Addressing an age-old dilemma

How a north-west GP is improving the health of Tasmanians in aged care homes

The Aged Care Royal Commission found people receiving aged care, particularly those living in aged care homes, do not consistently receive the health care they need. 

“Primary healthcare practitioners are either not visiting people receiving aged care at their residences, or not visiting enough, or not spending enough time with them to provide the care required,” the commission’s final report says.  

“Access to general practitioners will continue to be a challenge for people receiving aged care unless something significant is done to fix it.”  

The Australian Government is putting in place measures in response (see below).

Some Tasmanian general practices are already well embedded in aged care homes, and many others are considering how they can better support residents. 

One example is a GP in north-west Tasmania who has launched a medical model that is paying dividends for aged care residents.  

In April this year Dr Fiona Wallace opened the West Kentish General Practice which, rather than providing general community care like most practices, focuses only on providing care to people living in aged care homes. 

Fiona, who trained in the UK before coming to Tasmania 17 years ago, had previously been the senior doctor in the emergency department of Devonport’s Mersey Hospital. 

“I was getting very frustrated and upset with the number of very frail elderly people who were coming into hospital when we couldn’t realistically do anything for them,” she says. 

“They were going through a huge number of tests, but weren’t well enough to undergo treatment for anything that was discovered.” 

Fiona says when someone becomes unwell in aged care, GPs who already have demanding schedules often can’t immediately visit – sometimes resulting in the resident being sent to hospital by ambulance. 

This is sometimes done without consulting the older person or explaining what was happening. 

“Older people can at times feel other people are making decisions for them, without actually including them in the process,” she says. 

So Fiona decided to do something about it. Branching out on her own, she started visiting residents at one aged care home a couple of times a week. 

As word got around, Fiona’s client list soon began to grow. More and more homes sought her services, and she is now looking after 220 residents of aged care and group homes between Sheffield and Port Sorell. 

“I am fully remote,” she says. “I do not have a bricks and mortar practice. It’s me, my doctor bag and my laptop and I go from facility to facility doing my rounds.” 

Fiona believes it’s important that aged care specialisation features in the future of general practice.  

“GPs who have a lot of aged care residents on their books are going to have an even better understanding and knowledge of what it takes to provide that level of care,” she says. 

One of the homes Fiona works with is the Melaleuca Home for the Aged, a 48-bed high-care facility at East Devonport. 

Melaleuca clinical care director Linda Sheehan says the home’s priority is to ensure it gives people the best care it possibly can, “and Fiona makes that easy”.  

“She regularly visits, she’s accessible, and she will call us to check on a patient,” Linda says. 

“Fiona is willing to consult with us. It’s a respectful two-way communication. She listens to the nursing staff, listens to our clinical knowledge and experience, and believes that information is invaluable to her providing the best possible care. 

“She will take the time to speak to a patient, their family and every other person involved in their care until everyone is on the same page, so we can all be consistent in the care that we deliver.” 

Linda says Melaleuca residents and staff are lucky to be supported by a number of GPs from a range of practices.  

“But all practices and GPs are under pressure – I understand that and empathise with it,” she says. 

“It’s great to have Fiona’s focused aged care model in place alongside GPs who have the pressures of a busy community practice as well as their aged care work.” 

Linda says Fiona has already had a huge impact on many people at Melaleuca, including on one resident whose dementia had left her housebound. 

“Through Fiona’s perseverance we’ve now got this lady and her family some quality of life,” she says. 

“Her family can now take her out for lunch, for a drink, for a drive. 

“Our job is to provide quality care, and provide time for family to be with residents and enjoy each other. And Fiona just provides that in spades.” 

Fiona’s practice model has obvious benefits for her patients. But what does she get out of it? 

“Generally, old people are really nice!” she says, “and they’re grateful for someone who devotes that time to them – someone who is prioritising their needs and listening to what matters to them. 

“People value the fact that you come in and spend time with them and their family explaining things, talking through their options. When we have that conversation, I can answer all their questions. 

“That’s a really rewarding part of the job – being able to spend that time with people, and leaving them feeling listened to.” 

Do you know of another general practice or primary healthcare provider that’s doing great things in aged care homes? We’d love to hear from you.  

The General Practice in Aged Care Incentive program 

Part of the Australian Government’s response to the Aged Care Royal Commission has been to introduce the General Practice in Aged Care Incentive from 1 July 2024.  

This new program sees registered GPs and practices receive incentive payments for providing regular visits and care planning to older people living in aged care.  

GPs and patients must be registered with MyMedicare. 

Primary Health Networks – including Primary Health Tasmania – are providing support in connecting aged care residents with GPs.  

Want to know more? Visit the GPACI page here.  

This story features in Issue 19 of our Primary Health Matters magazine. Click here to read the rest of the issue.