Engaging General Practitioners

1. Module 5.4 Engaging General Practitioners Rome wasn’t built in a day!

2. Presentation purpose Target audience • Health professionals and project workers on DPMI projects Aim • To aid in engaging General Practitioners (GPs) Objectives • Provide an overview of the issues in engaging GPS • Discuss the importance of engaging GPs • Discuss the barriers and facilitators in engagement • Discuss projects successful in engaging GPs

3. 25-30+ patients 16 telephone calls (colleagues and patients) 1 pharmaceutical rep visit Staff meeting (over lunch) Meeting with practice nurse ( 4 patients) ~ 37 pieces of mail including pathology/radiological reports, specialist letters, patient correspondence, drug / commercial companies +++, fax from division of general practice, administrative related information Issues with administration discussions with practice manager x 2 A typical GPs day

4. Why are GPs so important? • GPs play a central role in primary health • GPs undertake more than 20 million consults per year in Victoria • 80% of consumers see their GP at least once per year • Almost half the people with diabetes identified GP as main source of information compared to 10% for DNE or dietitian (DAWN Study)

5. Why are GPs so important? • GPs have greater access to patients to support planned care (DCCT, UKPDS) • The provision of care in accordance with an explicit plan by multidisciplinary teams • Systematic assessment • Regularly scheduled follow ups • Attention to the self-management needs of the consumer.

6. A common challenge – Diabetes & Primary Care • GPs reluctant to pursue aggressive case finding • Not using registers for IGT or GDM • Low use of systemised recalls • Lacking interest in systems management

7. A common challenge • “GP recruitment proved to be very difficult” (WA) • “On the negative side the project failed to engage GPs” (SA) • “GP engagement proved to be the most difficult, time consuming and expensive element to the project. Despite following many of the evidence based initiatives for engaging GPs this did not translate into referrals to the program." (VIC)

8. Culturally and structurally separate from other providers due to practice organisation and funding Many competing initiatives for GPs time and attention Lack of GP numbers and large, unpredictable workloads Unwilling to engage with short term initiatives GPs lack of understanding about benefits of multidisciplinary care and knowledge of community programs Concern about reduction in GPs role Perceptions around interventions required by consumers and certain diseases “There are complex bureaucratic requirements for EPC items” “In my day GPs used to do all this stuff” Barriers to GP engagement

9. There are success stories! • The Goodlife Club and SE Diabetes IDM project both very successful in engaging GPs • Coordinated from GP Divisions • Linked to GP funding initiatives • Providing a service GPs value - Diabetes Education • Minimal change to current practice • Broadmeadows Diabetes Service

10. What do GPs want? • Improved outcomes for consumers • Maintained or increased income • Reduced workload and/ or complexities • Raft L, Crookes P, Fletcher A. Engaging GPs through educational outreach: A model to promote change in cervical screening practice. Illawarra Division of General Practice

11. Encouraging GP engagement Relationships • Relationships with Divisions of GP (DGP) and individual GPs • Partnerships with DGP and individual role model GPs • Systematic representation of GPs in planning, implementation and evaluation • Delivering or coordinating program through DGP or GP practices with staff known to GPs • Consider agency wide approach • Target small number initially and build • Consider the role of practice staff in engaging GPs and program process Programs • Target programs to priority areas e.g. diabetes or areas that GPs don’t feel confident or have to capacity to deal with • Qualitative research into GP needs

12. Systems Building on processes, systems and programs known to GPs : “Not another pilot” Linking with Commonwealth Initiatives eg MBS Practice Incentives, EPC items. audits Utilise clear and simple referral pathways with feedback builtinto service coordination Use inbuilt systems to help referral (e.g. electronic, practice processes) Encouraging GP engagement

13. Encouraging GP engagement Communication • Resources and education around best practice and programs (1:1 most successful) • Clearly stated benefits to GP (time, process, income, consumers) • One clear message (call to action) and make point of difference clear • Investigate systems for reminders or to seek referral • Personal communication preferable (e.g. book consumer appointment time) • High frequency communication reaching GPs through multiple communication channels eg personal, GPD fax, practice staff, consumers, letters, CME sessions,

14. “Focusing on the barriers is as important as ticking off on the enablers”

15. It takes time and persistence “You need to tell me at least 20 times before I remember or will think about it..” General Practitioner - Ivanhoe

16. “It takes time, commitment and trust to reap the benefits of successful collaboration and its development typically involves a series of stages, building on the many local achievements that have occurred to date across Victoria” (DHS. A Guide to General Practice Engagement In Primary Care Partnerships. 2001)

17. For more information • Enhanced Primary Care http://www.health.gov.au/epc • General Practice Divisions Victoria www.gpdv.com.au • Department of Human Services, 2001, A Guide to General Practice Engagement in Primary Care Partnerships , Department of Human Services, Melbourne on http://hnb.dhs.vic.gov.au/rrhacs/phkb/phkb.nsf