An integrative telehealth model allowing urban GPs to treat patients at rural and regional practices improved access to GP services for 95% of patients.
A virtual practice model remotely connecting urban GPs to rural general practice teams in western Queensland has worked so well it will be extended to another three sites before Christmas and a further three early in 2024.
Trialling Western Queensland PHN’s Virtual Integrated Practice Program in a western Queensland general practice in October 2021, with a second practice added in December 2022, University of Queensland researchers found that 91% of patients were “highly satisfied” with the care provided through the service, with 95% saying the service had improved their access to GP services.
Ninety-nine percent of patients either agreed or strongly agreed that they would use the service again, with more than 20% saying they would seek care at an emergency department if virtual GP services weren’t available.
According to the study’s senior author, Professor Claire Jackson, director of UQ’s Centre for Health System Reform and Integration, what was most surprising about the findings was that they demonstrated the virtual GP program had been as successful as planned, with participating urban GPs working closely with rural practice staff, and practices recruiting a wide range of patients to the service.
“What’s the thing that surprised me most? That what we had hoped and envisaged was delivered in that initial pilot site,” said Professor Jackson.
“The GP was an ex-locum based in an urban area [who] joined one day a week by video conference. The practice was highly successful with patient recruitment [and] the patients were really supportive of it.
“The VIPP GP felt very embedded in the practice – not all on their own in their lounge room, but really part of the practice. The week’s in-place locum every six months, that was a really critical part of the model.
“So that probably surprised me – what we assumed could work did work well. Now we’re extending to a further three sites before Christmas and then a further three that we’re hoping to place in early 2024.”
Across 1282 occasions of care provided, more than half were repeat patient encounters, while fewer than 30% required support from other staff members.
Across 1468 services provided between 2021 and 2022, the large majority were general consults (1197), followed by mental health treatment plans and therapeutic procedures such as ECG tracing (68), chronic disease management plans (59) and antenatal consults (10) with one script request.
The total non-recurrent cost of implementing the program at both rural practices was around $9700, with the first practice requiring $6900 to establish the service and the second requiring $2800.
Recurrent costs included staff wages, infrastructure and travel and accommodation for the recurrent GP onsite visits, with the greatest expense being wages for the GPs providing telehealth services.
According to Professor Jackson, the program’s funding model integrated well with existing arrangements for rural locums, including salary rates for participating urban GPs, but stood apart from the standard funding model for locums in urban areas.
“The funding model, most of it sits with the practice, so it’s important for practices to look at their clinical model of care but also at the business case, [and of the] three primary networks that are involved, two of them provide some assistance for the first six to 12 months to the practice whilst the patient numbers build up,” she said.
“And the model is not a model where the VIPP GP takes a percentage of their earnings, they take a daily salary based on rural locum rates, so it’s an amount in keeping with the model [the] rural workforce would receive.”
The VIP Program was developed in 2021 by Western Queensland PHN, Health Workforce Queensland and the University of Queensland in partnership with three rural general practices.
Aimed at establishing a virtual GP to provide ongoing care for patients attending rural general practices, the program involved urban GPs, recruited through local networks and existing rural locums, joining a rural general practice team for a minimum of 12 months.
The GP joining the rural practice was provided with secure, remote access to the practice’s software and medical records and worked alongside rural practice staff to provide ongoing care via secure telehealth connection, with a short stint working onsite for three to five days every six months.
While the program was not a silver bullet for addressing chronic workforce shortages and limited access to primary care in rural and regional areas, Professor Jackson said expanding the service would reduce workload burdens for rural practice staff and crucially improve the continuity of care for patients.
“It’s not a panacea. It’s really one strategy to try and build a rural remote workforce, so it can never replace boots on the ground,” she said.
“But when you can’t have the onsite rural workforce that you need, this is a way to offer continuity of care.
“We don’t want our rural consumers having six different doctors in six different weeks, which is often what happens on the ground at the moment in order to stretch that workforce.
“The golden lining of covid is that it moved us, as the Minister said, 10 years in 10 days – we all had to move out of our comfort zone and learn how to do remote video conferencing.
“Most importantly for our team and partners it’s creating continuity of care for rural communities, that continuity [and] that relationship is really central to the general practice model.
“One of the learnings [from the study] is how effective patients and practices are at working out what’s possible in those settings [and] that continuity, that relationship is really important to the general practice model.”
Career opportunities for GP partners across a number of industries in rural and regional areas were also a challenge for rural medical workforces, Professor Jackson added.
“I [also] think the world has changed, many medical graduates have a partner who has equal commitment to pursuing their career and that may be challenging in small rural areas,” she said.
“I think that’s just as much if not more of a problem than gaining the skills [needed] in rural generalism.”
The study is published in BMC Health Services Research.