Role of Specialist Services
The Specialist Services will contribute to the integrated care services by providing the following new services:
- Rapid access to specialist assessment and treatment
- Transition patient care back to primary care and the community setting following engagement with the hospital, facilitated by the development of multidisciplinary care plans and the involvement of care facilitators
- Support patients and GPs to reduce the need for acute hospital presentations
- Build capacity in primary care to better manage the complex patients
The Specialist Teams will provide rapid evaluation of any acute deterioration, through either intervening promptly to avoid hospital admission or expediting admission to hospital as required. The pathway for referral for these patients will be via the Rapid Access Specialist Service thereby bypassing unnecessary ED presentations.
Specialist Teams will also provide stabilisation services/clinics as required and work with the patient’s GPs and Care Facilitators to transition these patients from the hospital environment back to primary care and the community setting.