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Interpretive guide to the RACGP Standards

for Aboriginal community controlled health services

Standard 1.1 Access to care

Our practice provides timely care and advice.

Criterion 1.1.1

Scheduling care in opening hours

Our practice has a flexible system that enables us to accommodate patients’ clinical needs.

Indicators

► A. Our practice can demonstrate that we have a flexible system for determining the order in which patients are seen, to accommodate patients' needs for urgent care, non urgent care, complex care, planned chronic disease management, preventive healthcare and longer consultations.

► B. Our practice can demonstrate how we identify, prioritise and respond to life threatening and urgent medical matters (triage).

Services providing care outside normal opening hours

► C. Our service obtains feedback from practices for which we deputise, about the quality and timeliness of our care for their patients.

Explanation

Key points

  • Practice staff need to be able to quickly and accurately identify patients' needs for urgent care as well as non urgent, complex, planned chronic care and preventive healthcare consultations
  • Administrative staff members of the practice team require appropriate 'triage' training
  • Practices need a responsive system for seeing patients
  • Practices need procedures for administrative and clinical staff outlining:
    • identifying patients with urgent medical matters
    • seeking urgent medical assistance when required
    • managing patients who have urgent medical needs when the practice is operating at full capacity
    • a system for documenting triage responses by administrative staff.

Flexible systems to suit patients and setting

The needs of patients vary widely, as do the settings of general practice, so practices need to have flexible systems that can accommodate urgent, non urgent, complex and planned chronic care, as well as the preventive health needs of patients during normal opening hours. Such systems may focus on determining the order in which patients are seen, rather than an appointment system, in settings such as some Aboriginal medical services and other 'walk in' services.

Practices do not have to have a formal appointment system to meet this criterion if there is adequate communication to patients on anticipated waiting times and if the practice prioritises patients according to the urgency of need.

There are times when patients need urgent access to primary medical care and practices need to have systems that accommodate this. For example, some practices have an appointment system which includes unbooked appointment times for patients with urgent medical needs. Patients also value the opportunity to see a general practitioner within a reasonable time where possible for non urgent and preventive health matters.

Triage

Both administrative staff and members of the clinical team need to be able to describe the practice's policy and procedures for identifying patients with urgent medical matters and the procedures for seeking urgent medical assistance from a clinical staff member. The practice team also needs to be able to describe how the practice deals with patients who have urgent medical needs when the practice is operating at full capacity (eg. when it is fully booked).

When patients contact general practices by telephone, often the reason for contact is to make an appointment. It is necessary for administrative staff receiving incoming calls to assess the urgency of the need for care (ie. 'triage' patients). Staff should ask the caller 'Is the matter urgent or may I put you on hold?', so that patients with urgent needs are able to convey this information. As administrative staff do not usually have access to patient health records, the practice needs to have a method for appropriately communicating triage responses by administrative staff.

The practice's policy on triage should make a distinction between triage undertaken by members of the clinical team and triage undertaken by staff with non-clinical roles. Appropriate training should be provided to assist administrative staff and members of the clinical team such as practice nurses to identify patients in need of urgent care. Such training may be undertaken within the practice or by an external training provider.

Length of consultations

The length of individual consultations will vary according to clinical need. Data from Bettering the Evaluation and Care of Health (BEACH 2008–2009) show average consultation times in Australian general practice are 14.6 minutes. Patients should be encouraged to book longer consultations if they feel more time with the GP will be required. Members of the practice team should be sensitive to the need for longer consultations when the need for a longer appointment could be anticipated (eg. when the patient is attending for multiple or complex problems, chronic disease management or procedures). Practices generally recognise that some of their patients always need longer appointments.

Key indicators for whether consultation times are long enough include factors such as the adequacy of patient health records. Assessment of this criterion needs to take into account the specific circumstances of the practice.

Patients with special needs

The practice system needs to include consultations of appropriate length for patients with special or more complex needs. Longer consultations may be required if the patient has complex medical needs, complex communication needs, impaired cognition, or if the patient's carer or a translator is present. Patients need to be encouraged to ask for a longer consultation if they think it is necessary. Staff need to have the skills and knowledge to assist in determining the most appropriate length and timing of consultations at the time of booking. Although it is difficult to predict how much time will be needed for a particular consultation, this criterion requires that practices have systems that predict and endeavour to meet this need.

Practice closures

Where a practice is planning to close, the practice should develop a process which minimises any disruption to care. It is suggested the practice give patients at least four weeks notice of the practice closure and assist patients (especially those with high needs) in locating an alternative general practice or general practitioner. The practice should ensure that patient records are made available to the patient or transferred to an alternative general practice or care provider before the closure of the practice. Alternatively, patients should be given contact details for requests to access their health records.

Standard 1.1 Access to care

Our practice provides timely care and advice.

Other information for Standard 1.1

Related external standards

Some of the standards and criteria in the Standards for general practices are similar to those in broader organisational standards – specifically the QIC Health and community services standards (6th edition) and the International Organization for Standardization’s ISO 9001:2008 (E) (4th edition). Where these similarities occur they are identified. This may reduce the amount of work undertaken to achieve accreditation for both sets of standards.

Be aware, though, that each set of standards has a different purpose and scope. This means that you will need to be familiar with both sets of standards, and their similarities and differences, so that you respond appropriately as well as efficiently to the requirements of each.

The QIC Standards include the following standards that are relevant to Standard 1.1 Access to care:

1.6  Knowledge management
1.7 Risk management
2.1 Assessment and planning
2.2 Focusing on positive outcomes

The ISO Standards include the following requirements that are relevant to Standard 1.1 Access to care:

5.2 Customer focus
6.1 Provision of resources
7  Product realisation

Useful resources

The Standards for general practices include specific resources for each criterion. The following additional resources may be useful if you wish to enhance your understanding of this Standard or identify any gaps in your service’s policies, processes and procedures. Some of these resources will contain sample policies or templates that have been developed by other health services or support organisations, which you could customise to suit your particular circumstances.

Your state or territory NACCHO affiliate or Medicare Local may provide support and training for health services and general practices seeking accreditation against the Standards.

AGPAL and GPA ACCREDITATION plus have some useful tools and resources on their websites:

The South Eastern Health Providers Association has a very useful set of resources for health services and general practices freely available on its website. These include a Policy and procedure manual (2011), designed to align with the Standards for general practices, and a triage support guide:

The AH&MRC’s Policy and procedure manual for Aboriginal community controlled health services in rural NSW (3rd edition) has a section on patient telephone and electronic contact on pages 61 and 62, and a section on appointment management on page 64:

The AMSANT Administration manual includes drafts for developing your own health service policy, which includes sections on access and equity, appointments and patient services:

The AMSANT Administration manual also includes a draft for developing your own communications policy:

There is also information on dealing with violent or intimidating clients in the occupational health and safety (OH&S) section of the AMSANT Administration manual:

Andrew Knight and Tony Lembke’s Australian Family Physician (Vol. 40, No. 1/2, January/February 2011) article ‘Appointments: Getting it right’ shares lessons about improving appointment scheduling:

The Australian Medical Association has a position statement on personal safety and privacy for doctors:

The RACGP publications Keeping the doctor alive: a self care guidebook for medical practitioners and General practice – a safe place are both useful:

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