Primary Health Networks Core Funding Primary Health Networks After Hours Funding Activity Work Plan 2016-2018 Annual Plan 2016-2018 Western Victoria Primary Health Network When submitting this Activity Work Plan 2016-2018 to the Department of Health, the PHN must ensure that all internal clearances have been obtained and has been endorsed by the CEO. The Activity Work Plan must be lodged to your Grant Officer via email to VicTasPHN@health.gov.au on or before 6 May 2016. 1
1. (a) Strategic Vision Vision: Quality and Accessible Primary Health Care for Western Victoria. Governance Arrangements: Good governance of the commissioning process will ensure that public money is spent in an efficient and effective way and that Western Victoria PHN is held accountable for the decisions made and the impact on our local health population. We understand that governance for a commissioning organisation requires a structure which recognises the importance of delivering clinically safe and effective services and which holds service providers accountable for the way in which services are delivered on behalf of the organisation. Western Victoria PHN is underpinned by a governance structure which successfully enables commissioning as a series of interrelated organisational processes and which supports cross organisational decision making and support. The governance framework incorporates: Committee structures with the necessary clinical expertise and decision making authority. Business planning in line with our commissioning intentions and strategic plan. Procedural guidance for staff. A mechanism to provide the most stable financial solutions to commissioning requirements that align with our performance management objectives. 2
A risk management approach to ensure that risks associated with commissioning activity are documented and managed as part of the overarching organisational risk management framework. A quality management system to ensure commissioning activities are developed, delivered and monitored in a clinically safe and appropriate manner. Contract and performance reporting and evaluation. Conflicts of interest management, probity, transparency and fair handling of our procurement and tendering processes. Flexibility to adapt to changing commissioning responsibilities and environment. 3
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1. (b) Planned activities funded by the flexible funding stream under the Schedule Primary Health Networks Core Funding Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Communication and Service Coordination DIGITAL HEALTH F1 This activity will focus on three core activities: My Health Record Secure Messaging Telehealth This activity will provide Digital Health assistance and support for Healthcare Providers to increase their capacity and ability to contribute to the My Health Record by uploading Shared Health Summaries. This will involve training and information sessions as well as providing technical support to General Practices in particular. The Digital Health team will aim to support all General Practices in all components included in the Digital Health PIP. Secure Messaging has continued to broaden as uptake across the region, increases. The WVPHN is working very closely with two major secure messaging vendors ReferralNET and Argus and we envisage that we will be able to offer a secure messaging solution to all healthcare providers throughout the region as time progresses. This involves a high degree of relationship development with hospitals, general practice, private allied health and medical specialist private rooms. 5
Collaboration Indigenous Specific Duration Coverage Commissioning approach Performance Indicator Local Performance Indicator target Progress will be made in broadening the use of secure messaging systems and implementing strategies to enable GPs to send electronic referrals rather than just receive patient information. Telehealth will be supported throughout the region with the Western Victoria PHN supporting the use of the Health Direct platform. Through our collaboration with hospital and cancer networks in the region, It is envisaged that General Practitioners will attend Multidisciplinary meetings in cancer services via the Health Direct platform. Opportunities for increasing access to health care services for rural patients who attend bush nursing centres. No Local Hospital Networks General Practice Medical Specialists Allied Health Bush Nursing Centres 1 July 2016 30 June 2017 Entire PHN region except for cancer service multidisciplinary meetings which will be in the Barwon South West region of Western Victoria only. This activity will be directly delivered by Western Victoria PHN. General Practices compliant with the digital health incentive requirements Utilisation of secure messaging Utilisation of telehealth in rural areas Utilisation of telehealth for cancer multidisciplinary meetings Pre and post evaluation will be determined in consultation with the Digital Health team and Clinical Councils. 70% of General Practices in the PHN region to be compliant with the digital health incentive requirements. 6
70% of General Practices in the PHN region are using secure messaging Three Bush Nursing Centres are using Telehealth to other health care providers All relevant cancer multidisciplinary team meetings in the Barwon South West will provide the ability for GPs to attend via Telehealth. Data source Medicare Australia Secure Messaging Software Providers Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Communication and Service Coordination HEALTHPATHWAYS F2 HealthPathways is a web-based information portal that provides condition specific information on assessment, management and local referral options for general practitioners and other primary health care providers to use at the point of care. HealthPathways is both a process and an outcome. Workgroups consisting of general practitioners, specialists and other key stakeholders identify system issues and prioritise HealthPathway development. The improved communication and collaboration between primary and secondary healthcare providers is a major part of the program s success. HealthPathways provides locally agreed condition-based guidelines, with detailed information on local services and how to access them as well as information for patients, reference material and educational resources. HealthPathways is dynamic with new pathways constantly under development and existing pathways regularly reviewed HealthPathways aims to utilise and maximise primary care capacity and capability to ensure patients are treated within the community setting where possible. HealthPathways aims to build a stronger primary care sector through improving communication between all health care providers, supporting and empowering general practitioners and ultimately delivering quality care to our community via a systems approach. 7
