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Subacute, intermediate and primary care services
Overview
Subacute, intermediate and primary care disciplines focus on the prevention, early detection and management of patients with acute and chronic disease.
- Subacute services provide specialised multidisciplinary care in which the primary need for care is optimisation of the patient’s functioning and quality of life. A person’s functioning may relate to their whole body or a body part, the whole person, or the whole person in a social context, and to impairment of a body function or structure, activity limitation and/or participation restriction.
- Intermediate care services aim to prevent avoidable hospital presentations and admissions and to offer early supported discharge options.
- Primary care is generally the first point of contact people have with the health system and relates to the treatment of non-admitted patients in the community.
Delineating service system roles
The capability of each service level is based on:
- Clinical capability required to diagnose and manage the condition.
- Availability of, and access to, clinical support services to support delivery of care.
Service requirements
Models of care for delivery of health services described in the RDF, and the setting within which services are delivered are determined by individual health services.
This framework
The scope of subacute, intermediate and primary care services is extensive. Many services are not within the scope of a role delineation framework. This framework provides role delineation for the following subgroup of services:
Services
Palliative care is person and family-centred care provided for a person with an active, progressive, advanced disease, who has little or no prospect of cure and who is expected to die, and for whom the primary treatment goal is to optimise the quality of life. The following elements are integral to understanding this definition of palliative care:
- Palliative care should be strongly responsive to the needs, preferences and values of people, their families and carers. A person and family-centred approach to palliative care is based on effective communication, shared decision-making and personal autonomy.
- Palliative care should be available to all people living with an active, progressive, advanced disease, regardless of the diagnosis.
- Palliative care affirms life while recognising that dying is an inevitable part of life. This means that palliative care is provided during the time that the person is living with a life-limiting illness, but it is not directed at either bringing forward or delaying death.
Palliative care service delivery should be based on quality management principles complying with the National Palliative Care Standards. These standards incorporate key principles considered essential for all palliative care services, including comprehensive assessment and management of symptoms; patient, family and carer access to education and support; and coordination of care.
The scope of this Framework recognises that:
- Patients with life-limiting illnesses require different levels of involvement from specialist palliative care services based on their needs and the primary care provider's capability and capacity to meet those needs.
- Many patients receive primary palliative care without having any contact with specialist palliative care services.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
A Level 1 service provides low-acuity, ambulatory care and support to patients with non-urgent palliative care needs. |
Service provision includes delivery of education, pastoral care, bereavement support, self-management support and carer support. Service delivery may be supported via telehealth. |
Peer, health professional or other professional with relevant skills and experience. |
| 2 |
A Level 2 service provides palliative care for clients who are stable and who generally require low complexity care. Care may be provided in home or community settings and/or in healthcare facilities, including multipurpose health centres and rural hospitals. Delivered by nurses and/or allied health professionals in partnership or liaison with medical practitioner where required. |
As for Level 1 plus: Service scope includes assessment and referral of patients with general palliative care needs, care coordination / case management, case monitoring and review. Service scope may include bereavement risk assessment and bereavement care for patients with uncomplicated needs associated with end of life care. Access to comprehensive care pathways for palliative care. Service delivery may be supported via telehealth. Access to bereavement support services. Access to equipment hire service for items such as hospital beds. Access to specialist palliative care service for referral, consultation and specialist support. |
One or more community paramedicine, nurse practitioner, registered nursing and / or allied health professionals. |
