Better Sooner More Convenient Primary Care - New Zealand Doctor

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Recruitment: Establish a Coast-wide recruitment agency for primary care to support all practices/IFHCs, recruiting in the first instance all new permanent and locum primary care nurses and GPs for the West Coast. Work with practice owners to define what will be done by central agency, what processes they will need to manage, (eg. contracting). Develop a relationship with NZ locums to avoid duplication: subcontract what they do best. Establish fair processes for allocating available locums or new staff to IFHCs (distribute according to where recruits want to go and where the patient:GP/nurse ratio is highest). Plan, co-ordinate and support the orientation of all new doctors/nurses, working closely with the IFHC managers. Support recruitment for new pharmacists as required, and develop joint appointments between DHB and private pharmacies. Obtain feedback from all locums and new staff that can be used to improve recruitment processes. Develop a plan to increase the Māori health workforce. Create an atmosphere where Māori want to come and work because there is an organisational commitment to support the Māori workforce, ie. “Māori Friendly”. Retention: Provide central co-ordination to ensure all new recruits and their families receive the support they need to integrate into the community. Provide peer mentoring of new recruits by a peer in a different IFHC as required. Assist the mentors of GPs who are under Medical Council supervision. Support collegial relationships by providing an annual weekend getaway that combines educational and fun activities for clinical staff and their families. Invite house surgeons. As part of the development of new models of care, work with each practice/ IFHC to evaluate current job content and job satisfaction for each current staff member. Review job descriptions with regard to who is the most appropriative person to do each task. Provide practice workshops that facilitate the development of a team approach. Provide comprehensive career planning and education to support this. Ensure nurses feel supported in their clinical environment and receive training to meet role specific competency requirements. Retain Māori workforce by providing a culturally appropriate working environment thus showing a clear demonstration of organizational commitment to the Māori workforce, development. Business case appendices V12 AC 25Feb2010 Page 114
Professional development: Provide monthly professional development evening meetings for GPs, nurses, practice managers, pharmacist and other members of the multi disciplinary team (MDT), with videoconference links. Provide annual PHO workshops: PHO day, practice management workshops, practice nurse workshops. Link in educational activities with those of the Rural Learning Centre. Provide training in the use of standing orders, (see Acute <strong>Care</strong> plan). Develop guidelines for direct CT access and provide educational sessions to implement them, (see Direct Access to Diagnostics plan.) Adapt Canterbury HealthPathways for Coast use and provide educational sessions to implement them, (see HealthPathways plan). Provide education about health literacy, (see Long Term Conditions plan). Link with DHB Māori health team to provide cultural competence and health inequalities training annually. Actively engage Manawhenua to give guidance and support regarding Tikanga Māori protocol appropriate to Te Tai O Poutini rohe. Ongoing implementation and utilization of CTA funded cultural supervision for relevant staff. Fund conference/course leave for all members of team. Continued and increasing utilization of PG Nursing CTA funded education. Refinement of cohort learning between medical and nursing teams. <strong>Care</strong>er planning and educational support for nurses, including pathways leading to nurse practitioner. Quality initiatives: Develop quality improvement and clinical governance systems in every IFHC. Provide Cornerstone support and co-ordination support practice quality improvement teams . Support practice improvement activities for GPs (MOPS) and nurses (accreditation and expert endorsement). Produce practice level PHO Performance Programme reports with peer comparisons. Provide practice visits by GP and nurse facilitators to review PHO Performance Programme reports and assist in the development of quality improvement plans. Provide PHO Performance Programme incentive payments according to the percentage of targets met by each practice. Support pharmacists to provide feedback to GPs on cost effective prescribing. Develop active feedback loops so that any concerns about the quality of patient care will be fed back to the health providers concerned in a constructive, educational environment. Business case appendices V12 AC 25Feb2010 Page 115
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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
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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 and 182: There are often vacancies for allie
Page 183: 6 Deliverables / activities Program
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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