Collaboration Indigenous Specific HealthPathways aims to improve the coordination of patient care and ensure a smooth transition for patients between appropriate levels of care providers. HealthPathways supports the strategy of the right care, by the right clinician at the right time. HealthPathways uses a systems approach to address issues such as appropriateness of referral, completeness of pre-referral work-up and accuracy of referral information and ultimately delivers consistent quality care to individuals and the community while maximising primary care provider s time and skills. HealthPathways provide primary care practitioners with the information when needed in an easily accessible form. Systematising consistency of care for patients with chronic diseases and ensuring duplication and repeat tests are avoided provides patients at risk of chronic disease or with chronic disease with more effective and efficient care. 2015-16 funding allocation provided the delivery of the Healthpathways initiative in the Barwon region whilst we undertook engagement and establishment activities with the Grampians and Great South Coast Region in relation to governance arrangements, financial agreements and implementation planning. 2016-17 funding allocation includes the delivery of the initiative in Barwon, Grampians and Great south Coast parts of the region. General Practitioners Specialists Allied Health Barwon Health South West Healthcare Ballarat Health Service Duration July 1 2016 30 June 2017 Coverage Commissioning approach No Entire Western Victoria PHN Region Performance Indicator Number of clinical pathways developed The HealthPathways initiative will be directly by delivered Western Victoria PHN in collaboration with health providers and local hospital networks. 8
Local Performance Indicator target Number of resource and referral pages developed Number of unique users Number of page views of website Number of page views per pathway Number of GPs and specialists participating in workgroups Evaluation of GP workgroup members satisfaction with process Survey of GP satisfaction with program 70 clinical pathways developed 30 resource and referral pages developed 170 new unique users 3000 page views per month 40 GPs and specialists participating in workgroups 50% of survey respondents using health pathways over ten times in 12 month period 60% of respondents identify improved knowledge of local services 60% of respondents identify improved confidence in managing clinical conditions Data source HealthPathways HealthPathways Google Analytics Survey and attendance records 9
Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Collaboration Indigenous Specific National KPI IMMUNISATION F3 This activity will seek to maintain and/or improve immunisation coverage rates across the Western Victoria PHN region for both children and adults. Activities include: Annual immunisation update for Health Professionals delivering immunisation services across the PHN. Maintain quarterly Barwon Immunisation Reference Group and scope potential to extend across the PHN (Representation from Department of Health, Local Councils, Hospitals, General Practice) Maintain immunisation general practice support across the PHN including updates, ongoing education and support. Education of immunisation providers regarding changes to immunisation requirements for access to Centrelink benefits under the no jab no pay Federal legislation and access to childcare and kindergarten under the no jab no play Victorian legislation. No General Practice Local Government State Government Local Hospital Networks Duration 1 July 2016 30 June 2017 Coverage Commissioning approach Performance Indicator Entire Western Victoria PHN Region This activity will be contracted to Warrnambool City Council. Immunisation rates children aged 12-15 months Immunisation rates children aged 24-27 months Immunisation rates children aged 60-63 months Adolescent immunisation coverage rates including school HPV and DTP vaccination Immunisation coverage rates for Zoster vaccine for 70 years old (commences Nov 2016) 10
Local Performance Indicator target Data source National Immunisation program influenza vaccine coverage rate 95% of relevant population cohort as set by the Federal Government Australian Immunisation Register Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Collaboration Indigenous Specific Workforce HEALTH WORKFORCE F4 The specific issues identified in the needs assessment include the maldistribution of GPs, dentists and specialists in a range of disciplines outside urban areas and the ageing workforce, and difficulty in attracting and retaining health professionals. This activity is designed to develop a report containing a region wide workforce analysis of the identified issues and including proposed models to address these. This activity will involve a coordinated and collaborative approach with the broad range of stakeholders involved in workforce activities with the region. The focus of the models proposed will demonstrate the capacity to maintain and build a workforce that is efficient, effective and sustainable and has an emphasis on equity rather equality. GPs and other healthcare providers DHHS Clinical Training Network and Health Workforce Universities and other Clinical Placement and Education Providers Rural Workforce Agency Victoria (RWAV) Murray City Country Coast (MCCC) Local Hospital Discipline specific organisations eg National Prescriber Service (NPS), Australian Primary Care Nurses Association (APNA), Rural Doctors Association, Pharmacy ACCHOs No 11