| 3 |
A Level 3 service provides palliative care for clients who generally require low complexity care. Services provided in home or community settings, including residential aged care and / or rural hospital settings. Provided mainly by GPs. |
As for Level 2 plus: Service scope patient assessment, triage, clinical management and referral. Access to subcutaneous infusion devices for symptom management. Access to community nursing services. |
Registered primary care medical practitioner (GP or rural generalist) or NP (palliative care). Access to home-based hospital services where available, including via telehealth. Access to community nursing and allied health professionals (physiotherapy, occupational therapy, dietetics, speech pathology, social work, psychology). Access to clinical pharmacist. |
| 4 |
A Level 4 service provides palliative care for patients, caregivers and families with input from specialist palliative care services. Services provided in home or community settings, including residential aged care and / or rural hospital settings. |
As for Level 3 plus: Provides assessment, & community & clinical education. Provides coordination of care between community, acute and hospice settings. Provides grief and bereavement support. Access to Level 5 or 6 palliative care service for integrated models of palliative care. Has formal links with higher level palliative care services. |
As for Level 3 plus: Extended hours access to specialist palliative care team (registered medical specialist with credentials in palliative care, palliative care nurse, NP, social worker) on-site or via telehealth. Hospital liaison services to support continuity of care. Allied health professionals with palliative care expertise including dietetics, physiotherapy, social work, psychology, speech pathology and occupational therapy. |
| 5 |
A Level 5 service provides multidisciplinary specialist palliative care services to patients with complex and unstable conditions. Care of patients is shared between the primary care provider and a palliative care service. Services provided in home, community and inpatient settings. |
As for Level 4 plus: Service accessible extended hours. Regular patient reviews conducted by specialist palliative care team members and primary care providers. Access to invasive procedures for symptom management. Has formal links to Level 6 service to meet the needs of patients, caregivers and families with complex problems. |
As for Level 4 plus: On-site access to registered medical specialist with credentials in palliative care. On-site access to palliative care nurse / NP. RNs with appropriate post graduate qualifications and/or experience in palliative care nursing. Access to specialist clinical pharmacist - palliative care. |
| 6 |
A Level 6 service provides comprehensive specialist palliative care for the needs of patients with complex need, and support for their caregivers and families. Provides inpatient care, mostly in designated palliative care beds. |
As for Level 5 plus: Service accessible 24 hours. Service scope includes:
Service supports lower level services including through the provision of resources, education and information. |
As for level 5 plus: Extended hours availability (on-site and on-call) of specialist palliative care physician. On-site access to general medical and surgical specialist teams, medical oncology and radiation oncology. Specialist clinical pharmacist - palliative care. Palliative care CNC and CNE.
|
Rehabilitation services provide care for people with a range of functional impairments arising from acute or sub-acute conditions, accidents or injuries. Rehabilitation services aim to improve functional status by reducing impairment, activity limitation and participation restriction, thereby enabling people to maximise their independence, quality of life and participation in society.
Areas of clinical practice may include neurological conditions (including acquired brain injury and spinal cord injury rehabilitation), musculoskeletal and orthopaedic conditions, deconditioning post-acute illness, amputations, burns, occupational injuries, cardiorespiratory disorders and other complex or chronic conditions.
Management and care within rehabilitation services is provided by multidisciplinary teams with rehabilitation expertise. They work in various settings including inpatient facilities, ambulatory clinics and within the community. Programs include hospital-based services, including inpatient, outpatient and day hospital programs, transitional programs from hospital to home, community-based rehabilitation (including facility-based and home-based programs), consultative and outreach services within homes, and facility visits provided in partnership with local providers including rural and remote health clinics and hospitals, and group programs addressing areas such as mobility, social skills and workplace transition.
