Policy and Procedure Practice Manual

MAT Health Clinic Policy and Procedure

Chapter one: Practice services

MAT Health Clinic Practice services

MAT Health Clinic

Policy and Procedure Manual

260-264 Medical Road Strathpine 4500

Ph: 07 3889 0000 Fax: 07 3889 1234

Table of Contents1.Scheduling care in opening hours (Criterion 1.1.1)11.1.Scheduling patient appointments11.1.1.Booking an appointment21.1.2.Rescheduling an appointment – changed by a patient21.1.3.Rescheduling an appointment – changed by the practice21.1.4.Recording missed appointments31.1.5.Cancelled and missed appointment fees31.2.Triage41.1.Emergency telephone call with doctor present51.2.Emergency telephone call and no doctor present61.3.Emergency patient presents to reception with doctor present61.4.Emergency patient presents to reception and no doctor present71.5.Patient discomfort in waiting room81.6.Dialling emergency ‘000’81.7.Subsequent action following an emergency or exceptional situation91.8.Referring important information to the general practitioner91.9.Length of consultations101.10.Patients with special needs101.11.Practice closures111.12.Visitors112.Telephone and other communications (Criterion 1.1.2)121.13.Telephone communication121.1.1.Telephone techniques131.1.6.Answering incoming calls141.1.7.Placing callers on hold141.1.8.New patients151.1.9.Telephone requests for referrals151.1.10.Telephone requests for repeat prescriptions151.1.11.Telephone requests for results161.1.12.Taking messages161.1.13.Clinical messages161.1.14.Outgoing calls171.1.15.Handling difficult patients181.14.Electronic communication191.15.Telephone and electronic equipment191.1.16.Telephone functions191.1.17.Telephone problems201.1.18.Email201.16.Fees for telephone and electronic communications203.Home and other visits (Criterion 1.1.3)211.3.Providing safe and reasonable care211.4.Access to alternative sources of care211.17.Who can perform home or other visits221.18.Safety of health professionals224.Care outside normal opening hours (Criterion 1.1.4)231.5.Options for care outside normal opening hours231.6.Formal after-hours agreements231.7.Follow up of tests taken during after-hours care231.8.Who can provide after-hours care for the practice241.9.Communicating our after-hours arrangements245.Practice information (Criterion 1.2.1)251.10.Practice information251.11.Advertising practice information251.12.Practice website261.13.Practice services261.14.Practice hours276.Informed patient decisions (Criterion 1.2.2)281.15.Providing appropriate and sufficient information to patients281.16.Informing patients of potential treatment costs281.17.Patient-doctor collaboration297.Interpreter and communication services (Criterion 1.2.3)301.18.Patients of foreign background and ethnicity301.1.19.Translating services311.1.20.Using friends and relatives as interpreters318.Costs associated with care (Criterion 1.2.4)321.19.Fees for services and billing practices321.1.21.Private billing321.1.22.Bulk billing331.1.23.Department of Veterans’ Affairs331.1.24.Workers compensation341.1.25.Medical examinations not covered by Medicare351.1.26.Pre-employment medicals351.20.Costs of other health services359.Health promotion and preventative care (Criterion 1.3.1)361.21.Health promotion activities361.22.Preventative care371.1.27.Vaccination and occupational health clinics371.1.28.Mole scan unit371.1.29.Asthma awareness371.1.30.Seasonal ‘flu clinics381.23.Health risk assessments391.24.Managing patient information to support preventative care391.25.Clinical resources for the practice – preventative health4010.Consistent evidence based practice (Criterion 1.4.1)411.26.Clinical practice guidelines411.27.Clinical resources for the practice – evidence based practice421.28.Patient identification – prior to surgery431.29.Health inequalities441.30.Consistent communication4511.Clinical autonomy for general practitioners (Criterion 1.4.2)451.31.Clinical autonomy within evidence based care451.32.Professional and ethical obligations4612.Continuity of comprehensive care and the therapeutic relationship (Criterion 1.5.1)471.33.Provider continuity and patient outcomes471.34.The doctor patient relationship481.35.Courtesy notifications481.36.Supporting preferred relationships4913.Clinical handover (Criterion 1.5.2)501.37.Defining clinical handover501.38.Clinical handover actions511.39.Transfer of patient health information to another practice521.40.Transfer of patient health information from another practice521.41.Errors in clinical handover5314.Follow up of tests and results (Criterion 1.5.3)531.42.Definitions531.43.Essential follow up systems541.1.Receiving incoming results and reports541.1.Conducting a review of follow up systems541.1.31.The general practitioner and the reminder system551.1.32.Practice staff and the reminder system551.1.33.The general practitioner and the recall system561.1.34.Practice staff and the recall system561.19.Issuing recalls561.20.Reminders571.44.Errors in follow-up581.45.Sending letters to patients5815.Engaging with other services (Criterion 1.6.1)591.1.Patient resources591.2.Staff resources591.3.Location of resources6016.Referral documents (Criterion 1.6.2)601.46.Unique patient identifiers601.47.Sufficient information611.48.Disclosure of patient information611.49.Telephone referrals6117.Patient health records (Criterion 1.7.1)621.21.Dedicated patient health records621.1.35.Creating a new medical record631.1.36.Retention of records and archiving631.1.37.Destruction of medical records641.1.38.Collecting information from patients641.1.39.Recording cultural background651.1.40.Recording Aboriginal and Torres Strait Islander status6518.Health summaries (Criterion 1.7.2)661.50.Health summaries for safe and high quality care661.51.Coding6619.Consultation notes (Criterion 1.7.3)671.52.Consultation notes6720.infection control681.53.Blood and body fluid spills701.54.Spot spill711.55.Small or large spill721.56.Carpet721.57.Hand washing and hand hygiene72

1. Scheduling care in opening hours (Criterion 1.1.1)

Policy

Our practice provides timely care and advice to our patients.

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

1.1. Scheduling patient appointments

Patients are given an appointment with the doctor of their choice wherever possible and advised of the availability of other doctors at this time. Under normal circumstances, a patient can expect to see their doctor (or an alternative as approved) within two working days.

Walk in patients may see the next available doctor if there are less than six appointments for that hour. Practice staff should advise them of the approximate waiting time and that patients with an appointment will be seen first.

Our staff are vigilant of the need to detect and place urgent calls for immediate or earlier attention by a doctor. Patients unable to attend the practice are able to have a home visit.

Our practice manager will review the appointment schedule regularly to ensure that it remains correct and up-to-date. The appointment book is reviewed for:

Clerical errors

Change of doctor’s rostered hours

Appointment shortages

Rooms not double-booked

Booking an appointment

Ask the patient which doctor they would like to see.

Ask the patient to provide a name if not given.

If the patient is new, inform of practice location, parking, costs and payment methods (if applicable). Obtain phone number and other demographics as required.

Ask if the appointment is urgent.

Ask if the consultation will require a longer appointment (>15 minutes). For new patients, allow 30 minutes for the appointment.

Provide the nearest available appointment time for the patient to see their preferred doctor.

If the patients preferred doctor is not available, ask if another doctor would be suitable or if non-urgent, if they are happy to select another time and date.

Provide the patient with a time and date for the appointment.

Record the patient surname and given name in the agreed timeslot.

Reconfirm the appointment time and date, and the patient’s phone number.

Rescheduling an appointment – changed by a patient

1. Ask the patient the time and date of the appointment, the doctor and type of appointment made.

Delete the cancelled appointment.

Ask the patient if they would like to reschedule the appointment for a different time and date.

Follow the procedures listed above in booking an appointment.

Record the patient name, date of appointment cancellation, the number of times that they have cancelled the appointment (e.g. Joe Bloggs; 23/10/2020 – 1) and the date the appointment has been rescheduled in Did Not Attend (DNA) system.

Provide the practice manager with the DNA system at the end of the day.

The practice manager will review the DNA system and triage them into A B C Categories based on urgency of need, follow up or action as appropriate and leave comments.

Rescheduling an appointment – changed by the practice

1. Contact the patient as soon as possible to let them know of the required change.

Mark these appointments specifically until changes are completed.

Offer the patient apologies and ask if they would like to reschedule the appointment for a different time and date.

Delete the cancelled appointment.

