Would you like a GP to participate in a discharge case conference

for a patient with complex or chronic multidisciplinary needs?

The focus of discharge planning is the patient’s usual location (home, school, community etc.) and as such will often be enhanced by involvement of the patient’s GP in the care management planning and review. This is especially important for patients with complex needs (eg presence of complex medical, surgical or disability issues and/or complex social circumstances).

CHECKLIST

q Record patient/carer consent for a case conference to be developed with their GP’s participation. (If the GP does not bulk bill, advise the GP that s/he will personally need to obtain consent for a fee to be charged).

q Identify at least two other health professionals or service providers who will participate in the case conference along with the GP. They may all be workers from the hospital, as long as they provide different services and only one of them is a medical practitioner.

NB: These can include, for example, aboriginal health care workers; audiologists; dental therapists; dentists; dietitians; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists; probation officers, and home and community service providers such as care organisers and education providers.

q Inform the GP that they will be required to complete the Discharge Case Conference GP Proforma which can be obtained from their Division. This will allow them to be able to claim for MBS Item 768-773. The GP is responsible for filling out the details of the proforma and placing it in the patient’s file.

q Arrange time and place of conference and availability of participants. For the GP to claim, a minimum of three participants must be present for the duration of the GP’s attendance at the conference. The GP’s participation must be a minimum time of 15 minutes. The case conference can be carried out face to face, by telephone or by video link.

NB: A three way discussion can be arranged by telephone. The process is as follows:

- - Dial the first number of the person you wish to speak to.

- - Press ‘recall’, wait for the dial tone and dial the second number.

- - To join the calls together, press ‘recall’, wait for the dial tone, and then dial 3. The cost is 50c for local calls. STD rates apply for STD calls.

- A teleconference (involving four or more parties) may also be arranged through Telstra or Confertel. Call 1800 505 075)

q After the case conference, incorporate a copy of the minutes in the patient medical record, and send usual discharge documentation to the GP.

For more information, see the Australian Divisions of General Practice

Enhanced Primary Care website, http://www.adgp.com.au/epc