Medicus April 2016

O P I N I O N

After-hours GP services at home: is the quality high enough?

Dr Tim Koh Chair, RACGP WA

O ne of the more complex and troubling issues for GPs is the recent trend of growth in after-hours home visiting GP providers and services. On face value, increasing home visiting services may be seen as a good sign in the fight to divert patients from hospitals and reduce preventable hospital admissions. As a patient and consumer, it is hard not to notice the large array of providers competing in this market and the prominent advertising of services. Many GPs, however, have raised concerns about poor communication to the usual GP, usage of the home visiting services for convenience rather than emergency and quality of services provided. In order to understand these concerns, it is helpful to understand how and why these services and providers have proliferated. Historically, after-hours GP providers have been operating in metropolitan Perth for several decades, filling the niche of visiting patients in the home because of genuine inability to access help. For GPs working in practices, there has been a relative decline in incentives and remuneration to provide after- hours clinic services as well as an understandable desire from many within the profession to work hours more

conducive to better work-life balance. In addition to this, after-hours service providers are able to render a home visit MBS item that is not linked to consultation time or complexity and is accessible to non-trained junior doctors. This combination of factors has created an environment that has seen a dramatic increase in its usage. Looking beyond the medical drivers for these services, it is also important to understand the patient perspective. Surveys suggest that around 90 per cent of the population have accessed home visiting services. Many patients struggle to access their GP for a variety of reasons including a historical under supply of GPs, limited after-hours practice services and a reluctance to use hospital emergency services. genuine convenience in services such as home visiting, telehealth and video consulting. The latter two are newer services that have emerged in recent years but have not experienced the same growth as home visiting, probably because of the absence of MBS remuneration. With all of these considerations in mind, it is obvious that this is a complex issue. I believe that after-hours service In addition, people are leading increasingly busy lives and see a

It raises a simple question – is it sensible, and a

good use of resources, to expect non GP-trained doctors to provide these services?

providers play an important role for patients and GPs, but I have some reservations about the quality of after- hours services. My personal observations come from my experience as a GP who continues to provide in-hours home visiting services to my patients. Like most GPs, I find home visits technically difficult as they are conducted in an unfamiliar setting in which the capacity to deliver comprehensive care is limited. It raises a simple question – is it sensible, and a good use of resources, to expect non GP-trained doctors to provide these services? Many of the concerns about the quality and value of after-hours home visiting services could be addressed by the simple requirement for service providers to be trained GPs, FRACGP or equivalent, with experience in both in-hours and after-hours care. ■

GOVERNMENT FAILING TO MOVE INTO 21 ST CENTURY Continued from page 40

Dr Steve Wilson

It takes significant resources and organisational development skills to develop infrastructure and operating

processes for new ways of working and governments must change their ways and consult, listen, collaborate

with and support GPs to continue to deliver gold standard care to their communities. ■

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