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CHHS17/168

Canberra Hospital and Health ServicesOperational Procedure General Practitioner Phone Support: Advisory Line and Liaison Nurse (MHJHADS)Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Background.............................................................................................................3

Section 2 – General Practitioner Advisory Line.........................................................................3

Section 3 – General Practitioner Liaison Nurse Phone Support Service....................................5

Implementation........................................................................................................................ 7

Related Policies, Procedures, Guidelines and Legislation.........................................................7

References................................................................................................................................ 8

Search Terms............................................................................................................................ 8

Attachments..............................................................................................................................9

Attachment 1 – GP Advisory Line operation Flow chart......................................................10

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Purpose

The purpose of this document is to provide a framework for senior medical staff within Mental Health, Justice, Health & Alcohol and Drug Services (MHJHADS) to operate the General Practitioner (GP) Advisory service for GPs who are seeking medical and pharmacological advice for the treatment of people with mental illness in the general practice setting.

Furthermore, the document outlines the role and administration of the Mental Health GP Liaison Nurse Phone Support Service.

Back to Table of ContentsThe Chief Psychiatrist must provide approval for medical staff to participate in the GP Advisory Line service.

The GP Advisory line pertains to people who are NOT currently receiving mental health treatment, care or advice within MHJHADS. However, people may have been, or are currently receiving treatment or care from other areas within the division of MHJHADS (e.g. Alcohol and Drug Services).

The GP Advisory Lines pertain to persons aged 18 years and over. People under the age of 18 years are out of scope for this service.

Back to Table of Contents



This Standard Operating Procedure (SOP) describes for staff the process to

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General Practitioners within the ACT




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Section 1 – Background

According to the Australian Institute of Health and Welfare (AIHW), GPs are frequently the first point of professional contact by people seeking help when experiencing mental illness. It is estimated that in 2014-15, 12.7% of all GP encounters were related to mental health. Furthermore, the Australian Government Department of Health estimates that GPs provide up to 75% of mental health care overall, and their value and expertise in treating mental health conditions is well recognised.

GPs are considered by MHJHADS to be an integral part of the persons treating team.

The GP Liaison Nurse for MHJHADS is in a unique position to improve communication between the MHJHADS and General Practice, and to support integrated care of people with a mental illness by encouraging multi-disciplinary collaboration.

Poor communication between service providers, particularly with GPs has been found to lead to problems in providing post-discharge care and has been identified as one of the barriers to service integration and improving the person experience.

Improved communication between Mental Health Services and General Practice influences successful outcomes including:1. Reduced presentations to hospital and crisis services;2. Improved communications between primary and hospital sectors;3. Increasing the skills of the primary care team and reducing workload burden of health

professionals through supporting a coordinated, integrated collaborative service delivery model;

4. Improved treatment compliance; 5. Reducing unnecessary referrals into the Mental Health Service;6. Better continuity of care across the services and more seamless transition for people

entering and exiting acute services.


Section 2 – General Practitioner Advisory Line

The GP Advisory Line aims to facilitate communication between Psychiatrists within MHJHADS and GPs within the Canberra Region. It has been noted that a large number of referrals received into Adult Community Mental Health Teams (ACMHT) are from GPs requesting non-urgent treatment and pharmacological advice.

The GP Advisory line supports GPs in decision making and treatment planning for people in primary care, and reduces the need to refer into specialist mental health services.

Note:



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This service is not for particular issues and queries that may be better addressed by Alcohol and Drug or Justice Health Services.

Equipment Access to the MHJHADS electronic record (MHAGIC/MAJIC)

Procedure The GP advisory line may be used: For non-urgent treatment advice for mental health matters related to people accessing

general practice; For pharmacological advice; For diagnostic advice; For post-discharge planning for people who are not linked to Adult Community Mental

Health Teams (ACMH).

The GP advisory line may not be used: As a replacement for urgent treatment and care;

All urgent matters must be referred to the Crisis Assessment and Treatment Team (CATT) on 1800 629 354

For feedback/ complaints; For referrals; For verbal medication orders; For matters other than mental health; For people already receiving mental health treatment from MHJHADS.

