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GP Collaboration Unit

Program Overview and Rationale

The Central Coast GP Collaboration Unit is a unique service bridging the barriers between General Practice and the Central Coast sector of Northern Sydney Central Coast Area Health Service. It is jointly funded and supported through a MOU by both the Central Coast Division of General Practice (CCDGP) and Central Coast Health Services (CCHS). The consultancy and advice provided to the Area Health Service ranges from fundamental approaches that improve processes and mechanisms to address communication and continuity of care, development of shared models of care through to input that influences policy and planning. The GP Collaboration Unit also has a significant function of informing and updating General Practice regarding changes within the Area Health Service. It also receives and investigates complaints from General Practice. The particular focus for the Unit is the efficient utilization of resources, reduction of duplication and ensuring that new and existing programs within the Area Health Service are practical and accessible to primary care.

The Aim of the GP Collaboration Unit is

§To improve patient care on the Central Coast by providing a focal point of contact for collaboration/integration issues and activities between Central Coast Health Services (CCHS) sector of NSCCH, Central Coast Division of General Practice and local general practitioners.

The Goals of the GP Collaboration Unit are

1. To promote communication on all levels between CCHS, CCDGP and General Practice

2. Assist in the establishment of collaborative models of care between General Practice and CCHS

3. Facilitate partnership, collaboration and systems of integration between CCHS and CCDGP

4. Contribute to CCHS and CCDGP strategic planning and policy development

The Unit is staffed by a part-time GP Consultant and a part-time Program Manager.

To view the structure and reporting responsibilities for the GP Collaboration Unit please click on GP Collab Graph

Duration of Program and how it Operates

The GP Collaboration Unit is well established and has been in operation since 2000.

Keys Areas for Action

Since its inception the GP Collaboration Unit has been involved in many collaborative activities including addressing communication issues, promoting and expanding existing models of care, developing new models of shared care, assisting others to undertake collaborative activities and participating in health planning. Some of these projects as well as current activities are outlined below.

Communication

· GP Database - provides regular updated GP contact details for CCHS.

· Collaboration Unit Website - provides a summary of collaborative project information to NSCCH via the NSCCH Intranet.

Secure Messaging –involved in the Secure Messaging Pilot held in 2003. The pilot was designed to provide timely and secure electronic messaging from both CCHS and specialists to GPs. The pilot has since finished and a number of General Practices now receive status reports from CCHS regarding patient admission and discharge. Current activity in this area relates to the establishment of secure messaging infrastructure within all CC General Practices. The GP Collaboration Unit is also working with IT within CCHS to develop useful templates for use in electronic discharge summaries. The Unit also is advocating for clinical support to enhance the production and dissemination of clinically useful electronic discharge summaries to GPs for all patients.
Regular communication and updates – assists and facilitates the distribution of updates and relevant information from CCHS services to GPs and General Practice through articles in the CCDGP weekly fax out, Coast GP and Nursing Matters Newsletters.

Facilitate Collaborative Shared Models of care

Chronic & Complex Disease Program –involved in the Redesign of Chronic and Complex Care services within CCHS. The Unit is working closely with the newly developed Ongoing and Complex Care team to develop and implement GP friendly practice, communication and linkages. Support is also offered to the new roles of Complex Care Coordinators to provide these positions with the skills and confidence to work in partnership with General Practice.
APAC/GP Shared Care –involved in the development of the APAC (Acute Post Acute Care) GP Shared Care model. In this model of care the GP maintains medical responsibility while the APAC service provides nursing and allied health to the patient in their residential setting, eliminating the need for admission to hospital. This model has been very successful and is being rolled out in other sectors of NSCCH. The GP Collaboration Unit maintains an advisory role to this service advocating for enhancement of services that can be provided.
Ycentral (youth mental health) –involved in the development of ycentral, a mental health service for young people. This has included the establishment of primary health clinics including both GP and nurse led services.
GP/Mental Health Working Group –support and advise the collaborative partnership between CCHS Mental Health Services and CCDGP. This partnership is responsible for developing programs and supporting GPs to deliver high quality mental health treatment and support through education, referral and shared care.
Alcohol & Other Drugs GP Services –supports the Alcohol and Other Drugs Service to work effectively with GPs in developing sound systems to enhance communication, co-management and appropriate referral of patients with drug and alcohol problems. The GP Service also provides education, specialist advice, support and consultation for GPs, providing a Drug & Alcohol Local Consultancy Service to GPs and Pharmacists.