Duration 1 July 2016 to 30 June 2017 Coverage Entire Western Victoria PHN Region Commissioning approach A select approach to market will be undertaken to deliver this activity. Performance Indicator Completion of Health Workforce Report Local Performance Indicator target N/A Department of Health District of Workforce Shortage data AIHW National Health Workforce Data Set National Health Services Directly (NHSD) WVPHN Services and Provider Data Data source Victorian Department of Health and Human Services Victoria s Health Workforce Knowledge Bank Stakeholder consultation Western Victoria PHN Needs Assessment. 12
Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Chronic Conditions RURAL ALLIED HEALTH F5 This activity provides access to allied health practitioners in rural areas. It will be continued for a further 12 months to ensure service continuity for patients whilst we transition this funding allocation into the commissioning process and develop place based needs assessments and models of care. The following services will be contracted: Ballan District Health and Care Beaufort and Skipton Health Service East Grampians Health Service Edenhope and District Memorial Hospital Hepburn Health Service Maryborough District Health Service Rural Northwest Health Stawell Regional Health West Wimmera Health Service Wimmera Hearing Society Colac Area Health Otway Health Lorne Community Hospital Cameron Watson Physiotherapy Cobden District Health Coleraine Casterton Medical Portland Spinal Sports & Physiotherapy Dhawurd - Wurrung Gunditjmara Aboriginal Co-operative Harrow Bush Nursing Centre Heywood Rural Health Moyne Health Services St John of God 13
Western District Health Service Winda-Mara Aboriginal Corporation Collaboration Rural Local Hospital Networks Indigenous Specific Partially 3 ACCHOS funded under this activity Duration July 1 2016 30 June 2017 Coverage Entire Western Victoria PHN Region Commissioning approach This activity will be contracted to the Rural Health Services listed above. Submission of quarterly reports identifying Number of sessions delivered Performance Indicator Number of locations delivered Service challenges and opportunities Local Performance Indicator target 100% of reports received. Data source Rural Health Services Reporting Pro Forma 14
Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Collaboration Indigenous Specific Duration Jan 2017 June 2018 Coverage Commissioning approach Performance Indicator Local Performance Indicator target Data source Aboriginal and Torres Strait Islander Health / Chronic Conditions INDIGENOUS MOBILE TECHNOLOGIES DIABETES TRIAL F6 This activity will test the efficacy of using mobile technologies to positively impact modifiable health behaviours for Indigenous people with Diabetes. We will undertake a pilot project within defined indigenous communities (ACCHOS) to test this. The focus of this activity will be on one of the following: biomarkers, modifiable health behaviours, preventable hospitalisations. Yes Aboriginal Community Controlled Health Organisations General Practice Entire Western Victoria PHN Region This activity will be commissioned including a select expression of interest process for ACCHOs interested in participating in the trial. A project plan will then be developed accordingly. Pre and post measures of the intervention group (including a control group). Process indicator - demographic information of the cohort. Improved biomedical markers. Pre and post evaluation will be determined in consultation with a subject matter expert (medical advisor) and communicated to the department. Data collection will cover the activity duration period. The commencement date of the data collection will be identified in the project plan The data source will be generated from the study. 15
Proposed Activities Priority Area (e.g. 1, 2, 3) Activity Title / Reference (e.g. NP 1.1) Description of Activity Collaboration Chronic Conditions MULTIDISCIPLINARY CHRONIC DISEASE MODELS OF CARE F7 This activity will focus on the development and implementation of place based models of care in rural areas to manage patients with chronic and complex conditions. The models will be premised on a team based approach to ensure care is coordinated and integrated, and includes the broad range of health and wrap around services required to respond to people with multiple healthcare needs. We will commence codesign by undertaking intensive service and system mapping within the designated regions to identify the interconnectedness between the services and where the localised opportunities for improvement are. This process will be a collaborative and consultative process with local communities in order to ensure the models of care are supported This information will then be synthesised and used to inform the formulation of new models of care that meet PHN objectives, local needs and are within the financial constraints of the activity. An expression of interest process will then be implemented to procure providers to deliver the models. Local Hospital Networks General Practice Allied Health Victorian State Government Local Government Community Health Services Bush Nursing Centres Indigenous Specific Duration No 1 July 2016 30 June 2017 consultation, analysis, design and procurement 1 July 2017 30 June 2018 - Implementation 16
Coverage Commissioning approach Performance Indicator All rural SA3s within the Western Victoria PHN Region This activity will be fully commissioned. Outcome: Development of effective place-based chronic disease models that engage health providers and patients, and are financially sustainable. Local Performance Indicator target Data source Services are mapped for each potential place-based initiative Evidence of consultations with a broad range of stakeholders Evidence of feeding potential options back to the communities Evidence based models finalised Commissioning process undertaken in accordance with organisational framework, policies and procedures. Service maps Notes and attendance records from consultations Literature reviews Written documentation of the model and commissioning specifications. 17
