How GPs can assist with reducing hospital waitlists

Good news: GPs with a special interest (GPSIs) can help reduce public hospital waiting lists and increase our health system’s capacity.

Our recent pilot in Queensland found that the proportion of long waitlists were reduced in 66% of the specialties measured. For example, orthopaedic waitlists dropped by 42% and general surgery by 39%.

Long waits are defined as exceeding the clinically recommended waiting time, ie more than:

  • 30 days for Category 1
  • 90 days for Category 2
  • 365 days for Category 3.

The 24 experienced GPSIs – equivalent to three full-time equivalent (FTE) GPs – were responsible for 5000 extra episodes of care per year.

We found the pilot program improved collaboration and integration between general practice and hospitals by facilitating collegiate contact and inter-professional learning between GPs and specialty teams.

The UK has been experimenting with this model since 2000, defining GPSIs as GPs who continue with their core role, but who develop additional skills and knowledge in specific clinical areas.

In Australia, RACGP Specific Interests now has more than 5000 members and almost 30 individual networks.

So it appears there is no shortage of specific interests.

How did the trial come about?
The Queensland Specialist Outpatient Strategy set aside 361.2 million in 2016 to improve Queensland Health’s specialist outpatient appointments. This included an investment in new models of care.

In 2017, the Queensland Healthcare Improvement Unit selected the Sunshine Coast Hospital and Health Service (SCHHS) as a pilot site.

The GPSIs were recruited on a part-time basis and allocated to 12 specialties within the health service. GPs were required to hold vocational registration with the RACGP or ACRRM and have a minimum of five years general practice experience.

Specialties such as paediatrics and dermatology required GPSIs with additional qualifications, while other specialties provided on-the-job training.

The project was managed by the hospital’s General Practice Liaison Unit (GPLU) – where I and my co-authors, Dr Michelle Johnston and Dr Marlene Pearce work. The hospital’s Executive Director of Medical Services was executive sponsor.

The GPLU was responsible for advertising, promoting and recruiting the GPSI positions.

Role planning, selection and interviews were done collaboratively between the GPLU and the medical directors of each specialty. Consultants provided supervision.

GPSIs worked up to two clinic sessions per week, in addition to their work as community GPs.

Interestingly, discharge rates from GPSI clinics were higher on average than regular outpatient clinics. In combination with GPSI-facilitated follow-up plans for further care by the regular GP, this is an important strategy to reduce waitlists.

Three specialties saw an increase in waitlists, which was attributed to confounding factors such as the loss of consultants and the introduction of the new cervical screening program, which saw a significant increase in demand.

Feedback from GPSIs, consultants and patients demonstrated high levels of satisfaction. Common feedback themes included value gained from bidirectional inter-professional learning and co-design of new discharge planning models.

GPSIs can help build hospital team confidence in primary care handover and identify which patients can be appropriately transferred back to the regular GP, facilitating continuity of care.

Local upskilling opportunities support GPSIs to more confidently manage patients in primary care and may help horizontal referrals between GPs in the future, reducing hospital referrals and demand for specialist outpatient services.

We believe it is vital that GPSIs continue to actively work as community GPs, in order to avoid subspecialising and to improve integration between general practice and hospital care.

It is important to continue to develop and invest in integrated models of care, as they can be part of the solution to the ever-growing demand on Australia’s health services.

This article was originally published in NewsGP.

Why doctors run late

Doctors running late is a common problem. It’s the number-one complaint on the Facebook page of our practice.

The other day I read an interesting article about the waiting time at the doctor’s. The author wrote:

What other profession keeps you waiting an hour for a scheduled appointment. Working in newspapers I have lined up hundreds of interviews and never ran that late.

I can understand her frustration but don’t know how to fix it! This is why I am often running late:

  • People have difficult, e.g. emotional issues that take more time than expected
  • A patient presents with a problem that requires urgent extra treatment like a biopsy, sutures, ECG
  • Elderly people may need more time than the appointment time they booked. For example, it does take a while before my 89-year old patient is on the examination couch
  • Patients sometimes have a list of important problems they need to discuss
  • I am waiting for the Medicare script authority hotline while my patients are waiting for me.
  • I am getting flooded with requests for reports, workers compensation forms, centre link documents, certificates, insurance requests, closing the gap documents, travel cost reimbursement documents, DVA websterpack authority requests etc
  • Some days can be hectic with phone calls from hospitals, pharmacies, community nurses, faxes with urgent requests for information, reports and scripts. And occasionally I am called away for emergencies.

Getting back to the article. The author also said:

I know they are dealing with health issues which can mean life and death, but surely they could make the appointments a bit of a closer fit with the reality.

Some of my patients always need a double appointment and we’ve agreed that our receptionists give them that extra time when they ring up. But this may also more expensive, so most people would naturally try to fit as much as possible in a single appointment.

If we would give everybody a long appointment, we could only see half of our patients, which would increase the waiting time for an appointment. This would also reduce the practice revenue, which would mean that we can’t employ enough valuable nurses and receptionists, which would further increase the waiting times and decrease the quality of the service we can offer.

Occasionally, when the nature of a health problem allows it, I might say something along these lines: “I’m very sorry Mrs Jones, but we’ve talked for almost 20 minutes now and there are other patients waiting. I know it is important and I would like to ask you to book another appointment so I have enough time to help you.”

Not always easy to say, but sometimes it’s necessary and most people understand. A few get cranky with me, especially if they’ve had to wait for half an hour.