Follow the procedures listed above in booking an appointment.

If unable to contact patient, discuss with doctor as soon as possible.

Recording missed appointments

Cancellations and missed appointments are monitored and marked accordingly in the DNA system.

Reception staff will record DNA patient information in the DNA system, including:

Patient name;

Date of appointment cancellation;

The number of times that they have cancelled the appointment; and

The date the appointment has been rescheduled.

Reception staff will provide each doctor with their appointment schedule at the end of the day.

The doctor will review their schedule, triage missed appointments and action as appropriate, taking into account patient history.

The doctor will advise the reception staff of which patients to contact and reschedule if necessary in accordance with triage procedures.

Reception staff will record in the appointments schedule whether or not another appointment has been made as well as any other comments.

Ensure that appointments flagged as recall appointments are rescheduled and remain on the recall monitoring list until the patient has attended a consultation with the doctor.

Patients who are called and have forgotten or have no adequate reason for not attending will be advised of the practice policy on cancelation and missed appointment fees.

For more information see:

Practice services, Chapter 1.1.5 - Cancelled and missed appointment fees

Practice services, Chapter 1.2 - Triage

Cancelled and missed appointment fees

Our patients are asked to provide at least 24 hours’ notice to cancel an appointment.

Patients who repeatedly (3 times or more) fail to attend routine appointments and who cancel with less than 24 hours’ notice will be advised that any further missed appointments without suitable notice will in future be charged a standard consultation fee as a deposit over the phone prior to making any further appointments. This fee will be deducted from the consultation fee charged for the service provided at attendance, or refunded if the patient is bulk billed.

The non-attendance fee is not refundable from Medicare.

Information about this policy is found on public display:

In the patient waiting room

At the reception counters

In the patient information brochure

Advised over the telephone and when making appointments with new patients

For more information see:

Practice services, Chapter 1.2 – Triage

Practice services, Chapter 1.1.2 - Handling difficult patients

1.2. Triage

This practice classifies patients seeking medical consultations according to priority of need. Our triage system ensures that clinical care is provided to patients with urgent medical problems as a priority. At the beginning of their employment, staff are orientated to our triage system and given training to ensure it is used effectively. All staff are required to regularly update cardiopulmonary resuscitation (CPR) and other first aid skills.

The Emergency Procedures and Front Desk Triage Poster are posted in the reception area to enhance accessibility.

It is the policy of this practice that patient’s calling who are suffering from the following symptoms be immediately transferred to a doctor:

Chest pain

Breathing difficulties

Sudden onset of a severe headache

Poisoning

To determine urgency (and to triage the patient), follow the Front Desk Triage Poster steps and ask the following questions:

Do you have an urgent problem?

If the answer is no, offer the next available appointment.

If the answer is yes, continue.

Collect patient details including:

The patient’s phone number

What is the name and age of the patient?

What is the nature of the problem?

What is the duration of the problem?

What is the severity of the problem?

Has the patient had any previous major health problems?

Select a priority category based on symptoms.

Follow the instructions for actions.

Consider the following flags during the conversation for attention:

Level of distress or anxiety

Terms used such as ‘severe’

The elderly >65 years and the very young < 3 years

Emergency telephone call with doctor present

Under no circumstances are non-clinical staff to give medical advice.

Category 1

Call the doctor or nurse for help immediately.

Advise the patient to call 000 for immediate attention; or

Keep them on the line and call 000 on their behalf, (by seeking assistance from another staff member) if the location is known.

Once the ambulance has been despatched, remain on the line until its arrival to care for the patient. You may be asked to speak to the ambulance officers attending the scene.

Once you have been given the OK to hang up, retrieve the patient file. Document the activity.

Category 2

Direct the patient to go to the nearest emergency department immediately, or if unable, call 000.

Interrupt the doctor or nurse for help immediately.

Retrieve the patient file for the doctor or nurse. Document the activity.

Category 3

Put the call through to the doctor or nurse as soon as possible.

The doctor or nurse will make the clinical decision to tell the patient to come to the surgery or direct them to 000 for an ambulance to transport the patient to the emergency department.

Retrieve the patient file for the doctor or nurse. Document the activity.

Category 4

Advise the patient or caller to come to the surgery now.

Let the doctor or nurse know of the patient’s condition, action taken and when they are expected to arrive.

Retrieve the patient file for the doctor or nurse. Document the activity.

Category 5

Make an appointment for today and advise the patient to call back if symptoms worsen.

Let the doctor or nurse know of the patient’s condition, action taken and when they are expected to arrive.

Retrieve the patient file for the doctor or nurse. Document the activity.

Category 6

Make an appointment within 24 hours and advise the patient to call back if symptoms worsen.

Inform nurse or doctor.

Retrieve the patient file for the doctor or nurse. Document the activity.

Emergency telephone call and no doctor present

Category 1 or 2

If a Category 1 or 2, call an ambulance on behalf of the patient and give the ambulance the patient’s location, telephone number and an indication of their condition.

Call the hospital that they will be attending and provide details of the patient coming in and an indication of their condition.

Contact the doctor and advise him or her of the emergency and the action that you have taken.

Category 3

If a Category 3, advise the patient to go to the nearest emergency department.

Call the emergency department that they will be attending and provide details of the patient coming in and an indication of their condition.

Contact the doctor and advise him or her of the emergency and the action that you have taken.

Emergency patient presents to reception with doctor present

Category 1 or 2

If Category 1 or 2, attend to the patient following the DRABC (Danger Response Airway Breathing Circulation) Action Plan and ask another staff member or bystander to call the doctor and call an ambulance on ‘000’.

Assist the doctor as required.

Category 3

If a Category 3, assist the patient to the treatment or consulting room and make them comfortable.

Call or ask another staff member to inform the doctor of the patient’s arrival and an indication of their condition.

Assist the doctor as required.

Emergency patient presents to reception and no doctor present

Category 1 or 2

1. If a Category 1 or 2, implement the DRABC (Danger Response Airway Breathing Circulation) Action Plan, conduct a primary examination and if necessary stabilise him or her. Please refer to the Emergency Procedures for further information.

Ask another staff member or bystander to call an ambulance on ‘000’. If available, contact on-call doctors, the practice nurse or other practice staff for assistance.

Thoroughly review the patient by conducting head-to-toe secondary examination. Pay attention to the history (what happened to the patient), symptoms (indication of pain from the patient) and signs (what you can see for yourself).

If the patient is conscious, treat the injuries or illness according to the symptoms and signs.

If the patient is breathing sporadically, leave in a lateral position and treat any injuries.

If the patient has a pulse but is not breathing, commence mouth to mouth (Expired Air Resuscitation – EAR).

If the patient does not have a pulse but is breathing, commence cardiac compression.

If the patient does not have a pulse and is not breathing, place the patient on their back and commence mouth to mouth and cardiac compression (Cardio Pulmonary Resuscitation – CPR).

Stay with the patient until definitive care (ambulance) arrives.

When the ambulance arrives, call the hospital that they will be attending and provide details of the patient coming in and an indication of their condition.

Contact the doctor and advise him or her of the emergency and the action that you have taken.

Category 3

If a Category 3, assist the patient to the treatment or consulting room and make him or her comfortable.

1. Ask another staff member or bystander to call an ambulance on ‘000’. If available, contact the on-call doctor.

Stay with the patient until definitive care (ambulance) arrives.

Call the emergency department that they will be attending and provide details of the patient coming in and an indication of their condition.

Contact the doctor and advise him or her of the emergency and the action that you have taken.

Patient discomfort in waiting room

Patients in distress are to be regarded as urgent medical matters whether the contact is in person or by phone. Occasionally patients will arrive in the waiting room in a state of physical or emotional distress. Such patients may present as tearful, bleeding, aggressive, in pain or in a comatose/unconscious state.

1. Refer to triage procedures to correctly handle such a situation.

1. Notify the doctor immediately. Be prepared to call an ambulance if requested.

1. Provide an alternative area for the patient to wait, for example, treatment room.

1. Remain with the patient and reassure them while they are waiting.

1. Avoid touching a patient who is being difficult to deal with or aggressive.

Dialling emergency ‘000’

In the event of an emergency, dial 000 (free call) and ask for “ambulance”.

