Better Sooner More Convenient Primary Care - New Zealand Doctor

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Kua tawhiti ki te haereka, Kia Kore e haere tonu He tino nui rawa ou mahi Kia kore e mahi nui tonu. We have come too far, not to go further. We have done too much, not to do more. Business case EoI V38 AC 25Feb10 Page 2
1 Caveats/status This business case is a work-in-progress. Many clinicians and managers have contributed to its development, and to the thinking and analysis that lies behind it. That does not mean they all agree with everything in it. The business case has been endorsed by the respective boards of the DHB and the PHO, but not yet endorsed by the Ministry of Health. The business case presents a number of options for future delivery of health services. These are options for consideration and input, rather than proposals ready for formal consultation. If and when the business case gets to the point of being a proposal, the necessary formal public and employee consultation processes will be undertaken, prior to any decisions being made in regards to implementation. On Thursday 25th Feb 2010 the board of the DHB passed this resolution: "That the West Coast District Health Board endorses the direction of travel envisaged in the “Better, Sooner, More Convenient Primary Care” Business Case, subject to necessary further analyses, development, revision and consultation, and with particular focus on: budgets and financial sustainability; the West Coast Model of Care (Sustainability Project); and governance arrangement; and That the West Coast District Health Board authorises management to proceed with its continuing development and its submission to the Ministry of Health." On the same day the PHO board passed this resolution: "The board endorses the direction of travel envisaged in this business case, subject to necessary further analyses, development, revision and consultation, and authorises management to proceed with its continuing development and its submission to the Ministry of Health for their approval." Business case EoI V38 AC 25Feb10 Page 3
Page 1: Business Case Better, Sooner, More
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 and 20: Māori/Pacific Not Māori/Pacific D
Page 21 and 22: 4.7 West Coast region service deliv
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
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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
Page 61 and 62:
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
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
Page 163 and 164:
Model for shared care pathways deve
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Implementation plan: to June 30 Dev
Page 167 and 168:
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
Page 179 and 180:
11 Organisational accountabilities
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There are often vacancies for allie
Page 183 and 184:
6 Deliverables / activities Program
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Professional development: Provide
Page 187 and 188:
Mainstream arguments are concerned
Page 189 and 190:
Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
Page 193 and 194:
This option is effectively a Greenf
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7 Westland IFHC Facilities options
Page 197 and 198:
Year two Substantive-IFHC in Greymo
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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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Better Sooner More Convenient Primary Care - New Zealand Doctor

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