Rehabilitation services may be short-term, long-term or episodic depending upon the nature of the patient’s condition. Rehabilitation services range from Level 1, which may be delivered by a single practitioner to ambulatory clients in their local areas, to Levels 5 and 6, which treat patients with highly complex or specialised needs, and include outreach and statewide services. Level 6 rehabilitation services are provided to Tasmanians through interstate providers.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
Ambulatory rehabilitation care for clients who are medically stable and live in the community. Care focuses on improving functional capacity and promoting independence in activities of daily living. While care required is of low complexity it may address short-term, post-acute needs. May be provided in the home, ambulatory or community setting by clinicians who have general knowledge and skills in rehabilitation. May be delivered via telehealth. |
Service scope includes care for clients referred, transferred or returned from higher level services for treatment in their local environment. Service delivered according to documented rehabilitation care and treatment plan. Integration with local general practice, community nursing and other local primary care providers. Documented processes with higher level services for step-down care. Service delivery may be supported by telehealth. Service provides self-management support for chronic conditions, carer support and education. |
Suitably qualified and experienced clinicians (community nursing, physiotherapy, occupational therapy). Allied health assistant or rehabilitation under supervision of relevant specialist allied health professionals and/or RNs. |
| 2 |
Ambulatory and/or inpatient care for clients who are medically stable and who generally require low complexity rehabilitation care. Care may be provided in home or community settings and/or in healthcare facilities, including multipurpose health centres and rural hospitals. Delivered by nurses and/or allied health professionals in partnership or liaison with medical practitioner where required. May have outreach services from higher level rehabilitation services. |
As for Level 1 plus: Service scope includes individualised self-managed therapy and treatment and care coordination services. Access to higher level rehabilitation service. Access to appropriate rehabilitation equipment as required. Access to hydrotherapy facilities as required. |
As for Level 1 plus: Access to allied health professionals relevant to service scope, including physiotherapy, occupational therapy, speech pathology, dietetics, podiatry, pharmacy, psychology and social work. Access 24 hours to a registered medical practitioner where inpatient care is provided. Suitably qualified and experienced RN in charge of inpatient facilities appropriate to service being provided. Onsite access 24 hours to RN / EN where inpatient care is provided. |
| 3 |
Ambulatory and rehabilitation in the home service +/- inpatient component. Provides care for clients who require multidisciplinary specialist rehabilitation care (medical, nursing and / or allied health team). Service participates in national quality benchmarking e.g., AROC and NSF audit. |
As for Level 2 plus: Designated therapy areas and equipment. Provides rehabilitation in the home (RITH) and telerehabilitation services. Patient care plans developed collaboratively by multidisciplinary team. Access to clinical support services and post-hospital services to facilitate ongoing community management including hospital in the home and / or community rapid response type services. May provide leisure and/or diversional therapy programs. |
As for Level 2 plus: Access to consultant physician with knowledge and skills in rehabilitation on-site or via telehealth. On-site RNs with experience in rehabilitation nursing. On-site specialist allied health professionals (as per Level 2) with experience in rehabilitation. On-site allied health assistants and / or rehabilitation assistants to support rehabilitation management. Access to clinical pharmacist. |
| 4 |
Ambulatory and inpatient rehabilitation services for clients with moderately complex care needs. Provided as general rehabilitation service through multidisciplinary models of care. Coordinated by health professional with experience, knowledge and skills in rehabilitation reflecting casemix of the service. May provide outreach services to lower level services, as well as clinical and professional support and advice through established networks. |
As for Level 3 plus: Designated rehabilitation unit. Patient care plans developed collaboratively by multidisciplinary team and include structured ward rounds and multidisciplinary case conferencing arrangements. Provides step-down care for clients from Level 5 or 6 service who no longer require higher level or subspecialty rehabilitation interventions. Documented process to ensure clients have access to acute and critical care 24 hours. Access to persistent pain service. Service provision includes orthotic, prosthetic and podiatry services. Service scope includes day therapy programs and ‘pre-habilitation’ services prior to surgery. |
As for Level 3 plus: On-site rehabilitation physician. Registered medical specialists with credentials in geriatrics, general surgery, orthopaedic surgery, general medicine, available for consultation and liaison. On-site CNC and / or NP providing leadership in rehabilitation. RNs with advanced rehabilitation specialist qualifications as described by Australasian Rehabilitation Nurses Association. Clinical pharmacist. On-site psychology, social work, occupational therapy, physiotherapy, dietetics, speech pathology, podiatry, orthotics and prosthetics. Access to additional specialty services (e.g., neuropsychology) as required. |