You will then be transferred to the St John Ambulance Australia State Operations Centre.

Advise the operator that you are calling from a general practice.

The operator will ask you some important questions, including:

The address of where the ambulance is required

What the problem is

How many people are injured/unwell

The patient's age

The patient's gender

If the patient is conscious

If the patient is breathing

The operator may provide you with ambulance pre-arrival advice to assist the patient.

It is important that you DO NOT HANG UP until the operator tells you to. You may have to hold the line while an ambulance is dispatched.

For more information, see:

Practice services, Chapter 1.2 - Triage

Subsequent action following an emergency or exceptional situation

It is important that, following an emergency or exceptional situation within the practice actions, processes and outcomes are reviewed to ensure that the situation has been handled effectively and identify whether or not any improvements can be made.

Following an emergency or exceptional situation:

Comprehensive notes must be detailed in the patient’s record, even if the patient has not presented to the practice before.

It is recommended that the doctor contact their medical defence organisation to make sure that they have handled the emergency correctly.

It is recommended that debriefing in a formal setting occur with all staff to discuss how the situation was handled, whether or not it could have been handled differently, whether the current policy and procedures are adequate and may require alteration.

Referring important information to the general practitioner

Our reception staff are trained to take telephone calls and identify under which circumstances calls should be transferred to a medical practitioner or practice nurse.

The general practitioners will make time at the end of each session to attend to messages, return telephone calls or take calls from patients or other health professionals.

All contact of a clinical nature will be recorded in the patient health record.

If the reception staff receive a call from the pathology laboratory, radiology department, hospital or other health service identifying that they are returning the doctor’s call or are calling about a patient:

Ask if the call is urgent, or if the caller is returning the doctor’s initial call.

If identified as urgent, or if the doctor has the patient with them at the time, the caller should be placed on hold and the doctor interrupted.

Identify the caller and the patient concerned to the doctor, and transfer the call to the doctor.

If the doctor is not available (in the treatment room or not present) and the caller maintains urgency, the call should be put through to the nurse.

If there is no doctor or nurse on duty, and the caller maintains urgency, take down the patient details and telephone number of the caller and telephone the:

a. Referring general practitioner; or

b. Rostered on-call general practitioner.

Provide the general practitioner with the patient details and telephone number of the caller and ask the general practitioner to telephone the caller back.

Please refer to:

Front Desk Triage Poster

Length of consultations

Each doctor has specific times allocated to his/her consulting sessions with documented needs for interval times, short and long consultations, diagnostic tests and procedures.

There will not be more than six (6) appointments made for any one (1) hour period and. unless in specific circumstances as expressed by the doctor, there will not be any appointments scheduled for less than ten (10) minutes.

Our standard appointment time is 15 minutes.

One (1) appointment is required for each family member requesting to be seen.

Should a longer consultation be requested or determined by information received from the patient, then our staff will endeavour to allocate the appropriate time.

If a patient requires a long consultation (e.g. requesting the completion of a doctor’s report) and they have not booked one, unless in exceptional circumstances, the doctor reserves the right to advise the patient that they will need to schedule another visit specifically for that need. This decision is made on a discretional basis.

Patients with special needs

Our general practitioners and staff are aware of alternative modes of communication for our patients with special needs.

Posters and pamphlets to this effect will be made available in the patient waiting room encouraging patients and carers to make longer appointments if there are complex medical needs, communication difficulties or impaired cognition. Posters will also advise of the availability of translator services if necessary.

Where communication is difficult, patients with special needs will be offered assistance from one of the following (or other services such as family member as identified):

National Relay Service for patients who are deaf

Translation and Interpreter Service for patients from a non-English speaking background

For more information see policies on:

Practice services, 1.2.3 - Interpreter and other communication services

Practice closures

Should our practice be required to close outside of our normal opening hours, such as during the holiday season or on a long weekend, the practice manager will post a notice on the front door and in the waiting room no less than four (4) weeks prior to the closure to advise patients of alternative arrangements.

Alternative arrangements may include:

Directing patients to a nearby after hours medical centre

Directing patients to an alternative general practice

Directing patients to the nearest accident and emergency department

For more information see policies on:

Practice services, 1.1.3 - Home and other visits

Practice services, 1.5.2 - Clinical handover

Visitors

Patients and other visitors are warmly welcomed to the practice. Doctors and staff value the principles of good relationships whether they are maintained in person, via written or electronic communication or on the telephone. Visitors including patients, relatives, friends, health care providers, students, pharmaceutical/medical supplier representatives and Medicare Local representatives are shown friendly, courteous recognition and assistance.

When a person presents at reception or lingers in the main entrance or other areas of the practice and remains unidentified, ask if you may help and elicit the reason for their presence on the site.

Ask the person to wait in the waiting room.

If the visitor looks suspicious, call a doctor or other staff member to assist.

If the person is booked to see a doctor or staff member, check with them and their appointment diary to ensure the visitor can be seen at that time.

If the visitor is an unsolicited representative with no appointment pre-arranged, request the visitor to come back at another pre-booked time.

2. Telephone and other communications (Criterion 1.1.2)

Policy

Patients of our practice are able to obtain timely advice or information related to their clinical care by telephone and electronic means (where in use) where a general practitioner determines that this is clinically safe and that a face-to-face consultation is unnecessary for that patient.

Telephone communication

Our practice patients are able to obtain information or advice related to their clinical care by telephone in a situation where a consultation is unnecessary or impractical.

The following are guidelines for phone calls to the practice. These are guidelines only and if you are in any doubt you must check with the treating or duty doctor.

In all cases of requests for personal information such as request for results by phone, our practice staff will use a minimum of three (3) patient identifiers so that patient confidentiality is not compromised.

The patient identifiers are:

Patient name (family and given names)

Date of birth

Gender (as identified by the patient themselves)

Address

Patient record number where it exists

The doctors in this practice do not take any calls while they have a patient with them unless it is a medical emergency. All other calls will be returned as soon as possible.

For more information please see policies on:

Practice services, 1.1.1 - Patients with special needs

Practice services, 1.2.3 - Interpreter and other communication services

Telephone techniques

1. Always answer the phone regardless of your location in the practice. It is important that you either divert the phone through to where you are or ask the person on phone backup to take the calls.

1. Speak with a respectful and calm tone. This also applies in face-to-face conversations.

1. Smile when you dial out or answer the phone. Smile when talking on the phone as this comes through in your voice.

1. Have a pen and notebook ready.

1. Wait a moment before talking. Don’t rush the caller.

1. Feel comfortable confirming details with the caller including how they spell their name.

1. Focus on the call you are taking.

Answering incoming calls

1. Answer the telephone within three (3) rings.

1. Greet all external callers with:

Good morning/afternoon, MAT Health Clinic

This is (insert your name). How can I help you?

1. Ask if the patient is new or has attended the practice before.

1. If the patient is calling to request an appointment, ask the patient which doctor they would like to see.

1. Ask if the appointment is urgent (follow Front Desk Triage Poster steps).

1. Provide the nearest available time for the patient to see their preferred doctor.

1. If the patient’s preferred doctor is not available, ask if another doctor would be suitable or if non-urgent, if they are happy to select another time and date.

1. Ask if the consultation will require a longer appointment (>15 minutes).

1. For new patients, allow a longer consultation (approximately 30 minutes) for the appointment.

1. Provide the patient with a time and date for the appointment.

1. Ask the patient to provide the minimum demographics to confirm identity and enter the patient (if new) into the practice software:

Surname, first name

Date of birth

Address

Telephone number

1. Ask if the patient holds any Commonwealth Concession Cards.

1. Explain the practice policy on payment, fees and payment methods (if applicable).

1. Explain the practice location, parking, costs and reconfirm the appointment time and date.

Placing callers on hold

1. Our practice ‘on hold’ message provides advice to call 000 in case of an emergency.

1. Always ask the caller’s preference before placing them on hold, and always wait for the caller to respond.

1. If you are on another call and the phone is ringing, ask the caller if you can place them on hold for a moment. If the caller agrees, place them on hold and answer the next call. Ask this second caller if they can hold a moment. If they agree, return to your other call.

1. If you have a caller on hold for more than a minute, ask if they are still happy to continue holding or if they would like to leave a message. Repeat this process every 60 seconds.

