Review of after-hours service models: learnings for regional, rural and remote communities

Abstract

The Australian Government Department of Health’s 2014 Review of After-hours Primary Health Care (Australian Government Department of Health 2014a) found that after-hours primary health care delivery in Australia is functioning suboptimally. The transition of Medicare Locals (MLs) to Primary Health Networks (PHNs) provides a timely opportunity to re-evaluate and re-orientate after-hours primary care services. All PHNs have been tasked with evaluating their current after-hours service provision and determining the best approach for delivering after-hours primary care to consumers in their region. This Issues Brief, developed by the Northern Queensland Primary Health Network in partnership with Healthy Futures Pty Ltd, the Australian Healthcare and Hospitals Association, evaluates the current delivery models of after-hours primary health care nationally and internationally. In particular, it describes the varied approaches to service delivery. This variation is attributable to a range of factors including funding sources, workforce availability, consumer awareness, distance and remoteness, population structure and local economies. A literature review and a study of current and alternate models of service delivery identified a wide range of service models across Australia, including GP-centred models which utilise practice-based after-hours GP visits, Medical Deputising Services, co-located GP clinics in hospitals, nurse-led telephone triage models, and internet-supported triage models. Each of these approaches has its benefits and limitations. Additional challenges to effective after-hours service delivery were identified in regional, rural and remote areas, including poor transport access, lack of home visiting for some patient groups, poor access to allied services including pharmacy and mental health services, lack of or poor internet access and widespread health care workforce insufficiencies. Delivery models considered relevant to rural and remote Australia are explored to inform PHN decision making for commissioning of services, and ensure the best possible care is provided to consumers during the after-hours period. In order to tailor after-hours services appropriately, each model must be assessed in terms of suitability in the local context. As such, this Issues Brief describes individual program elements and options for innovations in after-hours service delivery which may be adaptable and transferrable across PHNs. Key principles common across the options proposed are: Services are flexible, responsive and tailored to regional circumstance Efficient and effective use is made of the broader health workforce Innovative service delivery is promoted Data is used to inform policy change Communication with patients and providers is key to success. The Issues Brief highlights the limited availability of formal evaluation material in the scientific literature. More work is required to address this evidence gap.