| 5 |
Specialty and subspecialty ambulatory and/or inpatient rehabilitation services. Ambulatory services should include subspecialty rehabilitation outpatient clinics and multidisciplinary day-only therapy programs. Inpatient care is provided in designated specialty units for clients with complex care needs. Multidisciplinary team also functions as an interdisciplinary team to provide integrated team based care. Programs coordinated by Rehabilitation Physicians with appropriate skills e.g., prosthetics. Acts as hub supporting smaller centres using telerehabilitation. Robust transparent processes to involve consumers e.g., consumer advisory groups. |
As for Level 4 plus: Dedicated multidisciplinary team led by a rehabilitation physician and comprising rehabilitation specialists with extensive experience in all disciplines (medical, nursing, allied health) that are involved in leadership, liaison, research and support for other lower-level rehabilitation Services. Accredited training site for Australasian Faculty of Rehabilitation Medicine trainees. Provides step-down care for clients from Level 6 service who no longer require higher level or subspecialty rehabilitation interventions. Additional infrastructure and equipment commensurate with rehabilitation needs of most complex patients. |
As for Level 4 plus: Access 24 hours to registered medical specialist with credentials in rehabilitation or advanced trainee in rehabilitation medicine. Registered medical specialists with credentials in psychogeriatrics, urology, cardiology, neurology, endocrinology, gastroenterology, rheumatology, neurosurgery, vascular surgery available for consultation and liaison. Neuropsychologist part of multidisciplinary rehabilitation team. Extended hours access to allied health professionals / allied health assistant. On-site access to orthotic and prosthetics service, rehabilitation technician and audiology services during business hours. CNE rehabilitation. |
| 6 |
Subspecialist services for clients with care needs of highest complexity. Provided in designated facility with dedicated multidisciplinary subspecialty teams. Ambulatory services include complex multidisciplinary day-only treatment, subspecialist outpatient clinics and community outreach programs. Programs coordinated by Rehabilitation Physician with appropriate specialty skills e.g., spinal cord injury. |
As for Level 5 plus: Extensive range of allied health professionals with subspecialty expertise in rehabilitation disciplines onsite. Range of diagnostic services relating to individual specialty and/or subspecialty on-site. May provide specialist and subspecialty statewide and interstate consultancy services, and subspecialty outreach services. Evidence of consultation and leadership role within relevant specialty and/or subspecialty. Access to pool of specialty equipment pertaining to subspecialty area. |
As for Level 5 plus: Sub-specialty rehabilitation physicians, including brain injury, spinal cord injury and amputee management. On-site physiotherapist, occupational therapist, speech pathologist, dietitian and social worker available 7 days a week. Rehabilitation engineer. |
Geriatric medicine services provide care for older people with complex medical conditions which result in a functional impairment. Patients of geriatric medicine typically have a range of complex chronic conditions overlaid by functional decline/ frailty, frequent falls, dementia, delirium and incontinence.
Geriatric care is multidisciplinary care delivered by coordinated medical, nursing and allied health services. Care is provided in various settings including inpatient facilities and within the community. Services include inpatient and outpatient hospital-based services; transitional programs from hospital to home; community-based services supporting older people in their home; and services addressing areas such as mobility, falls and balance and nutrition.
Geriatric services may be short-term, long-term or episodic depending upon the nature of the patient’s condition/ needs. Geriatric services range from Level 1, which may be a sole practitioner delivering ambulatory geriatric medicine services, to Levels 5 and 6, which treat patients with highly complex or specialised needs, and include outreach and state-wide services.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
Ambulatory care for clients who are medically stable and live in the community. Care focuses on identifying functional decline, providing opportunities for early intervention and promoting independence in activities of daily living. Provided by clinicians with general knowledge and skills in geriatrics including aged care nursing, community nursing and general practice clinicians). Service may be delivered via telehealth. |
Service scope includes care for clients referred, transferred or returned from higher level services for treatment in their local environment. Integration with local general practice, community nursing and other local primary care providers. Service delivered according to documented care and treatment plan. Documented processes with higher level services for step-down care. Telehealth may be used to support delivery of services. Access to community nursing and ACAT services. Service provides self-management support for chronic conditions, carer support and education. |
Suitably qualified and experienced clinician (medical, NP, nursing). Service delivery may be supported by allied health assistant and / or nurse assistant under supervision. Access to allied health professionals relevant to service scope, including pharmacy, physiotherapy, occupational therapy, speech pathology, dietetics, podiatry and social work. |