1. Ensure practice on-hold music or message is working and can be clearly heard.

New patients

New patients will be advised of the following information during the initial phone enquiry or booking of an appointment.

Fees charged

Appointment time

Appointment length

Type of appointment

Doctor’s name

The following information is to be provided to a new patient during the first visit.

Patient information sheet

Services and special interests

Reminder system availability

After hours care arrangements

Fee structure

Billing and payment system

Practice hours

Availability of home visits

Telephone requests for referrals

Patients at times will telephone or call in and ask for a referral letter/repeat referral letter to a specialist. All patients are required to make an appointment with a doctor for referral letters. There are no exceptions.

Telephone requests for repeat prescriptions

For regular medications, patients are encouraged to ensure that they have a sufficient number of repeat prescriptions before leaving the surgery, to ensure continuity of medication until their next scheduled visit.

Patients at times will telephone or call in and ask for repeat prescriptions. It is the policy of this practice that all patients are required to make an appointment with a doctor for repeat prescriptions. There are no exceptions.

Telephone requests for results

Patients at times may telephone and ask administrative staff for test results. It is very important that patients and staff understand the policies of this practice. Due to the serious nature of many of these tests it is vital that all staff adhere to the following policy. During an appointment, the doctor will explain this practice’s policy to all patients to reinforce its importance.

No results are given out over the phone by any staff member. There are no exceptions to this. All patients are required to make an appointment to see their doctor to discuss their results.

Advise the patient that it is the policy of this practice that no results are given out over the phone by any administrative staff member and that there are no exceptions to this.

Advise the patient that all patients are required to make an appointment to see their doctor to discuss their results.

Offer the patient the opportunity to make an appointment.

Taking messages

All staff will remain up-to-date with each doctor’s policy with regards to returning patient phone calls.

It is the responsibility of all medical and non-medical staff to check for his or her messages. Staff will only verbally pass on urgent and important messages.

Patient messages taken for subsequent follow up by a doctor or staff member will be documented for their attention and actioned as appropriate.

This practice uses internal email to relay telephone messages to the doctor.

Clinical messages

If a message from a patient is of a clinical nature, the patient is to be offered the practice nurse in lieu of the general practitioner. If an email message is sent to the general practitioner, the practice nurse will be copied in for follow up.

When taking a message, record the following details in the message:

Date

Time of the call

Full name of caller and of patient if different

Telephone number

Reason for the call

Action to be taken

Name of staff member taking message

Repeat the details back to the caller to ensure that they have been noted correctly

Deliver the message as detailed above on the day of receipt, or in that person’s absence, to the person who is caring for that absent team member’s patients

Please refer to: Front Desk Triage Poster

Outgoing calls

To ensure that incoming calls are not interrupted, this practice prefers that all outgoing calls are made on line number 45

Our most commonly used and emergency telephone numbers have been programmed into the speed dial. Brief personal calls can be made only if necessary and when they do not interfere with work.

The home and mobile telephone numbers of practice staff are private and are not to be given to anyone without the express permission of the practice principal or practice manager.

When making calls on behalf of the practice such as to a hospital or specialist rooms:

Identify yourself by name and practice

Identify why you are calling and whom you wish to speak to

If patient details are to be discussed, such as following up on results, identify the patient in no less than three patient identifiers

Patient name (family and given name)

Date of birth

Gender (as identified by the patient themselves)

Address

Patient record number where it exists

If a message is to be left, repeat the details back to the operator to ensure they have been noted correctly

When making a call to a patient at home, the procedure must maintain the privacy and confidentiality of the patient.

Do not identify where you are calling from. Maintain a pleasant manner.

Ask for the patient by name.

If the patient is not available do not leave a return number or message.

Handling difficult patients

It is a requirement that during normal opening hours, there are at least 2 members of staff present.

The practice has implemented the principles in the RACGP Guide General Practice- A Safe Place toolkit. All staff have been provided training in how to deal with difficult patients and the security protocols of the practice during their induction.

The practice also makes available RACGP GP support programs. Security issues are discussed regularly at staff meetings and all violent incidents are discussed and assessed on a whole of practice level.

Our practice has available a duress alarm system to notify all staff members if they are experiencing a violent encounter.

It is the responsibility of the appointed Risk Management leader to ensure that these policies and procedures are implemented and adhered to.

Electronic communication

This practice may use electronic means (email and SMS) to communicate with a patient or carer. At all times, the clinical team will consider the quality and safety of care when providing information by telephone or electronic means. Staff will be mindful of personal information privacy and only use electronic means of communication in the following circumstances:

where the patient or legal guardian has completed the New Patient Registration Form which includes permission to use electronic means of communication

in non-urgent conditions only

to remind the patient of an upcoming appointment

to send a non-urgent reminder or recall for follow up or regular testing

A record of the communication will be kept in the patient records. If a fee is to be charged for the telephone or electronic communication, patients will be made aware of this and information about the costs will be made readily available.

Telephone and electronic equipment

The practice needs sufficient telephone and electronic equipment to support reliable and efficient communications. An incoming telephone call is the principle method for initial and subsequent communication with a patient and most other persons to this practice.

As such the telephone is recognised as a vital medium for creating a positive first impression, displaying a caring, confident attitude and acting as a reassuring resource for our patients and all others.

All staff will be trained to use the telephone system and other electronic means of communication using the following procedures.

Telephone functions

All staff will be taught to use the following phone functions:

Put on hold

Retrieving calls from on hold

Answer other calls

Transfer calls

Using the intercom

Answering from other extensions

Program the after-hours message

Program on-hold music or message

Divert to after-hours service provider

Activate/deactivate answering machine

The operations manual for this telephone system is located in the operations folder behind the front reception desk.

Telephone problems

The following incidents must be reported to the practice manager if they cannot be fixed quickly by staff:

Telephones do not work due to power failure.

Loss of music/on-hold message and staff are unable to reprogram.

Loss of recorded messages and staff are unable to reprogram message.

For equipment failure, contact the telephone equipment provider listed in our Business and service provider contacts list.

For landline failure, contact the communications provider listed in Emergency contacts

Email

Patient information is only sent via email if it is securely encrypted according to industry and best practice standards.

This practice may use electronic means (email and SMS) to communicate with a patient or carer. At all times, the clinical team will consider the quality and safety of care when providing information by telephone or electronic means. Staff will be mindful of personal information privacy and only use electronic means of communication in the following circumstances:

where the patient or legal guardian has completed the permission to use electronic means of communication;

in non-urgent conditions only;

to remind the patient of an upcoming appointment; or

to send a non-urgent reminder or recall for follow up or regular testing.

A record of the communication will be kept in the patient records. If a fee is to be charged for the telephone or electronic communication, patients will be made aware of this and information about the costs will be made readily available.

Fees for telephone and electronic communications

Our practice may conduct telephone consultations when the patient cannot attend the surgery.

Patients will be advised in advance of the fee and that any billing for this style of consultation is not claimable through Medicare and a private invoice will be raised.

3. Home and other visits (Criterion 1.1.3)

Policy

Regular patients of this practice are able to obtain visits in their home, residential aged care facility, residential care facility or hospital, both within and outside normal opening hours where such visits are deemed safe and reasonable and where the patient is:

Acutely ill

Immobile or elderly

Has no means of transport to the practice

If disabled access to the practice is unsuitable

Our doctors, and where appropriate, practice nurses or Aboriginal health workers, have home visit schedules, which are recorded in the appointment book at reception.

1.3. Providing safe and reasonable care

Our practice ensures safe and reasonable arrangements are in place for medical care for patients outside our normal opening hours.

Prior to making a home visit, the following steps must be considered:

Visits are made to patients located within a 15 kilometre radius of the practice

Patients must have a telephone number which the general practice can call back

A health professional is not sent to a patient/caller requesting pain relief unless a pain management plan is in place

Police are requested to attend when a patient is threatening suicide

A health professional is not sent to a premises where there is evidence of a threatening or abusive person present – police are requested to attend in these instances

Callers are asked to restrain dogs, to turn on an outside light at night and provide guidance on identifying the residence in the absence of a house number (eg nearest intersection, landmark)

Patients are asked to provide their date of birth, and the name of their regular general practice. Where these details are not given or the patient is not known to the practice, consideration is given to referring the patient to a hospital or calling an ambulance (as appropriate)

1.4. Access to alternative sources of care

If our practice team decides that there is cause for concern or the option of a home or other visit is not safe or reasonable for the staff member or the patient, the patient will be referred to an alternative mode of care.

