The role of allied health in the management of complex conditions in a comprehensive primary care setting
G Mitchell, H Senior, M Foster, I Williams, J Chaffey, R Chambers, T Henwood, C Freeman
Policy Context: Chronic and complex diseases require multidisciplinary care (MDC). Much of this care is delivered in the community by primary care professionals- general practitioners (GPs), nursing and allied health professionals (AHPs). Ensuring appropriate interaction, particularly between these professionals is essential to high quality care, but is not well understood. Recent advances in primary health care policy have allowed limited Medicare funding of AHPs. Recent work has highlighted difficulties faced by AHPs as a result of the limitations of the Medicare funding arrangements. As a prerequisite to reviewing the policy around funding of allied health care by Medicare, how AHPs operate in community settings needs to be clarified, as does the relationships between AHPs, GPs, and people with chronic, complex conditions.
Setting: We conducted an in-depth study of the role AHPs play in the care of complex conditions in older people, in a large urban general practice (Camp Hill Health Care – CHHC) which has developed a comprehensive MDC model of care. CHHC employs over 50 people and has about 38,000 patients. There are 15 GPs and several CHHC-based AHPs. Some of these are independent practitioners situated on the premises, and others actually work within the practice. The practice owner is a GP, and there is an Executive Officer who has comprehensive management oversight. CHHC has developed a system of review of older patients deemed to have complex medical problems. Patients are assessed in their homes by an experienced community nurse, then by the person’s GP, and a GP management plan is developed and implemented. A comprehensive database of 6 years of health assessments was the basis of this research project.