| 2 |
Care for clients who are medically stable and who generally require low complexity geriatrics care. Care may be provided in home, residential aged care and/or in community healthcare facilities, including multipurpose health centres or rural hospitals. Delivered by medical, nursing and allied health professionals with general knowledge and skills in geriatrics in partnership or liaison with higher level geriatrics services. Capacity to deliver limited multidisciplinary interventions. May have outreach services from higher level services onsite or via telehealth. |
As for Level 1 plus: Service scope includes individualised self-managed therapy and treatment and care coordination services. Access to higher level geriatrics service to access members of multidisciplinary team and to facilitate patient transfer if needed. |
Access 24 hours to a registered medical practitioner where inpatient care is provided. Suitably qualified and experienced RN in charge of inpatient facilities appropriate to service being provided. NP with skills in cognitive assessment and complex case management. Onsite access 24 hours to RN / EN where inpatient care is provided. Allied health professionals relevant to service scope, including physiotherapy, occupational therapy, speech pathology, dietetics, podiatry, psychology and social work. Access to a clinical pharmacist. |
| 3 |
Provides ambulatory care in the home or other community settings by multidisciplinary team with specialist skills in geriatric medicine (medical, nursing and allied health). |
Multidisciplinary team with demonstrated experience, and specific knowledge and skills, in delivery of geriatric services. Service accepts clients referred and transferred from higher level services for ongoing ambulatory care. Patient care plans developed collaboratively by multidisciplinary geriatrics team. Multidisciplinary case conferencing arrangements in place. Access to hospital diversion services to facilitate ongoing community management including hospital in the home and community rapid response services. Access to community nursing and community palliative care services during business hours. Telehealth capability to support service delivery. |
As for Level 2 plus: Registered medical practitioner with experience and specific knowledge and skills in geriatrics. Access to consultant physician with knowledge and skills in geriatrics on-site or via telehealth. RNs with knowledge and experience in geriatrics. Access to specialist allied health professionals (as per Level 2) with knowledge and experience in geriatrics. Allied health assistant and diversional therapist. |
| 4 |
As for Level 3 plus: Provides multidisciplinary ambulatory and inpatient geriatric services to clients with moderate complexity care needs. Geriatrics team caring for adult patients includes geriatricians and/or general physicians with skills in geriatrics. May provide outreach services to lower level services, as well as clinical and professional support and advice through established networks and telehealth arrangements. |
As for Level 3 plus: Inpatient care provided within a designated ward area. Integration of inpatient and ambulatory services to facilitate referral and admission processes and discharge and community management. Provides step-down care for clients from Level 5 or 6 service who no longer require higher level services. Documented process to ensure clients have access to acute and critical care 24 hours. Service has access to rehabilitation, palliative care, community dementia services, general medicine and older persons mental health services. |
As for Level 3 plus: Medical specialists with credentials in geriatrics available on-site. Medical specialists with credentials in geriatrics and / or general medicine on-call 24 hours. Registered medical specialists with credentials in older persons mental health and palliative care available for consultation and liaison. RNs with appropriate post graduate qualifications and/or experience in geriatric nursing. On-site NP, physiotherapy, occupational therapy, speech pathology, dietetics, podiatry, psychology and social work. Clinical pharmacist. Access to dental, audiology and optometry services. |
| 5 |
Provides specialty geriatrics inpatient and ambulatory geriatric services for clients with complex care needs. Ambulatory services include subspecialty geriatric outpatient clinics and multidisciplinary clinics. |
As for Level 4 plus: Inpatient care is provided in designated specialty geriatrics unit with secure area. Service scope includes provision of comprehensive inpatient and ambulatory geriatric evaluation and management services. Service provision includes ortho-geriatrics and community dementia support services. Service may provide specialist geriatrics support to hospital in the home / community rapid response services in providing in-reach into aged care facilities and / or rural hospitals. Accredited training in geriatric medicine. Provides step-down care for clients from Level 6 service. Extended hours access to community nursing and community palliative care. |
As for Level 4 plus: Suitably qualified and experienced nurse manager (however titled) for the service. Registered medical specialists with credentials in older persons mental health, general medicine and neurology available for consultation and liaison. Specialist clinical pharmacist (geriatrics). CNC and CNE geriatrics. |
| 6 |
As for Level 5 plus: Provides specialist and subspecialist services for clients with care needs of highest complexity. Provided in designated unit/s with dedicated multidisciplinary teams. Ambulatory services include complex multidisciplinary treatment, specialist outpatient clinics and specialist community outreach programs. |
