Better Sooner More Convenient Primary Care - New Zealand Doctor

HealthPathways is not:
decision support software (no patient information is entered)
evidence-based guidelines
designed for patients
comprehensive – many departments and clinical areas have not been started.
Development of pathways:
Pathways are initiated by the clinical work groups within the Canterbury Initiative and
then progressed by clinical editors. T he relationships developed in the work groups
provide the foundation to develop the pathways. Additional pathways are continually
being added to HealthPathways as additional work groups are created.
While one of the key drivers in Canterbury for the development of HealthPathways was to
decrease waiting times for first specialist appointments (FSAs), the drivers for the West Coast
are somewhat different. Currently, the primary care system on the West Coast is not in a good
position to take on clinical tasks currently performed in secondary care settings. Similarly, Grey
Base Hospital services are generally staffed on a capacity model – in which staff costs do not
vary with reductions in activity. However, in the medium term, with the strengthening of the
primary care sector, and the development of more activity based staffing for some services,
associated with a closer working relationship with Canterbury DHB 47 , there may be an
opportunity to move some clinical work from the hospital setting into Integrated Family Health
Centres (IFHCs).
West Coast issues to be addressed by this programme:
The care provided is not always consistent across primary and secondary providers.
There is a heavy dependence on locums, often from overseas, to provide GP care and
they do not always know what can be done in general practice, and when to refer to
secondary care.
Nurses are taking an increasing role in first line care in general practice and will find
locally adapted HealthPathways valuable to guide the care they provide.
While waiting times for FSAs are not a major issue currently given the relative high
specialist:population ratio, as the Sustainability Project effects the numbers and types
of secondary care clinicians on the West Coast it will become important to have
pathways that describe what is expected to take place in primary care prior to referral
for an FSA.
An increasingly amount of secondary care is provided by clinicians jointly employed by
Canterbury and West Coast DHBs; it is therefore important that care and access to
FSAs is consistent across the regions.
47 See LECG report: Analysis of options: models of care for West Coast DHB. Nov 2009
Business case appendices V12 AC 25Feb2010 Page 64