The governance of the GP Advisory Line Service lies with the Chief Psychiatrist, Clinical Director of Adult Community Mental Health Services and the GP Liaison Nurse for MHJHADS.

The Adult Community Mental Health Services program will make available Consultant Psychiatrist/s to attend calls on the GP Advisory Line. Senior Registrars may be considered at the discretion of the Chief Psychiatrist.

Dedicated time will be made each day for a Consultant Psychiatrist to attend the GP Advisory line duties. The Consultant Psychiatrist will not be required to attend other clinical work such as routine appointments, walk-ins etc. with the exception of walk in crisis presentations, during this period.

The GP Advisory line will be available from 1-2pm on Monday, Tuesday, Thursday & Friday.

Note: The GP Advisory Line will not operate on Wednesday due to operational commitments.



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The GP Liaison Nurse will ensure the day to day operation of the GP Advisory Line including staff availability, facilitating cover for planned and unplanned leave, service evaluation and advertising of the service.

GPs will be given the City Mental Health Team phone number, and calls will be answered by the Administrative Officer who will forward the call to the Consultant Psychiatrist. In the event that the line is engaged, a message can be left with the receptionist and the Consultant Psychiatrist will return the call within the allocated hour if time permits. If this is not possible, the Consultant Psychiatrist will return the call to the GP within 24 hours.

Note:The Administrative Officer will establish whether or not the person is currently registered and active within MHJHADS before the call is transferred to the Consultant Psychiatrist. If the person is currently registered with MHJHADS, the receptionist will assist the GP in contacting the relevant treating team.

If the person discussed requires further assessment from MHJHADS, the Consultant Psychiatrist will advise the GP to refer the person through the MHJHADS triage service.

A “MH GP Advisory Line” Team exists on MHAGIC and is managed by the Administrative Officer answering calls.

The Consultant Psychiatrist will send an email to the Administrative Officer which includes: The person’s name and DOB The GPs name and Practice The nature of the call eg. pharmacological advice A description of advice given.

The Administrative Officer will cut and paste this email into the file.

The person does not need to be allocated to the GP Advisory Team on MHAGIC.

Note: Definition of “active within MHJHADS”A person who is active within MHJHADS is receiving mental health treatment of any kind, support or advice from a particular team. This includes a person who has been referred to a particular community team but has not yet been reviewed.


Section 3 – General Practitioner Liaison Nurse Phone Support Service

The Mental Health GP Liaison Nurse phone support service provides non-urgent clinical information such as copies of mental health related discharge summaries, assessment and review documents, and advice and support to GPs who have queries relating to best referral options within the service. This reduces time spent by the GP in gathering key pieces of information and supports positive collaboration and confidence building between services. Doc Number Version Issued Review Date Area Responsible PageCHHS17/168 1 28/07/2017 01/07/2019 MHJHADS 6 of 11


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Note:This service is not for queries related to alcohol and drug or justice health services.

Equipment Dedicated GP Liaison VOIP phone Dedicated GP Liaison Mobile phone Access to MHAGIC, CRIS and Clinical Portal Access to ACTPAS

Procedure The GP Liaison Nurse Phone Support Service offers a dedicated service whereby GPs can phone for non-urgent support to reduce the burden on GPs and practice staff in retrieving patient information or seeking advice in how to access particular services within the mental health sector.

This provides a central contact point for GPs to gain access to clinical documentation including discharge summaries, medication charts, personal information, and outcomes of assessment in the event of a delay in receiving them.

The GP Liaison Nurse Phone Support Services is for non-urgent enquires only. Urgent clinical matters will be the transferred to the relevant acute team;

The GP Liaison Nurse Phone Support Service is operational during business hours (8:30 – 5pm) Monday to Friday. Weekends and public holidays are excluded;

During times that the phone is unanswered or calls are received outside of dedicated hours, a voicemail service will allow a message to be left and will advise the caller that they can contact the GP Liaison Unit of the Canberra Hospital during business hours, or the relevant acute team outside of business hours;

The GP Liaison Nurse position does not require back filling in the event of unplanned leave. However in the event of planned leave, the GP phone should be redirected to an appropriately designated person;

People not already engaged by the Mental Health Service may be required to sign a “Release of Information” form or other method of informed consent before clinical information can be shared with the GP. In cases where the person is receiving treatment by the Mental Health Service, the GP is considered part of this treating team and information can be freely shared unless the person has withdrawn consent to information sharing and has the capacity under the Mental Health Act, 2015 to do so;

Confidential clinical information must not be sent by email as per the Release or Sharing of Clinical Records or Personal Health Information SOP. Sending this information via facsimile is acceptable;

The GP Liaison Nurse will keep a log of calls received by GPs on MHAGIC as a method of evaluating the service and general record keeping.

