Better Sooner More Convenient Primary Care - New Zealand Doctor

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4 Objectives to continue with direct access from primary care to plain film radiology to develop direct access by primary care to CT scans for health problems that meet the criteria to develop access to musculoskeletal ultrasound without significantly increasing the waiting list for other types of ultrasound to enhance the skills of those requesting radiological investigations and interpreting the reports. 5 Benefits and gains Output measures - track quarterly Indicator Baseline Target – Yr 1 Year 2 Year 3 Number of plain film and US 5000 pa 5200 5400 5700 Total number of CT scans 3500 3750 4000 4250 Numbers CTs ordered by GPs Est. 10 300 320 340 Number of musculoskeletal 0 0 40 60 ultrasounds Orthopaedic FSAs 873 870 830 810 Number of educational sessions held per annum 1 1 1 1 6 Deliverables / activities Implementation phase: to June 30, 2010 Develop guidelines for general practitioners to access: CT head for head injury CT scan for painless haematuria CT urogram for renal colic CT colonography instead of barium enemas. Task Gather copies of guidelines used in other regions Establish multidisciplinary groups to review guidelines and adapt for local use (include Māori participation) Develop referral template based Provide educational session for referrers in the use of the guidelines Establish system for tracking volumes By when March March – April May May Business case appendices V12 AC 25Feb2010 Page 74
Year One – July 2010 to June 2011 Task Continue open access to plain x-rays Provide a generic Coast-wide educational session plus regular updates in newsletters and reminders of websites that provide guidance for both ordering and interpreting investigations, eg. CRG Review use of plain x-rays: audit use by practice according to size of enrolled population Put in place educational intervention for any practices that have significantly greater than average usage. If necessary develop notional budget holding Report on numbers of CTs requested Audit of CT requests against the guidelines Review existing CT referral templates, modify and develop an electronic version Review need for increased access to other radiology investigations as part of Health Pathways project Ensure HealthPathways contain helpful advice for those ordering investigations Review travel assistance arrangements and develop plan for Buller region (include Māori participation) By when July Annually August October June Quarterly April June Ongoing February Year Two – July 2011 to June 2012 Investigate ability to provide direct access for musculoskeletal ultra sound (US) possibly increase capacity in Greymouth through starting regular fortnightly or monthly US service in Buller possibly establish notional budgeting for primary care US services and enable musculoskeletal US though tighter management of other US capacity. Expand direct access to other diagnostics as part of Health Pathways project. Annual educational session. Year three Consolidation and review. 7 Capability and capacity Current capacity and capability exists to allow access to CT scans as along as volumes are controlled by the use and audit of referral guidelines. Business case appendices V12 AC 25Feb2010 Page 75
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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
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C. Extended role for pharmacists:
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11 Engagement Working group who dev
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Appendix B: Acutely unwell adult pa
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4 Objectives to implement nur
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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 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: to easily access by telephone). Oth
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
Page 185 and 186: Professional development: Provide
Page 187 and 188: Mainstream arguments are concerned
Page 189 and 190: Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192: A key possibility is that land at t
Page 193 and 194: 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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