| Project Objectives / Summary:
This project sought to design an effective Group Practice Network (GPN) for inner urban and rural application over an extended period of 18 months.
Project Collaboration:
The Melbourne Division of General Practice in collaboration with the North East Victoria Division of General Practice.
Project Outcomes:
Attempts to design an effective GPN for inner urban and rural application did not yield a replicable design. At best, the process of exploring specific infrastructure arrangements for shared or common information technology and management, yielded information about the methodology used and about particular options.
Recommendations:
Two design cycles were completed and a third begun but none of them yielded a GPN design useful to small and solo general practices, whether urban or rural. Consequential and better services to patients could neither be evaluated nor costed because the first, Comprehensive Design, cycle was found to be incapable of producing a prototype in time or at all. The second, Central Server, design had a working prototype but the costs were found to be beyond the capacity of solo and small practices and there were numerous privacy, reliability and legal problems needing resolution.
A third design cycle, around a Practice Router, is being set up by the Melbourne Division for load and clinical data testing. Before anyone concludes that this design or any other single design is capable of reaching the production or application stage it would seem desirable that the Australian Divisions of General Practice and / or the Department of Health and Ageing convene and support a research and development process, conference or seminar in which the learning's from this project and relevant parallel activities are discussed, like:
- the 15 virtual amalgamation projects, three of which have explicit links to our second design cycle, and
- at least the most relevant of the Division-facilitated corporatisation exchange information on achievements and "road-blocks".
The Melbourne and North East Victorian Divisions appreciate the opportunity provided by the second Innovations Round funding and wish to learn about and from other experiences of designing Group Practice Networks.
Lessons / Assessment:
While inner-Melbourne and North-East Victorian GPs recognised a number of potential benefits that could flow from virtual amalgamation such as opportunities to improve care, improvement in practice efficiency and quality of life, evaluation of our process suggests that a number of factors are likely to influence which GP will consider what kind of association or amalgamation. The main factors that can be seen as 'reasons for resistance' are:
- Perceived incompatibility of GPs
- The similarity in the position along the continuum of parameters from being anti- amalgamation to being already involved in amalgamation
- The similarity with respect to a number of clinical and business practices
- Generality and diversity of patient populations tend to increase with the number of co- located GPs in a practice.
- Loss of autonomy
- The cost and benefits of virtual amalgamation
- Preparedness to standardise practice
- Management of incompatible data and software standards
- Anxiety-cycling concerns about imposed reforms
- Privacy and data confidentiality issues
- Geographic factors
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