Members of the AGPAL team were lucky enough to catch up with Dr Ian Williams (GP) and Ms Jan Chaffey (CEO) from Camp Hill Healthcare, the recipients of the 2015 Queensland RACGP General Practice of the Year Award. Dr Williams and Ms Chaffey were happy to share details relating to their recent achievement, quality improvements and unique initiatives within their practice including the success of employing a non-dispensing pharmacist within their practice team and the comprehensive research they are currently undertaking via their research arm – the CHARMING Institute.

2015 Queensland RACGP General Practice of the Year Award Recipient

(Left to right) Dr Ian Williams and Jan Chaffey with Dr Merelie Hall and Dr Nathan Elmes at the RACGP Awards evening with their QLD of the Year Award.

With a long standing commitment to quality improvement, Camp Hill Healthcare was one of the first general practices in Australia to be accredited by AGPAL in 1998. Camp Hill Healthcare’s achievement of AGPAL accreditation has been continuous since that time and, in 2013, they were the first practice to undergo their 6th accreditation cycle.

Camp Hill Healthcare uses a systematised approach to care and service delivery, which ensures the ideal of accreditation is not merely a triennial event, but rather a process of daily rigour. This means that their entire practice team works together to ensure the practice runs consistently and smoothly throughout the entire accreditation period.

Camp Hill Healthcare has a multidisciplinary practice team consisting of over 52 staff and is a registered training practice for general practice registrars. They have been providing healthcare to patients within the suburbs of South-East Brisbane for over 60 years, and this dedication to the provision of safe and quality care to their local community has seen Camp Hill Healthcare expand and evolve to become a patient centred medical home.

By creating a patient centred medical home, Camp Hill Healthcare aims to provide patients with all their individual health care needs from the one central location while empowering patients to be active participants in their own health and well-being. There is growing evidence1 that people benefit from having an ongoing relationship with a particular trusted generalist provider, and the results obtained from the implementation of this model at Camp Hill Healthcare positively contribute to this evidence. The practice uses a system based approach to service delivery through multidisciplinary team care.

A high level of patient centred care is complemented by two practice committees comprised of members from different professions – the Quality Improvement Committee (QIC) and the Incident Review Committee (IRC). The QIC is responsible for facilitating and implementing quality improvement activities. The most recent initiative was practice involvement in the latest wave of the Australian Primary Care Collaboratives Program. The IRC is responsible for systematically reviewing and making recommendations about incidents that have occurred or have been identified as potential problems. This is a quality control activity to help improve the quality of the patient’s journey. Camp Hill Healthcare employs an external credentialed mental health nurse to conduct focus group sessions for GPs and practice staff. The groups provide professional support and development in a safe environment, which encourages engagement of clinicians with patients in meaningful ways.

Support for self-management is also available to patients and accessibility to care is well managed through a range of strategies including online appointments and extended hours.

The practice offers patients a gateway to the broader health system when specialist care beyond what is available in the practice is required. This is through referral, and is facilitated by the good relationships Camp Hill Healthcare has with other health providers in their region.

Patients and their families are particularly appreciative of practice innovations involving allied health professionals as part of the treating team; for example, community nurses act in a liaison role with many of the Government and not-for-profit service providers in their region. This is of great comfort to many elderly patients and their families.

A service of particular mention, not commonly seen in general practices throughout Australia, is Camp Hill Healthcare’s on-site consultant pharmacists who provide non-dispensing pharmaceutical services to the health care centre.

The idea to introduce non-dispensing pharmaceutical services came over seven years ago, when Dr Williams was conducting a practice’s on-site assessment, in his additional role as an AGPAL Surveyor. Dr Williams was highly impressed with the practice’s incorporation of a pharmacist, who provided non-dispensing pharmaceutical services, and engaged this innovative approach at Camp Hill Healthcare to help improve their quality use of medicines.

