> Resources and Publications > PHC RIS infonet > August 2006 > Effective links

Effective links: crisis averted! Divisions, GPs and Queensland Health working together

In this issue of PHC RIS infonet we highlight a different category of effective links, between Divisions and state health services. The situation demonstrates the key attributes of effective links: willingness to work together for a common purpose, respect, communication, and problem solving. The urgency of this situation meant there was no time to build relationships from scratch, so the Division's sound relationships with the GPs were essential for the initiative's success.

A recent hospital crisis in the Fraser Coast area developed from an understaffed Emergency Department (ED) at Maryborough Hospital in Queensland, and was escalated when Junior Medical Officers refused to work without a Senior Medical Officer present. The problem was further exacerbated due to wider problems with Queensland hospitals receiving adverse media attention. Community consultation was sought, and it was clear that closing the emergency department was not the preferred option. GP assistance was needed in two weeks or the Maryborough Hospital ED would close. In response to this crisis the Wide Bay Division of General Practice and Fraser Coast Health Services worked together to address the immediate need and keep the ED open.

PHC RIS staff attended the Queensland Divisions of General Practice (QDGP) Forum in June this year and were impressed by the presentation detailing this excellent example of a Division and State Health service working together to cope with this crisis. The presenters were Dr Riitta Partanen, Chair, Wide Bay Divisions of General Practice Board; Ms Kerry Winsor, District Manager, Fraser Coast Health Services; and Dr Shaun Rudd, GP.

GPs were approached to help in the Maryborough ED although there was already a GP shortage in the Wide Bay area. The Division facilitated this approach to GPs, and with Queensland Health (QH), set up the appropriate administrative procedures and protocols for this to occur.

Divisions acted as an advocate for GPs to help deal with numerous issues relating to a GP working within the framework of an ED. All parties found that it was important to acknowledge that emergency medicine is different. Issues identified included: GPs needed to be up-skilled, induction and orientation were required, supervision and mentoring had to be provided, indemnity issues needed to be identified and addressed, GPs needed to be registered for the hospital system (issues were also identified around international medical graduates and their restricted registrations), QH protocols needed to be in place, and remuneration had to be agreed. With Wide Bay DGP as the facilitator and voice for the Fraser Coast GPs, these and other issues were addressed and enabled a relatively smooth transition of GPs into the EDs.

The integration of GPs into the ED and internal medicine wards was well received, and community support for this was excellent. This experience has shown that it is important to provide support for the integration of GPs and local health services, and that mainstream structured processes should be established. Further community and clinician involvement in problem solving is critical to success.

Feedback from GPs was that they didn't find the extra workload 'too much' - although it contributed to a 'long day' when going to the ED after normal practice. Moreover, GPs found it valuable as it added to better understanding of the communication channel between hospitals and the local GP, and better integration practices were employed. Evaluation was only considered in hindsight after dealing with the initial crisis; however, the presenters felt it is important to consider the evidence for GPs working in hospital settings and whether this impacts positively or negatively on patient prognosis and longer term care.

This session demonstrated the value of Divisions collaborating with local health services to address medical workforce issues. Partnerships between these organisations led to benefits for the community, hospitals and GPs. The general consensus was that it couldn't have happened without the Divisions.