Quality MMDS has a pool of 100+ Visiting Medical Officers (VMOs) who work across the after-hours period. The majority work part-time, and twelve are full-time. Approximately two-thirds are vocationally registered practitioners who hold FRACGP, the remaining doctors are on their way to Fellowship of the RACGP and working with MMDS under the auspices of the Approved Medical Deputising Service (AMDS) Program, a Commonwealth initiative to increase after-hours workforce and reduce reliance on overseas temporary resident doctors. MMDS is an approved provider under the AMDS Program. As a prerequisite to commencement, clinical personnel must complete a comprehensive induction program (accredited by the RACGP as a Category 1 Active Learning Module). Each of the three medical directors is a Fellow of the RACGP. They are available on-call, contactable by mobile phone as necessary during the after-hours period for Control Room staff and VMOs. The principal medical director manages all clinical governance. The Control Room is staffed by 14 personnel (primarily part-time on rotating rosters) who are trained in customer relations, first aid and triage procedures to a level that ensures patient safety. The Operator’s role is to arrange a home visit or provide appropriate referral information; it is not their role to provide medical advice. Structures for clinical governance and support for consultation in place Large numbers of VMOs have or are working towards vocational registration Structured Induction into afterhours care is likely to improve the quality of care The large number of part time staff may reduce continuity care for patients with complex needs The induction of staff (both clinical and telephone staff) may not be sufficient to deal with particular population groups including those from CALD backgrounds(see earlier comment about knowledge of local services) Comprehensive Care There will be timely and successful referral of all groups to meet their needs through support services and linkages. Health needs of all groups will be adequately addressed either through the scope of direct service provision or timely referral through MMDS Patients with severe mental illness, dementia or drug and alcohol problems may not receive the care they need in a timely way Children from vulnerable and disadvantaged populations may experience delays in urgent treatment although they are at greater risk Monitoring and reporting Ongoing monitoring and reporting Ability to identify if there are systematic differences between identified vulnerable groups and take action to improve access Currently there is little empirical data on access and equity in deputizing services and so inequities are not recognised or addressed
Comprehensive Care Equity issue 12: Timely care. All populations but greater risk for elderly, newly arrived (greater risk of mental illness), those with drug and alcohol problems, and children from vulnerable populations (CALD, low SES, Aboriginal and Torres Strait Islander) at risk of presenting with urgent needs. Recommendation (already in successful EOI): timely and successful referral of all groups to meet their needs through support services and linkages in health needs of all groups will be adequately addressed either through the scope of direct service provision or timely referral through MMDS). Monitoring and evaluation Equity issue 11: IT system. All population groups. One very important strategy for monitoring equity of service provision is collection and reporting routinely of characteristics of service users. This is important for the monitoring distribution of care characteristics such as waiting times, clinical care processed, use of interpreters, providing evidence of any differences in access to services by vulnerable and disadvantaged groups. Recommendation: Ensure IT system developed includes information on age, gender, country of birth, place of residence, time until service provided, address/location, education level, occupational group, employment status, length of time in area, and refugee status.