This decision and the known outcomes will be recorded in the patient health record.

Who can perform home or other visits

Our clinical staff, including doctors, nurses and Aboriginal health workers are appropriately trained and qualified to meet the needs of our practice community.

Our medical practitioners will provide home or other visits, providing the arrangements are deemed safe and reasonable.

Practice nurses and Aboriginal health workers may provide home and other visits under the supervision and instruction of the medical practitioner, providing the arrangements are deemed safe and reasonable.

Information about our home visit policy is available in the patient information sheet and on the front door of our practice.

Safety of health professionals

This practice has a policy of promoting staff security by having appropriate procedures in place that will minimise risk to staff.

Our practice recognises the RACGP Standards for General Practices: Fourth edition guidelines for the safety of health professionals undertaking home and other visits (as adapted from the National Association for Medical Deputising Services):

Patients must have a telephone number which the general practice can call back.

A health professional is not sent to a patient/caller requesting pain relief unless a pain management plan is in place.

Police are requested to attend where a patient is threatening suicide.

A health professional is not sent to premises where there is evidence of a threatening or abusive person present – police are requested to attend in these instances.

Callers are asked to restrain dogs, to turn on an outside light at night and provide guidance on identifying the residence in the absence of a house number (eg nearest intersection).

Patients are asked to provide their date of birth, and the name of their regular general practitioner/general practice. Where these details or a contact telephone number are not provided, consideration is given to referring the patient to hospital or calling an ambulance (as appropriate).

4. Care outside normal opening hours (Criterion 1.1.4)

Policy

Our practice ensures safe and reasonable arrangements for medical care for patients outside our normal opening hours.

1.5. Options for care outside normal opening hours

Our doctors provide their own care for patients outside normal opening hours, either individually or through a roster. Information about this service is made available on our front door notice and on our on-hold/after-hours message.

1.6. Formal after-hours agreements

During our non-operational hours, this practice has a formal arrangement with an After Hours Medical Deputising Service (National Home Doctor Service)The After Hours Medical Deputising Service is able to make contact with the patients doctor if necessary to ensure measures are implemented to facilitate continuity of care. A summary of care provided to patients of this practice who are attended to by the MDS is sent to the treating doctors within 24 hours of attendance

1.7. Follow up of tests taken during after-hours care

Our practice has a formal agreement with a cooperative of one or more local practices deputising service to provide a comprehensive after-hours service to our patients.

When the cooperative of one or more local practices sees a patient after hours, the patient will be asked who their regular general practitioner is.

The cooperative of one or more local practices will be provided with emergency mobile numbers of our practice general practitioners and are able to make contact with the patient’s usual general practitioner if necessary to ensure measures are implemented to facilitate continuity of care.

Where there are seriously abnormal or life threatening results the consulting doctor at the cooperative of one or more local practices will follow up the results and report back to the patient’s usual general practitioner.

Copies of all diagnostic imaging and pathology reports will be sent to the regular general practitioner upon receipt by ordering doctor or upon discharge by the hospital.

Information about this service is made available on our front door notice and on our on hold/after-hours message.

1.8. Who can provide after-hours care for the practice

Our clinical staff, including doctors, nurses and Aboriginal health workers are appropriately trained and qualified to meet the needs of our practice community.

Information about our home visit policy is available in the patient information sheet and on the front door of our practice.

1.9. Communicating our after-hours arrangements

This practice diverts the phone to our after-hours care provider when the practice is closed so that patients have access to care 24-hours a day, 7 days a week via our main telephone number.

Details of our practice arrangements for after-hours care and emergency services are detailed on the front doors of our practice.

5. Practice information (Criterion 1.2.1)

Policy

Our practice provides patients with adequate information about our practice to facilitate access to care.

1.10. Practice information

Our practice information is available to patients on our website and at reception. It contains:

Our practice address and telephone numbers

Our consulting hours and arrangements for care outside our practice’s normal opening hours, including a contact telephone number

Our practice’s billing principles

Our practice’s communication policy, including receiving and returning telephone calls and electronic communication

Our practice’s policy for the management of patient health information (or its principles and how full details can be obtained from the practice)

The process for the follow up of results

How to provide feedback or make a complaint to the practice including contact details of the local state or territory health complaints conciliation body

It is the responsibility of the Practice Manager to ensure that the practice information is kept up-to-date and copies are available at reception

1.11. Advertising practice information

All advertising carried out by our practice will comply with the Medical Board of Australia Code of Conduct and will include:

Factual and verifiable information about our practice and services offered

Justifiable claims about the quality and outcomes of our services

No guarantee of cures or exploitation of patients’ fears, or vulnerability about future health expectations

No inducements or testimonials

No unfair or inaccurate comparisons to competitor services

1.12. Practice website

Our practice website contains up-to-date information about our practice services including:

Clinical and management staff

Schedule of common fees

Hours of operation

Contact details

After-hours arrangements

How to provide feedback

The practice manager is responsible for updating the website on a regular basis and where there are changes in the above details.

1.13. Practice services

In addition to medical consultations, this practice offers the following services:

Women’s/Men’s Health

Pre-Employment Medicals

Occupational Medicine

WorkCover Consultations

Paediatrics/Immunisations

Enhanced Primary Care

Pathology

Skin Checks

Antenatal Care

Podiatry

Driving Medicals

Spirometry Testing

Dietician

Vaccinations/Immunisations

Health Checks

Psychology/Mental Health Counselling

Clinical Nutritionist

Insurance Medicals

1.14. Practice hours

Monday to Friday

8.00am – 5.00pm

Nursing Home and Home visits

Dr Phillip Clarke visits patients at Ella Cara Aged Care Community on pre-arranged days. All other home visits are provided by our After Hours Deputising Service.

After Hours

During our non-operational hours, this practice has a formal arrangement with an After Hours Medical Deputising Service (National Home Doctor Service)The After Hours Medical Deputising Service is able to make contact with the patients doctor if necessary to ensure measures are implemented to facilitate continuity of care.

A summary of care provided to patients of this practice who are attended to by the MDS is sent to the treating doctors within 24 hours of attendance.

For more information please see policies on:

Practice services, 1.1.3 - Home and other visits

Practice services, 1.1.4 - Care outside normal opening hours

6. Informed patient decisions (Criterion 1.2.2)

Policy

Our practice gives patients sufficient information about the purpose, importance, benefits, risks and possible costs associated with proposed investigations, referrals or treatments, to enable patients to make informed decisions about their health.

1.15. Providing appropriate and sufficient information to patients

Our patients will be given comprehensive information to enable them to make informed decisions about their health care.

The information will include for all investigations, medications, treatment or surgery:

Purpose

Importance

Benefits

Risks

Possible costs

Referrals

When providing this information our medical practitioners will avoid the use of jargon or complicated medical terms and if possible provide diagrams or written information such as brochures or leaflets from our practice software for the patient to review (possibly with family or carers).

1.16. Informing patients of potential treatment costs

Complaints may arise when patients receive accounts that are of an unexpectedly high cost.

It is the policy of this practice that doctors and staff are open and honest with patients in all discussions regarding costs. This does not necessarily mean that exact costs are provided to patients; however the patient must be made aware that there is potential for cost and an approximate indication of how much it will be.

This practice clearly outlines billing practices to patients through signage, the patient information sheet and verbally.

1.17. Patient-doctor collaboration

Our medical practitioners value the patient doctor relationship and will acknowledge the rights of patients to question or discuss the provider’s referrals or treatments and to make decisions about their own healthcare.

Our medical practitioners may refer our patients to read a copy of the former Australian Council for Safety and Quality in Health Care publication, 10 tips for safer healthcare. A copy of the publication is available at

www.safetyandquality.gov.au/wp-content/uploads/2003/01/Tips-for-Safer-Health-Care-PDF-302KB.pdf

7. Interpreter and communication services (Criterion 1.2.3)

Policy

Our practice provides for the communication needs of patients who are not proficient in the primary language of our clinical team and/or who have a communication impairment.

