Better Sooner More Convenient Primary Care - New Zealand Doctor

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3 Table of contents 1 Caveats/status .................................................................................................................................................. 3 2 Executive summary .......................................................................................................................................... 4 2.1 Assessment criteria summary ............................................................................................................. 5 3 Table of contents ........................................................................................................................................... 10 4 Introduction .................................................................................................................................................... 12 4.1 Strategic context ................................................................................................................................. 12 4.2 Financial context ................................................................................................................................... 12 4.3 Secondary services sustainability ................................................................................................... 13 4.4 Population & health status .................................................................................................................. 14 4.5 West Coast PHO .................................................................................................................................... 17 4.6 Changes underway ................................................................................................................................ 20 4.7 West Coast region service delivery issues ................................................................................... 21 5 Future model of care ................................................................................................................................... 23 5.1 The desired patient care pathway/model of care ..................................................................... 23 5.2 Goals for better, sooner more convenient ................................................................................... 25 5.3 Reducing inequalities ........................................................................................................................... 27 5.4 Service specific model of care developments............................................................................. 28 5.5 Enablers .................................................................................................................................................. 35 5.6 Clinician engagement ........................................................................................................................... 36 5.7 Community engagement ...................................................................................................................... 37 5.8 Evidence for this model ..................................................................................................................... 38 5.9 Quality, safety and evaluation .......................................................................................................... 41 6 Business model ............................................................................................................................................... 44 6.1 Business concept .................................................................................................................................. 44 6.2 Locality Integrated Family Health Centres................................................................................. 48 6.3 Service outputs and outcomes ......................................................................................................... 49 7 Governance, Ownership & Management .................................................................................................. 53 7.1 Options .................................................................................................................................................... 53 7.2 Assessing the options ......................................................................................................................... 55 8 Contracting arrangements .......................................................................................................................... 56 8.1 Role of the IFHS ................................................................................................................................. 56 8.2 Annual health service plan ................................................................................................................. 56 8.3 Contracted providers within IFHCs. .............................................................................................. 57 9 Financial sustainability ................................................................................................................................ 58 9.1 Status quo financial situation........................................................................................................... 58 9.2 Addressing affordability ................................................................................................................... 59 9.3 Impact on the DHB .............................................................................................................................. 60 10 Implementation plan ..................................................................................................................................... 62 10.1 Project governance and management ............................................................................................. 62 10.2 Change management ............................................................................................................................ 62 10.3 Investing in change .............................................................................................................................. 64 Business case EoI V38 AC 25Feb10 Page 10
