workforce general practice and part of their duty to be engaged in RACF work. Either individually or corporately, and even those who were not currently engaged, but were considering doing so, did feel that this was the proper role of general practice.
Those two attitudes hadn’ t really been drawn attention to in earlier research among GPs, which largely consisted of surveys. That was heartening to see that there were no attitudinal barriers to the GPs in our sample doing aged care facility work.
The GPs did, however, voice some frustrations and hesitancy surrounding RACF visits. What were chief among their issues? Well, younger GPs were hesitant about engaging in RACF work because they hadn’ t done it before, or they’ d had little training. They were also concerned that they [ wouldn’ t ] be supported by other doctors within the practice if they were going to engage in this work.
As I understand, it’ s still possible to train as a GP without ever having set foot in an RACF. And that, together with the complex nature of the work – looking after residents who have a heavy burden of chronic disease and likely a degree of dementia – is very challenging.
Together with looking after patients needing palliative care, or segueing into palliative care, some of the younger GPs were hesitant about palliative care because they felt they hadn’ t been adequately trained in that area.
Older GPs were hesitant about adding to their patient lists in the years coming up to retirement, because they wanted to ease off rather than add to their load.
When we moved to frustrations, this was where the GPs involved in our research were most vocal, and most visceral, in their responses. They were immensely frustrated with the avoidable delays and inefficiencies involved in the work.
For example, to be able to find a nurse who knew about the patient, then find the patient, then find their notes, then find their medication charts was sometimes quite difficult, or impossible.
It was seen by our participants as a lot of unnecessary bureaucracy. Lots of charts that needed to be signed and re-signed and reviewed and reviewed which caused delay and distraction from the essential task. So, frustration was a big part of it.
Similarly, there was dislocation and duplication of information about the patients, the medical records. While the patient notes were usually kept on the RACF site, many of the GPs would have to return to their practice, to their rooms, to write the prescriptions or renew prescriptions, to do referrals and reports, to check pathology, and so on.
There was a big difference in caring for a patient in a community of the same age as somebody who was in an RACF. These frustrations and difficulties loomed large in the minds of the GPs we spoke to.
Remuneration was another barrier identified by GPs visiting RACFs. What did the GPs in the study have to say about that? Most of the GPs involved in the study were of the opinion that the RACF work was relatively poorly remunerated.
One of the younger female GPs, for example, said if you compare the amount of time you spent and how many patients you could have seen in your surgery, it’ s not viable.
Other GPs felt the practice they owned or which employed them subsidise their involvement in RACF work to a degree.
This may be a pointer to the hesitancy felt by part-time GPs. Indeed, in the study of early-career GPs I mentioned earlier, one of the associations of doing RACF work was working full-time. Parttime doctors can less afford a poorly remunerated session.
How can we ensure more GPs visit RACFs? Our research revealed that there were no attitudinal barriers to doing this work. There were, however, avoidable logistical and bureaucratic barriers. Many of the problems that the GPs discussed are locally soluble, or have solutions already available but not yet applied. For example, general practices and general practice managers can streamline the logistics of the visit – schedule and timetable them at times when the GPs are not rushed.
RACFs can liaise with general practices about the preferred timing of the visit, and organise it so that there’ s not a game of hide and seek when the GP arrives, having to find the patient and find the nurse, and find the notes, and lose time searching out information and access which could be provided with forward planning.
It would be nice if the IT support to good patient care, which is mandatory in accredited general practices, was also available in RACFs, but that might be something the policymakers might have to address at a higher level than at the local.
In the next phase of your research, you want to find out about the experience of RACF staff, residents and families. What aspects of the relationship between GPs and nursing homes are you hoping to home in on? Well, one of the criticisms of the research that we’ ve just done, and a reasonable one at that, was we’ ve only sought the opinion of the GPs. It’ s only one view of what is happening, and obviously there may be some inherent biases and blinkered vision when we’ re looking at just one point of view.
We thought it would be nice to look at the medical care delivery to RACF residents from a 360-degree view by talking to all the stakeholders involved in a GP visit. That is, the patients
GPs were immensely frustrated with the avoidable delays and inefficiencies involved in residential aged care work.
themselves, their families, the RACF staff engaged in the nursing home visit, and the GPs.
We did this as a multi-site study at four different RACFs, collecting the data last year. We’ re currently analysing that data, and it’ s going to be very interesting, and hopefully we’ ll be able to present that data soon, because while some of what the GPs said is perhaps validated, there are some interesting alternative views about how things could be improved.
Going back to that job ad that said‘ no RACF visits’, what do you make of that, now that you’ ve conducted this research? Well, I didn’ t really answer the question: Have the authors of those advertisements properly assessed the attitudes of GPs? I think many early-career GPs would be willing to visit RACFs with training and support. So that’ s an imperative for the future if we want to address the disengagement of GPs from caring for these patients.
I’ m hopeful that research like this, which we have published, will stimulate greater efforts in addressing the avoidable frustrations and delays involved in RACF visiting. ■ agedcareinsite. com. au 33