Abstract
The acute healthcare system is under increasing pressure, with emergency departments (EDs) and ambulance services experiencing unprecedented levels of demand and increased patient complexity. Collaborative Commissioning is achieving the ambitions of the National Health Reform Agreement and acts as an accelerator for the Regional Health Inquiry and the Primary Health Care 10 Year Plan by harnessing a one-system approach. The program is designed to enable and support delivery of shared care, in this specific case, to the Western Sydney community, to reduce acute demand, through targeted prevention and intervention. Primary Health Networks (PHNs), Local Health Districts (LHDs) and other organisations create a partnership to deliver patient-centred and outcome-focused care in the community.
Western Sydney Care Collective’s Value Based Urgent Care Service (UCS) is an example of a Collaborative Commissioning model of care. With the region’s 14.2% increase in ED presentations during FY16-FY19 and 20-32% of these ED presentations determined to be low or semi-urgent, there was a strong case to consider an alternative to addressing the current trend. The Value Based Urgent Care initiative aims to reduce the number of non-urgent presentations to Western Sydney EDs. People who would usually present to EDs for urgent but non life-threatening treatment , can receive the same level of care that is patient-centred and cost-effective by attending a UCS, often based in general practices and supported by the broader healthcare neighbourhood.
The pathway aims to reduce the number of low acuity conditions (minor injuries and illnesses) requiring ‘urgent’ treatment presenting to Western Sydney EDs, through the provision of sustainable, alternative, local patient-centred urgent care services. In keeping true to the network-orientated approach to delivering urgent care, each UCS has access to a pooled network of resources as facilitated through the LHD/PHN partnership. These resources will provide specialist advice via phone support lines (Orthopaedic, Cardiology, Respiratory and Paediatrics) and may also be directly involved in treatment. Resources that will be important include supporting musculoskeletal conditions, wound care and minor illnesses and will be largely driven by the involvement of upskilled practices nurses. Nursing will play a leading role in the triaging of patients on arrival to the UCS, supporting general practitioners and the broader healthcare team as they manage the patient’s journey through the urgent care service, and on to acute services as required, or via clinical handover processes back to the usual care GP. The model allows for increased upskilling for general practice nurses, as well as increased engagement with LHD based clinics, other stakeholders and the acute sector, allied health providers, pharmacists and the broader healthcare neighbourhood.
Since inception, the program has iterated and adjusted based on patient and consumer feedback, and real-time data which has driven the direction and allowed for modification of the model. Consumer co-design and feedback has also allowed for the development of culturally appropriate awareness content and implementation, a key driving factor for engagement and uptake within the local community.