Cental Goldfields - Grampians Medicare Local

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Pathology Services There is one pathology provider based at MDHS which operates Monday to Friday 8am to 5pm and Saturday 8.30am to 12 midday. After Hours Health Care Maryborough District Health Service (MDHS) Urgent Care Centre (UCC) This is a 24 hour centre staffed by Registered Nurses with medical care attended to by the local GPs on an on-call after hours roster. Residents presenting to the UCC are bulk billed. MDHS UCC reports an after hours throughput of 7000 patients per annum (average 136 patients per week). This figure does not include the number of residents who bypass the UCC to attend care at other health services. Ballarat is the closest regional city centre to Maryborough. Ballarat Health Services (BHS) Emergency Department (ED) reports that in 2010-11 over 120 ATS Category 4 & 5 (non-urgent) presentations in the after hours period to Ballarat Heath Services ED were from Maryborough. (6) We are unable to ascertain if this has been on referral from a Maryborough GP or from the Urgent Care Centre in Maryborough, or through self-referral/presentation. The trend for presentations to BHS ED for all hours is quite steady which probably reflects the difficulty the local community has with accessing a GP during the day. On 12 July 2012, representatives from Westvic After Hours Service (WAHS) met with Maryborough District Health Service staff and doctors to discuss some of the issues around the high demand for after hours services in Maryborough. The key issues identified at this meeting included: high number of phone calls direct to the UCC nursing staff (no IVR or receptionist after hours) no fee for service after hours at UCC encourages walk-ins (appointments at General Practices are not bulk billed) no appointments available during the day with popular GPs, but patients can get seen by these doctors when they are on-call some people do not get out of bed until later in the day “nice doctors” – do not like to refuse to see people presenting to the UCC if they are already there number of calls received by the GP after hours directly relates to the nursing staff competency – which can vary on call doctors only want one person contacting them after hours (eg getting a call at 1 a.m. that someone is going to go to the hospital but then the person does not present until several hours later results in a broader period of broken sleep for the GP than warranted). The efficiency and effectiveness of care at the UCC, combined with the no fee-for-service model continues to make the MDHS UCC an attractive after hours option to seek health care. In the community survey, eighteen people reported the time it took to be seen by a health professional at the UCC. Most had a first assessment attended to in a very short time frame (less than one hour). Only one person reported waiting more than two hours to be seen by a doctor. Sixty three percent of respondents were bulk billed, with no out-of-pocket expenses. Out-of-pocket expenses were usually for additional services such as pathology and radiology. Page | 8
One UCC staff member reported that when popular GPs are on-call, and these are usually the GPs that are not taking new patients or have a 3 week wait for an appointment in business hours, the “word” spreads quickly in the community resulting in a higher number of walk-ins. There is no doubt that the access block to Maryborough GPs is a significant influence on presentations to the UCC. There is also a tendency for people to use MDHS UCC as a default pharmacy supplier. The UCC is trying to discourage this practice, requesting GPs provide starter packs of medication, and sending patients with prescriptions to late opening pharmacies in Ballarat. In an attempt to control presentations, the UCC has tried directing patients to return at a single time to be seen by the GP at a “mini-clinic”. On several occasions this has not worked due to emergency presentations – which have resulted in a waiting room full of people unable to be seen by the on-call GP for many hours. One GP interviewed, who has been providing after hours services for decades, has observed that nursing staff are becoming reluctant to do the face to face assessment and management of people presenting to the UCC without calling the GP. He believed that this was less about competency, but more about nurses being constrained by risk-averse policy. Another GP thought that better training in initial patient assessment and a review of hospital policy regarding GP call-outs would be helpful. Advanced nurse practitioners in the UCC could also reduce GP workloads. Dunolly Urgent Care Centre Dunolly UCC is a 24 hour service attached to the Dunolly campus of MDHS. It’s operation is maintained by ward staff and a solo GP. The population of Dunolly is generally managed by the solo GP and he will answer calls 24/7. Due to his intimate knowledge of the Dunolly population there is limited demand for after hours services, as most queries are managed by phone. Acutely unwell residents are generally transferred directly to Bendigo. Most of the activity in the Dunolly UCC is non-urgent care, as it functions as a default outpatients department. District Nursing/Palliative Care Nursing Registered clients can contact the nurse and access a home visit up until 8pm on weeknights, and up to 6pm on weekends. The Hospital Admission Risk Program (HARP) and palliative care services both provide detailed home care plans. Westvic After Hours Service (WAHS) is promoted as the first contact point for advice, although it is known that the community preference is still to present at the MDHS UCC. Palliative care patients are more likely to get a home visit by a GP at the end-of-life stage, if the patient has expressed a wish to die at home. General Practice All GPs working in Maryborough are on the after hours roster. CMC and NC share the on-call after hours roster that provides service to their own patients, walk-in presentations to MDHS UCC and also to the Residential Aged Care Facilities (RACF). Dunolly Medical Practice will take calls from patients in the after hours period, but rarely provide face to face after hours services. These patients are referred to other centres, such as Maryborough, Ballarat, Castlemaine or Bendigo. There is also a collaborative agreement in Maryborough to run weekend clinics that operate on Saturday from 9am to 12 midday and Sundays and Public Holidays from 10am to 11am Whichever practice is oncall opens the clinic during these hours, which is staffed by a nurse and a receptionist. These clinics do not have appointments, but operate on a walk-in basis. Attendance at these clinics attracts the usual Page | 9
Page 1 and 2: Contents Acronyms: ................
Page 3 and 4: Community Overview Central Goldfiel
Page 5 and 6: Transport Bus services connect betw
Page 7: Clarendon Medical Centre (CMC) Staf
Page 11 and 12: Residential Aged Care Facilities (R
Page 13 and 14: In the community survey there was s
Page 15 and 16: 25% Call % by Day and Time 20% 15%
Page 17 and 18: Seven of these did not go on to see
Page 19: Works Cited 1. Community Indicators

Cental Goldfields - Grampians Medicare Local

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