Accredited through collaboration: AGPAL’s first non-traditional general practices

Congratulations to Dr Sharon Levy and Dr Eva Stepankova – AGPAL’s first accredited non-traditional general practices!

 

Dr Sharon Levy and Dr Eva Stepankova have become the first two professionals in Australia to achieve non-traditional general practice accreditation through AGPAL. This milestone was made possible through a strong collaboration between the GPs themselves, AGPAL’s Client Liaison Team, and their local Primary Health Network (PHN), the Central and Eastern Sydney PHN (CESPHN). Within CESPHN, Practice Support and Development Program Officer Evelina Kozok and Digital Health Support team member Linda Silver played a pivotal role, providing tailored guidance and support to help their local GPs reach this Australian-first achievement.

Today, Sharon and Eva lead the way as the first clinicians to be accredited with AGPAL under the RACGP’s expanded definition of non-traditional general practice. The partnership between general practice services and organisations like PHNs highlight the benefits of collaboration when navigating the accreditation process.

This milestone follows the RACGP’s 2024 update to its definition of a general practice for the purposes of accreditation, which now recognises non-traditional practice models that operate without a dedicated physical premises, including mobile services that conduct consultations at multiple locations, such as residential aged care and disability facilities. By extending accreditation to these innovative models, the RACGP aims to promote greater healthcare equity and inclusivity, ensuring that patients in vulnerable or underserved communities can access safe, high-quality care. Accreditation not only validates the quality of these services but also gives them access to the same support programs, incentives, and quality improvement opportunities as traditional practices.

For the first time, general practice services operating outside conventional settings are being recognised through AGPAL accreditation. Dr Sharon Levy and Dr Eva Stepankova’s accreditation journeys, based on peer support and PHN guidance, demonstrate how non-traditional practices can successfully get accredited. In conversation with both clinicians and CESPHN team member, Evelina Kozok, we learned about their experiences in pursuing accreditation and what this milestone means for the future of general practice today. Their story also highlights how proactive PHN support can help non-traditional services achieve similar outcomes, providing a model that other regions can follow.

The non-traditional accreditation journey

Non-traditional practices like those led by Sharon and Eva operate differently from regular GP clinics. Both doctors run solo mobile practices that bring care directly where patients live, rather than seeing patients in a fixed clinic. For example, Dr Eva provides home visits to patients who would find it “very difficult or impossible to visit their GP outside of their home due to disability,” focusing mostly on elderly people in residential aged care or supported independent living. In Dr Sharon’s case, she attends to patients across several aged care facilities, having left her mainstream clinic at the end of 2021 to focus exclusively on aged care.

Patients seen by them generally have more complex or chronic conditions, which makes consultations longer and more involved. As Sharon explains “Attending aged care facilities is remarkably different to traditional type of practice.” Many residents cannot communicate their symptoms easily, so coordinating with nursing staff, family members and carers is essential. A single visit to an aged care facility is “almost like doing a ward round” says Sharon, as she needs to review charts, examine the patients, consult with on-site nurses, call specialists (such as geriatrics or palliative care teams) for advice, and later update the families. There is also substantial paperwork and care coordination involved. As Eva puts it, “It is a solo practice with one employee which is me. It means I do clinical work and administrative work.”

Unlike traditional brick-and-mortar clinics, non-traditional GPs like Eva and Sharon do not have receptionists, nurses, or practice managers to support them. They handle all tasks on their own, which usually doesn’t create opportunities for peer support or shared workloads. As Evelina from CESPHN points out “The biggest difference with non-traditional practices is that they are often a one-person operation. These GPs don’t have the support of receptionists or practice managers and are solely responsible for managing every aspect of their practice to remain compliant.”  This emphasises the need for external support, and according to Evelina, PHNs play a crucial role in supporting non-traditional GPs “by providing education, guidance, and practical resources to make the accreditation journey more manageable and less overwhelming.”

PHN support: the role of Central and Eastern Sydney PHN

Facing these unique challenges, both Eva and Sharon turned to their local PHN for help when they decided to pursue accreditation. At the time, CESPHN had already been receiving calls from other non-traditional GPs seeking guidance on how to start the process. “This was such a new process – and many non-traditional GPs do not have a practice manager or even administrative support – they often turned to the PHN for guidance”, Evelina explains. As the RACGP only recently expanded the definition to include non-traditional practices, there were only a few resources beyond the official interpretative guide. Evelina started working closely with Sharon and Eva to unpack the accreditation requirements step by step. “It was new for all of us, and we were learning as we went” Evelina tells us about navigating this new type of accreditation process, also noting that they reached out directly to AGPAL to seek clarification.

Over several months, the PHN’s Practice Support team regularly met in person with both clinicians to work through AGPAL’s online self-assessment tool and the requirements of the RACGP Standards. They established a timeline to go through each section at a time as the PHN provided them with valuable mentorship and practical tools at each step. “Utilising the support from our local primary health network was invaluable” says Sharon, “We could not have done it without them.” The team helped both doctors to interpret how each RACGP Standard could be met in a non-traditional GP context, adapting them to reflect the aged care and mobile settings while still aligning with the standards.

Eva also found the PHN’s involvement essential. “The word that comes to mind is pivotal”, she says, reflecting on the support she received, “I would not yet have been accredited without Evelina and Linda’s help.” She found value in “the numerous prolonged meetings, the systematic fulfilment of all the requirements that AGPAL had listed in their accreditation hub.”

