After-hours primary care, after years in the wilderness, is now a hot topic of conversation.
Concerns have been raised from the RACGP and GPs as to whether all of the players in the crowded after-hours market are true deputising services for daytime GPs or they’re simply running their own race.
Medical Forum spoke to Ben Keneally, the CEO of National Home Doctors Service, a newish player in the WA market, and president of the peak body, National Association for Medical Deputising (NAMDS), who was visiting Perth last month, about some of these concerns. The message was clear. After 20 years of a poor performing and in some instances non-existent after hours’ service, which saw a flood of non-acute presentations at hospital EDs, there was traction at last for these consumers to return to where they belonged – the primary care sector.
Ben said the Medicare statistics showed the greatest growth (in numerical terms) in after-hours’ services were in consulting rooms (items 5020, 5040) than home visits (items 597, 599) though there had been increases in those as well.
“What we’re seeing is the success of government policy,” he said. “But to speak to those GP concerns, the total number of after-hours home visits represents less than two visits per GP per week. In the 1950s when GPs were responsible for their own homes visits, they would have done at least that number of home visits. Yes, there has been growth, but it’s been off an extremely low base.”
“However, there is a distinction between those organisations that genuinely behave in support of general practice and those that have set up with no connection to general practice at all.”
“At National Home Doctor Service, and for NAMDS members generally we ,are very strict about collecting GP details from 90% of callers, which reflects the proportion of people who don’t have a regular GP. So we report back to the GP; we don’t provide referrals; and we don’t get involved in check-ups. There is a clear and detailed triage protocol to preclude routine work. Though there are websites that promote referrals after hours and that is clearly inappropriate and shouldn’t be happening.”
The RACGP is waiting and watching.
Continuity of care
Ben argued that after hours’ deputising, if done properly, provided that strongest continuity of care but if it came to be relied upon as an alternative to seeing a daytime doctor then that was a problem.
“A well-run deputising service doesn’t allow that to happen. Every month we review different time frames to see if patients have been presenting too frequently, in which case we will be in touch with them and their GP around appropriate restrictions because we don’t want to become an alternative to their regular GP.”
In response to the College’s criticism about services advertising, Ben said deputising services had to raise awareness.
“We’ve tried the RACGP’s preferred model – consumers finding out about a service out through their GP – and it didn’t work. In order to provide universal access we need to make people aware.”