Better Sooner More Convenient Primary Care - New Zealand Doctor

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Year two: Maintain deliverable/activities from year one. Monitor & audit progress & changes. Extend MedTech across all health centres and for all community nursing and allied health. Develop a client load aligned with practice populations, eg. each physiotherapist, social worker or specialist nurse relates to one (or more) health centres and may see patients there. They will be members of the multi disciplinary team. Review the location of sexual health services, with a view to them being located in IFHCs Year three Build on and maintain previous years work. 7 Capability and capacity Capability and capacity are core aspects of this plan and are therefore covered in the above sections. 8 Effect on inequalities This work stream focuses on those who are current frequent users of the health system, including the frail elderly, and aims to improve their care. While focusing on optimizing care for those who do frequently interact with the health system, it will be important to ensure that those who typically don't benefit, and are disconnected, from the health system (but who could benefit from better care) are not forgotten. It is intended that achieving better (as distinct from more) care for those patients currently utilizing the health system frequently, will free resources that can then be focused onto meeting the needs of Māori and Pacific peoples. 9 Evidence for this initiative The need for new models of integrated care for the aging population and those with long term conditions has been well described by Rosen and Ham 44 : 44 Rosen R, Ham C. Integrated <strong>Care</strong>: lessons from evidence and experience. Report of the 2008 Sir Roger Bannister Annual Health Seminar by R Rosen, Nuffield Trust , C Ham, University of Birmingham Business case appendices V12 AC 25Feb2010 Page 58
“With an aging population and an increasing prevalence of chronic disease, ever more people require care and support services from organisations that cross the boundaries of health, social care, housing and voluntary organisations. A wealth of studies report that people with chronic, complex health problems – particularly older people – are often confused by the array of services they are faced with, receive duplicate interventions, and find it hard to understand where to turn with specific problems. They value initiatives to coordinate care and simplify their journey through the health and social care systems. Equally, with pressure to deliver elective care in community settings and prevent avoidable ill health, integration and collaboration between generalists and specialists – GPs, consultants, specialist nurses and other clinicians – is increasingly important.” They advise that any project involving integration of services: makes improved patient care the main objective of every proposal develops clearly articulated and shares goals involves local primary care networks and clinicians in developing the strategy takes time and effort to build the relationships, trust and clinical leadership required in integrated teams measures clinical and social outcomes so that the effect of changes can be reviewed and programmes modified is careful to unbundle the true costs of any services before devolution occurs develops robust governance arrangements from the start establishes the right incentives for services and clinicians to want to be involved. Similarly Glendenning 45 observes that integration is more likely when the following are present: joint goals tight knit highly connected professional networks high degree of mutual trust joint arrangements which are part of „core business‟ rather than marginal integration at the edges joint arrangements covering operational and strategic issues and shared or single management arrangements, Nick Goodwin, Kings Fund 46 , in his recent presentation to the Ministry of Health concluded from the international literature that: “There is a lack of rigorous evaluations of polyclinics in other countries. Contextual differences are important. Co-location of professionals is not sufficient to guarantee integrated care - in the same polyclinic, and between polyclinics and hospitals. 45 Glendenning, C (2002) „Breaking down barriers: integrating health and care services for older people in England‟, Health Policy 65: 139–151. 46 Nick Goodwin. Powerpoint presentation to Ministry of Health, Wellington. 15 March 2010 Business case appendices V12 AC 25Feb2010 Page 59
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Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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The base populations of the three d
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Māori/Pacific Not Māori/Pacific D
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4.7 West Coast region service deliv
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5 Future model of care 5.1 The desi
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support them. Help with understandi
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LEVERS VISION Better, sooner, more
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providing the majority of care). Th
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The Community Health System Deliver
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To better integrate the support pro
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5.5 Enablers A key aspect of this b
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Two rounds of meetings with front l
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While doctor-nurse substitution has
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Nick Goodwin, Kings Fund 14 , in hi
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Quality domains Each new initiative
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Preventative Acute LTC management R
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Preventative Acute LTC management R
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The core services are provided or p
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Total required FTEs for the Grey IF
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7 Governance, Ownership & Managemen
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Option D: PHO/DHB jointly owned Pri
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The IFHS will need the ability to b
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Of note, a large proportion of the
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The DHB delegates decision making o
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Limited integration of community se
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10.4 Key milestones The table below
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Expanded pharmacy roles Improving a
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Devolved community based services w
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Appendices Appendix One: Health Equ
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ongoing GP shortage creating an env
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10. What are the unintended consequ
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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
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Page 111 and 112: Clinical care Practice self managem
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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
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Page 133 and 134: Appendix Seven: Integration - Healt
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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
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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
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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
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Page 175 and 176: Year one: Maintain and continue the
Page 177 and 178: Māori have a higher incidence of m
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11 Organisational accountabilities
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There are often vacancies for allie
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6 Deliverables / activities Program
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Professional development: Provide
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Mainstream arguments are concerned
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Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
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This option is effectively a Greenf
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7 Westland IFHC Facilities options
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Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
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utilize MedTech, but via their own
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4 Objectives: To implement c
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Security An individual‟s health i
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8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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Better Sooner More Convenient Primary Care - New Zealand Doctor

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