Examples:



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A person attends a GP practice for the first time and informs the GP that they have recently been discharged from the Adult Mental Health Unit at the Canberra Hospital. The person has changed GPs and needs scripts for some medications initiated in hospital. The GP phones the GP Liaison Nurse who sends a copy of the discharge summary directly to the GP practice.

A GP who is new to Canberra has just seen a person whom they believe requires a psychiatric assessment. The GP is unsure of where to refer the person to within the Mental Health Service. The GP contacts the GP Liaison Nurse who explains the process for referral into the Mental Health Service and provides further education about where key Mental Health Service information can be found (e.g. The GP Healthnet). The GP Liaison Nurse updates the GP details on MHAGIC.


Implementation

GPs will be notified of this service and any related updates via the Mental Health GP Liaison Nurse email distribution list;

The GP Liaison Nurse will provide notification of this service to the Canberra Hospital GP Liaison Unit and the Capital Health Network;

The GP Liaison Nurse will provide notification and updates to the relevant internal staff such as the Chief Psychiatrist, Consultant Psychiatrists and Community Mental Health Team staff;

Publications for the purpose of advertising the GP Advisory Line will be provided to GPs for distribution within their prospective practices.


Related Policies, Procedures, Guidelines and Legislation

Policies Hospital Access and Sharing of Clinical Information for Adult and Paediatric Patients General Practitioners – Hospital Access and Sharing of Clinical Information for Adult and

Paediatric Patients Clinical Records Management Policy

Strategies Primary Health Care Strategy 2011 – 2014

Procedures Release of Sharing of Clinical Records or Personal Health Information Standard Operating

Procedure – Health wide General Practitioners – Hospital Access and Sharing of Clinical Information for Adult and

Paediatric Patients - CHHS TCH and Health Services - Confidentiality, privacy and access to MHJHADS clinical records

Standard Operating Procedure



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Legislation Health Records (Privacy and Access) Act 1997 Mental Health Act 2015


References

1. Australian Government, Australian Institute of Health and Welfare. Mental Health Services in Australia. 2016. https://mhsa.aihw.gov.au/home/

2. Australian Government, Department of Health. The role of primary care including General Practice. 2006.

3. Fredheim et al. Collaboration between general practitioners and mental health care professionals: a qualitative study. International Journal of Mental Health Systems. 2011, 5: 13

4. Royal Australian College of General Practitioners http://www.racgp.org.au 5. Wilkes L, Doull M, Paterson J, Le Cornu K, Mg Chok H. The role of the General Practice

Nurse as integrated care coordinator: A Delphi study. Clinical Nursing Studies. 2016. 4:3, p67 – 77

6. McNab J, Paterson J, Fernyhough et al. Role of the GP liaison nurse in a community health program to improve integration and coordination of services for the chronically ill. Australian Journal of Primary Health. 2015. PMid: 25704062


Search Terms

General Practitioner, GP, Mental Health, Psychiatry, Phone support service, GP Advisory LineGP Nurse Liaison




http://www.racgp.org.au/

https://mhsa.aihw.gov.au/home/

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Attachments

Attachment 1 – GP Advisory Line operation Flow chart

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair



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Attachment 1 – GP Advisory Line operation Flow chart



The GP calls the GP Advisory Line

The line is answered by the City Mental Health

Team Receptionist

The receptionist determines if the person is a current MHS client

The person is a current client of the MHS

Transfer to the relevent treating team

The person is not a current client of the MHS

The call is transferred to the Consultant

The Consultant emails the Admin Officer with a brief

descripton of the call

The Admin Officer pastes the email into the patient

file

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