Nurse practitioners, paramedics lead urgent and after-hours care

Working in a hospital emergency department, nurse practitioner Andy Keygan saw plenty of people who, in his opinion, shouldn’t have been there.

Wards and waiting rooms were often packed with patients presenting with minor, non-urgent issues – making it even harder for staff to deal with actual emergencies.

“It was evident to me that a lot of the patients presenting to emergency didn’t need to be there, but they went because of a lack of access to alternative options,” Andy says.

“GP waiting lists are notoriously long, and people are really struggling to get same-day care.

“That will either lead to them not engaging with services and then deteriorating to the point that they have to seek hospital-level care, or they will present to emergency for something that could have otherwise been dealt with outside of a hospital setting.”

Andy knew there had to be a better way of doing things. So when the opportunity arose to join the team at the innovative Cygnet Family Practice, he jumped at the chance.

The practice had recently begun offering a new urgent and after-hours service on Thursday, Friday and Saturday nights, providing local patients with same-day access to health care in their own community and helping alleviate some of the issues currently plaguing health care provision in Tasmania – including GP shortages, ambulance ramping, and an increasing number of 000 calls and emergency department presentations.

Taking a multidisciplinary, collaborative approach to health care, the urgent and after-hours service is led by a team of nurse practitioners and paramedic practitioners: highly skilled, experienced and expertly trained nurses and paramedics.

While the practice also employs GPs, the nurse practitioners and paramedic practitioners practise autonomously – so there doesn’t need to be a GP on site during all opening hours.

An emergency, on-call medical specialist team (My Emergency Doctor) can be called on the few occasions when additional medical advice is needed – which was only five times (0.5% of appointments) in the first six months.

Along with the extended opening hours, the Cygnet model includes a primary care outreach service for frail and vulnerable community members who are unable to attend the practice in person.

The urgent and after-hours service has been extremely well received by locals, treating more than 900 patients in the first six months.

Andy says the number of patients continues to grow as people from Huonville, Geeveston and other nearby communities increasingly take advantage of the service.

“It’s really exciting to be engaged in something that is quite innovative and that really puts patients first,” he says.

“Particularly in Tasmania but also on the mainland, I think similar models could get a lot of traction.

“It’s not about overheads or financial stuff; it’s just about timely access to better health outcomes for patients in rural communities, and that’s what drew me here.

“I think it’s a very positive thing we’re trying to achieve, and it has been really well received. We’ve initiated patient satisfaction surveys as part of our evaluation model, and that’s been really positive.

“I’ve noticed that people who might not traditionally go to see the doctor are happy to engage and share with the nurse practitioners. Anecdotal feedback we’ve received from patients has been that they’re just so grateful and thankful.

“To be part of something that is so meaningful is very humbling but very rewarding at the same time. It has been fantastic.”

At a time when many health services are struggling to attract and retain staff, the Cygnet Family Practice is bucking the trend.

Like Andy, the newest member of the team, paramedic Ben Smith, was attracted to the opportunity to make a real difference in a small community.

“Doing ambulance paramedic work, you’re not building patient rapport,” he says. “You see a patient, treat them and transport them to hospital, often in an emergency situation.

“You’re not having conversations with them the same way you do when you get to build long-term relationships.

“So the idea of being in a community, working regular hours, getting to know the locals, that really appealed to me.”

In his first week in Cygnet, Ben – an experienced paramedic who is working towards becoming a qualified paramedic practitioner – quickly learned what a huge impact the new service is having.

“I’ve already had several patients say that I saved them a trip to Hobart,” he says. “In four shifts I’ve had three or four patients directly say that to me, and a couple more who I think may have ended up in Hobart if they hadn’t found us and used our service.

“The feedback has been great; people are really happy and surprised to have found us.”

That includes patients like Josh*, who was dehydrated from gastroenteritis and was treated with IV fluids, avoiding a weekend visit to the Royal Hobart Hospital emergency department; and Sally*, who was relieved to be able to access antibiotics for her kidney infection on a Saturday night.

Having worked in the region for nearly a decade, Cygnet Family Practice founder and nurse practitioner Kerrie Duggan knew just how beneficial an urgent and after-hours service would be, and that nurse practitioners and paramedic practitioners could make it happen.

In December 2022 she applied for Tasmanian Department of Health grant funding designed to encourage innovative healthcare models, and was successful in securing “delivery of service” funding for 2023-26.

Now Kerrie thinks the Cygnet model can be part of the solution to workforce shortages in primary health care, with potential for the model to be rolled out across Tasmania and Australia.

“It’s a no-brainer, it ticks all the boxes,” she says.

“We really need to embrace healthcare reforms – we can’t keep doing the same things and expecting different outcomes.

“This is a new model of care that is very cost-efficient and provides safe, quality care by AHPRA**-registered health professionals who are highly regulated and highly experienced.

“All the data shows it’s a safe model. It’s used in Canada, the UK and New Zealand, and there are similar models in rural Victoria, Queensland and New South Wales.

“It’s the way of the future, and a way for people to get help on the day they need it.”

* identity protected

** AHPRA stands for the Australian Health Practitioner Regulation Agency

This story features in Issue 17 of our Primary Health Matters magazine. Click here to read the rest of the issue.