TWENTY-THREE AGED CARE RESIDENTS KEPT OUT OF HOSPITAL DESPITE GP WORKFORCE CRISIS
1st August 2019
By Belinda McNab, Rekha Pillai, Shane Hatton
In the last few weeks, the GP workforce crisis has hit critical levels across much of rural NSW, if not most of rural Australia. With more than 300 GP vacancies in rural NSW, patients and communities are suffering from the lack of locally available health services.
Recently, the already depleted GP workforce levels in Condobolin were impacted further when a locum GP was forced to withdraw from their placement at short notice. Given the shortage of rural GPs across the country, in both permanent and locum roles, it was impossible to replace that locum.
This meant that there were not enough GPs in the town to appropriately and safely meet the health needs of the community, particularly the needs of the residents in William Gardens nursing home. The nursing home, which is managed by RSL Lifecare, offers 34 hostel-type beds, and 34 beds for aged care residents requiring a higher level of care.
As a solution, RaRMS Health Condobolin, Ochre Health, Shortis and Timmins Pharmacy and the nursing home, worked together to implement an innovative, telehealth model of care. The solution involved informed patient consent, the sharing of relevant health information, input into electronic medical records, provision of prescriptions, secure video link, and importantly, involved the nursing team from the nursing home working via video consultation with a suitably qualified and experienced GP who was working remotely.
Dr Freddy , working for RaRMS’ Remote GP Service, provided telehealth consultations using Healthdirect’s Video Call platform. Three such telehealth clinics resulted in 23 residents being offered episodic and event-based care, chronic disease management, medication management, whilst other urgent care needs were also managed.
Dr said, “It was a very fulfilling experience for me as a clinician. With the help of the local nursing staff, I was able to review the residents via video, provide the medical management required, update the clinical notes in an electronic health record, and provide an encounter summary back to the resident’s usual GP.”
Dr was supported by RSL Lifecare nurses working alongside the residents. Michele Buxton, Manager, RSL Lifecare, said “The residents and staff of William Gardens were very pleased with the service provided by RaRMS. The service allowed us to provide uninterrupted care for our residents, and also provided support for our nursing staff. We are very grateful to Dr Freddy and the RaRMS team for their assistance.”
This primary health care lead collaborative solution has transferability and scalability across almost all locations and will be instrumental into the future in supporting towns who may not have the GP workforce needed to safely care for the community.
RaRMS CEO, Mr Shane Hatton said, “Importantly, RaRMS’ Remote GP Service model does not replace local service providers but supports them and all relevant stakeholders. In the case of Condobolin, this model was implemented at short notice, to overcome an immediate GP workforce shortage, and once the workforce levels improved, face-to-face medical services within the nursing home resumed. Telehealth is certainly not new, but unfortunately it has had limited application in keeping nursing home residents out of hospital up until this point due to a lack of funding. Thankfully, an anonymous donor came forward in Condobolin and provided the modest amount of funding necessary to make this possible, however it should not be left to donors, or service providers themselves, to cover the costs of these essential services.”
Further, Mr Hatton said, “I would like to acknowledge the amazing work done locally by representatives of RaRMS, Ochre Health, RSL Lifecare and and Timmins Pharmacy to make this possible. It was a true demonstration of what is possible when health service providers come together to solve a common problem. We would be very keen to talk with representatives from the Commonwealth or State health departments about how this model can be scaled up elsewhere, where and when necessary. I would also like to acknowledge that our Remote GP Service has evolved over the past 12-18 months, in part because of the support of the Western NSW Primary Health Network. We hope to work with the Western NSW Primary Health Network in aged-care and after-hours service provision into the future.”
Pharmacist David Rees of and Timmins Pharmacy said “We found the service quite useful and it seemed to work well from our end. It was vital for medication management for residents who required controlled medicines as we have no leeway for 'owing prescriptions' or dispensing from medication charts in this instance”.
It was a win-win situation for all involved, but most importantly the 23 residents who were kept safe out of hospital, even during a time of severe GP shortage.