Patients who do not speak English or who are more proficient in another language, have the choice of utilising the Translating and Interpreting Service (TIS).

1.18. Patients of foreign background and ethnicity

If the patient requires an interpreter, ask the patient if they would like the use of an interpreter and offer translation services available in the practice.

If an existing patient, check the patient’s medical record to see if an interpreter has been used before.

If a new patient, record the patient’s preferred language and if they have requested an interpreter. If an interpreter is required, record what service they would prefer to use (eg family member, friend, staff member or TIS).

Ask what time the patient would prefer their appointment and whether or not they would prefer a male or female interpreter. Also ask how the patient prefers to be addressed and their preferred order of name (eg family name first, then generation name, given name last).

Record this information in the patient’s medical record.

Make a long appointment to accommodate interpreting time.

Ask the patient to repeat appointment details back to you to confirm they have understood.

If the TIS is the chosen option, contact them to book an interpreter. Advise the TIS operator of a nominated patient code for easy identification, patient name and language, preferred gender of interpreter, and appointment details.

Once confirmed, ask the patient to call if they are unable to attend the appointment. Alternatively, call the patient the day before to confirm the appointment.

The TIS is a free service available via telephone at the time of consultation, or if appropriate, the interpreter can be on site at the practice (48 hours advance notice is required).

Translating services

This practice encourages the use of the free Translating and Interpreting Service (TIS) – Doctors Priority Line (1300 131 450) as we consider it the right of all patients with limited English to be provided with a professional interpreter.

Other reasons for using a professional interpreter include:

Risk management

Effectiveness

Efficiency

Accuracy

Impartiality

Confidentiality

Professional conduct

Experience

Patients are advised of this service by:

Translating and interpreting services

Waiting room and doctor’s room signage

Brochures

Patient information sheet

Reception

Doctor

Using friends and relatives as interpreters

It is the policy of this practice that staff members are not to be used as interpreters, except in emergency situations. This is because bilingual staff, unless appropriately accredited, should not be presumed to have the necessary skills to act as interpreters. If an unqualified interpreter has been used in an emergency, a qualified interpreter must be obtained as soon as possible to ensure the patient has understood what has taken place.

8. Costs associated with care (Criterion 1.2.4)

Policy

Our practice informs patients about the potential for out-of pocket expenses for health care provided within our practice and for referred services.

1.19. Fees for services and billing practices

Our practice billing principles including a schedule of fees and services are displayed at the front desk, on our website and in the waiting room. Staff will draw patients’ attention to the billing process whenever appropriate.

Where an increase to our private and third party fees will take place or a change in our billing principles, the practice will provide notices on our website, at the reception counter and in the patient information brochure for a period of no less than one month before the changes take effect.

It is the responsibility of the doctor to enter/advise reception staff of the appropriate Medicare item number(s) the patient is being charged for.

Private billing

All patients will be issued an invoice at the time of seeing the doctor. All invoices are payable on the day.

Problems regarding a patient’s ability to pay must be referred to the treating doctor. Unless in specified circumstances, patients will receive a bill from the doctor at the time of consultation.

Payments may be made by:

Cash

Credit card

EFTPOS

Direct deposit

Bulk billing

When bulk billing Medicare, it is the responsibility of reception staff to ensure that the practice has an up-to-date record of the patient’s Medicare card number and that all patients are offered a copy of their Medicare assignment form.

This practice bulk bills Medicare for Medicare Benefits Schedule (MBS) items in the following circumstances:

At the discretion of the consulting doctor

For all Commonwealth Concession Card holders

All children under the age of 16

For follow up appointments; to receive results; for childhood immunisations

Department of Veterans’ Affairs

The Department of Veterans’ Affairs (DVA) provides a range of benefits and services to veterans and their dependants for injury, disease or death which is related to service with the Australian Defence Force. Eligibility for benefits depends on where and when a veteran served.

This includes:

Current serving members

Former serving members

Carers

Families

DVA patients eligible for this service will hold a DVA card. These come in the following formats:

Gold card

A gold card entitles the holder to DVA funding for:

All health care needs, for all health conditions, whether they are related to war service or not.

The card holder may be a veteran or the widow or dependant of a veteran; and

Only the person named on the card is covered.

Gold card holders may also be eligible for the Coordinated Veterans’ Care (CVC) program. The CVC targets gold cardholders who are more at risk of being admitted or readmitted to hospital.

White card for specific conditions only

The white card offers:

Medical treatment of the accepted specific condition(s);

Transport related to treatment of the accepted specific condition(s); and

Access to Repatriation Pharmaceutical Benefits Scheme

The white card is issued to:

Eligible veterans for the care and treatment of accepted injuries or conditions that are war caused or service related;

For the treatment of malignant cancer, pulmonary tuberculosis, posttraumatic stress disorder, anxiety and/or depression whether war caused or not; and

Ex-service personnel who are eligible for treatment under agreements between the Australian Government and New Zealand, Canada, South Africa and the United Kingdom for disabilities accepted as war-caused by their country of origin.

Orange card for pharmaceuticals only

An orange card is issued to Commonwealth and allied veterans and mariners who:

Have qualifying service from World War I or World War II;

Are aged 70 or over; and

Have been resident in Australia for 10 years or more.

Treatment Authority letter

A Treatment Authority letter acts as ongoing approval from DVA for the client to access reasonable primary and allied health treatment as required (up to certain limits for some treatment types). This Treatment Authority states:

The accepted condition/s that the client has.

All treatment outlined in the Treatment Authority letter is pre-approved.

Treatment Authority letters will be issued either at the point a needs assessment is undertaken, or when a client contacts DVA for medical approval.

Item numbers and fees for DVA are different from those for Medicare. If unsure, check with the practice manager.

Workers compensation

Workers Compensation is a form of insurance that is provided for all workers in the event of their being injured at work. A number of patients will present to the practice with a history that they have been injured in this way.

The patient is to lodge a claim with their employer, who must lodge relevant documentation with their insurance company. Until the relevant insurance company accepts the claim, no medical expenses are payable.

It is extremely important to note that the items able to be charged and the amounts will vary significantly from Medicare. Third party accounts will be charged according to the current Australian Medical Association Schedule of Fees or as arranged privately with an insurer or employer.

This practice will directly bill the relevant insuring organisation once a claim has been lodged.

It is the responsibility of the worker to lodge the initial claim and obtain the claim record number. This will be included on all patient invoices.

Once this is done, the appropriate item number is selected, and a tax invoice is generated charging the patient’s care to the appropriate insuring organisation.

The following information will need to be included on the tax invoice:

Practice details including ABN

Patient’s name

Patient’s date of birth

Claim number

Description, Medicare item number and fee for the service rendered

Account due date

Payment facilities (direct deposit details etc)

Medical examinations not covered by Medicare

Several services may be requested by patients that are not allowable to be billed to Medicare. Such services include practice consumables, pre-employment medical examinations and reports, commercial driving licence assessments, diving and aviation medicals. Third party accounts will be charged according to the current Fee Schedule or as arranged privately with an insurer or employer.

The doctor will inform the administrative staff if the consultation cannot be bulk billed and if the invoice is to be sent to a third party such as insurer or employer or paid privately by the patient. If the invoice is for practice consumables such as dressings or bandages, the patient will be made aware that there is no Medicare rebate available for those items.

Pre-employment medicals

Many industrial employers require pre-employment medicals to assess fitness to work or continue working in a role. Some will provide template forms for completion. A longer appointment and time with the nurse is often required in order to complete a full medical examination. Blood and urine tests may be required, as will an ECG and audiometry testing.

These requests cannot be charged to Medicare. Pre-employment medicals (third party accounts) will be charged according to our current Fee Schedule or as arranged privately with an employer.

This practice will directly bill the relevant insuring organisation once an examination has been completed.

Once this is done, the appropriate item number is selected, and a tax invoice is generated charging the patient’s care to the appropriate organisation.

The following information will need to be included on the tax invoice:

Practice details including ABN

Patient’s name

Patient’s date of birth

Claim number (if applicable)

Description and fee for the services rendered

Account due date

Payment facilities (direct deposit details etc)

1.20. Costs of other health services

Our medical practitioners will advise patients of the potential for out-of pocket expenses such as when undergoing further treatment, visiting specialists and allied health practitioners or having diagnostic imaging or pathology testing.

