Abstract
Background: The Western Sydney Care Collective (WSCC) is a partnership between Western Sydney Primary Health Network (WSPHN) and Western Sydney Local Health District (WSLHD). It was established as part of the NSW Collaborative Commissioning Program, building on 20 years of regional partnership. It focusses on improving resource use through joint regional planning, value-based care and the Quintuple Aim, anticipating future system demands and financial needs, and influencing funding reforms at the state and federal levels.Through integrated governance, delegations, shared culture, information sharing, community partnership and communications, the WSCC overcame organisational barriers to partnership to allow key players to delivery truly integrated care. This presentation will overview the establishment of the WSCC, co-design and implementation of models of care with providers, consumers and key system partners and outline the outcomes achieved to date as well as broader implications for system change at the regional, state and national levels.
Approach: In 2020, WSCC was the first region to implement the state Collaborative Commissioning transformation. After a year of co-design, in 202 it launched its largest two integrated care models.The first model, Value Based Urgent Care (VBUC), provides a sustainable, local, person-centred urgent care pathway by: building community awareness to influence consumer behaviour so that the community recognises urgent care services as a safe and accessible care alternative over emergency care; establishing a central intake line to streamline referrals to Urgent Care Services (UCS); opening UCS Centres to deliver care for a range of non-life-threatening urgent conditions with access to a pooled network of resources and streamlined referrals into providers across the healthcare neighbourhood; and enhancing community based support through warm handover from acute care to link patients back to their home; general practice for ongoing management and integrated follow-up. The second model, Cardiology in Community (CiC), strengthens participation and screening to improve identification of people at risk of cardiovascular disease to improve management of atrial fibrillation (AF). Once identifying pre symptomatic patients, enhanced ongoing management and treatment of patients with AF was achieved through shared care planning and discharge support and transition between primary and specialist care, implementing a team-based approach to care. Both models built on a network of Patient Centred Medical Homes (PCMHs), where WSPHN extracts data from ~300 family practices and provides data-driven practice support for continuous improvement, integration and health pathways in partnership with 700+ community providers, 4 hospitals and 7 community health centres.
Results: Program co-design, monitoring and evaluation utilised the NSW Lumos dataset to systematically simulate the impact of the planned interventions and monitor progress toward expected outcomes.VBUC has demonstrated a reduction in patients presenting to ED requiring non-life-threatening urgent treatment while CiC has identified asymptomatic AF patient, improved access to outpatient clinics, proactively improved stabilization and risk management, improved quality of care evidenced through enhance capacity for cardiology management in community and reduced the volume of avoidable ED presentations.Both models are attracting a renewed interest in family medicine. General Practitioners and their teams also report greater connectivity, ease of referral to specialist, less administrative burden and improved satisfaction while Patients report an improved experience of care, reduction in wait times, increased compliance with protocols and follow-ups and better integrated services.
Implications: There are significant leanings from this work from a policy, strategy and implementation perspective, especially with respect to collaborative governance. Evaluations are underway across both models as they transition to as permanent fixtures in Western Sydney. At a national level, VBUC influenced Australian national policy directions with the roll out of urgent care clinics across Australia, which was a component of the VBUC model.