Identifying and engaging with your patient’s GP
Rehabilitation clinicians and support staff should begin identifying and engaging with a patient’s General Practitioner (GP) immediately following an admission to an inpatient rehabilitation service.
Step one – patient admitted to inpatient rehabilitation
- Identify the patient’s GP or direct the patient, family or carer to the Adult or Child journey through rehabilitation information to assist them in finding a GP.
- Support your patient with person-centred interdisciplinary goal-setting and action planning. Communicate the goals with the multidisciplinary team and incorporate into the patient’s daily rehabilitation and nursing plans.
- With the patient’s consent, email or post the Rehabilitation admission cover letter and information, including progress with rehabilitation goals to their GP. This will inform the GP that their patient has been admitted to rehabilitation. Please include contact details in this letter so that the GP can call should they have any questions.
Step two – during discharge planning
- Consider inviting the GP to your patient’s case conference or discharge planning meetings. The GP participation in multidisciplinary case conferencing information provides details on how GPs can bill for this time.
- Encourage the patient to see their GP when they leave hospital. Give the patient a time-frame in which this appointment needs to be booked. Assist the patient to book this appointment if needed.
Step three – on discharge
- Ensure the patient has a GP appointment booked in before they leave the ward.
- Facilitate and support the patient to make follow up appointments in a timely way.
- Complete the Enterprise Discharge Summary (EDS) in a timely manner. Discharge recommendations should be documented clearly in case conference notes.
- Provide the patient with a copy of their discharge summary so they can take this to their GP appointment.
- Ensure the next set of goals are determined with the patient and communicated to the team.
The Checklist – identifying and engaging with your patient’s GP will help ensure each step is completed with roles and responsibilities clearly identified.
Essential resources
- Enterprise Discharge Summary (EDS) (PDF, 665KB)
- GP participation in multidisciplinary case conferencing (PDF, 712KB)
- Checklist – identifying and engaging with your patient’s GP (PDF, 702KB)
- GP letter template – rehabilitation admission (PDF, 461KB)
- GP letter template – rehabilitation discharge (PDF, 465KB)
Additional resources
- Rehab and your GP – project recommendations (PDF, 689KB)
- Rehab and your GP – what is rehabilitation? (PDF, 892KB)
- General Practitioner Liaison Officers (GPLOs) (PDF, 598KB)
Contact us
Email: QldRehabilitationNetwork@health.qld.gov.au
Phone: +61 7 3328 9175
Postal Address: GPO Box 48, Brisbane 4001
