After Hours Doctor GP Assist (Tasmania) Dr John Davis & Dr David Law

1. After Hours Doctor GP Assist (Tasmania) Dr John Davis & Dr David Law

2. Essentially Private Fee For Service • ‘GP Contract’ After Hours • Value of After Hours ‘Call Back’A$80 = £33 • Public ED Free • Problems:- Workforce- Remuneration- Morale • After Hours Typically Solo, Small Co-op, MedicalDeputising Service, Nothing! Australia In General Practice

3. Established 1986 • MDS, Serving Urban Population c180,000 • 80% of GPs Opt-In • Home Visits = 12,000 • Clinic Consults = 15,000 • Public EDs = 17,000 • Problem With The Service, All Requests For Home Visits Lead To A Home Visit After Hours Doctor - Original

4. 1999 – Extension To All Of Southern Tasmania • One of Five AHPMC Trials (under DoHA funding) • Addition of - GP Based Telephone Advice - Extension to Rural Areas • Population = c250,000, 80% of GPs • Home Visits = 600 • Clinic = 15,000 • Triage = 10,000 • - 55% Advice, 1% Ambulance Service After Hours Doctor - New

5. Reduction in Rural GP Phone Calls After Hours by 80% • High Satisfaction GPs & Patients • No Adverse Impact ED or Ambulance Service After Hours Doctor - New

6. Extension of Telephone Advice State-wide • Population 460,000 • 1st December 2003 • Rural Workforce Support - Recruitment - Retention GP Assist (Tasmania)

7. RNs Front-line • Utilising Clinical Solutions Teleguide Algorithms • 2 years of Research to Select Product • Product Well Referenced • Excellent Value For Money • Supportive and Responsive Company GP Assist (Tasmania)

8. An Example of Sequence of Call to Response • Patient – Own GP – GP Assist (Tasmania)- RN (Teleguides): Advice Triage GP - Advice - Local GP • RN/Paramedic – GP Assist (Tasmania) – RN (Demographics Only) - Triage GP - Advice - Local GP • No ‘Interference’ In Rural GP Face to Face Care • Introducing ‘Dispatch’ Capability via SMS, VPN (Thin Client Model) • Notes on all patients to principal GP By Next Morning GP Assist (Tasmania)

9. A LOCAL SOLUTION BASED ON: • Demand Management Rather Than Open Access • Integrated Face To Face GP Care • Well Located Clinic, Rather Than Co-located • Local GP Remains In Control • Which has Retained and Recruited GPs To Rural Areas • And is Supported By All GP Groups • And Delivers Timely and Effective Patient Care GP Assist (Tasmania)

10. FUTURE • Aged Care • Ambulance Service • ED • District Nursing Service • Pharmacy • Is the Government brave enough to continue Funding? GP Assist (Tasmania)