Currently two pharmacists work as part of the multidisciplinary team. They assist with the provision of Home Medication Reviews, up-to-date medication information, and quality prescribing activities that enhance the skills of all clinicians. Patients have direct contact with the non-dispensing pharmacists who educate and reinforce their knowledge about their own medication. The work has been subject to peer review, through a conscious decision to research the concept with six papers published to date via their research arm, the CHARMING Institute.

In Australia, apart from the dispensing of prescriptions and related services, there is usually very little communication and collaboration between pharmacists and the wider primary health care system.

In 2001, Home Medication Reviews commenced in Australia with a brief to be consumer-focused, structured and a collaborative health care service provided in the community setting, to optimise quality use of medicines and consumer understanding. These Reviews involved the consumer, their general practitioner, pharmacy, and other relevant members of the health care team. These Home Medication Reviews were designed to be performed by the community pharmacist or an accredited pharmacist working on his/her behalf. As the pharmacist was working for an entity different to the general practice, the pharmacist did not have access to the patients’ complete medical file, including consultation notes, pathology, radiology and other specialist reports. Based on this instance, the CHARMING Institute believe that not having access to this information has limited the value of the Home Medication Review.

In the model implemented by Camp Hill Healthcare, the pharmacist conducts home medication management reviews, provides drug information to general practitioners, nurses, allied health professionals and patients, and delivers therapeutic education, assists in the learning experience of medical and pharmacy students, and is also involved in the Quality Improvement Team of the practice.

Members of the Camp Hill Healthcare team regularly promote and disseminate the integrated non-dispensing pharmacist model to the wider primary health care sector. This is done through a number of different forums including presentations at conferences and seminars to a diverse range of attendees (such as GPs, allied health professionals, pharmacists, practice nurses, practice managers, and receptionists); in peer reviewed journal articles; and in the medical and pharmacy press.

Peer reviewed research in conjunction with the University of Queensland has been developed and can be viewed by visiting www.charminginstitute.com.au.

The results of research undertaken by the CHARMING Institute demonstrates that there was a greater uptake of medication reviews, more medication reviews completed, and the reviews were timelier during the integrated pharmacist period. The integrated pharmacist identified similar drug related problems and made similar recommendations to that of an external pharmacist with some important differences. The proposed cause of these differences was attributed to the practice pharmacist having access to the patient’s medical file.

Camp Hill Healthcare and the CHARMING Institute’s work doesn’t stop there.

In addition to the ongoing improvements to the safety and quality of care provided to their patients, they are currently conducting research on:

  • Reducing potentially inappropriate polypharmacy in older persons through deprescribing in primary care.
  • Pharmacists’ integration into private healthcare clinics: the perspective of pharmacists, general practitioners and consumers in Malaysia.
  • Integrated Pharmacist-led Rapid Advice and Information Service Evaluation (IPRAISE).
  • Systematic Review of the Incidence and Characteristics of Medication Related Problems in Australian Primary Care.

The AGPAL team congratulates Camp Hill Healthcare on their recent recognition as the 2015 Queensland RACGP General Practice of the Year Award Recipient.
The team’s immense passion and drive to implement continuous quality improvements within their practice and across the general practice profession as a whole is obvious and deserving of this recognition.

A special thank you to Dr Williams and Ms Chaffey for taking the time to speak with members of the AGPAL team, allowing a mini photo shoot to take place in the practice and giving us an insight into their recent achievements in this edition of Quality News.

About – The CHARMING Institute

Camp Hill Healthcare’s interest in research has led to the development of their research arm – The CHARMING Institute. Charming stands for Camp Hill A Researching Multidisciplinary Integrated Group.
The CHARMING Institute’s aim is to conduct high quality, translational, primary health care research which influences policy and also to provide advanced clinical primary care training.
The institute is ingrained with the philosophy of co-ordinated, patient centred, integrated, multidisciplinary health care.
To learn more about the CHARMING Institute visit www.charminginstitute.com.au.

1. http://medicalhome.org.au/the-person-centred-health-system-and-the-medical-home/