Better Sooner More Convenient Primary Care - New Zealand Doctor

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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
It is expected that HealthPathways will provide: Better care – in line with Best Practice guidelines, and consistent between providers, including primary, secondary and Māori providers. Sooner care – patients will be able to access some investigations and treatment options earlier directly from their general practice, and waiting times for FSAs may decrease. More convenient care –more care will be provided at IFHCs rather than hospital based. Nurses and doctors working in general practice have expressed interest and support for this development, as have those in community nursing, allied health and secondary care. 4 Objectives To enhance the patient journey for patients presenting with common health problems, including the incorporation of a whanau ora approach. To increase the consistency and co-ordination of care between primary and secondary care. To increase the appropriateness of FSAs. 5 Benefits and gains Output measures Indicator Baseline Target – Yr 1 Year 2 Year 3 Number of topic areas HealthPathways sections adapted for the WC 0 8 6 6 Referral quality audit TBC 20% improvement Number of hits on West Coast HP web site per month Further 10% improvement Further 10% improvement 0 500 1000 2000 Outcome measures Indicator FSA rates (numbers actually seen) Paediatrics Gynaecology Baseline 2009 year 177 371 Target – Yr 1 Year 2 Year 3 No change 10% decrease Further 10% decrease Business case appendices V12 AC 25Feb2010 Page 65
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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
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Outcome measures Indicator Baseline
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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: Appendix Seven: Integration - Healt
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
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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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