1. Planned core activities funded by the operational funding stream under the Schedule Primary Health Networks Core Funding PHNs must use the table below to outline core activities (excluding administrative and governance related activities) funded under the Operational Funding stream as described in section 1.5.1 of the PHN Grant Programme Guidelines. Note 2: Indicate within the duration section of the table if the activity relates to a two year period (2016-2018) or a one year period (2016-2017). Proposed general practice support activities Activity Title / Reference (e.g. OP 1) Description of Activity GP AND PRIMARY CARE DEVELOPMENT HEALTH CARE HOME - OP1 This activity is focussed on engaging and supporting general practice in the implementation of a health care home and its importance in the delivery of efficient and effective care, particularly for people with chronic and complex health conditions. This activity is premised on the recommendations of the report of the Primary Health Care Advisory Group (December 2015). The recommendations we will emphasise include: Recommendation 1: Better targeting of services for patients with chronic and complex conditions Recommendation 2: Establish Health Care Homes Recommendation 3: Activate patients to be engaged in their care Recommendation 4: Establish effective mechanisms to support flexible team based care Recommendation 5: Enhance regional planning 18
Collaboration Recommendation 12: Support a quality and continually improving primary health care system We will work with general practices to understand the extent and implications of the reform and in particular their role as the central coordinators of a multidisciplinary response to managing patients with complex and chronic disease. The change management process required within general practice to implement this model is significant and will include workforce, structural and business considerations. As a primary health network we have a critical role in influencing general practice to prepare for this reform, however we are cognisant that the uptake will vary depending on the interest, motivation and capability of individual practices and practitioners. GPs General Practice Allied Health Department of Health Education and training providers Duration 1 July 2016 30 June 2018 Coverage Expected Outcome Entire Western Victoria PHN Region Increased awareness of the health care home concept Increased confidence and capability to engage in the reform and implement a health care home Build confidence in the ability of the PHN to support general practice through significant periods of change 19
Proposed general practice support activities Activity Title / Reference (e.g. OP 1) Description of Activity GP AND PRIMARY CARE DEVELOPMENT QUALITY AND SAFETY OP2 This activity will create opportunities to partner with general practice to promote disease prevention and improve health outcomes and reduce preventable hospital admissions. Through supporting the development, implementation or enhancement of existing models of care across the continuum of care to improve the prevention, detection and management of high prevalence chronic conditions. Utilising the Plan, Do Check Act quality cycle within individual Practices and place based approaches. Patient data will be analysed and used to implement quality improvement activities to address identified service gaps and innovation opportunities within General Practice and with key stakeholders as well as PHN processes and activities. This activity will: Identify three priority health issues (where local levels of prevalence and burden of disease are higher than the state average and were identified as a high priority with stakeholders) Identify barriers to integration and develop a long term plan to address barriers with strategic investment Develop benchmarks or targets for quality of care and outcomes for management of patients with chronic diseases Identify and develop cross partner models of care for each of the priority issues Promote practice participation in the Accreditation process. Utilise practice staff peer support forums to provide updates on relevant changes to legislation & practices and participation in quality improvement projects and activities including data capture and management. Collect, collate and analyse data to inform quality and safety activities and to identify emerging areas of need and develop strategies to respond. Influence business practices to enhance patient s access to services and increase practice productivity. This activity comprises staffing resources across our four regional centres in Geelong, Ballarat, Horsham and Warrnambool and essentially includes all elements traditionally provided as practice support but within a quality and safety and continuous quality improvement framework. 20
Collaboration Duration 2016-2018 Coverage Expected Outcome Cross sector knowledge exchange, sharing and communication across the health sector will be proactively fostered to achieve this aim. Western Victoria PHN Community and Clinical Councils General Practice Primary Care Partnerships Peak bodies Disease specific organisations Local Health Networks Allied health clinicians Academic alliances Entire Western Victoria PHN Region Increased patient access to chronic disease prevention and management in primary care Improved integration between primary, community and secondary sectors Enhanced capacity within General Practice and improved access for patients Effective, efficient delivery of primary care services in the region that is modelled on best practice methodology. Access to data at the Practice and PHN level to inform activities and projects to ensure resources are focussed on achieving improved health outcomes for patient s particularly those who are vulnerable. 21
