The Times They Are A-Changin’

Posted by Dr Campbell Brebner, Chief Medical Advisor – Primary & Integrated Care on 18 June 2014 |

Tags: ,

campbell brebner 426

I have been working in healthcare for over 30 years and during that time I have seen the demand for health services grow, the health system become more fragmented and complex, and an increased focus on specialised care. These challenges are being felt across our entire health sector.

While our hospital struggles with increasing demand, particularly in the winter months, our GPs are also feeling the strain with more complex patients coming through their doors. All of these patients require greater clinician effort, increased health resources and family and community support. With numbers rising, it’s not surprising that many fear it is an unmanageable situation and in desperation, often the only realistic course of action for a GP is to refer these patients to hospital to get the support they need.

Making things more complicated and frustrating are the barriers to sharing information between secondary, primary and community care. For example, a GP who orders blood tests for a patient may be unaware tests have already been taken due to the patient’s unexpected trip into hospital. This disconnect makes it harder to provide timely, responsive and consistent care to our patients.

This has been one of the main catalysts for Project SWIFT, which came about because clinicians wanted to bridge the gap between how information is shared between secondary and primary care. At the moment we have many different information systems, which are used by our hospital, GP and community teams. The problem is they are all sitting in different places and don’t join up. But a central integrated space, or ‘integration engine’, would enable health professionals, whether in the hospital or out in the community, to tap into and pull out relevant and important information about their patients.

We already have this system operating within our hospital with Middlemore Central – what we now need is a ‘Community Central’. So for example when Sapele, a known at risk individual, passes out at work and turns up at Emergency Care, a General Practice or A&M, doctors can pull up his record and more importantly can trigger off a response based upon a previous care plan. Patients and their families could also use this integration engine to access information about their care.

It’s an exciting prospect but Project SWIFT is more than linking up information systems with better technology. Project SWIFT is also about looking at transforming care across the system and that takes a new way of thinking.

Over the past 30 years the concentration of health resources has been predominantly directed into specialty services. Now imagine if these same resources were invested in services provided closer to the home. From this ‘Healthcare Home’, patients and their families would receive a range of healthcare services, some specialty in nature led by the GP and delivered by a multi-disciplinary team based in the community where people live.

Supported by new models of care the Healthcare Home is an exciting opportunity to redesign how we provide care for our community. It’s especially exciting for our GPs and community health teams who are already working in this space and who can play a vital part in reshaping how these services are delivered.

There is a much quoted saying that “the healthcare system we have is perfectly designed to deliver the results it gets”. So if we want better results we must design a better system. General Practice has always been an integral component of the healthcare system and GPs need to get in the game if we want to remain so.

Over the coming weeks Project SWIFT will be identifying what our current problems and challenges are in our day-to-day work, and how we would like things to look in the future, along with the solutions we would put in place. At the end of the programme (22 August), we hope to develop a 4 year programme of initiatives, supported by business cases. To have your say, click here to be directed to an online tool where you can leave your comments about the challenges you are facing.

Campbell Brebner, Chief Medical Advisor – Primary & Integrated Care