Criterion GP2.1 – Continuous and comprehensive care

        1. Criterion GP2.1 – Continuous and comprehensive care

Indicator


GP2.1 A Our patients can request their preferred practitioner.

GP2.1 B Our health service provides continuity of care.

GP2.1 C Our health service provides comprehensive care.

Why this is important

Continuity of care

Continuity of care is when a patient experiences a series of discrete healthcare events as coherent, connected and consistent with their medical needs and personal circumstances. Continuity of care is distinguished from other attributes of care because of two key characteristics: it refers to care that takes place over time and focuses on individual patients.

When patients visit the same GP over a period of time, they develop a patient–practitioner relationship, which has been shown to reduce visits to emergency departments and preventable hospital admissions.3

Research shows that continuity of care:

  • contributes to an overall lowering of healthcare costs, increased patient satisfaction and greater efficiency in investigating health problems4
  • supports the provision of quality patient care5
  • reduces the use of emergency departments and preventable hospital admissions.6,7 There are three types of continuity of care:
  • Informational continuity – the flow of information from one healthcare event/consultation to others, particularly via documentation, handovers and reviews of notes from previous consultations
  • Management continuity – the consistency of care provided by multiple people involved in a patient’s care
  • Relational continuity – the sense of connection between the patient and their doctor8

Comprehensive care

Comprehensive care is an important part of quality healthcare.

Communities benefit considerably from having local general practices that offer a range of health and medical services, including aged care, preventive care, palliative care, immunisation, women’s health, men’s health, children’s health, after-hours services, home care and hospital-in-the-home.

If patients are able to access a comprehensive range of services from a primary health provider in their community, it reduces demand for more complex and expensive services in the secondary and tertiary health sectors.7

The provision of comprehensive care is particularly important in rural, remote and socially disadvantaged areas, where patients may have reduced access to other healthcare services.

Meeting this Criterion

Continuity of care in your practice

Your practice could have a system that enables patients to see the practitioner of their choice, even if you do not have a formal written appointment system. This could be a note in the patient’s health record indicating which practitioner they saw the last time they attended the practice, or whom they prefer to see.

If a patient’s preference is unable to be met, inform the patient and explain why their preference cannot be met on this occasion.

If you are providing services to Aboriginal and Torres Strait Islander patients, continuity of care may involve more health professionals, such as Aboriginal and Torres Strait Islander health workers/ practitioners and nurses.

Maintain patient health records that show:

  • how long a patient has been attending the practice
  • the management planning, preventive health interventions and referrals made for a patient
  • evidence of care provided by other healthcare professionals for long-term patients, especially those with complex or chronic health problems.

When a practitioner leaves your practice, it is courtesy to notify that practitioner’s usual patients and, if appropriate, tell them how they can access their health information if required.

Comprehensive care

Provide comprehensive care for your patients, including:

  • care for infants, children and older people
  • chronic disease management
  • infectious disease management
  • mental health care
  • travel medicine
  • preventive healthcare
  • advance care planning and end-of-life care
  • arrangements with other health professionals such as general practice nurses, mental health nurses, allied health professionals, and Aboriginal and Torres Strait Islander health workers and practitioners.

Meeting each Indicator

GP2.1 A Our patients can request their preferred practitioner.

You must:

  • have processes so patients can see their preferred practitioner when possible and when appropriate, taking into account the medical urgency of the issue
  • have a system that aims to accommodate a patient’s choice of practitioner and appointment time.

You could:

  • document in the patient’s health record when ongoing care has been provided by a particular practitioner, where possible
  • display notices in the waiting room notifying patients that a practitioner is on leave and the date they are due to return
  • display a notice in the waiting room or on your website if a practitioner leaves the practice
  • demonstrate how patients can book an appointment with their preferred GP via your practice’s online booking system
  • have a policy to ask patients which practitioner they would like the appointment with.

GP2.1 B Our health service provides continuity of care.

You must:

  • demonstrate that the practice provides continuity of care
  • use a clinical handover system when clinicians are away
  • have a process for recall.

You could:

  • document management plans in patient health records, especially for patients with complex or chronic health problems
  • have a policy and procedure for follow-up systems
  • generate reports that demonstrate continuity of care (eg you could use your practice data to demonstrate this).

GP2.1 C Our health service provides comprehensive care

You must:

  • demonstrate that the practice provides comprehensive care
  • demonstrate that your practice team is trained to attend to the needs of your patient population.

You could:

  • provide a list of services offered by the practice
  • generate reports on the proportion of patients who had a preventive practice provided in the past year (this could include a health assessment, vaccination, cervical screen or completed cycle of care)
  • have a policy and procedure for follow-up systems
  • conduct regular reviews of patients’ health assessments.