Supporting others to undertake collaborative activities

· GP Consultancy - able to provide CCHS services a GP perspective. This assists in the modification of existing services and the development of new services that are GP friendly and aware and therefore have the best likelihood of success either of engaging GPs or being adopted within the General Practice setting. The long history of the Unit means that it has a well developed knowledge of what is effective.

· GPLO Network – provide support and mentoring to GP Liaison positions within the Area Health Service and CCDGP. A network is established and meets regularly.

· Annual Conference – convened their first annual conference, “The Enigma of Working with GPs” in 2008, in association with the GPLO Network. The conference will become a regular annual event and has the aim of increasing knowledge and confidence both within AHS and General Practice of how to work collaboratively.

· Evaluation of Collaborative Activities – able to provide advice and support to evaluate the effectiveness of ongoing collaborative activities eg in 2008 the Unit conducted a survey of GPs regarding the Antenatal Shared Care program

· Delivery of Education to GPs and Practice Staff – support and advise services within CCHS to develop education opportunities that are timely and relevant to General Practice

Contribute to Health Service Planning

Health Service Planning identified for GP Collaboration Unit to participate in effectively include:

CCHS Executive meetings, including Primary and Community Care Division and Rehabilitation and Aged Care Division
CCH Services A&OD GP Team
CCDGP/CCHS Mental Health Steering Committee
CCDGP/CCHS Mental Health GPLO Steering Committee
CCHS Chronic and Complex Care Committee
CCDGP Chronic Disease Management Advisory Committee
APAC GP Shared Care Advisory Committee
Ycentral Primary Health Clinics Steering Committee
Participation in invited Planning Activities both within AHS and CCDGP

The Central Coast GP Collaboration Committee oversees the direction/management of the GP Collaboration Unit. The Committee reports to the Central Coast Joint Executive. Membership of the GP Collaboration Committee includes;

CEO, CCDGP
General Manager, CCHS
Area Director, Public Health Unit, NSCCH
General Manager, CCDGP
Manager Primary and Community Care and Allied Health, CCHS
GP Consultant, GP Collaboration Unit
Program Manager, GP Collaboration Unit
Managers of relevant programs within CCDGP as required
Managers of relevant programs within CCHS as required

How the Program benefits GPs and their Patients

The work undertaken by the GP Collaboration Unit benefits GPs and their patients in the following ways;

1. Smoother patient journey – addressing issues that impede continuum of care, patient is not inconvenienced by spending longer in the hospital than is necessary

2. Improved patient safety – establishing processes and mechanisms for exchange of critical health information

3. Increased efficiency – improved communication decreases duplication of tests

4. Best practice delivered consistently – sharing of knowledge and information works towards best practice delivered in both AHS and General Practice settings leading to optimal patient care

5. Efficient usage of resources – programs and models developed that are GP friendly ie take into account the needs of and resources in General Practice and are therefore more likely to succeed

Current level of Program Participation / Utilisation

The Central Coast GP Collaboration Unit has an excellent track record of achievements and continues to negotiate for improvement in collaboration and integration. The Unit also works opportunistically to enhance linkages between the AHS and General Practice.

Co-ordination of the Program

Dr Rachel Sheather-Reid Dr Lyndon Bauer

Program Manager, GP Collaboration Unit GP Consultant
Ph: 4320 3046 Mobile: 0434 011 551 Ph: 0409 034 559

Fax: 4320 2562 Email:lyndon@healthpromotion.com.au
Email: rsheather-reid@nsccahs.health.nsw.gov.au