As for Level 5 plus: Dedicated multidisciplinary team led by geriatricians and comprising geriatrics specialists with extensive experience in all disciplines (medical, nursing, allied health) that are involved in leadership, liaison, research and support for other lower-level geriatrics services on-site and / or via telehealth. Provides specialist consultation liaison and reach services to rehabilitation and older persons mental health services. Provides statewide leadership and support for primary care and aged care knowledge and skills development. Access 7 days to extended hours community nursing and community palliative care services. |
As for Level 5 plus: Specialist geriatrician on-site and on-call 24 hours. Medical registrar on-site 24 hours. Access during business hours to physiotherapist, occupational therapist, speech pathologist, dietitian and social worker 7 days. Access to neuropsychologist. |
Home-based hospital services include Hospital in the Home (HITH), community rapid response services (ComRRS), community nursing enhanced connection services (CoNECs) and other services that provide care in the person’s usual place of residence that would otherwise be provided in an inpatient environment. HITH is a home-based alternative to an inpatient stay where patients are admitted to the hospital’s HITH service. Patients can be offered this option if care can be delivered safely at home. In Tasmania, ComRRS provides hospital in the home-type services in partnership with the patient’s treating GP for people who are at risk of needing to go to the hospital with an acute illness, injury or deterioration of a pre-existing condition. CoNECs provides enhanced access from hospital Emergency Departments (ED) to Community Nursing Services. It is a non-admitted alternative for the provision of clinical care, following ED presentation, assessment and initial treatment.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
Provides low-risk care for patients as an alternative to extended hospital inpatient stay. Delivered by community nurses or other community health provider. |
Clinical oversight of patient provided by community health service delivering care. Collaboration with patient’s usual GP. Referrals received from inpatient or community-based service provider. Community service may have provider in inpatient environment to support identification of potential clients and streamlined referral. Telehealth linkages with inpatient services. Service provides self-management support for chronic conditions, carer support and education. |
RNs with specialist skills in community nursing. Access to allied health professionals / NPs relevant to service scope. Support staff including Health Care Assistants and / or Allied Health Assistants depending on service scope. Access to and communication with GP. |
| 2 |
Provides low-risk home-based hospital care. Delivered by GPs with or without the assistance of RNs depending on the type of patient care needed. |
Clinical oversight of patient provided by GP. |
GP available during business hours and on-call arrangements in place for patient care after-hours. May have access to one or more nurse practitioner, registered nursing or allied health professionals relevant to service scope. |
| 3 |
Provides low complexity home-based hospital care referred by GP. Provides community rapid response services. Care delivered for a defined short-term period. GP retains clinical responsibility for the patient. |
Clinical oversight of patient provided by GP. Service delivery may be supported through use of agreed evidence-based protocols. Care delivered by multidisciplinary team (RNs / NPs / allied health) relevant to service scope. Service available extended hours. |
RNs relevant to service scope. May have one or more NPs and/ or allied health professionals relevant to service scope. Access to and communication with GP. |
| 4 |
Provides low to moderate complexity home-based hospital care. Patient referred by GP, ED or inpatient hospital team. Delivered by multidisciplinary team. |
Clinical oversight of patient provided by treating clinical team. Care delivered by multidisciplinary team (medical practitioners, RNs / NPs / allied health) relevant to service scope. Close communication with GP. Access to short stay unit co-located with hospital ED for management of patients requiring short-term bed-based care. Access to palliative care services for integrated patient management. Telehealth infrastructure. Formal arrangements with hospital for care outside service hours. |
Physician practicing in general medicine and / or emergency medicine physician. May have registrar and / or RMO. RNs with relevant experience and qualifications. May have NP with relevant experience and qualifications. Pharmacy, social work, physiotherapy and occupational therapy professionals. |
| 5 |
Provides high complexity home-based hospital care. Patient review and referral by inpatient hospital team. Delivered by multidisciplinary team. Care is transferred from admitting hospital inpatient team to home-based hospital consultant for episode of care. |
As for Level 4. |
As for Level 4. |
| 6 |
Provides high complexity home-based hospital care in collaboration with inpatient hospital team. Delivered by multidisciplinary team. Treating inpatient hospital consultant retains responsibility for the care of the patient throughout the episode of care. |
As for Level 4 plus: Clinical decisions for episode of care retained by inpatient consultant. Home-based hospital team communicate and share information with admitting hospital inpatient consultant throughout the episode of care.