Our practitioners are not expected to know exact costs but will recommend that patients check with the provider when booking their appointment.

The medical practitioner will also consider alternative referrals to public health services if costs are considered a barrier to treatment.

9. Health promotion and preventative care (Criterion 1.3.1)

Policy

Our practice provides health promotion, illness prevention and preventive care and a reminder system based on patient need and best available evidence.

1.21. Health promotion activities

Our practice recognises the integral part that general practices play in the coordination of health promotion and preventive care objectives in conjunction with other health professionals and key agencies.

We aim to provide a holistic approach to health care, allowing for each patient’s individual circumstances to be considered when providing health promotion, preventive care, early detection and intervention.

Health promotion activities in the practice assist the patient and promote patient proactivity towards health care and management. This results in patients increasing their preventive health appointments within the practice.

Health promotion activities that our practice regularly engages in include:

information on waiting room or community pin up boards

leaflet handouts

awareness raising on specific health areas using the WA Health Department What’s on in Health calendar for health topic ideas

feature of a health topic for one week of each month or every second month. Activities commence one month prior to the ‘feature’ week

contact with other relevant organisations for resources and promotional materials for distribution (such as pamphlets and posters)

‘theming’ the practice – for example, red balloons for heart awareness week; pink for breast cancer awareness

patient involvement – for example, the heart foundation jump rope for kids program or community walking challenges

contact with our Medicare Local to interact with the programs they have on offer

Current information on health promotion activities and support services within our local community are available in the waiting room and in each doctor’s consulting room.

1.22. Preventative care

Our practice provides health promotion, illness prevention, preventative care and a reminder system based on patient need and the best available evidence.

Our systematic approach to preventative care includes:

Vaccination and occupational health clinics

Our practice will:

Set up and promote influenza vaccinations on Friday mornings (in season).

Coordinate with local employers to vaccinate their workforce against influenza in an effort to reduce sick days.

Offer occupational health services, for example, pre-employment screenings, hearing tests, workplace health assessments and visit the workplace to conduct basic health checks such as BMI, blood pressure, blood glucose levels, resting heart rate.

Mole scan unit

Our practice will:

Promote the availability of the mole scan unit (if available).

Set aside a half day a week for a month and promote this time as skin check.

Promote 18–24 November as National Skin Cancer Awareness Week.

The Cancer Council of WA offer health professional resources to promote skin checks and sun safety, contact them for promotional gear such as posters http://www.cancerwa.asn.au/professionals/.

Asthma awareness

Our practice will:

Promote 1 – 7 September as national asthma week.

Promote this week as the time for Asthma patients to come in for a Chronic Disease Management Plan (CDMP) or a CDMP review (if applicable).

Utilise Asthma WA’s (www.asthmawa.org.au) range of resources available for health professionals and their patients including action plans and handbooks.

If not already registered, contact the Medicare Practice Incentives Program (PIP) and register for the Asthma incentives. PIP payments are available for sign on and service incentives.

Seasonal ‘flu clinics

Our practice will follow the Australian Government Department of Health recommendations and promote the free flu vaccine to at-risk patients including:

Over 65’s

Aboriginal and Torres Strait Islanders 15 years and above

Pregnant women

Anyone over 6 months of age with:

Heart disease

Severe asthma

Chronic lung condition

Chronic illness requiring medical follow-up or hospitalisation in the past year

Diseases of the nervous system

Impaired immunity

Diabetes

Children aged 6 months to 10 years who are on long-term aspirin therapy

1.23. Health risk assessments

Our practice promotes participation in early detection screening programs such as the:

National Cervical Screening Program

BreastScreen Australia

National Bowel Cancer Screening Program

1.24. Managing patient information to support preventative care

Members of our clinical team routinely collect information that is transferred to a patient’s health summary. A complete health summary makes a useful statement of the patient’s main health issues. This contributes to better continuity of care within the practice and when patients seek care in other settings.

Some information may also be transferred to national registers (eg immunisation data) or state and territory based systems (eg cervical screening or familial cancer registries) in order to improve care.

Where the practice participates in national registers, patients are required to provide consent for the transfer of related health information to a register or be made aware that they can opt out of such registers.

1.25. Clinical resources for the practice – preventative health

Useful resources for the practice:

PrimaryCare Sidebar® is an electronic platform that can host a range of products including prompts which notify general practitioners of follow up activities required. The PrimaryCare Sidebar® has add-ons including the RACGP Guidelines for preventive activities in general practice (the ‘e-red book’). This means the general practitioner is automatically notified about which preventive care activities are outstanding, up-to-date or unknown for the patient record that is opened. The preventive activities are based on the latest evidence based recommendations from the e-red book. Further information is available at www.pencs.com.au/products/primarycare-sidebar.

RACGP Guidelines for preventive activities in general practice (the ‘red book’) are available at www.racgp.org.au/guidelines/redbook.

RACGP Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting (the ‘green book’) is available at www.racgp.org.au/greenbook.

RACGP Smoking, Nutrition, Alcohol and Physical Activity (SNAP) framework for general practice is available at http://www.racgp.org.au/your-practice/guidelines/snap/

RACGP learning modules are available at http://www.racgp.org.au/your-practice/business/managementtoolkit/

Australian absolute cardiovascular disease risk calculator is available at www.cvdcheck.org.au.

Information on cancer screening is available at www.cancerscreening.gov.au.

The National Preventative Health Strategy launched in 2009 includes technical papers on obesity, tobacco control and the prevention of alcohol related harm and can be found at http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lp

The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) is an evidence based diabetes risk assessment tool that can directly link into the provision of a lifestyle modification program for patients who are found to be at risk of diabetes. The tool is available at www.health.gov.au/preventionoftype2diabetes.

10. Consistent evidence based practice (Criterion 1.4.1)

Our practice has a consistent approach for the diagnosis and management of conditions affecting patients in accordance with best available evidence.

1.26. Clinical practice guidelines

Our clinical teams will maintain up-to-date knowledge of current clinical practice guidelines to assist in the diagnosis and management of our patients by:

Regularly attending Continuing Professional Development activities

Utilising clinical software installed on the practice computers

Attending face-to-face clinical meetings

Access and utilising clinical guidelines for patients who identify as Aboriginal or Torres Strait Islander

1.27. Clinical resources for the practice – evidence based practice

Known and trusted resources will be used for reference and clinical care guides. These include:

Australian Commission on Safety and Quality in Health Care Ensuring Correct Patient, Correct Site, Correct Procedure Protocol at www.safetyandquality.gov.au/our-work/patient-identification/patient-procedure-matching-protocols/ensuring-correct-patient-correct-site-correct-procedure-protocol/

Australian Medicines Handbook at www.amh.net.au

Australian Prescriber at https://www.nps.org.au/australian-prescriber

Central Australian Rural Practitioners Association (CARPA) treatment and reference manuals at http://www.remotephcmanuals.com.au/about_CPM.html

Cochrane library at www.thecochranelibrary.com/view/0/index.html

Diabetes Australia at www.diabetesaustralia.com.au

National Aboriginal Community Controlled Health Organisation (NACCHO) at www.naccho.org.au

National Asthma Council at www.nationalasthma.org.au

National Health and Medical Research Council at www.nhmrc.gov.au/guidelines/index.htm

National Heart Foundation at www.heartfoundation.com.au

National Prescribing Service at www.nps.org.au

RACGP Guidelines for preventive activities in general practice (the ‘red book’) at www.racgp.org.au/guidelines/redbook

RACGP Medical care of older persons in residential aged care facilities (‘silver book’) at www.racgp.org.au/guidelines/silverbook

RACGP Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting (the ‘green book’) at www.racgp.org.au/greenbook

RACGP Smoking, Nutrition, Alcohol and Physical Activity (SNAP) framework for general practice at http://www.racgp.org.au/your-practice/guidelines/snap/

Rational Assessment of Drugs and Research (RADAR) at https://www.nps.org.au/radar

Royal Children’s Hospital Melbourne clinical guidelines at www.rch.org.au/clinicalguide

Therapeutic Guidelines at https://tgldcdp.tg.org.au/etgcomplete?sectionid=71

1.28. Patient identification – prior to surgery

Our clinical staff will ensure all patients undergoing minor surgery and procedures within our practice rooms receive the correct procedure.

