Better Sooner More Convenient Primary Care - New Zealand Doctor

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It may even be possible to pull together a private funding syndicate to fund both projects - a completely integrated Family Health Centre and the eventual refurbishment of the Greymouth Base Hospital facility - if there is political interest in such an arrangement. 6 Buller/Westport IFHC The West Coast DHB currently owns and operates the medical centre, Buller Medical Centre, and Buller Hospital, in the town of Westport. Westport is 107kms from Greymouth (at least an hour and a quarter by road). There is no public transport connection between the two centres. Earlier work has explored options for revamping the facilities on the Buller Hospital site. The future status and size of Buller Hospital is unclear, with discussion currently occurring in relation to the DHB contracting out aged residential care, and the impact for other services of this proposed change still somewhat unclear. A greenfields IFHC in Westport, probably on the Buller Hospital site (there is sufficient land), is a distinct possibility. A revision of the earlier proposed facility is likely to be required to match the revised model of care envisaged in this EoI business case, and to fit with any decisions regarding the future shape of secondary services. One proposed floor plan for a greenfields construction on the Buller Hospital site is as follows: This and other options are being explored. This option had a $16.3m price tag in Aug 2008. Revisions will be required to reduce the capital spend to more manageable proportions. Private financing for this facility has not yet been explored, as further work is required to understand the likely final size and scale of the project. Business case appendices V12 AC 25Feb2010 Page 124
7 Westland IFHC Facilities options are not top of the list for the Westland District. Hokitika's sole medical centre, the Westland Medical Centre, and the DHB's community nursing & mental health services at the Hokitika Health Centre, are in separate buildings across the road from each other. But the two services work well together, and a facilities revamp is thought unlikely to offer significantly greater benefits, such that the required capital spend could be justified. Both building are relatively modern and comply with health centre facility standards. In South Westland, the population is scattered over vast distances. General practice and community nursing services are currently delivered from five clinic locations. This business case does not envisage further changes to the facilities aspects of service delivery in South Westland, apart from a separate facilities development already planned in that area . This proposed development will contribute in a physical sense to the development of an otherwise virtual Integrated Family Health Centre. The project is the joint development of a combined rural health centre / ambulance station in Franz Josef, which will act as the centerpiece for the DHB's remote South Westland practice (covering Hari Hari, Whataroa, Franz Josef, Fox Glacier and Haast). Both St John and the West Coast DHB have already committed to this project, which will be built on St John owned land. An artist impression of the proposed Franz Josef Health Centre / Ambulance Station Business case appendices V12 AC 25Feb2010 Page 125
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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
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Low uptake by primary and secondary
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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 and 190: Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192: A key possibility is that land at t
Page 193: This option is effectively a Greenf
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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