Building Bridges between Primary Care and Hospitals

1. Building Bridges between Primary Care and Hospitals Will Butcher – Vascular Surgeon Gold Coast

2. Gold Coast - Vascular Outpatients

3. Vascular Surgery: Outpatient Practice reform Ensure consultant presence at all lists Quarantine dressings Stop cancelling clinics Get clinics up to realistic numbers (one clinic had only 8 patients for a morning) Start discharging long term reviews Stop reviewing varicose veins

4. Gold Coast - Vascular Outpatients

5. Lessons Consultant engagement is THE key If YOU are not IN clinic chances are not much is happening When you start the process there are often collateral benefits Wound care much better Everybody enjoys the clinic much more Having no waiting list is immensely liberating: Because discharge is suddenly much easier Because if you need to cancel a clinic it is relatively painless

6. Outpatient dashboard

7. Gold Coast Surgical workload • New Appointments 2009: 18000 • New Appointments 2010: 22000 • In 2011: New >25000 • Referrals for 2011 were 31000 • Total Appointments in 2011 over 100000.

8. Gold Coast Surgical outpatient waitlist • New Appointments 2009: 18000 • New Appointments 2010: 22000 • In 2011: New >25000 • Referrals for 2011 were 31000 • Total Appointments in 2011 over 100000.

9. New referrals

10. New referrals THIS IS UNSUSTAINABLE

11. On Bridge Building

13. Make outpatients a better place • 8% of our patients do not attend • Surgeons are more likely to cancel a clinic than an operating session • Last year 6000 referrals did not get seen, saw 70000 reviews • Large waiting lists paralyse the discharge process • We need to increase the perceived value of outpatients • Need to change the way we do business because we can not grow our capacity much more

14. GP Liaison Officer • Facilitate communication with General practice • Deteriorating quality of communication • Loss of contact between GP and Hospital doctors • Meet within hospital community • Engage projects to improve access and information

15. Referral template

16. Categorisation • Single page • Simple criteria • Available to GPs

17. CategorisationVascular Surgery • Cat 1: Large aneurysms (>55mm), Critical ischaemia, Symptomatic Carotid cases, Leg Ulcers • Cat 2: Claudication, Small aneurysms, Asymptomatic Carotid cases • Cat 3: Uncomplicated Varicose Veins

18. Grading • Single page • Simple criteria • Available to GPs

20. Other communication • Uncomfortable up front information about care that is not available • Information about potential care options for GPs wanting to avoid hospital referrals • Strategies available for patients subject to long waiting times

21. GP – Hospital Communication • Projects must be local • Must be substantial buy in from both clinician groups • Both sides must feel supported and empowered

22. The Future- Traffic across the Bridge • Consultants work more in Primary care • GPs work in Hospital practice

23. A Word on Purchasing Intent • Queensland Health decides what healthcare it will purchase from the providers • In time some cases with symptomatic disease will not be offered care • LHHN Board will be heavily involved in this process

24. Local Management • Clinics that are oversubscribed will have to rationalise their business • Only Offer Appointments on the assumption of need for further treatment

25. Who is the gatekeeper GP Hospital clinician Queensland Health

26. We need to work together in achieving this common goal