Better Sooner More Convenient Primary Care - New Zealand Doctor

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Risks to professional development and motivation. Issues of patient choice and continuity of care, and how these are to be safeguarded within a polyclinic-based system Caution needs to be exercised in basing policy on international experience. “ His advice for successful integration was: “Strong clinical leadership – quality focus Team working Cluster services & diagnostics around patient needs Investment in change management & process redesign Maximise benefit of new technologies and IT” 10 Risk analysis Risk Probability Impact Contingency plan Co-location of community nursing and allied health with medical centres is achieved, but does not lead to better integration Re-orientation and re-focusing of community nursing/allied health workforces towards primary end leads to overload for staff ("something added, but nothing dropped") Re-orientation and re-focusing of community nursing/allied health workforces towards primary care, worsens connection with secondary care High High Recognise this key risk (as identified from overseas experience/published literature). Understand the limitations of co-location back-up co-location with electronic records integration back up co-location with common organisational/management structures where possible back up co-location with development and implementation of an Integration Charter that is linked to lease/tenancy arrangements. High High Identify early opportunities for improving outcomes (rather than just responding to service demands) for patients with high demands on the system with view to reducing the current level of demand/service utilization. Target services to those most in need/most able to benefit; refine entry/exit & prioritisation criteria. Medium High Recognise this key possibility and address from the outset. Ensure inpatient workload is fully understood and necessary availability to the wards etc is protected. Business case appendices V12 AC 25Feb2010 Page 60
Differences between revenue generating imperatives faced by medical centres and free service ethos of community nursing/allied health causes professional disconnects and/or confusion for the public Management of change process handled ineffectively. Physical co-location of community nursing and allied health with medical centres cannot be achieved Community nursing/allied health workforce being allocated to medical centres leads to fragmentation and loss of support within the professional groupings Sub-specialisation becomes impossible and/or is not supported (in any move to generalist roles) High Medium <strong>Care</strong>fully examine & understand public policy implications & possibilities; engage with MoH early. Ensure all workforces are aware of financial imperatives & requirements. Ensure clear boundaries, entry/exit criteria etc. Ensure clear communication with patients/public. Medium High Have a transition pathway. Introduce a change manager to lead this. Ensure patients/family/whanau and the Community walk alongside the developments/ Consumer input and involvement. Have clear guidelines and timeframes. Have plan for management of staff resistance and monitor. Medium Medium Ensure clinical notes integration. Implement common organisational/management links. Medium Medium Recognise this key possibility and address from the outset. Ensure professional support and communication needs are understood and addressed in implementation plan. Ensure new business/organisational model contains necessary support, mentoring, professional development infrastructure for all professional groups. Low Medium Recognise this possibility and address from the outset. Identify and plan out the skills required, set education around this plan and review. 11 Engagement Working group who developed this plan: Hecta Williams, Raewyn McKnight, Maureen Frankpitt, Janette Anderson, Hecta Williams, Helen Reriti, Pauline Ansley, Barbara Smith, Jenny Robertson, Jane O‟Malley, Cheryl Hutchison, Jenny Woods, Dr Jocelyn Tracey, Anthony Cooke. Other clinicians involved: Dee Dolby, Dr Carol Atmore, PHO Clinical Governance Committee. Business case appendices V12 AC 25Feb2010 Page 61
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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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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: “With an aging population and an
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
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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
Page 179 and 180: 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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