Practices hip to the value of HIPs through Access and Choice programme, study finds

Practices report the Govern­ment-funded Access and Choice prima­ry mental health scheme relieves pressure on GPs, fills gaps in patient care and reduces referrals to a PHO brief intervention service, a researcher says.

University of Otago public health student Bianca Crichton studied the in­tegrated primary mental health and ad­diction service at small to medium-sized practices in Oamaru, Dunedin and Cen­tral Otago.

Ms Crichton interviewed health improvement practitioners (HIPs), health coaches, general practice staff and key community informants.

“One GP commented that they now almost never prescribe antidepressants because they can just refer to the HIP,” she told GP22: Conference for General Practice last month.

Based on a pilot programme in 2019, Access and Choice was extended nationally and, at October last year, had been implemented at 237 or 23 per cent of the country’s GP sites, across 16 of the 20 then-DHBs.

Ms Crichton’s supervisor, Jim Ross of the Department of General Practice and Rural Health, described how the scheme is supposed to work, with the new types of workers in the practice most of the time and available for an immediate introduction to new clients, called the “warm handover”.

Dr Ross said it wasn’t possible in smaller practices to have all three of the scheme’s roles – HIP, health coach and community support worker – present continuously.

Ms Crichton said she found warm handovers were often not possible, so practices developed “work-arounds”.

In one of the towns where the study was done – she didn’t say which one – two practices shared a HIP, and a pa­tient from one practice could walk to the other to meet the practitioner.

Other work-arounds were “semi-warm handover” by phone, and having a HIP and a health coach working on alternate days, so someone was availa­ble. In some larger practices, a system was developing of pre-booking appoint­ments instead of having every second appointment free, Dr Ross says.

One practice had had to step back from booking up too much in advance.