are the different career pathways and options available if you choose to be a GP and really encourage that pipeline.
Q: What are your top strategic priorities over the next 12 months?
Multidisciplinary care is one of the big ones, always. That’s obviously been a big focus of Strengthening Medicare policies, but we’ll be rolling out some new multidisciplinary care services around diabetes.
We’ll also be extending our Social Workers in General Practice model, which is a multidisciplinary care program that has looked at how we improve connection and support for people with complex health and social needs.
This was a first in Australia trial. We had four practices to start, and we embedded social workers either part time or full time within that practice. The practice employed the social worker, looking at those patients that have that complex social intersection between health and social needs that need to be addressed.
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We had 500 patients go through the program, and a lot of the work done was around supporting things like housing, access to Centrelink, access to aged care, access to NDIS, helping to connect the system around that patient.
What we’ve heard from GPs is that it really reduced the pressure on them to be all to everyone and address that bigger picture need.
It supported whole wellbeing of the practice, because it took some of that pressure out of trying to support all of that in one or two consultations.
The other program that I really want to highlight (because it’s probably one of the most scalable programs) is the ACT breathlessness intervention service. That’s been funded through Greater Choices for At Home Palliative Care.
We commissioned a physiotherapist organisation to conduct home visits and work with people experiencing breathlessness and work with them around managing that breathlessness rather than going to hospital.
What we have seen from that program is that both patients and carers involved have rated the program really highly. 21% of patients said that they thought about calling an ambulance on 46 occasions, but were able to self-manage at home.
We’ve heard a lot of stories about people being able to return to the things that they love doing as part of this program. There’s the managing of the symptoms, there’s the reduced pressure on ED because they’re not going unnecessarily.
But also there’s that quality-of-life element where people get a chance to return to doing things that they love.
Q: How are you supporting the local primary care workforce, especially in the face of GP shortages or burnout?
We have the Explore GP program, which is around building up that pipeline and promoting the role and opportunities for general practice. But we also have a number of other GP and broader primary care supported programs.
We’ve got a really strong education and events program where we offer continuing professional development to GPs across a range of issues. A lot of that is GP focused, but we also extend a lot of CPD and events opportunities to practice nurses and allied health. We’ve been doing more interdisciplinary events where we’re bringing those different health professionals together to build that team approach to care. We get pretty good feedback that it helps. Part of that is also helping to build the community network.
We’ve also been doing quite a lot of work recently around engaging with practices through GP health checks, to understand what challenges they have on the ground that we can help with.
We’ve got the health pathways program, which is a tool that we use around building referral and clinical information that GPs can refer to, to help connect different parts of the system.
We also support mainstream general practice to provide culturally safe and responsive care, particularly to First Nations community members. We offer cultural awareness training to general practice and our commission services providers, and we’re going to be introducing a cultural safety audit tool where they can take the tool and look at the things that are going on in their practice and how they can improve cultural safety.
Q: How do you use data/technology to identify needs and measure impact across your region?
From a digital perspective, we have been engaging quite a lot with general practices around the use of various digital technologies. There are obviously things around My Health Records, telehealth and e-prescriptions, but there’s been a lot of work over the last couple of years around e-referrals and supporting the uptake.
ACT was one of the early adopters around e-referrals. Through the support the team has received, there’s been a steady increase in those e-referrals. It started out at about 2000 referrals per month, and is now averaging about 7,000 per month this year.
We’ve also done things like providing telehealth grants to residential aged care facilities to support the uptake.
We’ve got our needs assessment and we undertake a lot of data analysis, working with publicly available data, but also looking at what data we can use from our commissioned service providers and general practice to give us a sense of where the current and emerging needs are around health in the community.
We also do quite a lot of work, particularly to engage with our commission services providers around looking at the data that they’re collecting as part of their programs, to really evaluate whether the funding is being used appropriately, and achieving the outcomes we expect.
We’re doing quite a lot of work at the moment around introducing specific patient reported outcome measures and experience measures to better assess some of our programs.
Q: Is there a local health issue or population group you think deserves more national attention?
I think probably housing and homelessness is an area where I think there could be a lot of interesting work. Looking at that intersection between health and housing homelessness.
We do get some funding at the moment around that, but I think it’s an area where there could be really big impact with some strategic investment and policy work.
Also at a local level, building partnerships in that space could have a huge impact if we took that on as a priority.
Q: Is there anything about the PHN model that you think needs to change or help you make a bigger impact?
PHNs, from my perspective, are really well placed to respond and address emerging needs in their local area and have a nuanced approach to how we address those needs.
I think what we need to do that well is flexibility in how we are funded, and the decision making we’re given at that local level to target funding where we think it’s needed.
We all do really robust needs assessments, and so thinking about how PHNs are funded and supported to act on the needs assessments is something that would continue to strengthen the program.
Q: If you had one message for policymakers about PHN impact, what would it be?
PHNs have a real, detailed and nuanced understanding of the local health issues. I think it’s easy to look at something and go, ‘there’s an issue here around bulk billing’, but it’s understanding what those local dynamics are that lead to that or are falling out of that issue.
I think it’s that nuanced understanding and ability to engage locally to come up with solutions.
This article was first published by Health Services Daily. See the original here. Get your GP discounted subscription here.
