Table 4.

Illustrative quotes for theme “Factors impacting the uptake and sustainability of GP advice lines”

Barriers to the uptake of GP advice lines	Limited hours of the service “We do have quite a few [GP practices] that run on Sundays, so there was no access on a Sunday, you know, is-… so I definitely think having longer hours would have been good, because I think that there are people, you know, people get sick on the weekends.” [Participant 3; Female; 54 years] “sometimes it's also if it's after hours, you know, that’s just the way it is, but yeah, I guess that’s a potential barrier.” [Participant 9; Female; 59 years]
	Lack of clarity of receiver’s role “…the only problems I've had are when I've rung the line and the person has no idea-…they can still answer my question because it was a clinical question, but not understanding what they're actually answering, what, you know, what their role is.” [Participant 9; Female; 59 years] “There needs to be a workforce, and to be truly blunt, at the moment, sometimes GP's are calling this line and having a great experience, sometimes they're calling someone who doesn't even know what the GP advice line is, they didn't even know it existed.” [Participant 5; Male; 38 years] “…if I was a GP it would irritate me if, you know, I want to speak to the paediatrician, but I have to go through three different people and everyone is saying, ‘Oh no, this is not me. You need to call this person and that person’. So, I'll get frustrated, and then lesson learned, I won't call anymore, and I'll just send them to ED. I think that’s human nature.” [Participant 14; Male; 41 years]
	Manual data collection “…with the GP advice line, we've done a lot of the data collection manually on spreadsheets… it's… it's a bit clunky, doesn't make for easy reporting.” [Participant 2; Female; 52 years] “…so I set it up in REDCap (…) what we did was set up a standard questionnaire so when we received a call we would take the name of the GP that was calling, their contact details, their email if they provided it, and the reasons for their call, and I put in a number of drop downs so it would be quick and easy to fill in, (…) whether they were calling about covid, whether we’d given them advice and whether we had ended that conversation or referred the patient on to the hospital” [Participant 1; female; 60 years]
Facilitators of GP advice lines	Availability of specialist response “…responding to the need that's in front of you, regardless of what that need is and obviously that requires, you know, a degree of seniority and training and experience. You don't want…you don't want it to be the most junior member of the team that's picking up the phone.” [Participant 6; Male; 47 years] “…specialist clinical advice. So, I mentioned the medical specialists, but also the medical specialists having the specific, the condition specific experience and expertise. So, for example, COVID or respiratory conditions….acute-… sorry….urgent care conditions, that's really important.” [Participant 2; Female; 52 years]
	Real time support “…if I'm a GP and I speak like for like with someone in their rapid access clinic, I either get advice to support my patient in their home, or a referral into the-… their outpatient clinic the next day, to help that patient…that patient avoid ED. That is a big win in the GP's book. And that will support future engagement number one, hands down. That is the number one thing.” [Participant 5; Male; 38 years] “…if the GP's got the patient in front of them and they need to lift the phone, there needs to be someone answering the phone there and then to assist them with making sure they're making a good decision based on the services and information that's available.” [Participant 6; Male; 47 years]
	Promotion strategies to create awareness “…when we set this up, we made sure that health-…I don't know if you're familiar with health pathways, but health pathways reflected what we were doing. It described the care, it described what was available, it described the contact points.” [Participant 6; Male; 47 years] “I think it also requires education of patients and also GP’s on how to use the lines, I don’t think we can assume they just know how to do it.” [Participant 10; Male; age unknown]
	Co-design with GPs “…you've got to get GP's opinions and feedback when you're trying to set it up to make sure that you're setting up something that works for them.” [Participant 13; Male; 47 years] “I think having clear communications, like, we have gone and done site visits…to the centres and introduced our team, and having regular meetings with the managers of the practices, encouraging…and then we’ve established models of care” [Participant 14; Male; 41 years] “You've got to get GPs involved in setting them up, so you've got to (…) get GP's opinions and feedback when you're trying to set it up to make sure that you're setting up something that works for them. Because a lot of the time, that's what happens, general practice (…) [is] doing the bulk of the heavy lifting in the health sector and it's certainly the most effective part of what goes on in health, but it, sort of, sits back and does all this work and then everybody around it from federal and state bureaucrats and other (…) authorities and organisations—they're making decisions about how GPs go about doing their job without often talking to general practice itself and GPs-…so I think that's…that's really vital…” [Participant 13; male; 47 years]
	Funding support “The PHN agreed to give us some funding. So, the way we were able to establish the advice line was through PHN funding in the first instance” [Participant 2; Female; 52 years] “The GP access line was originally funded by the PHN. So, it was actually a collaboration with the PHN who funded that position, but we've since taken the position over and funding it from within the virtual hospital for that reason, so that we can borrow the services.” [Participant 6; Male; 47 years]
Strategies to sustain the use of GP advice lines in the long term	Broadening the GP advice line service to other patient cohorts to support GPs “ So, I mean the advice line is great because we provide advice, but there's… there need to be a point that, you know, there's real difficulty in managing that patient including on COVID or any …any… any other condition, so that we need to actually get more involved to support the GP.” [Participant 4; male; 34 years] “…now we're looking to do more things, so you know, not only COVID, now with the GP advice line, but we're, you know-…influenza…” [Participant 7; Female; 62 years]
	Digitise advice lines “…because it allows all of those things in one, real-time, sharing of images, discussion of real-time information. So, I think having that visual component adds value and that ability to share information, patient information, adds value as well, so, yeah, that's how I could see it potentially looking.” Participant 5; Male; 38 years] “I think just making use of the technology that's there, that we really just don't make use of. As I said, you know, at the moment for that, sort of-…to get to-…get sort of that secondary care advice, you either-…you kind of need to get on the phone sometimes, you know, and that's often, probably not the most efficient way of…of doing it, you know, you get on a landline, it's particularly not very efficient. You gotta ring up the admitting officer at an emergency department, I mean, that's just, you know, it can be really difficult. So, making better use of, you know, our mobile phones and…and…and…and systems like Teams where you can interact, you know, visually, audio, upload information, upload images, upload videos, all sorts of things. We need to …be making use of these sort of things rather than just getting on traditional telephone and having to call up another landline.” [Participant 13; Male, 47 years]
	Evaluate impact on health outcomes “So, if we go back to the principle that I think we were trying to focus on, the outcome. So, whether we have actually prevented the hospital presentation or hospital admission, whether we were able to, you know, move that care from the traditional hospital to the community by supporting the GP and then obviously the experience for providing and receiving care…” [Participant 4; male; 34 years] “I would say it would be feedback-based and probably also assessment of the numbers. So, feedback from all parties involved including the consumers, patients. Looking at the types and numbers of referrals, whether the stated aims of-…well, with our service, one of our key priorities is around ED avoidance. So, whether that's met and whether the patients’ needs have been met through the alternative pathways.” [Participant 12; Female; 37 years]
	Involve consumers to gain their trust “…if the GP's using the advice line with the person or carer there, it should be a routine part of that conversation to involve the person or carer in the conversation. So it…it really should be a three way conversation, not a two way conversation.” [Participant 11; Female; 50 years] ““I’m happy for my GP to use GP advice lines. I mean the only thing I’d want to be assured of was actually that advice line went through to a hospital and another clinical professional who was qualified to advise on whatever it was” [Participant 16; Female; 68 years] “I think the transparency should be there, as family…parents, I don't know about adults, but parents with a child would appreciate that the GP is taking the effort and time to speak to a paediatric service there and then.” [Participant 14; Male; 41 years]