General Practitioners
Affordable & compassionate support for patients navigating complex care
Support beyond the clinic that saves you time, increases your billing, & protects continuity of care
Written summaries to referring General Practitioner
Bridging gaps in care when services are delayed
Practical in-home support aligned with clinical plans
Support through service and care transitions
Supporting reduced avoidable hospital admissions
Support beyond the clinic
Home-based nursing visits for house-bound or vulnerable patients
Risk monitoring and early escalation
Nursing components of 75+ Health Assessments
Chronic Disease Management preparation
Post-hospital discharge check-ins
Wound care and clinical observation
Medication support and monitoring, including patient education and support for injected medications
Telehealth support with GP during home visits
Nurse escort support to GP appointments
Written summaries provided to GP after visits
GP Clinic Day service
In-home foot health appointments
Support in preparation of advance care planning
Support with home monitoring (e.g. continuous cardiac monitoring)
Clinical interventions, such as PEG line feeding, urinary catheter (IDC) and stoma management
We understand the pressure general practice is under. Our role is to work with you, not to replace or complicate care. By offering steady, skilled support in the home, we can help you stay connected to patients who need additional support.
Patients who will most benefit from referral
Caring for a loved one at home
Family members or friends providing informal care at home, especially first-time carers or those managing alone. Often these carers are unaware of the supports available or unsure how to access them.
Adjusting to a new or complex diagnosis
Patients recently diagnosed with chronic or progressive illnesses (e.g. dementia, heart failure, Parkinson’s, COPD, renal disease, diabetes) who may need time, space, and guidance to adjust. We help clarify next steps and gently introduce future planning, including ACP and service linkage if appropriate.
Waiting for services or need stop-gap care
Clients approved for services (e.g. Support at Home [My Aged Care]) but facing delays in commencement, or those ineligible but still needing support. We offer short-term, flexible nursing input to keep them safe and connected during gaps in formal care.
Transitioning to palliative care
When care goals shift from curative to comfort or quality of life (e.g. cancer no longer responsive to treatment), we can provide education, practical support, and family guidance alongside the treating team.
Navigating home, hospital, RACH transitions
Patients transitioning between home, hospital, or residential aged care who need practical help during short-term recovery or decision-making (e.g. post-discharge support, respite return, or interim care while awaiting aged care packages). Especially useful where there are unmet needs, system complexity, or family overwhelm.
Medication support
For patients who are otherwise independent, may be reluctant to obtain a Webster Pack, and who would benefit from having clinical support for their medication management at home. We can provide gentle education and help to ensure medication doesn’t run out.
Rural & remote outreach to Mount Isa, Charters Towers, & Ingham, by negotiation
Earlier Identification of deterioration
Improved adherence to clinical plans
Reduced avoidable risks
Escorted nurse clinic visits
Nurse escorted pre/post-operative appointments
Benefits for health professionals
See how we are connecting communities
We provide community outreach nursing for patients who cannot attend clinic appointments or need home-based assessments. Our qualified nurses support your treatment plan, maintain follow-up, and keep you connected to patients who may otherwise slip from care. Where appropriate, we can support GP review via telehealth during home visits. We offer timely communication back to you and deliver reliable, skilled nursing that extends your reach, supports adherence, identifies early clinical deterioration, and reduces avoidable deterioration.
This service is designed to act as an additional referral option for clients needing extra support post-discharge. The service does not replace clinic-based follow-ups but enhances recovery support at home by assisting with continuity of care, medication support, liaising with GPs, and patients/family guidance.
The primary physician treating the patient will remain responsible for clinical governance and medication prescribing, nursing orders where medical direction is necessary. Nursing care will be provided to enhance the quality of care and support at home. Including to support carers and families where appropriate.