Better Sooner More Convenient Primary Care - New Zealand Doctor

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4.6 Changes underway A number of initiatives have been implemented over the last three years to address some of the health needs and service delivery concerns on the West Coast. PHO based initiatives: development of health promoting practices and a wide number of high profile health promotion activities, including Smokefree, Heart Week, men‟s health days, Green prescription, Tai Chi classes, community activity programmes breastfeeding co-ordinators and peer support programme kaiawhina role to improve access for Māori in the Buller district long term condition management programme incorporating targeted care, self management support, delivery system redesign and clinical information systems primary mental health assessments and brief intervention counselling navigation support for those with cancer Māori health plan PHO Performance Programme with GP facilitator immunisation enhancement. DHB based initiatives in primary and community care: Māori health needs analysis investment in nursing competency and role extension movement to models of care in which nurses provide front line services where appropriate greater use of nurses – with nurse to GP consult ratios being the highest for any DHB in NZ closer working relationships with Canterbury in many services movement to more community based mental health service delivery – with reduction to five acute inpatient beds on the Coast delivering a predominately community based mental health service delivery model, enhancing community based support services delivered by NGOs and reducing acute inpatient beds to five establishment of an academic practice to co-train rural GPs and rural nurses and sourcing CTA support for pilot training programmes development of an IT platform which provides for a single shared patient record across DHB practices with access through Healthviews to hospital sourced health information such as discharge summaries, PACS radiology, lab results through After Hours funding providing West Coast-wide after hours triage phone support. Business case EoI V38 AC 25Feb10 Page 20
4.7 West Coast region service delivery issues Key problems identified by the steering group, advisory group, reference group and stakeholders that face the West Coast health care system are: Workforce shortages Difficulties in recruiting and retaining staff (especially GPs and allied health staff) has led to high turnover, excessive reliance on locums and under staffing. This is exacerbated by the relatively deprived nature of the community, the low population density and high on-call requirements in rural areas. Leading to poor access to care: Difficulty in staffing GP roles has resulted in enrolled patients being unable to book routine appointments within an acceptable timeframe (waits of longer than 3 weeks are typical in some practices) and patients new to town unable to enroll in any practice. Difficulty in resourcing also results in a tendency towards responding reactively to acute presentations and allowing these to take precedence over proactive, planned care of patients with chronic conditions – reducing the possibility of managing future demand. Again, the Coast geography mitigates against easy access, with many people living more than 60 minutes travel time away from major urban centres. Service fragmentation Services operate in partial silos resulting in: lack of continuity of care difficulties navigating through the system duplication of assessment, needless administration, disparate treatment policies and protocols, and poor sharing of clinical information. Within primary care, there is frequent use of locums, and high dependence on Emergency Department (ED) services at Buller and Greymouth. People often see a different GP or nurse each time and thereby experience poorer quality care. Further, when GP numbers are insufficient, and nursing staff are used as sole caregivers for most primary care consults, without changes to the overall model of care to ensure adequate GP support, quality processes and professional development, there is a risk of people operating outside their scopes of practice and of avoidable harm to patients. Services are not co-located in some areas, making it particularly difficult for the frail older people or those without transport. When services are co-located, they are often not integrated, meaning that opportunities to schedule, for instance, a physiotherapy appointment at the same time as a diabetes annual review (to reduce the travel burden) are missed. Service fragmentation leads to duplication in reporting and management infrastructure – and siloed funding streams – reducing the ability to innovate and to use funding flexibly. Business case EoI V38 AC 25Feb10 Page 21
Page 1 and 2: Business Case Better, Sooner, More
Page 3 and 4: 1 Caveats/status This business case
Page 5 and 6: Current situation By three years Wa
Page 7 and 8: staffed on a capacity model - in wh
Page 9 and 10: support from DHBs, specialist clini
Page 11 and 12: 10.4 Key milestones................
Page 13 and 14: Annual government health funding pe
Page 15 and 16: Ambulatory Sensitive Hospitalisatio
Page 17 and 18: The base populations of the three d
Page 19: Māori/Pacific Not Māori/Pacific D
Page 23 and 24: 5 Future model of care 5.1 The desi
Page 25 and 26: support them. Help with understandi
Page 27 and 28: LEVERS VISION Better, sooner, more
Page 29 and 30: providing the majority of care). Th
Page 31 and 32: The Community Health System Deliver
Page 33 and 34: To better integrate the support pro
Page 35 and 36: 5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39 and 40: While doctor-nurse substitution has
Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
Page 43 and 44: Quality domains Each new initiative
Page 45 and 46: Preventative Acute LTC management R
Page 47 and 48: Preventative Acute LTC management R
Page 49 and 50: The core services are provided or p
Page 51 and 52: Total required FTEs for the Grey IF
Page 53 and 54: 7 Governance, Ownership & Managemen
Page 55 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59 and 60: Of note, a large proportion of the
Page 61 and 62: The DHB delegates decision making o
Page 63 and 64: Limited integration of community se
Page 65 and 66: 10.4 Key milestones The table below
Page 67 and 68: Expanded pharmacy roles Improving a
Page 69 and 70: Devolved community based services w
Page 71 and 72:
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
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to easily access by telephone). Oth
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Year One - July 2010 to June 2011 T
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LECG 50 evaluated whether “the im
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Appendix Nine: Referred services 1.
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them by technical errors or lack of
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Identify patients that would benefi
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• Provision of patient specific m
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12 Organisational accountabilities
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emain under the care and management
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Service user pathways in an optimal
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Model for shared care pathways deve
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Implementation plan: to June 30 Dev
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Year two Review progress, outcome m
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10 Risk analysis Risk Probability I
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Appendix Eleven: Frail older people
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ehab and treatment programmes that
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Year one: Maintain and continue the
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Māori have a higher incidence of m
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11 Organisational accountabilities
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There are often vacancies for allie
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6 Deliverables / activities Program
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Professional development: Provide
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Mainstream arguments are concerned
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Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
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This option is effectively a Greenf
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7 Westland IFHC Facilities options
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Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
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utilize MedTech, but via their own
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4 Objectives: To implement c
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Security An individual‟s health i
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8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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