Our practice incorporates the former Australian Commission on Safety and Quality in Health Care Ensuring Correct Patient, Correct Site, Correct Procedure Protocols into our standard processes for checking the identity of a patients and matching that identity to the correct procedure.

The five protocols are:

Days to hours before the procedure

Step 1: Complete a consent form or procedure request form.

Step 2: Mark the site of the invasive procedure.

Just before entering the operating theatre or treatment room

Step 3: Have the patient confirm their patient name, date of birth and site for, or type of, procedure.

Immediately prior to the procedure

Step 4: Team ‘time out’ – verbally confirm presence of the correct patient, that the correct site has been marked, the procedure to be performed and the availability of correct implant where required.

Step 5: Imaging data – if imaging data is used to confirm the site or procedure, two or more members must confirm the images are correct and properly labelled.

The Ensuring Correct Patient, Correct Site, Correct Procedure Protocol kit contains workplace posters and patient brochures. It also includes a fact sheet which our practice distributes to patients.

More information is available at:

If time is money – poster www.safetyandquality.gov.au/wp-content/uploads/2012/02/timingposter.pdf

Ensuring Correct Patient, Correct Site, Correct Procedure www.safetyandquality.gov.au/wp-content/uploads/2012/02/ensureposter.pdf

Ensuring Correct Patient, Correct Site, Correct Procedure Fact Sheet www.safetyandquality.gov.au/wp-content/uploads/2012/02/factsheetb.pdf

Patient Brochure – Understanding your procedures www.safetyandquality.gov.au/wp-content/uploads/2012/02/patbrochp.pdf

Patient Brochure – Understanding your surgery www.safetyandquality.gov.au/wp-content/uploads/2012/07/understandingyoursurgery.pdf

1.29. Health inequalities

Our practice team recognises that nationally there are some significant differences in key indicators of general health and wellbeing. This information highlights the need for primary healthcare interventions tailored to specific groups within the Australian community.

We understand that health gains have not been equally shared across all sections of the population and today Australia is characterised by large morbidity and mortality inequalities between population subgroups.

This includes homeless youth, children of single parent families, people with developmental disabilities, Aboriginal and Torres Strait Islander people, refugees and those from culturally and linguistically diverse populations.

For example, the Australian Institute of Health and Welfare (AIHW) report, Australia’s Health 2010 (available at www.aihw.gov.au/publication-detail/?id=6442468376 ) identifies that Aboriginal and Torres Strait Islander people have a life expectancy that is significantly less than that of other Australian men and women.

In an effort to combat these inequities, our staff will accommodate the specific health needs of individuals who may be suffering disadvantage.

Resources related to managing the chronic health conditions of Aboriginal and Torres Strait Islander people are available at:

Australian Indigenous HealthInfoNet www.healthinfonet.ecu.edu.au

For more information please see policies on:

Practice services, Chapter 1.7.3 - Recording cultural background

Practice services, Chapter 1.7.4 - Recording Aboriginal and Torres Strait Islander status

1.30. Consistent communication

With our patients

Our practice team understands the importance of a consistent approach to all communication, treatment and clinical care of our patients.

For our patients to have confidence in our systems and trust in our medical practitioners it is imperative that all staff work in accordance with the same policies and procedures and that clinical care is consistent with the best available evidence.

With the clinical team

In order to achieve a consistent approach to clinical care, our practice staff will record detailed patient records and provide handover notes between doctors and other clinical staff members.

Records will be precise and have a clear plan for the patient’s care.

Our team has regular clinical team meetings to discuss interesting or difficult cases and comprehensive management of patients. This is particularly important for our registrars and non-vocationally recognised medical practitioners working towards Fellowship exams or under supervision and mentorship of our clinical team leaders.

11. Clinical autonomy for general practitioners (Criterion 1.4.2)

Our practice ensures that all general practitioners in our practice can exercise autonomy in decisions that affect clinical care.

1.31. Clinical autonomy within evidence based care

Our general practitioners are free, within the parameters of evidence based care, to determine:

The appropriate clinical care of patients

The specialists and other health professional to whom they refer

The pathology, diagnostic imaging and other investigations they order and the provider they use

How and when to schedule follow up appointments with individual patients

Whether to accept new patients

Members of our clinical team are also consulted about the length and scheduling of appointment times and team discussions are held to discuss the purchases of new clinical equipment and supplies.

1.32. Professional and ethical obligations

All members of our clinical team will comply with the professional and ethical boundaries required by law, their boundaries of knowledge, skills and competence and their associated professional organisations such as:

Australian Health Professional Regulation Authority (AHPRA)

Royal Australian College of General Practitioners (RACGP)

Australian College of Rural and Remote Medicine (ACRRM)

Australian Medical Council (AMC)

Australian Medical Association (AMA)

12. Continuity of comprehensive care and the therapeutic relationship (Criterion 1.5.1)

Policy

Our practice provides continuity of comprehensive care to our patients

1.33. Provider continuity and patient outcomes

The RACGP defines general practice as providing patient centred, continuing, comprehensive, coordinated primary care to individuals, families and communities.

Our practice understands that patient trust and confidence is built over time and as such encourages patients to receive ongoing care from the same doctor. Our staff will check with the patient who their normal doctor is each time the patient presents for an appointment.

Our practice will encourage the attendance of a patient with their regular general practitioner in order to maintain a trusting, continuing, comprehensive and coordinated cycle of care.

In the case of the patient’s usual doctor being unavailable, staff will offer an appointment with an alternative doctor at this practice. All doctors in this practice, including locums, keep accurate records and important updates are passed directly to the usual doctor.

Provision of after-hours service to ensure continuity of care is detailed in sections:

Practice services, Chapter 1.1.3 - Home and other visits

Practice services, Chapter 1.1.4 - Care outside normal opening hours

In the event of a patient leaving this practice, or transferring to another practice, this practice will assist in continuity of patient care by forwarding a copy or summary of the records to the new practitioner.

For more information please see policies on:

Practice services, Chapter 1.5.2 - Transfer of health information – To another practice

This practice does not deny access to any patient on the basis that the doctors may or may not specialise in the area of the patient’s medical condition. Should a patient present with a condition where the appropriate management is not within the capacity of this practice, they will be referred to an appropriate provider.

1.34. The doctor patient relationship

Our medical practitioners value the patient doctor relationship and will acknowledge the rights of patients to question or discuss the provider’s referrals or treatments and to make decisions about their own healthcare.

Our medical practitioners may refer our patients to read a copy of the former Australian Council for Safety and Quality in Health Care publication, 10 tips for safer healthcare. A copy of the publication is available at:

www.safetyandquality.gov.au/wp-content/uploads/2003/01/Tips-for-Safer-Health-Care-PDF-302KB.pdf

If a patient is unable to be effectively treated by a doctor in this practice for various reasons, including lack of rapport, the doctor will make every effort to locate another doctor to undertake the care of this patient.

1.35. Courtesy notifications

Where a medical practitioner ceases or will cease practise within our general practice, our team members will make an effort to advise the medical practitioners’ regular patients of this change.

If desired, patients will be given information on how to request a transfer of medical records.

For more information please see policies on:

Practice services, Chapter 1.5.2 - Transfer of health information – To another practice

1.36. Supporting preferred relationships

Our practice team supports preferred professional relationships between our patients and our clinical team.

To support preferred relationships, our practice has a formal appointment booking system, using our practice software system Clinic to Cloud.

Patients are able to book an appointment to see their doctor of choice in accordance with our appointment triage system:

urgent care;

non-urgent care;

complex care;

planned chronic disease management;

preventative health care; and

long consultations.

Walk in patients may see the Aboriginal health worker or practice nurse for baseline assessment prior to seeing the next available doctor. Patients wishing to see a particular doctor will be advised by practice staff of the approximate waiting time.

13. Clinical handover (Criterion 1.5.2)

Policy

Our practice has an effective clinical handover system that ensures safe and continuing healthcare delivery for patients.

1.37. Defining clinical handover

The Austr