By Dr Jeannie Knapp, based on the RACGP Standards for general practices (5th edition).
Criterion GP1.3 – Care outside of normal opening hours
GP1.3 A Our patients are informed about how they can access after-hours care.
GP1.3 B Our patients can access after-hours care.
Did you know?
- Analysis of the Victorian Emergency Minimum Dataset identified that the age group with the highest proportion of primary care-type visits to the ED between 2002-2013 was 0–4 year-olds.
- Between 2014 and 2016, in the North Western Melbourne Primary Health Network (NWMPHN) area, 250,673 people were triaged as categories 4 and 5 (semi-urgent and non-urgent ED attendances). Patients in the 0–4 and 25–29 age groups were highest represented.
- Seeking care at an after-hours GP clinic costs the system an average of $93, compared to $368 for people presenting at an emergency department. This cost balloons to $1351 if the patient arrives by ambulance.
- Connecting people with appropriate after-hours health care services may help to reduce pressure on hospital emergency departments and provide care closer to home.
What is meant by ‘primary care-type’ emergency presentation?
There are several methods used to estimate the number of primary care-type patients who present to emergency departments. The Australian Institute of Health and Welfare considers a primary care-type patient to be any patient allocated an Australasian Triage Scale (ATS) category 4 or 5, who does not arrive by ambulance, police or correctional vehicle, and is not admitted to hospital, is not referred to another hospital and does not die.
Why is this an issue?
Many parents or caregivers may not be aware of after-hours services provided by their GP and instead present to hospital with their child. Connecting people with appropriate after-hours care may help to reduce pressure on hospital emergency departments.
How does this link with accreditation?
Patients value an ongoing relationship with a practice or GP who provides medical care on a 24-hour basis. Research indicates that patients who have better access to their practice during after-hours periods make significantly fewer emergency department visits. If your practice is not able to provide after-hours care, you need to have arrangements in place so that other services can manage your patients’ needs during these times.
How can I meet these Indicators?
The RACGP Standards for general practices (5th edition) states that you must inform your patients of your after-hours arrangements and your patients must be able to access after-hours care.
Informing patients of your after-hours arrangements
Your practice must inform patients of your normal opening hours and the arrangements for care outside of normal opening hours. To do this, use one or more of the following:
- An out-of-hours message on your practice’s telephone.
- Relevant information on your website and in your practice’s collateral, including leaflets, newsletters and an information pack for new patients.
- A clearly visible sign outside of the practice that indicates your normal opening hours and the arrangements for care outside of those hours.
Ensuring access to after-hours care for your patients
For your patients to be able to access care after-hours, your practice could deliver after hours care directly, either during sociable after-hours or for the full after-hours period (view after-hours periods here).
If your practice cannot provide after-hours care to its patients directly, you could participate in a cooperative arrangement with another practice to deliver after-hours care during sociable or unsociable hours.
After-hours care may also be performed on behalf of your practice; however, there must be a direct and continuing relationship between your practice’s GPs and the clinicians who perform the after-hours care on their behalf. This could be done by having:
- Formal arrangements in place with other providers, such as a medical deputising service, to deliver after-hours care.
- An agreement with local health care providers that operate outside of your normal opening hours. If your practice uses other services to provide care, you must agree on and document:
- Details of the arrangements.
- How and when you receive documentation and information about care provided to your patients outside of normal opening hours.
- How the providers of after-hours care can contact the practice in an emergency or under exceptional circumstances.
Regardless of how your practice ensures patients can access care outside of normal opening hours, your patient health records must contain reports or notes of after-hours care that is provided by, or on behalf of, your practice.
Where can I get more information?
In the NWMPHN area there are a number of after-hours options available for patients:
The RACGP’s Supporting continuity and access: A guide to establishing an agreement between your general practice and an after-hours service provider is designed to assist general practices when entering into formal agreement with an after-hours service provider. It includes:
- a checklist that can assist in guiding a conversation between a practice and an after-hours service provider when developing an agreement
- an example agreement that could be adapted by a practice when appointing an after-hours service as its provider of after-hours medical services.
RACGP Standards for after-hours and medical deputising services – to support after-hours and medical deputising services in identifying and addressing any gaps in their systems and processes.
MBS Online – guidance about the new and revised MBS items for urgent after-hours attendances that were introduced on 1 March 2018.
Promoting your after hours service
NWMPHN promotes healthdirect.gov.au as an easy way for patients to find services in their area. Make sure that you add or update your practice’s details on the National Health Service Directory.
Disclaimer: This article was provided by Dr Jeannie Knapp. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.