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Aims: The objective of the inaugural 2-year GP Liaison program in Central Australia is to improve transitions for patients between GPs and hospitals through improving referral processes, discharge communications, relationship building, and promotion of NT Health Pathways to support coordinated care.
Context: The Central Australian Regional Health Service, the Remote Health and Primary Care branch of Northern Territory Health, and the Northern Territory Primary Health Network designed, in partnership, a General Practice Liaison service for Central Australia from October 2024.
Rural and remote settings commonly describe communication issues arising from geographic distance, limited workforce and infrastructure resources, and complex coordination of care across primary and tertiary settings. Despite this, GP Liaison programs are often concentrated in metropolitan areas.
A GP Liaison program started in Top End Health Service approximately 18 months before commencing in Central Australia, and the success of this service model provided the basis for expansion.
Intervention: We undertook a needs analysis for the primary and secondary care sectors in Alice Springs, consisting of all parts of the primary care sector (NTG Remote, Central Australian Aboriginal Congress Urban and Remote, private and Medicare GP practices, and NGOs) and secondary/tertiary care sector (Emergency, Outpatients, Allied Health, and Inpatient services at Alice Springs Hospital).
Interventions by the GPLO in ASH included:
1. Single point of escalation for bidirectional communication, which often served as entry and awareness for the new program;
2. Advocacy for and input from primary care to multiple stakeholder engagements, as invitee and standing member of digital health, community interest groups, hospital education, and tertiary care committees;
3. Promotion of NT Health Pathways for GPs and GP Registrars and strengthening of the HP platform by leveraging relationships with Subject Matter Experts;
4. Early development and identification of shared care pathways appropriate to the local context.
Evaluation: Several key patient care outcomes for GPs and hospitalists, such as wait times for initial and review specialist outpatient appointments, are multifactorial. Thus, the outcome measures chosen for the impact of the GPL program included:
1. quarterly engagement metrics from the GPL in coordination with NT PHN, response to the GPL Survey undertaken by NT PHN annually in November, Health Pathway engagement metrics from NT PHN, and engagement rates from GPL communications such as the GPL Bulletin and NT PHN eNews;
2. Resolution rates from communication escalations;
3. Deferred referral rates calculated manually.
Findings: We identified several insights into service gaps. These included:
1. Discharge summary rate and quality for inpatients contain significant variability, highlighting the opportunity for both technological enabling and culture change;
2. Optimisation of referrals so patients are ready for care at initial appointment for outpatient specialists, with similar opportunities.
The program identified several barriers to improvement in service gaps, namely, workforce challenges and delays in digital health platforms.
Findings are expected for the 12-month interim report in November, 2025.
Conclusions: A GPL program in Central Australia provides the opportunity to improve the integration of primary and tertiary care with downstream improvements for patient care. These are like improvements in the plumbing of communication: removing barriers, filing in the cracks, and advocating and creating larger pipelines. |
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