10.4 Key milestones....................................................................................................................................... 65 10.5 Objectives, key activities and workplans ..................................................................................... 66 10.6 Work in progress items ...................................................................................................................... 70 10.7 Risks and Mitigations .......................................................................................................................... 70 Business case EoI V38 AC 25Feb10 Page 11
Page 1 and 2: Business Case Better, Sooner, More
Page 3 and 4: 1 Caveats/status This business case
Page 5 and 6: Current situation By three years Wa
Page 7 and 8: staffed on a capacity model - in wh
Page 9: support from DHBs, specialist clini
Page 13 and 14: Annual government health funding pe
Page 15 and 16: Ambulatory Sensitive Hospitalisatio
Page 17 and 18: The base populations of the three d
Page 19 and 20: Māori/Pacific Not Māori/Pacific D
Page 21 and 22: 4.7 West Coast region service deliv
Page 23 and 24: 5 Future model of care 5.1 The desi
Page 25 and 26: support them. Help with understandi
Page 27 and 28: LEVERS VISION Better, sooner, more
Page 29 and 30: providing the majority of care). Th
Page 31 and 32: The Community Health System Deliver
Page 33 and 34: To better integrate the support pro
Page 35 and 36: 5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39 and 40: While doctor-nurse substitution has
Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
Page 43 and 44: Quality domains Each new initiative
Page 45 and 46: Preventative Acute LTC management R
Page 47 and 48: Preventative Acute LTC management R
Page 49 and 50: The core services are provided or p
Page 51 and 52: Total required FTEs for the Grey IF
Page 53 and 54: 7 Governance, Ownership & Managemen
Page 55 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59 and 60: Of note, a large proportion of the
Page 61 and 62:
The DHB delegates decision making o
Page 63 and 64:
Limited integration of community se
Page 65 and 66:
10.4 Key milestones The table below
Page 67 and 68:
Expanded pharmacy roles Improving a
Page 69 and 70:
Devolved community based services w
Page 71 and 72:
Appendices Appendix One: Health Equ
Page 73 and 74:
ongoing GP shortage creating an env
Page 75 and 76:
10. What are the unintended consequ
Page 77 and 78:
It is common for people with an acu
Page 79 and 80:
Outcome measures Indicator Baseline
Page 81 and 82:
determine ratio of nurses and GPs t
Page 83 and 84:
C. Extended role for pharmacists:
Page 85 and 86:
11 Engagement Working group who dev
Page 87 and 88:
Appendix B: Acutely unwell adult pa
Page 89 and 90:
4 Objectives to implement nur
Page 91 and 92:
Review Buller after hours arrangeme
Page 93 and 94:
Year three Community education camp
Page 95 and 96:
13 Costs Budget considerations:
Page 97 and 98:
established. This group now oversee
Page 99 and 100:
Output measures Tobacco control / s
Page 101 and 102:
Improving immunisation coverage - h
Page 103 and 104:
Year three Continued joint plan
Page 105 and 106:
extending health promotion activiti
Page 107 and 108:
Immunisation Coverage Funder Provid
Page 109 and 110:
The Community Health System Deliver
Page 111 and 112:
Clinical care Practice self managem
Page 113 and 114:
and increases in the numbers of pat
Page 115 and 116:
Ambulatory Sensitive Hospitalisatio
Page 117 and 118:
% CVD on lipid lowering drugs, beta
Page 119 and 120:
Health navigators/ kaiawhina: chan
Page 121 and 122:
Committee‟s objectives 41 of prov
Page 123 and 124:
- lack of consistency of care betwe
Page 125 and 126:
qualifications and skills. Where ca
Page 127 and 128:
6 Deliverables / activities Impleme
Page 129 and 130:
“With an aging population and an
Page 131 and 132:
Differences between revenue generat
Page 133 and 134:
Appendix Seven: Integration - Healt
Page 135 and 136:
It is expected that HealthPathways
Page 137 and 138:
Year two implement the process to
Page 139 and 140:
Low uptake by primary and secondary
Page 141 and 142:
Appendix Eight: Improved access to
Page 143 and 144:
to easily access by telephone). Oth
Page 145 and 146:
Year One - July 2010 to June 2011 T
Page 147 and 148:
LECG 50 evaluated whether “the im
Page 149 and 150:
Appendix Nine: Referred services 1.
Page 151 and 152:
them by technical errors or lack of
Page 153 and 154:
Identify patients that would benefi
Page 155 and 156:
• Provision of patient specific m
Page 157 and 158:
12 Organisational accountabilities
Page 159 and 160:
emain under the care and management
Page 161 and 162:
Service user pathways in an optimal
Page 163 and 164:
Model for shared care pathways deve
Page 165 and 166:
Implementation plan: to June 30 Dev
Page 167 and 168:
Year two Review progress, outcome m
Page 169 and 170:
10 Risk analysis Risk Probability I
Page 171 and 172:
Appendix Eleven: Frail older people
Page 173 and 174:
ehab and treatment programmes that
Page 175 and 176:
Year one: Maintain and continue the
Page 177 and 178:
Māori have a higher incidence of m
Page 179 and 180:
11 Organisational accountabilities
Page 181 and 182:
There are often vacancies for allie
Page 183 and 184:
6 Deliverables / activities Program
Page 185 and 186:
Professional development: Provide
Page 187 and 188:
Mainstream arguments are concerned
Page 189 and 190:
Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192:
A key possibility is that land at t
Page 193 and 194:
This option is effectively a Greenf
Page 195 and 196:
7 Westland IFHC Facilities options
Page 197 and 198:
Year two Substantive-IFHC in Greymo
Page 199 and 200:
12 Costs Capital costs Greymouth IF
Page 201 and 202:
utilize MedTech, but via their own
Page 203 and 204:
4 Objectives: To implement c
Page 205 and 206:
Security An individual‟s health i
Page 207 and 208:
8 Effect on inequalities The increa
Page 209:
Appendix Fifteen: Project advisory
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Better Sooner More Convenient Primary Care - New Zealand Doctor

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