Service available extended hours. |
As for Level 4 plus: Inpatient specialists available for consultation during hours of service. Clinical pharmacist |
Urgent primary care services deliver care to patients in the after-hours period where treatment cannot be delayed until the next in-hours period. Urgent primary care services are community-based services that provide care for conditions that do not need to be managed in a hospital emergency department. Urgent primary care services provide care to patients without needing an appointment.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
A Level 1 service provides community-based care for patients with minor illness and injury. There is no medical practitioner in a Level 1 service. |
Service provides clinic-based and / or mobile urgent primary care services. Service delivery support by telehealth. Service has access to basic resuscitation equipment and medications. Service infrastructure may include community health centre or ambulance station with equipped treatment room. |
Community nurses and / or paramedics. Hospital-based emergency physicians for urgent telehealth consultation and support. |
| 2 |
A Level 2 service provides telephone-based triage and assessment services for patients with urgent primary care needs. |
Telephone triage is performed for all calls by a trained health professional. Triage is supported through the use of standardised decision algorithms and patient management software. Secondary triage is performed by a specialist medical practitioner (e.g., GP). The service may be integrated with medical deputising services and face to face after hours GP services. |
RN and / or trained paramedic as primary receiver of calls. GP or other specialist medical practitioner (e.g., emergency physician) for medical advice / secondary triage. |
| 3 |
A Level 3 service is a mobile service that provides care to patients in community settings or their usual place of residence. |
Service provides mobile urgent primary care services. Service provides care to patients without needing an appointment. Medical practitioner travels to patient. Medical practitioner may be supported by after-hours nursing (RN / NP) professionals. Service has access to imprest medications. Service has basic resuscitation equipment. Service has access to prescribing information, referral pathways and electronic decision support. Service equipped with doctor’s bag medications, consumables and equipment. May have ECG capability. |
Registered medical practitioner. May have nursing personnel (RN / NP) depending on service scope. May have security / driver depending on service model. |
| 4 |
A Level 4 service is a mobile and / or clinic-based service that provides multidisciplinary care to patients. |
Multidisciplinary team includes medical and RN professionals. Team may include allied health professionals depending on service scope. Service provides care to patients without needing an appointment. Service may provide general primary care services (e.g., after hours GP clinic) or be specific to patient groups e.g., after-hours palliative care or mental health primary care services. Service has resuscitation and patient stabilisation capability. Service may be equipped for patient monitoring and observation and minor procedures. Service has access to imprest medications, prescribing information, referral pathways and electronic decision support. Service equipped with doctor’s bag medications, consumables and equipment including ECG machine. |
Registered medical practitioner. May have nursing personnel (RN / NP) depending on service scope. |
| 5 |
A Level 5 service is a clinic-based Urgent Care Service. |
As for Level 4 plus: Service has access to pathology, radiology and pharmacy on-site or via network arrangement. Service linkage via telehealth with acute hospital services. Service provided 7 days over extended hours. Service equipped for patient monitoring and observation and minor procedures. |
Registered medical practitioner. RNs / NPs with advanced skills in primary care. |
| 6 |
A Level 6 service is a designated Urgent Care Centre. |
As for Level 5 plus: Service provided >16 hours a day (minimum 7am to 11pm), 7 days a week. Purpose built facility with resuscitation bay and ambulance reception. On-site pathology, radiology and pharmacy. Capacity for sedation / complex regional anaesthesia. Equipped with monitoring and medical gases. |
Medical practitioners with credentials in anaesthetics, emergency medicine. RNs / NPs with advanced skills in primary care and emergency medicine. May have on-site extended care paramedics as part of care team. On-site radiography, pharmacy. May have social worker, senior mental health nursing as part of care team. |
