To download a PDF version of the ACE Service Newsletter click here.

GP Model of Care - Anglican Care, Jesmond Grove

Judith Cornish, Residential Care Manger from Anglican Care, Jesmond Grove gave an overview of their GP Model of Care at the Newcastle Interagency meeting.

Jesmond Grove has 5 GP’s who visit residents.
To address issues such as time constraints, inability to find staff or residents and provide easy access for resi- dents the following actions and strategies have been put in place:
  • Residents go through a clinical care co-ordinator to arrange a GP appointment
  • A clinical space has been set up like a surgery
  • All medical files for residents have been moved to this space for easy access
  • The clinic opens 3 days a week
  • 5 GP’s, who will see each other’s patients
  • GP’s will provide medical support if resident’s GP away
Judith advised this model works well for residents, GP’s and staff. For support initiating the GP Model of Care or updating your details in HealthPathways contact Nerida Walker via email at 

Congratulations Regis the Gardens, Corlette
By committing to the implementation of ACE processes, Regis has improved their internal capacity to manage acute clinical episodes. This has been demonstrated by reducing “000” callouts from 136 in 90 days to 12. 

Manning ACE Interagency Meeting

The inaugural Manning Interagency meeting was held on the 10th December 2015. Manning ED hosted the meeting.

Fiona Horsington, MRRH ASET nurse, presented a case study that reinforced the ACE process. Kathryn Freihaut from Great Lakes Nursing Home followed with a RACF perspective of the case study. RACF and ED staff worked together to ensure a smooth and timely experience for a resident in the end stage of life. The importance of a quality ISBAR clinical handover was reiterated to enable quality integrated care for residents.

ED staff were able to focus interventions on the goal of care that RACF staff had outlined, which expedited interventions and return the resident to their home within an hour. 

ACE Reports
HRMI have been commissioned to develop a dashboard to provide a mechanism for merging HNE Local Health District and Hunter Primary Care data. This dashboard is due for completion in February 2016.

From this dashboard, data reports for individual RACF’s, HNELHD ED’s, will be able to be generated. It is the aim of these reports to provide feedback to facilities on ACE implementation, as well as determining what information results in improved outcomes and performance.

A key performance indicator will be that ED presentations have an ACE call. It is envisioned, through implementation of ACE, the end result for residents is the right care, in the right place at the right time. True integrated care occurs through excellence in clinical handover (ISBAR) between health care teams, ensuring resident’s goal of care is identified; enabling residents to smoothly negotiate the health care sys- tem, in a timely and efficient manner.

If you would like a copy of the draft ACE report to review, please email: 
Video presentation of ACE process
To support the implementation of the ACE process in RACF’s, Hunter Primary Care has commissioned MossPitt Media to develop a short 4 minute video presentation.

The video recreates a common scenario where vital decisions are made about whether to send a resident to hospital or stay at home. A typical scenario was utilised to outline the steps involved in the ACE process. Whilst the scenario may change the process remains constant.

The video presentation was filmed at Tinonee Gardens Multicultural Centre; many a star was born that day. A special thankyou to the staff and residents who gave up their time to be involved in the project. 

Hunter Primary Care would like to thank its partners:
  • Hunter New England Central Coast PHN
  • Hunter New England Local Health District
  • Ambulance NSW; and
  • RACF’s

Copies of the video presentation will be available at the interagency meetings and soon to be available on the ACE website 

End of Life Care in HNELHD
Kate Munro is the End of Life Care Project Officer for HNELHD. HNELHD are currently implementing The NSW Resuscitation Plan form for patients 18 years and over. For more information about the form contact Kate via email at

NSW Trustee and Guardian are encouraging everyone to plan ahead. Planning ahead ensures rights and wishes of residents can be respected, because they are properly documented. The website is a guide to steps to consider.

Brochures can be downloaded for discussions with residents, family and carers. Visit the website at
Aged Care Interagency Meetings
Hunter Primary Care and HNELHD have now established local regional interagency meetings at Newcastle, Port Stephens, Manning, Singleton and Maitland.

These meetings are held in conjunction with the Residential Aged Care Facility (RACF) collaborative group and provide an opportunity to learn from each other and showcase how the service is making a difference.

Guest speakers will present their experiences, innovations and strategies for emergency care. 
Art Therapy
The introductory workshop is an enriching experience for people who work, or would like to work, with children, adolescents and adults in the practice of art therapy. Over two days participants create an artwork and are introduced step-by-step to the concepts involved in art therapy. 

For further information visit:
Singleton ACE Interagency
Date: Wednesday 24 February 2016 Time: 9.30am - 12.00pm
Venue: Singleton District Hospital
Dangar Road Singleton NSW 2330

Manning ACE Interagency
Date: Thursday 25 February 2016 Time: 9.30am - 12.30pm
Venue: Great Lakes Nursing Home
27 - 31 Crawford Street Buladelah NSW 2423

Hold the Dates
Tomaree: Thursday 12 May 2016
Newcastle: Thursday 19 May 2016
Manning: Thursday 9 June 2016
Maitland: Tuesday 17 May 2016
Singleton: Wednesday 18 May 2016

Upcoming Conferences
Geriatric Emergency Medicine Seminar
Thursday 7 April 2016
Macquarie Park, New South Wales
Putting together a range of experts with a passion for the care of the elderly. For event information visit: 

Falls Prevention Forum
Wednesday 4 May 2016
Club Taree, Wingham Road, Taree
For information about this free forum click here.
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