Proposed general practice support activities Activity Title / Reference (e.g. OP 1) Description of Activity GP AND PRIMARY CARE DEVELOPMENT CONTINUING PROFESSIONAL DEVELOPMENT OP3 This activity involves the design and delivery of professional development opportunities to primary health professionals across the Western Victoria region. The CPD program will include a range of activities to meet individual learning needs including practice-based reflective elements, such as clinical audit, as well as participation in activities to enhance knowledge such as courses, conferences and online learning. Western Victoria PHN will make CPD readily accessible and therefore delivery methods will include use of technology to deliver programmes face to face and electronically to remote sites as required. Programmes will be tailored to meet the specific needs of the clinicians throughout the region. Provision of training opportunities for practice management staff and business owners to increase system capacity to ensure practice productivity and financially viability is maintained Develop and facilitate a CPD program of activities that is reflective of the needs of primary health professionals Develop and facilitate the delivery of CPD utilising a range of methods that meet the needs of Primary Health Professionals. Evaluate the provision of CPD to ensure that it is relevant and targeted to the needs of the audience Utilise highly skilled and credentialed providers in the delivery of CPD Ensure the ability of participants to accumulate Continuing Education points for participation in CPD events. Include health literacy for health professionals within CPD activities and provide access to health literacy resources wherever appropriate. Include consideration of needs of vulnerable patient cohorts in the development of presentation materials for example ATSI, CALD and those with limited literacy. Collaboration General Practices Private Allied Health Specialists LHNs 22
Private Businesses RACGP and ACCRM Allied health clinicians Training organisations e.g. MCCC Universities e.g. Deakin University Local Health Networks Primary, secondary & tertiary health organisations Primary Care Partnerships Clinical & Community Councils Duration 2016-2018 Coverage Entire Western Victoria PHN Region Primary health professionals have access to high quality CPD General Practitioners assisted to achieve continuing education points required to maintain registration Primary Health Professionals have improved knowledge of local specialists and specialist programs Primary Care providers aware of HealthPathways and the benefits it provides to their clinical Expected Outcome Practice Improved understanding of systems health literacy and the impact on the primary care sector and patients. Increased awareness of the factors impacting on the health outcomes of vulnerable groups. Proposed general practice support activities Activity Title / Reference (e.g. OP 1) Description of Activity BUILDING CAPACITY IN AGED CARE OP4 The needs assessment identified that access to aged care and home care packages was limited in specific areas of the region. This is of particular concern given a large proportion of the Western Victoria region is aged 65 years or over with this number forecast to increase markedly over the next decade. This activity will: 23
Collaboration Duration 1 July 2016 to 30 June 2018 Coverage Expected Outcome Model the impact of the ageing population on the utilisation of medical and health resources to enable the development of proactive strategies. Connect aged care: build inter-relationships to improve communication between primary, palliative, community, acute and residential aged care service providers. Develop an activity plan to identify strategies to connect and link services with the aim of supporting the aged to live in the community and improving patient outcomes for the aged. General Practice Local Government Community Aged Care Providers (Public and Private) Local Health Networks Residential Aged Care Facilities Specialist Palliative Care Services /Hospice services Entire Western Victoria PHN Region Identification of the needs of the ageing population and the resources needed to meet these needs. Development of evidence based models of service delivery and demand management. More appropriate and timely access for older people to primary health care services, improving health outcomes and reducing avoidable hospital admissions and readmissions 24
2. (a) Strategic Vision for After Hours Funding Vision: Quality and Accessible After Hours Healthcare for Western Victoria. Western Victoria Primary Health Network considers access to primary health care, including after hours, an important element of high quality health care with General Practitioners playing a central role in its delivery. The PHN will work collaboratively with other stakeholders to encourage innovative solutions to support appropriate, timely, available and affordable care arrangements in the after-hours period. 25
3(b) Planned activities funded by the Primary Health Network Schedule for After Hours Funding Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity Access to GP Services (including after-hours period) AFTER HOURS NEEDS ASSESSMENT (URGENT CARE CENTRES & GENERAL PRACTICE) - AH 1.1 Western Victoria PHN has identified that unscheduled service use places significant pressure on urgent care services in the region. The long term capacity and sustainability of on call Visiting Medical Officer (VMO) in urgent call centres is also of concern in the Western Victoria region. There are opportunities to work collaboratively to develop an improved whole of system approach to ensure patients are treated in the right place, at the right time and by the right care team. Western Victoria PHN will undertake a detailed review of current urgent care centre models and identify further opportunities to strengthen regional systems and build on existing innovative emergency care models to meet the needs of rural and urban communities. The after hours needs assessment will leverage the broad scope of the PHN Needs Assessment by focussing on the provision of after hour medical access and services in rural areas of the PHN specifically, access, utilisation, workforce availability, capacity and capability for the delivery of after hours care. Seeking to identify systems enablers and barriers and models and activities that will strengthen the provision of safe efficient after hour care in rural areas of the PHN. 26
