Better Sooner More Convenient Primary Care - New Zealand Doctor

LECG 50 evaluated whether “the improvement processes implemented in these pilots were cost
effective and provided value for money”. They concluded that “redesign of pathways for
patients referred by GPs for diagnostic tests do offer opportunities for cost effective
improvements”. They also identified that “opportunities for improvement are location specific
and need to be identified with care” and provided helpful guidance for the development and
implementation of direct access pathways.
LECG anlaysed in depth a number of pilots that have direct relevance to this project:
Northland DHB musculoskeletal ultrasound, Nelson Marlborough CT urograms, Whanganui
general ultrasound.
The information from these analyses will be very useful in guiding the implementation of direct
access on the West Coast.
10 Risk analysis
Risk Probability Impact Contingency plan
Too many CTs ordered –
(significant amount of
radiation per CT)
Low High Develop referral guidelines and audit
regularly.
Only general practitioners order CTs.
Unable to free up
capacity for
Low High Work closely with all those involved
using a variety of approaches.
musculoskeletal US
Increase in numbers of x-
rays ordered resulting
from changed primary
care delivery models
Medium Medium Educational sessions and audits as
described above.
11 Engagement
Working group who developed this plan: Raewyn McKnight, Jason Lister, Wayne Champion,
Jocelyn Tracey, Helen Reriti, Anthony Cooke.
Other clinicians involved: Vicki Robertson, Martin Smith, Dr Martin London, Dr Andy Backhouse,
Tony Young (Canterbury Radiology Group) .
50 Moore D, Black M, van Essen E. Evaluation of 13 diagnostic pilots. Report from LECG for MoH, Nov 2009.
Business case appendices V12 AC 25Feb2010 Page 77