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The connection between GPs and hospitals can be fraught. Dr Edwin Kruys describes a Queensland system he believes is making a difference.
According to Dr Edwin Kruys, when primary care and hospitals work together, they ‘can achieve great things’.
Dr Edwin Kruys is acutely aware of the challenges when navigating between primary care and the hospital system.
The Sunshine Coast GP, who is a member of the RACGP Expert Committee – Funding and Health System Reform, is one of the co-authors of an article published this week in Insight+ about the way GP liaison officers (GPLOs) work in his home state of Queensland.
‘A challenge we all come across regularly is the lack of formalised partnerships across the traditional boundaries of our health system,’ Dr Kruys told newsGP.
‘I believe that, when given the opportunity, Primary Health Networks [PHNs] and hospitals can achieve great things together – but we need a better mechanism to encourage this.’
As it stands, he says there is tension built into the system due to activity-based funding incentivising hospitals, and Medicare’s fee-for-service model which he says ‘makes general practice run harder and harder’.
‘We don’t often have the opportunity to sit down together, reflect and co-design a system that works better for all parties,’ he said.
He adds, however, that COVID-19 ‘has changed the landscape’, bringing more goodwill and impetus for state and Commonwealth entities to work together.
According to Dr Kruys, the GPLOs and their work with Queensland General Practice Liaison (QGPL) network – an organisation he co-chairs – is helping to address the gaps.
Formed around 15 years ago, the QGPL is funded by Clinical Excellence Queensland (part of Queensland Health), with the Country to Coast Queensland PHN coordinating the network since 2019.
During that time, Dr Kruys says there have been numerous systemic improvements, such as the ‘same day discharge summary policy’ now in place in Sunshine Coast public hospitals.
It means patients must leave the hospital with a paper clinical handover document for the GP, while an electronic version is also sent to the general practice on the day of discharge.
He also highlights work at the Sunshine Coast hospital where he works, with a GPs with Special Interest (GPSI) program bringing around 25 ‘amazing, experienced community GPs’ to work a few shifts each week in outpatient clinics.
It is a model he says has been adopted in many hospitals both in the state and beyond.
‘I think it’s great seeing generalists in hospitals again,’ Dr Kruys said.
‘Our local experience is that the model is well received by GPs, hospital clinicians and patients, it adds to the job satisfaction of GPSIs and improves their skillset, but also has a significant positive impact on outpatient waitlists, improving hospital access for patients.’
Other initiatives supported by GPLOs, and described in Insight+, include health assessment templates for children in out-of-home care, support for the virtual knowledge sharing model Project ECHO, and the development of shared COVID-19 response.
Dr Kruys says the QGPL Network is designed to back up the work of the liaison officers, who are often members of hospital and PHN committees tasked with quality improvement or governance for transfer of care, and communicating safety or collaborative care initiatives.
‘As GPLOs are small cogwheels in the hospital system it is important they get this support through QGPL,’ he said.
‘The network also provides higher level expert direction and advice on strategic matters relating to the interface between general practice and hospital care.’
Dr Kruys stresses that the GPLOs are not lobbyists for either general practice or the hospitals.
‘The challenge [they] have is to find solutions that work for all parties and the wider health system, not in the least our patients,’ he said.
‘I have a slide I often show in presentations to explain my role … [of] a person standing in a somewhat uncomfortable split; in the case of the GPLO that is one foot in general practice and one foot in the hospital system.
‘GPLOs need to be able to manage complex system challenges, tolerate slow change processes, as well as emotional responses and feedback from stakeholders.
‘Clinicians and non-clinicians in different areas of the health system are not always happy with the level of communication, clinical handover or collaboration.’
With what he describes as the ‘siloed decision-making’ and complex healthcare in Australia, Dr Kruys says GPLOs are in an ideal position to raise systemic issues and bring about change – and he advises GPs to connect and develop a relationship with their local GPLO.
‘They are heavily relying on feedback they receive from GPs and other clinicians,’ he said.
‘Make sure you and/or your practice manager provides them with lots of examples and opportunities for improvement.
‘Working with big hospitals can be frustrating, but the best feedback contains facts and is formulated in a respectful and professional way.
’It is this kind of feedback from GPs I find most useful as I can take it to various meetings and decision makers within the hospital system.’
Dr Kruys also suggests that if GPs find there is no liaison officer in their area, they may wish to raise the matter with hospital or PHN executives.
The model he is involved with in Queensland, he believes, may be relevant further afield.
‘Feedback from colleagues in other states seems to indicate that a similar network would be useful to support, develop and align GPLO models, acknowledging that it is not a “one-size-fits all” and should be designed to accommodate local circumstances,’ he said.
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GP Liaison Officer GPLO PHN Queensland Health
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