Better Sooner More Convenient Primary Care - New Zealand Doctor

“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