A new system is being trialled whereby patients call their GP to be assessed before making a visit to the clinic. (Photo: Getty Images)

GP visits change under money-saving model

News
Health

Author: Natalie Akoorie, NZ Herald,
Publish Date: Sat, 5 May 2018, 8:47AM

A dramatic shake-up in the way patients visit their GP could spell the end of long waits and short consultations, as well as wasted healthcare.

And the new way of delivering GP visits has the potential to reduce hospital care by hundreds of millions of dollars each year, a new report shows.

The Health Care Home model, in 128 general practices across the country, is helping keep urgent care needs out of crowded hospital emergency departments.

Initially controversial, the model allows patients to speak by phone first to their doctor, on appropriate care - from advice, prescriptions, same-day appointments, specialist referrals and lab tests - all before the patient leaves their home.

GPs are being freed up to deal with complex and chronic cases as well as creating longer appointment slots and time for paperwork to keep doctors from burning out.

One GP, who has written an open letter to hundreds of his colleagues, said his practice would "never go back".

According to an evaluation of the model by EY (Ernst and Young), patients in practices operating Health Care Home [HCH], have significantly increased access to a GP and better long-term health plans.

The analysis found:

• 14 per cent less patients presented at ED, including 24 per cent less Maori and 32 per cent less pensioners.

• 62 per cent of same-day appointment requests managed without need for a GP visit that day.

• Fewer referrals to specialists.

• 20 per cent of patients were less likely to attend a hospital with an avoidable health issue.

The model was developed by Pinnacle Midlands Health Network when, in 2008, the organisation that represents 400 GP practices began a planned response to growing demands, changing populations and workforce expectations.

John Macaskill-Smith, chief executive of Midland region subsidiary Ventures, said in a normal GP practice a patient often rang and couldn't get through. When they finally did appointments were already taken for that day.

But HCH, first introduced to some Pinnacle practices in 2011, is making a dent in that scenario because of its focus on valuing the time of patients and clinicians, Macaskill-Smith said.

EY compared 83,000 patients in 14 Pinnacle HCH practices with the same number from non-HCH practices, finding a significant proportion of acute need was being prevented or successfully met.

If the model was in 75 per cent of Pinnacle practices instead of nine and with similar results, it could equate to a reduction of $25 million of hospital care per year, Macaskill-Smith said.

Dr Brendon Eade, a GP owner at Health Te Aroha Medical Centre where HCH began in 2013, said in the past there was mixed support and the model was controversial among GPs.

"But the benefits to practices, patients and the broader system are really clear. Initial concerns over the expense of the model and the loss of the 'consultation' have simply not been borne out," Eade said.

"I feel like I'm doing good quality consultations where previously I was doing rushed, rapid consultations ... because of the stress of the system."

Patient Eileen Joyce said to be able to talk to a triage nurse and get advice from her doctor on the phone was "very convenient" because it saved her a GP visit, and money and time in the process.

Ministry of Health service commissioning deputy director Keriana Brooking said the ministry supported work in the sector to improve primary care models, and HCH was an example of that.

A collaborative working group around the project, involving the Royal New Zealand College of General Practitioners, primary care representatives, DHBs, and the ministry, had been under way for three years.

"In its very formative stages, a limited amount of funding was provided as part of the Midland Better Sooner More Convenient business case, which was underpinned by Health Care Home," Brooking said.

"We are in regular communication with Pinnacle and it's pleasing to us that over time they have come to a position where they can put forward such positive evidence."

Pinnacle would now ask all district health boards, the Health Minister and the Ministry of Health to support adoption of the model on a larger scale.

Waikato DHB interim chief executive Derek Wright said the DHB was already partially funding HCH and he was waiting with interest for the EY results.

A formal presentation of findings was due to take place next month.