Both GPs also benefitted from the support of Digital Health Support Officer Linda Silver, who helped them with IT and data management, focusing on topics like clinical record-keeping and data improvement.

Unique challenges for non-traditional GPs

Evelina, Linda, Sharon, and Eva worked together to ensure all accreditation criteria were met. Some of the main challenges they faced included items such as essential equipment, vaccine management, patient feedback and various clinical protocols.

Non-traditional GPs often rely on the facilities they work at to provide certain equipment, but this might not always be available. For example, one of the aged care facilities where Sharon provides her services had no defibrillators which are needed to stay compliant with the Standards. To solve this issue, and with the guidance of the PHN, she formally addressed and wrote to the aged care provider about the safety implications which resulted in the later installation of the equipment. The PHN also developed an equipment checklist to help both doctors document which equipment they must carry themselves and which equipment should be provided by the facility, so no essential items were overlooked in the accreditation process.

Another complex issue for both Sharon and Eva was vaccine management and administration, as both clinicians noted that most facilities that previously had vaccine fridges had stopped supplying them due to the administrative burden. This meant the GPs had to find new ways of administering immunisation to their patients. After lengthy discussions and with help of CESPHN they came up with a plan to outsource vaccinations to visiting pharmacists. This solution allowed residents of aged care and other living facilities to receive their vaccines, and it also satisfied accreditation requirements.

Collecting patient feedback also looks different in a non-traditional practice context as surveying patients in aged care or disability homes isn’t a straightforward process. Many residents have cognitive impairments and rely on carers and workers of these facilities to attend the consultations. To be able to meet this requirement, both GPs and the PHN support members adapted the standards RACGP patient questionnaire, simplifying some of the language and allowing input from carers when appropriate. They also contacted the RACGP to seek approval creating a tailored feedback tool that informs further improvement in their mobile practices.

Quality improvement in non-traditional settings

Going through accreditation provides benefits to both GPs and patients. In conversation with AGPAL, Sharon expressed that being formally accredited finally validated her role as a practitioner, while also granting her access to various support and incentive payments such as the Practice Incentives Program (PIP). This provides her solo practice additional funding for activities like chronic disease management, quality improvement, and more.

Patients also benefit from these incentives. Eva points out that this formal recognition helps bridging the “gap between outcomes for people who can and cannot access health services outside of their home.” With accreditation enabling her to participate in these incentive schemes, she can dedicate more time and resources to proactively care for her patients.

The accreditation process also encouraged both doctors to adopt new data-driven improvement tools. For example, with help of Evelina and Linda from CESPHN, Eva began using a new clinical data analysis software to help her monitor her patient records. By analysing this data, Eva can now identify any areas for improvement and make sure that all her care plans are up to date for each patient. In Sharon’s case, she mentioned that keeping a “near-miss and error log” and an “ethical dilemmas log” which was introduced as part of meeting the standards, helped her reflect on and enhance her practice’s safety and ethics.

All these efforts translate into higher standards of care delivered in non-traditional settings. Clearly outlining and formalising certain procedures has been a useful exercise for these GPs to drive improvements with lasting benefits for patient care.

Lessons learned during the accreditation process

The experiences of Dr Sharon Levy and Dr Eva Stepankova offer valuable lessons for other non-traditional general practices and the organisations that support them. Everyone involved in the process agreed that collaboration was essential. Both doctors emphasised the importance of seeking guidance and working alongside peers. “I would recommend all non-traditional GPs to closely collaborate with their PHN to achieve accreditation. They are there to help you,” advises Eva. Sharon echoes this, encouraging other practitioners to connect with their networks because “sharing information and supporting one another makes a huge difference.”

The two healthcare professionals paired up to tackle accreditation together, frequently exchanging policies and ideas, brainstorming solutions, and supporting one another along the way. “It also allowed me to share practice strategies and ways of working with a colleague, which I might not otherwise have been able to do,” says Sharon.

From the PHN’s perspective, Evelina believes the support model implemented by CESPHN can be replicated to help other non-traditional GPs succeed. CESPHN has already assisted a third GP through accreditation, refining its approach to be more efficient and tailored to the unique needs of mobile and aged care practices. Her advice to other PHNs is to develop “clear templates, a structured plan, and a lot of patience.” Evelina also notes that the effort is well worth it: “Once the foundational tools were in place, it became much easier to guide others and point them in the right direction. Seeing real progress and improvements in the practices throughout the process really motivated us all to see it through and achieve non-traditional accreditation.”

Summary

This experience showcases what is possible through genuine collaboration. With the support of AGPAL and their PHN, Dr Sharon Levy and Dr Eva Stepankova have become the first non-traditional general practices to achieve accreditation with AGPAL, a milestone that sets a precedent for others to follow. Their journey demonstrates that, with the right guidance and tailored resources, non-traditional practices can meet the RACGP Standards and be recognised for the quality of care they provide.

This achievement is a personal success for Sharon and Eva, a model that can be replicated across the country, and an important step forward for Australian primary care. As more PHNs and non-traditional GPs embrace accreditation, the sector will benefit from greater equity in healthcare access, higher standards of care for vulnerable populations, and a more inclusive national approach to general practice accreditation. This is a powerful example of innovation and collaboration driving quality in Australian healthcare.