Keeping the North Coast well this winter

Every winter, there is a surge in healthcare demand both in the community and hospitals. Older and frail patients are especially vulnerable during this time.

As part of the Northern NSW Integrated Care strategy the Northern NSW Local Health District (LHD) and the North Coast Primary Health Network (PHN) have embarked on the Winter Strategy initiative.

The Winter Strategy is being piloted as the first of its kind and aims to support general practices to keep their most vulnerable patients well and reduce their likelihood of being hospitalised this winter.

The Winter Strategy has now commenced in Northern NSW, and is available for General Practices and Aboriginal Medical Services located in the Tweed Valley, Richmond Valley and Clarence Valley regions.

PHN sent out an expression of interest to general practices within the LHD footprint and received enrolments from 27 practices. These Practices have identified and are now in the process of registering an estimated 1040 patients.

For the purpose of this pilot the number of patient registrations is being capped and the journey of these patients will be tracked from July to October, the duration of the strategy..

Each of these patients will have Admission and Discharge Notifications activated.

The PHN will contribute a ‘fee’ to support general practices to provide additional care, usually by practice nurses, over winter. There is no Medicare rebate to cover this additional activity. This is new approach and will be carefully monitored /evaluated.

In support of the Winter Strategy The Tweed Hospital and Lismore Base Hospital are working towards having systems in place to book GP appointments for chronic inpatients aged over 70 years prior to hospital discharge. The LHD’s Chronic Disease Management Service (CDM) staff have been working hard with local GP practices to enable patients receive timely / appropriate care.

How will it Work?

Below is quick look at the Winter Strategy from the GP’s perspective.

General practice and LHD staff have access to an arsenal of tools and resources available online via the PHN’s website https://ncphn.org.au/winter-2017/. Tools and resources include information on:

• Planning with Patients
• Sick Day Action Plans
• HealthPathways
• Chronic Disease Management Team
• Hospital in The Home
• Urgent Allied Health
• Influenza Vaccine

Consumer materials are also available as part of the Winter Strategy Consumer Campaign and are also available online. These materials include:

• Short videos for waiting rooms, website or Facebook
• Newsletter advertisements
• Social media content
• Digital banners
• Posters

If you would like more information on the Winter Strategy please visit the PHN’s official website via the following link https://ncphn.org.au/winter-2017/ or contact the team via email at winter@ncphn.org.au.