Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix Twelve: Workforce 1. Aspirational statement The Integrated Family Health Centres (IFHCs) will be centres of rural excellence that have the capacity and capability to meet the health care needs of the people of the West Coast, and are attractive and rewarding work environments both the current and future workforce. 2 Project overview Because of the current difficulties recruiting and retaining core general practice staff, with consequent major access difficulties for patients to primary care, the first year of this plan focuses on detailed workforce planning for the core general practice team workforce. During 2010/11 detailed planning will take place to extend the project to include other members of the multi disciplinary team (MDT) within the Integrated Family Health Services. The plan covers activities to enhance retention, recruitment, professional development and quality improvement, including the need to develop a centre of excellence for health provider training, in part to support recruitment and retention. 3 Problem definition Current issues that need to be addressed are: The number of permanent GPs is low: currently there is one GP per 2000 people, including locums. There is currently one nurse per 1180 people, a low ratio considering the extent of remote rural areas covered by rural nurses. There are continuing difficulty getting GP and nurse locum cover and making new appointments. There is a high dependence on GP locums with subsequent lack of continuity and consistency of care. Long waiting times often exist for appointments. This adds to the workload of other primary care providers, eg. pharmacists. In many areas there is a dependence on nurses for first line care, without always providing adequate training and support. Business case appendices V12 AC 25Feb2010 Page 110
There are often vacancies for allied health and community nursing roles, with disruptions in service delivery as a result. Under representation of Māori working within the West Coast Health & Disability workforce. Currently there are 8 vacant positions for GPs, 4.7 for nurses and none for practice managers or admin/receptionists, as shown in the following table: General practice full time equivalent (FTE) positions on the West Coast Current FTEs Vacant FTEs Total Patients per staff member now Patients per staff member if all positions filled GPs 15.35 8 23.35 2020 1328 Nurses 26.3 4.7 31 1179 1000 Practice Manager 5.35 0 5.35 5794 5794 Admin/ Receptionist 22 0 22 1409 1409 When these numbers were collected in February, a time of relatively low patient demand for appointments, the average waiting time for a routine appointment was five days. The desirable ratio of GPs and nurses per head of population is difficult to determine and depends on a number of factors such as models of care, rurality, skill sets, level of support from secondary care, and available funding. The RNZCGP suggested a ratio of 1: 990 59 , on the basis of a traditional model of care with GPs doing the majority of first contact care. Pinnacle carried out a workforce survey of staff in general practices in Waikato, Lakes, Taranaki, Eastern Bay of Plenty and Gisborne regions in 2007 60 which found a GP to patient ratio of 1:1,794 and Practice nurse to patient ratio 1:1927. Activity based modeling was carried out based on a model of care where the majority of first contact care and long term condition care is done by skilled nurses, with readily available back up support from GPS, shared consultations as needed and longer review consultations with GPs for complex patients. This resulted in a ratio of one GP per 2000 patients and 1 nurse per 900 patients. This was considered appropriate by the working group who produced this plan as long as extra FTEs are allocated for remoteness, travel and teaching time. Having a stable nurse and GP workforce based on these ratios has advantages over a workforce that has more GPs, but with many of them being short term locums who have a limited understanding of the local health care system. 59 Fretter J, Pande M. How many general practitioners are enough? Forecasting GP workforce capacity in <strong>New</strong> <strong>Zealand</strong>. NZ Family Physician 2008; 35: 232-44. 60 http://www.nzdoctor.co.nz/news?article=81145179-bd90-40cf-a249-fc1b4a719ec9 Business case appendices V12 AC 25Feb2010 Page 111
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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
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Year three Community education camp
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13 Costs Budget considerations:
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established. This group now oversee
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Output measures Tobacco control / s
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Improving immunisation coverage - h
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Year three Continued joint plan
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extending health promotion activiti
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Immunisation Coverage Funder Provid
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The Community Health System Deliver
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Clinical care Practice self managem
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and increases in the numbers of pat
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Ambulatory Sensitive Hospitalisatio
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% CVD on lipid lowering drugs, beta
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Health navigators/ kaiawhina: chan
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Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
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qualifications and skills. Where ca
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6 Deliverables / activities Impleme
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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 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: 11 Organisational accountabilities
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
Page 195 and 196: 7 Westland IFHC Facilities options
Page 197 and 198: Year two Substantive-IFHC in Greymo
Page 199 and 200: 12 Costs Capital costs Greymouth IF
Page 201 and 202: utilize MedTech, but via their own
Page 203 and 204: 4 Objectives: To implement c
Page 205 and 206: Security An individual‟s health i
Page 207 and 208: 8 Effect on inequalities The increa
Page 209: Appendix Fifteen: Project advisory
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