After Hours Care without Tears
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- Category: NRGPN News
- Published on Thursday, 17 January 2013 07:25
- Written by David Guest
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"On 1 July 2013, Medicare Locals will administer additional after hours funding to further improve access to after hours care, ensuring that communities across their region have suitable after hours services in place." Thus DoHA handed Medicare Locals the poisoned chalice.
You have to feel sorry for MeL. She's on a hiding to nothing.
The Feds have reduced the available funds. (They use the word "additional" in a new and innovative way.) The PIP money remains the same but the After Hours Grants have been withdrawn. For practices providing face to face after hours consultations this is a material loss. However, there's not much PIP money to start with. Even when you provide all after hours care yourself the funding only equates to about a $100 per day for a typical practice. You'd be better off staying half a hour later and seeing one or two more patients.
Disenfranchised general practitioners may feel resentment toward the Feds for removal of the AH PIP funds. The focus for this resentment may well fall on the MeLs since they are the ones now responsible for distributing the money at a local level. The fact that the MeLs may be able to make more efficient use of the money may make not sway you, if "you're as mad as hell and ain't going to take it any more".
Many may still choose to provide an after hours telephone service for their own patients. They know their patients' problems. They know their local environment. A quick word with Betty and an agreement to see her at 9 am the next morning may save a ride in an ambulance, 12 hours in the ED and $3000 in State Health expenses. And it was so good of you to do it for free.
The After Hours Helpline is the alternative. A fully manned call centre, staffed by trained nurses and doctors, who are both awake and properly paid, is a model that appears to work in several European countries. It has been chosen as one component of the solution to After Hours care by the Feds and MeL is duty bound to support it. It works for emergency services, the taxis and Dominos so it should work for patient care. Unfortunately the HelplIne doesn't know Betty and they don't really know your area. This may improve a bit with time, experience and possibly the PCEHR.
The Helpline has been criticised for not reducing attendances at Accident and Emergency. This, however, is not its function. It is there to give advice and if that results in more after hours attendances at hospitals or other medical services that could be appropriate. It may prove to be useful to patients in the city where there are other options to after hours hospital attendance such as late night clinics and medical deputising services.
Practices are currently funded for PIPs on their practice size. The unit of measure is the SWaPiE. This fractional patient is composed of the sum of her parts, or at least her rolling attendances over a 12 month period ending 3 months prior to the reference period. She is also weighted for her sex and age. An 80 year old woman being 4 times bigger than a 17 year old boy. She is also a little bigger in the country but we are indifferent to her socio-economic status. How much she needs after hours care is undefined and hence not calculated.
So, back to MeL. She's doing her best. On the North Coast she would like to recognise the cost to local GPs in providing after hours telephone advice. Using some of the limited PIP money as an on call payment for telephone advice for your own patients looks like a good investment. It would be even better, If this could tie in with a "social hours" (6-9 p.m. weekdays and week-ends) after hours medical service. Ideally, running this as a co-operative in or near the larger hospitals would take the pressure off Accident and Emergency services. For this they would be most grateful. This gratitude would have to be demonstrated by payment, either directly or in kind.
There's a lot of work to do and not much time to do it. The deadline for the new arrangements is June 30, 2013 and it is important we get at least temporary arrangements in place by then. The alternative for your patients is not good. A dead line on July 1 could be potentially fatal.