Other key areas of focus for this needs assessment will be health inequalities, key demographics and special needs groups within the region. Locations of after-hours services and the communities they service will be mapped. This will include Emergency Departments, urgent care centres, general practices, and the National Home Doctor Service. Available workforce and those currently delivering services will be analysed. The characteristics of general practices and their workforce (e.g. what services/models are being delivered, number of FTE GPs in each region and their distribution by age) GPs will also be considered. Current models and the utilisation of existing after-hours services will be mapped. This exercise will draw upon data from the following sources: MBS, Ambulance Victoria, hospitals, residential aged care facilities, Safety Link, Nurse on Call, Health Direct, PEN CAT Plus, general practices, Doc Geelong utilisation statistics, and medical imaging services. This activity will enable the PHN to identify and address service gaps in the after-hours period and explore the future direction of after-hours care and sustainable service delivery models. The depth of this activity will build on the PHN needs assessment findings rather than duplicate the work already undertaken. Collaboration Subsequent to this needs assessment after-hours models will be reviewed and possible service delivery models shortlisted for implementation in 2017/18. Local Health Networks General Practitioners Clinical and community councils National Home Doctor Service Urgent care centres and health services Nurse on Call After Hours GP Helpline (AHGPH) Health Direct Residential Aged Care Facilities (RACF) Ambulance Victoria Medical imaging services Pharmacies 27
Duration Needs Assessment April - September 2016. Model development September December 2016 Coverage Entire Western Victoria PHN Region Commissioning approach This activity will be directly delivered by Western Victoria PHN. Process Indicator: Issues and options analysis completed Literature review completed Priority setting and validation completed Stakeholder feedback and validation completed Performance Indicator Output indicator: number of possible service delivery models shortlisted Local Performance Indicator target Data source Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Outcome indicator: After hours services mapped across the region Needs assessment robust and reliable Sustainable models for after-hours services identified This activity will be directly delivered by Western Victoria PHN. MBS, Ambulance Victoria, hospitals, residential aged care facilities, Safety Link, Nurse on Call, Health Direct, PEN CAT Plus, and general practices, Doc Geelong utilisation statistics, and medical imaging services. Access to GP Services (including after-hours period) IMPLEMENTATION OF NEEDS ASSESSMENT - AH 1.2 Upon finalising the needs assessment process, and identifying models (specific to urgent care and Description of After Hours Activity general practice in the after hours period) the PHN will seek authorisation to procure services to implement the outcomes of the needs assessment. Collaboration GPs who work in the provision of afterhours care Health services 28
Local health networks RACF s Duration July September 2016 Coverage Entire Western Victoria PHN Region Commissioning approach This activity will be directly delivered by Western Victoria PHN. Outcome indicator Development of models of 24/7 urgent care in rural areas that are not Medical Officer Performance Indicator dependent Development of models of urgent care management across the region Local Performance Indicator target In development Data source This activity will be directly delivered by Western Victoria PHN. Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity Access to GP Services (including after-hours period) COORDINATION - AH 1.3 Western Victoria PHN will continue to fund a dedicated afterhours resource to identify barriers to the provision of and access to after-hours medical services. The position will work in collaboration with key stakeholders to develop and implement solutions. Key activities include: Leading the development and implementation of after-hours strategies, policies and projects. Developing and implementing after-hours communication plans to support specific strategies Develop tools to assess services at risk of reducing or not providing extended or after hours care 29
Working with the Western Victoria PHN population health planning team to contribute after hours information and data to inform the after-hours urgent care needs assessment The activities will focus on sustaining community access to primary care medical services in the afterhours period by creating innovative solutions and models that consider the needs and preferences of the community, general practices, hospitals and ambulance services. GPs who work in the provision of afterhours care Health services Collaboration Local health networks RACF s Duration June 2016 July 2016 Coverage Entire Western Victoria PHN Region Commissioning approach This activity will be directly delivered by Western Victoria PHN. Process indicator Delivery of key activities Stakeholder communication and engagement strategy completed Stakeholder consultation to inform needs assessment completed Monitoring and performance management of after-hours contracts completed. Performance Indicator Output indicator Monthly collated after-hours activity data Quarterly analysis of after hours activity data Translation of after hours data to inform PHN decision making Outcome indicator Completed After hours urgent care needs assessment Well informed and coordinated after hours response for the region 30
