Virtual Integrated Practice (VIP) General Practitioner

Aim

To address the critical lack of general practitioner (GP) workforce in rural and remote Queensland, this study aimed to implement and evaluate a Virtual Integrated Practice (VIP) Program in the rural SWHHS-managed GP setting.

Outcomes

Between January 2024 and March 2025 716 GP telehealth services were provided for patients of two rural/remote practices (MMM-6 & 7) in SWHHS. Patients were majority female (57.5%), average age 51.8 years (SD 18.6) and 18.3% identified as Aboriginal or Torres Strait Islander. Returning patients increased from an average of 19% in the first 3 months, to 61% at 10-12 months from commencement. Patients attended the practice for 16% of telehealth consultations. Surveys (n=15) found 14/15 respondents would use the service again, 14/15 indicated VIP improved their access to primary care and seven reported that the VIP appointment prevented ED presentation. Key factors for implementation include practice staff support, physical room and digital infrastructure, and provider continuity.

Background

There is a rising demand for primary care, with a rapidly ageing population, and chronic  disease burden. Demand for GP services in Australia are expected to increase 38% by 2032. However, with a critical lack of general practitioner (GP) workforce in rural and remote Australia patients in some rural areas have no option other than to seek care  from emergency departments, travel to larger centres (with resultant cost in time, money and loss of work) or go without care. A 2020 report found that almost 10% of people living in inner regional, outer regional, remote, or very remote Australia, had no  access to any primary healthcare services within a 60-minute drive time, and this inequity is compounded by the lack of medical workforce. As Australians living in rural and remote areas have higher rates of disease, potentially preventable hospitalisations,  and deaths, they are particularly at risk. Poor access to primary care also puts additional stress on the hospital system with patients presenting in extremis and requiring higher level care. Strategies to address workforce shortages are urgently required.

In urban or regional centres general practice care is provided predominantly by private general practices outside the remit of Queensland Health. However, within smaller rural and remote areas general practice services are often provided by Queensland Health-managed practices and staffed by Queensland Health. Recruiting permanent medical staffing in rural areas can be challenging and while locums can be used to ensure care is maintained, short-term locums do not offer continuity of practitioner or foster longitudinal
care in general practice.

The introduction of federally funded telehealth in Australian primary care settings during the coronavirus pandemic resulted in increased access to virtual care options for patients, and Australia’s Primary Health Care 10 Year Plan  2022-23 endorses further integration of telehealth into primary care settings to optimise service delivery. However, there is limited evidence on virtual integrated care models to support rural and remote primary care practices, particularly in Australia [1].

There is a need to implement and evaluate this model of service delivery and to identify the service characteristics associated with safe, high-quality continuity of care. The aim of this study was to implement and evaluate a Virtual Integrated Practice (VIP)  program in the Australian primary care setting and specifically in SWHHS.

Discussion

The outcomes demonstrate the feasibility and acceptability of a digitally supported healthcare initiative to offer continuity of care and improve access to primary care for rural communities. This evaluation has informed strategies for ongoing implementation across public general practices in rural/remote Queensland.

Benefits of the VIP GP program at SWHHS include: longitudinal continuity of care, patient acceptability, patient reported ED presentation avoidance and the ability to prioritise presentations requiring face to face care through the delivery of other care via telehealth. Several
local healthcare workers opined a preference for care from the external VIP (compared to a local) doctor for privacy and separation to their workplace. The remote nature of VIP consultations enabled sessions to be shared between multiple practices during low demand periods when appointment supply exceeded demand at a particular site, thus limiting medical officer non-productive time and maximising service provision.

Compared to existing private external telehealth services benefits of ‘in-house’ telehealth provision included reduced fragmentation of care by avoiding multiple service providers and care provision by a doctor familiar with the local context. For the VIP GP the provision of onsite visits as well as telehealth helped to foster team building and sense of community.

Other benefits include attendance by the VIP GP at multidisciplinary meetings and the ability to provide support to other local health providers (e.g. Nurse Practitioners). The videoconferencing platform was only accessible in clinic, meaning that out of clinic
consultations had to be via telephone. This is an area for future focus as video consultations have several MBS item numbers/funding available that are not available to telephone services. The VIP GP also reported rapport and work satisfaction being higher with video consultations compared to telephone. Limited physical space for videoconferencing at one of the two initial sites likely contributed to the majority (84%) of consultations taking place externally to the clinic via phone. From mid-February 2025 the program was extended to a third SWHHS site in Mitchell. In contrast to the initial two sites, at this site (which has a dedicated room available for telehealth consultations), only 21% (23 of 106) of consultations were by phone and the majority (83%, 88 of 106 consultations) took place with the patient located in clinic, enabling nursing input. The elements necessary for implementation success include the infrastructure and resourcing required to support the model (IT, physical space and staffing).

Supportive local practice administration and nursing staff are critical to successful implementation. Potential other locations in Queensland Health where this project could succeed are HHS’ serving rural/remote communities where the HHS provides general practice services.
This is especially relevant for areas that either have a limited local medical workforce, limited availability of GP appointments compared to local demand or are currently serviced by rotating locums that could benefit from a continuity model.

References

Acknowledgments I would like to acknowledge the invaluable support of CHSRI staff for their contribution to the development of this abstract and data analysis.

References

Calleja Z, Job J, Jackson C. Offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice: a rapid review of the literature.

Aust J Rural Health. 2022;00:1–14 Lepre B, Job J, Martin Z, Kerrigan N, Jackson C. The Queensland Virtual Integrated Practice (VIP) partnership program pilot study: an Australian-first model of care to support rural general practice. BMC Health Serv Res. 2023 Oct 31;23(1):1183.