After Hours mobile primary care service for RACHs - EOI application form

Section A - Applicant details

RAC home name (one application per facility)

Contact (CEO/facility manager/executive)

Name

Email adress

Mobile number

Role within the RAC (including memory support and respite)

Names of general practices and practitioners linked with your home

Application questions

1. In 150 words or less, please describe your current after hours procedure.

2. What factors influence staff confidence when working with primary care providers after hours?

3. During the past 12 months, how many residents were transferred to emergency between 8:00pm – 8:00am?

4. Of these transfers to emergency, approximately how many residents were then admitted for longer than 48 hours?

5. In the past 12 months how many individual residents were transferred on multiple occasions after hours?

6. During the past 12 months on how many occasions did you utilise your telehealth facilities either during business hours or after hours?

7. The purpose of this Grant is to support the Project in gathering data about transfers and resident characteristics, in 100 words or less what challenges or barriers might you face in completing this task?

8. In 150 words or less, what steps would you need to take to enable access to training for staff who work after hours.

9. What do you hope to gain from participating in this project?

Section B - Declaration

This must be completed by an authorised representative of the organisation submitting the application:

I declare that the organisation is able to implement the project within the designated time frame.

If this application is successful, I agree to provide required deliverables to COORDINARE – South Eastern NSW PHN via designated platform (Folio Contract Management System).

I can confirm that the contents of this application are to the best of my knowledge accurate, complete and do not contain any false, misleading or deceptive misrepresentation, claims or statements.

I declare that funding has not been sought or received for this activity from any other source.

I declare that the organisation is financially viable and able to manage the funding within the timeframe and within budget.

I understand that this application does not create a legal or binding commitment and that if successful I will be bound by a contract with COORDINARE - South Eastern NSW PHN.

I understand that the RAC is required to have current and adequate accreditation/insurance in place / Aged care accreditation certificate / Public liability insurance - at least $10 million per claim and in the aggregate of all claims / Professional indem

I understand that if the conditions of the funding are not complied with, COORDINARE – South Eastern NSW PHN may seek to recover any funds allocated.

By signing this declaration, the signatory below represents, warrants and agrees that they have been authorised by the Respondent to make this declaration on its/their behalf.

Applicant signature

Full name

Date