Local Performance Indicator target Data source Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity More effective delivery mechanisms to support the delivery of after hours care in the region To be developed N/A Access to GP services (including the after hours period) HEALTH LITERACY - AH 1.4 Evidence suggests that low health literacy and poor community awareness of available GP after hours services are barriers to accessing primary care after hours. Increasing community awareness of the afterhours services available locally has been a strategy of our known gap filling proposal. Poor health literacy in the community is viewed as an after-hours access issue. GPs have commented that in some regions of Western Victoria, some community members have limited knowledge and awareness of available primary care after-hours services and what health issues constitute an emergency. General practitioners triage an increasing number of non-urgent health issues in the after-hours period. Improved health literacy will help patients to avoid having to go to emergency departments or being admitted to hospital for conditions that can be effectively managed outside of hospitals. This activity aims to increase consumer awareness of afterhours primary health care available in their community and improve patient health literacy on the appropriate health services to access in the after-hours period. Promotion of afterhours services is critical in the Western Victoria region due to seasonal fluctuations in demand for GP services located in regional tourist destinations. Objectives: Provide consistent information to the community (both residents and visitors) on accessing urgent health care after hours Promote the use of AHGPH as the first assessment point in the after hours period Promote the National Health Services Directory Promote Western Victoria PHN after hours initiatives such as Doc Geelong and Need a GP Ballarat. 31
Collaboration Duration June 2016 July 2018 Coverage Commissioning approach Communication methods will be tailored to each program and the local context in which they operate to ensure efficiency. This will include: Webpage promotion Brochure distribution Newspaper/magazine advertising Newsletters Continuing professional development activities Meetings Western Victoria PHN Clinical and Community Councils General Practice Entire Western Victoria PHN Region This activity will be directly delivered by Western Victoria PHN Process Indicator: Resources developed that are consumer friendly Audit of practice resources and messaging Record of distribution of resources and number and timing of media promotions. Performance Indicator Output indicator: Measurement of website traffic Number of after hours resources developed Communications plan developed by August 2017 Report on resource distribution completed August 2017 Data collection and assessment of after-hours assessment completed to inform communications strategy Outcome indicator: Increase in calls to AGPH 32
Measures AGPH user statistics Doc Geelong website traffic Targets 5% increase in # of calls to AGPH Local Performance Indicator target Baseline Average number of AGPH calls per month 2015/16: 6 Advertising campaign Publications (Jan 2016) Welcome to Wimmera Horsham region x 2 Out & About Horsham region x 2 The Local Ballarat region x 3 Surf Coast Geelong region x 4 Geelong Advertiser Geelong region x 2 Geelong Echo Geelong region x 4 Data source Internal advertising report AGPH report Google analytics 33
Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity Access to GP services (including the after hours period) INNOVATION FUNDING - AH 1.5 In the 2015/16 financial year Western Victoria PHN committed $393,000 to promote and support innovation in after-hours service delivery. Projects funded under this initiative will continue over 2016/17. The funding enables general practices and health services to trial initiatives designed to support more effective and efficient after hours service delivery. The following services were approved to receive funding: 1. Ballarat Hospice 2. Geelong Hospice 3. Grampians Community Health 4. Maryborough Health Service 5. Rural North West Health 6. Tristar Medical Collaboration Duration June 2016 July 2017 Coverage Commissioning approach Performance Indicator Local Health Networks General Practice Primary health service providers Entire Western Victoria PHN Region This activity has been contracted to health service providers following a competitive expression of interest process. Process Indicator: Contracts in place by May 2016 Output indicator: Number of monthly reports received 34
Number of patient surveys completed Number staff surveys completed Local Performance Indicator target Outcome indicator: Surveys indicate an improvement in Measures Percentage of projects that achieved project objectives Percentage of projects that achieved project outcomes Percentage of projects that stayed within their allocated budget We will work collaboratively with practices and health services to implement, monitor, and evaluate the outcomes of innovations supported under this activity. Innovations piloted under the scheme will be evaluated to ensure the efficacy of the models in achieving the desired outcomes. Targets 70% of projects achieved project objectives. 70% of projects achieved project outcomes. 100% of projects stayed within their allocated budget. Data source Project plans Progress reports Final evaluation reports Monthly surveys 35
Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity Access to GP services (including the after hours period) CRITICAL AREA SUPPORT GRANTS - AH 1.6 In the 2015/16 financial year Western Victoria PHN committed $305,824 to promote and support critical areas in after-hours service delivery. Projects funded under this initiative will continue over 2016/17. This funding specifically acknowledges the diverse and complex after hours needs in the region. The funding and support is tailored to address specific community and general practice needs. If these systemically important practices reduced or terminated existing after-hours services the after hours health inequities faced by these communities would be critical. There would be a likely impact on the survival of some patients and the health outcomes of the community. Practices were funded in areas of need such as remote locations, growth areas, tourist areas, or areas of social disadvantage. Collaboration 1. Apollo Bay 2. Corio Medical Centre 3. Epic Health Medical 4. Lorne General Practice 5. Myers Street Family Practice 6. Port Fairy Medical Clinic Local Health Networks General Practice Primary health service providers Duration July 1 2016 30 June 2017 Coverage Commissioning approach Performance Indicator Entire Western Victoria PHN Region This activity has been contracted to health service providers following a competitive expression of interest process. Process Indicator: Contracts in place by May 2016 36
