Organisational and health practitioners’ capability

Specialist services are enabled by the health services and health professionals they work with. Health services and health professionals must embody the Framework principle of ‘Culturally Safe & Equitable’. Culturally safe professionals and services must be supported by organisational policies, workforce development opportunities and resources to appropriately engage with specialist health care for their patients.

The responsibility for cultural safety is inclusive – it belongs to each health practitioner as well as each organisation and constituent part of each organisation, all of which must have (and be seen to have) appropriate professional competence, including cultural competence, and resources and organisational policies to support this.

Regional collaboration

Collaboration between funders, facilitators and service providers is required to support the delivery of complete geographical coverage across Australia. Regional collaboration should be established based on existing health services geographical boundaries.

Purpose

• Bringing together the various stakeholders responsible for equitable specialist medical care access for Aboriginal and Torres Strait Islander peoples within a defined region.
• Providing a mechanism to collectively analyse the health needs of the Aboriginal and Torres Strait Islander populations, determine available resourcing and identify service gaps and unnecessary service overlaps and inefficiencies.
• Providing a mechanism to plan and coordinate the provision of equitable, principles-based specialist medical care service for identified patient needs.

Identification, data and technology

Identification

Information about Aboriginal and Torres Strait Islander patients and potential patients begins with identification. The national best practice guidelines for collecting Indigenous status in health data sets includes guidelines for asking the question, recording responses, and putting the guidelines into practice. Medicare also has a Voluntary Indigenous Identifier scheme, and there are special arrangements for people without documents who can have an approved referee, such as a community elder or minister of religion. A lack of documents may be the result of a birth failing to be registered, multiple birth dates and use of different names.

Data

National Key Performance Indicators (nKPIs) for Aboriginal and Torres Strait Islander primary health care data is reported annually. nKPIs provide information about primary health care organisations that receive Commonwealth Department of Health funding and information on chronic disease burden, use of Team Care Arrangements, and detailed information on chronic disease management indicators. These KPIs also point to a service gap via a table comparing nKPI data with statistics for the non-Indigenous population in Australia or with the Australian total (including Indigenous people) when appropriate comparison data are available. Such data, along with detailed statistical information about jurisdiction and remoteness variation figures can be valuable for specialist service planning, integration with primary care, and staffing/administration support planning.

Technology

Electronic records are key to efficient recording of patient health information, and efficient and timely access to it. Electronic health records are particularly useful for patients who are mobile and/or have multiple health care providers. They can improve collaboration between health practitioners and between health services, reducing unnecessary duplication of tests (and reduce the inconvenience due to preventable appointments), reduce errors from handwriting, and provide for patient control and engagement with their health. Specific strategies and co-design processes are needed at the My Health Record implementation phase in order to gain the trust and active participation of Aboriginal and Torres Strait Islander people as well as medical specialists. Patients may have concerns about breaches of privacy and confidentiality which could have negative consequences for them and their family.

Telehealth

Telehealth is instrumental in reducing costs of specialist and patient travel, especially in rural and remote areas. It enables the provision of specialist consultations to patients in locations where a specialist is not physically available. Telehealth can be used to respond to inequitable service distribution and reduce travel costs paid for specialist travel, as well as ease the burden on patients, and often their carers, in travelling often long distances to access care. Effective telehealth for Aboriginal and Torres Strait Islander people and communities is an enabler of specialist care but also requires careful planning and education, including the capacity of primary health care practitioners to facilitate telehealth and support patients 'at the other end'. Telehealth is a useful means of supporting multidisciplinary care and professional development between staff.

Contracts and Service Level Agreements

Contracts and Service Level Agreements (SLAs) are the means through which funders can negotiate the provision of services designed to meet targets and goals for specific populations. However, targets and goals need to be appropriate for the context, and must be negotiated collaboratively. Contracts and SLAs can outline specific targets as part of overall deliverables, including specifying timelines. These mechanisms are useful to track multiple stakeholders involved in one area of work and are crucial to monitoring and reporting, which in term assists with managing quality and accountability.

For Contract and SLAs resources, go to Tools and Resources.

Meeting the total cost of specialist care

Patients face barriers of various types, including financial barriers, associated with specialist care. The cost of accessing specialist care is an obstacle for patients. The gap between Medicare reimbursement and the service cost varies. Models of care can access funding streams for the amount over and above the Medicare rebate including Closing the Gap grants, PHN commissioning resources, and the Medical Specialist Outreach Assistance Program funding – now incorporated into the Rural Health Outreach Fund.

Some successful models of care, such as An Inner-City Hospital Establishes an Aboriginal Health Unit and Reaching Out to Indigenous People in Outer Suburban Brisbane, bulk bill all clinical services delivered in-house or via local outreach.

Patients in regional and remote Australia often need to travel long distances to see specialists and incur accommodation costs in addition to travel. Travel can also mean time away from family, work, and communities, which can be challenging for patients who have family or other care responsibilities. States and territories provide a range of travel and accommodation subsidies, including some specifically for specialist care, and in some cases including subsidies for escorts. Subsidiaries may not include the cost of accommodation for escorts and the cost of patients and escorts traveling between their accommodation and the health service.