Recommendation 11 MDSs play a critical role in after hours care. However, the rapid increase in deputising service utilisation of MBS items raises questions around the appropriateness of a purely fee-for-service funding model for the sector. Funding for MDSs should be considered to strike a better balance between infrastructure and activity based funding for a sector with unpredictable and uneven service demand. MDSs are accredited deputising services and access to after hours should happen via a patient’s regular general practice, rather than through direct marketing. Recommendation 12 The After Hours GP Helpline (AHGPH) was incepted to relieve after hours pressure on regional and rural General Practitioners (GPs) and support GP continuity of care. However there is limited evidence that this has occurred. Direct Commonwealth funding to the AHGPH should not continue in its current form beyond the completion of the 30 June 2015 contract, with funding reallocated to support innovative after hours services delivery locally. A need to relieve pressure on GPs in regional and areas and improve the continuity of care after hours remains a priority. Therefore population based after hours planning should identify the need for GP phone support, best linkages and application. Innovation funding for this purpose should be available for PHNs that submit appropriate applications, endorsed by local stakeholders. Recommendation 13 Many stakeholders identified after hours care as only one component of high quality comprehensive general practice care. Other elements included in hours service flexibility, eHealth excellence, comprehensive chronic disease management and effective integration of care. This Review recommends the further development of the PIP to recognise and reward the practice infrastructure required to deliver to Australians high quality comprehensive primary care. This should be progressed by the PIPAG. Executive Summary Attachment A
Recommendation 6 Residential aged care after hours service needs and provision are complex, with a high and increasing service utilisation, particularly from MDSs. This Review recommends the Department of Health engage with key clinicians from primary and acute care, residential aged care organisations, MDSs and other relevant stakeholders to identify innovative solutions, applicable locally and consider an appropriate role for PHNs. Recommendation 7 Palliative care similarly involves a complex interplay between patients, carers, families and service providers both in and out of hours. Palliative care should be a special focus for local service planning. Recommendation 8 Consumers are frequently unaware of the many after hours support options available to them. A clearly articulated pathway for consumers to access high quality after hours advice and support should be developed. This should identify the many support modalities available (quality self-help sites, after hours support via the family general practice, after hours cooperatives, MDSs, ambulance services and emergency departments) and indicate those most appropriate for the care required. This pathway should be provided to PHNs for local customisation and broad community dissemination. Recommendation 9 MDS accreditation should include a requirement for deputising services and others providing after hours care outside the practice to return clinical summaries within 24 hours to the patient’s regular practice. Recommendation 10 As state funded after hours support plays an important role in rural and remote settings, after hours service planning should be integrated as part of PHN/LHN local service delivery mapping. States and territories vary widely in rural after hours models of care. Best practice approaches should be identified at state level and discussed with a view to broader implementation via the National Rural Health Standing Committee or the Council of Australian Governments’ (COAG) Health Council. Recommendation 11 MDSs play a critical role in after hours care. However, the rapid increase in deputising service utilisation of MBS items raises questions around the appropriateness of a purely fee-for-service funding model for the sector. Funding for MDSs should be considered to strike a better balance between infrastructure and activity based funding for a sector with unpredictable and uneven service demand.