Output indicator: number of monthly reports received number of patient surveys completed number staff surveys completed Local Performance Indicator target Data source Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) Outcome indicator: Surveys indicate an improvement in Measures Targets Baseline percentage of projects that achieved project objectives percentage of projects that achieved project outcomes percentage of projects that stayed within their allocated budget We will work collaboratively with practices and health services to implement, monitor, and evaluate the outcomes of innovations supported under this activity. 70% of projects achieved project objectives 70% of projects achieved project outcomes 100% of projects stayed within allocated budget No baseline data available. PENCAT Plus data PEN CAT Plus Project plans Progress reports Final evaluation reports Monthly surveys Activities will be measured, analysed and reported on to support continual improvement. Access to GP Services (including after-hours period) 37
After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity Collaboration FOSTERING EXTENDED HOURS - AH 1.7 Duration July 1 2016 30 December 2016 Coverage Commissioning approach In the 2015/16 financial year Western Victoria PHN committed $100,000 to promote and support innovation in after-hours service delivery. Projects funded under this initiative are currently funded until December 2016. It is proposed that services currently funded under this initiative are extended until June 2017 to enable sufficient time to build a sustainable model. This activity specifically encourages GPs to provide extended hours clinics in the RRMA 4 or 5 regions of the Western Victoria PHN. Twelve practices have been engaged through this initiative to sustain and/or increase after-hours service delivery. General practices Entire Western Victoria PHN Region This activity has been contracted to health service providers following a competitive expression of interest process. Process Indicator: Contracts in place with practices by May 2016 Performance Indicator Local Performance Indicator target Output indicator: Number of extended hours provided Number of available appointments Number of used appointments Number of walk ins Number of patients bulk billed Outcome indicator: Increase in number of hours medical services are available in the after hours period Measures Pre- and post- after hours data number of practices providing extended hours Pre- and post- number of low acuity ambulance trips Patient surveys post implementation survey of patients 38
Targets Baseline 70% of practices meet their target number of operating hours in the extended hours period No baseline data available. Data source Fostering extended hours monthly reports Proposed Activities After Hours Priority Area (e.g. 1, 2, 3) After Hours Activity Title / Reference (e.g. AH 1.1) Description of After Hours Activity Access to GP services (including the after-hours period) AH 1.8 PATIENT STREAMING SERVICE (PSS) The Western Victoria PHN baseline needs assessment identified that there is limited access to GP services. GPs report telephone calls as a significant burden after hours, no remuneration for phone calls and report lack of coordination of care and communication as a major frustration when on-call after hours After hours primary health care is a central tenet of a high quality health care system. A key focus of the PHN is to improve the efficacy and efficiency of after-hours primary health care coverage in the region. The PSS is a fully integrated after hours service working collaboratively with the after hours GP helpline, Nurse on Call, Ambulance Victoria, local hospitals and GPs providing after hours services. The aim is to provide local care coordination after professional triage to identify the most appropriate port of call for patients with afterhours urgent care needs. The service is active in the Wimmera Mallee and Ballarat Goldfields region and there may be opportunity to expand the service across other areas of the Western Victoria region as appropriate. This service supports the PHN objectives by ensuring that people are not attending emergency departments or being admitted to hospital for conditions that can be effectively managed outside of hospitals. Objectives: To provide a care coordination service 39
To provide a single entry point for callers and clinical information where those callers have been managed by national or state based telephone advice lines (Nurse On Call, AGPH) To provide a care coordination point for other regional initiatives, such as the Assisted Transport Assistance Scheme (booking service) To reduce after hours demand for GPs through appropriate use of telephone triage services To ensure continuity of care through the provision of clinical information to all relevant healthcare providers Collaboration Duration July 1 2016 30 June 2017 Coverage Commissioning approach Performance Indicator Model to be evaluated by June 2017 to provide evidence of: - service uptake - ongoing support from users - reduction in burden of after-hours telephone calls to GPs - reduction in presentations to emergency departments GPs and practice managers After Hours GP Helpline Local Health Networks Ambulance Victoria Health service urgent care centres Safety Link Consumers Wimmera Mallee and Ballarat Goldfields region Safety Link will continue to be the PSS site for service continuity. Contracting will continue based on a review of the value and effectiveness of the existing contract developed and Safety Link s ability to perform the services required. Safety Link Personal Response Service is a division of Ballarat Health Service Process Indicator: Continued integration with AGPH and PSS Contracts in place Provider engaged for evaluation Output indicator: 40