Friday 21 November 2025 | 13:05-14:35 

Format: Presentation

Stream: Populations

Part One: Supporting Health, Empowering Lives: The Important Role of Integrating Social Workers in General Practice

This presentation highlights the often-overlooked role of social workers in general practice and the positive outcomes of their integration into the healthcare team. Our study shows that social workers support both clinical and non-clinical team members, foster collaborative group discussions, and build relationships with hospitals, patients, RACFs, service providers, and NGOs.

Delegates will gain insights through case study examples where the integration of a social worker in team-based care led to improved health outcomes for patients, particularly in managing challenging behaviours and coordinating care and services. Attendees will leave with a better understanding of the social worker’s impact on primary healthcare and the value of their role in supporting holistic patient care.

Tamieka Nugent Prestantia Health; Australia

Part Two: Evaluation of the Social Workers in General Practice (SWiGP) Pilot Program – Addressing Barriers to Healthcare Among Priority Populations in Australia’s Capital

The Social Workers in General Practice (SWiGP) pilot programme is an innovative trial that integrates social workers into general practices to address complex social and health needs. This approach has shown promising results in improving patient support, enhancing continuity of care, and increasing the capacity of General Practitioners (GPs). Social workers assisted patients overcome barriers to accessing essential services by coordinating additional assistance and navigating health care systems. The programme’s early intervention strategies are essential in preventing hospitalisations and improving overall community health outcomes. As the first of its kind in Australia, this pilot offers valuable insights into the potential benefits of interdisciplinary collaboration in primary health care.

The presentation will showcase an overview of the SWiGP pilot and program evaluation findings independently conducted by the University of Canberra. This includes impact on general practice and multidisciplinary teams, impact on patients and carers, and learnings for future iterations of the programme.

Sheila Brito Capital Health Network; Australia

Part Three: The Australian Capital Territory Breathlessness Intervention Service (ABIS): A co-designed home-based public-private partnership model delivered by physiotherapists

Internationally, growing research evidence supports the use of symptom-based care to lessen the effects of breathlessness on quality of life and distress for carers and families. Despite this, few services are available in Australia that focus on the management of this troubling symptom.

To address this issue, hear how Capital Health Network (CHN) – ACT’s Primary Health Network partnered with University of Technology Sydney, Southside Physio, and consumers and clinicians to co-design and implement the first Breathlessness Intervention Service (BIS) model worldwide to be delivered to patients free of charge by a private allied health provider with funding and support from a primary health network. Hear how the pilot was implemented and evaluated as a quality improvement project.

Ros Kirk Capital Health Network; Australia

Part Four: Doing What Matters and Addressing Critical Gaps: Optimising Community Aged Care in General Practice

Most older Australians rely on General Practice for care, yet a vast majority of GPs and nurses lack formal geriatric training, relying on outdated software templates. This session presents a ground-breaking PHN-funded initiative that audited patient care and identified major gaps in health assessments, including missed vaccinations, frailty screening, and medication reviews.

Learn how 33 GPs implemented practical changes, improving frailty diagnosis and home medication reviews, with 100% recommending the program to peers. This session is essential for healthcare professionals seeking to enhance aged care through evidence-based practices, peer collaboration, and advocacy for improved software tools. Don’t miss this opportunity to be at the forefront of aged care innovation in General Practice!

Chris Bollen Bollen Health; Australia