Better Sooner More Convenient Primary Care - New Zealand Doctor

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5 Grey/Greymouth IFHC An interim step towards the development of the Greymouth IFHC, is the construction of an academic/rural training practice (an outpost of one of the three existing medical centres in Greymouth), in a re-locatable building, on the Grey Hospital site, adjacent to the Emergency Department. The floor plan is below, and opening date is scheduled for 1 Jul 2010. Work has begun on bringing the three medical centres in Greymouth together into a single facility, that might also contain other private providers (e.g., physiotherapy) and pharmacy, and that would allow the community nursing and allied health workforces currently operated by the DHB to work in an integrated way with the medical centres. The PHO led a process of engagement during Feb '10 with private provider in Greymouth around the possibility of a one-stop shop for primary care services. All three practices have indicated a significant level of interest, including providing detailed information around their current and likely future level of service delivery and space requirements. Private pharmacists have asked for space in the IFHC, though there are some limitations on their ability to relocate entirely in the short term, given their current investment in, & commitment to, existing retail premises. Physiotherapists, dentists, opticians, chiropractors, massage therapists and acupuncturists in town were all also invited to participate, as were various NGO/disability support providers. It is from this process that the following facilities proposals and options have arisen. Specifically, the proposal is that the facility be constructed such that the non-hospital, nondomiciliary, clinic-based patient contact work of the community nursing and allied health workforce, be conducted in the clinic rooms of the co-located medical centres. Whether, the facility might also contain the office bases of the community nursing and allied health workforce is being explored. Business case appendices V12 AC 25Feb2010 Page 120
A key possibility is that land at the north end of the Grey Base Hospital site is vacant and available for such a facility. It is possible that the construction of the Greymouth IFHC could be integrated with, and even physically connected to, Grey Base Hospital (in a way which colocates services initially but allows for full integration when the hospital is eventually refurbished). This option is one that is likely to deliver cost savings for both the IFHC facility development, and for the Grey Hospital redevelopment, particularly if both projects were done together. This site, however, is not the only one being considered. A key limitation of the Grey Hospital site is its Crown ownership, which reduces its attractiveness to private investors, who have expressed greater interest in options that involve freehold land. Three separate options for the Greymouth IFHC have been developed. Option 1 - greenfield IFHC The first is a greenfield option that is agnostic about location; it describes a stand alone facility that could be constructed on either a freehold site elsewhere in Greymouth, or on the vacant north end of the Grey Hospital campus. This option provides a stand-alone primary care facility with some community and allied health services relocated and/or duplicated from existing hospital facilities. Separation from hospital-based services means that this option is the least supportive of integrated multi-disciplinary health service delivery across the primary-secondary continuum, but it does deliver an integrated primary & community IFHC. The gross floor area is 4,200 m 2 .and the estimated costs in the region of $14.8m, excluding land. Business case appendices V12 AC 25Feb2010 Page 121
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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
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Appendix Seven: Integration - Healt
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It is expected that HealthPathways
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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 and 184: 6 Deliverables / activities Program
Page 185 and 186: Professional development: Provide
Page 187 and 188: Mainstream arguments are concerned
Page 189: Appendix Thirteen: IFHCs - Faciliti
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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