Better Sooner More Convenient Primary Care - New Zealand Doctor

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Nurse practitioner positions have been added to the output targets below but not yet included in the modeling; while there is a commitment to move to including nurse practitioners in IFHCs, our ability to attract nurse practitioners to the Coast, and their roles and responsibilities within the core general practice team have yet to be determined. 4 Objectives: To recruit sufficient GPs and nurses to provide better, sooner, more convenient care. To retain GPs and nurses so as to provide continuity and consistency of care. To provide a professionally fulfilling work environment. To provide or assist access to the professional development activities required to maintain competence. To support quality improvement activities. To develop the multidisciplinary team. To broaden the above activities to support all members of the multidisciplinary team. 5 Benefits and gains Output measures Indicator Baseline Target – Yr 1 Year 2 Year 3 No. patients per practice/rural 1140 1000 900 900 nurse* No. patients per permanent GP* 2000 2000 2000 2000 No. primary care nurse practitioners Number Māori practice team members 0 1 2 3 3 nurses, 1 manager 5 6 7 Shared recruitment agency est. No Yes Yes Yes *These ratios depend on a full complement of postgraduate students, and locum cover for holidays. They do not include teaching time. Remote areas need higher Dr/nurse: patient ratios. Outcome measures Indicator Baseline Target – Yr 1 Year 2 Year 3 % of PHO Performance Programme targets met Number of practices cornerstone accredited 79% >80% >90% >90% 3 6 7 7 Business case appendices V12 AC 25Feb2010 Page 112
6 Deliverables / activities Programme to be in place by June 2011 Attract students and new graduates to primary care on the Coast: Stimulate interest among intermediate and high school students in careers in health by offering workplace experience attachments. Greater participation in career expos at the local high schools. Greater utilization of the incubator project, designed to encourage year 12 and 13 high school students to consider a career in health. Provide 24 third year nursing student placements, each 6 weeks duration. Work in partnership with schools of nursing to include a dedicated rural component in the undergraduate training, including participation in guest speaking opportunities. Continue to utilize road shows to nursing schools for recruitment purposes and greater exposure to rural opportunities. Provide 3 rural immersion medical student 5 th year placements per year. Provide twelve 5 th year medical student placements per year. Provide 6 th year placements as possible. Develop opportunities for contact between house surgeons and general practitioners, eg. take them on a general practice tour as part of their orientation, invite to GP professional development activities and PHO activities, encourage GPs to participate in educational sessions at Grey Base Hospital, eg. radiology sessions. Develop a package to be given to all those applying to the RNZCGP to be GP registrars encouraging them to come to the West Coast for their training. Provide two full year Rural Hospital Medicine registrar placements per year and three placements for GP registrars per year, with scholarships available. Attract four GPEP2 (second and third year registrars) to the West Coast each year, for a full year placement. Provide four nurses with scholarships to complete the NETP Expansion programme in primary care. Provide one placement per year for newly graduated primary care nurse practitioners. Provide centrally co-ordinated teaching from the Rural Learning Centre in Greymouth, with local teachers in each IFHC. Utilise Buller Hospital for work experience for advanced Rural Hospital Medicine registrars and Reefton as a placement for nurse practitioners towards the end of their training. Continue to work with the Clinical Training Agency to develop rural training opportunities for doctors and nurses on the West Coast. Promote West Coast health scholarships uptake by Māori. Increase the number of Māori utilizing CTA funding. Providing opportunities for Māori intermediate and high school students and Māori second chance learners by utilizing national initiatives, eg. nursing and midwifery for Māori and Hauora as a career. Develop programme and support so that the West Coast becomes the most desirable centre for rural primary care training in <strong>New</strong> <strong>Zealand</strong>. Business case appendices V12 AC 25Feb2010 Page 113
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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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“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 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: There are often vacancies for allie
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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