Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix Thirteen gives considerably greater detail re these proposed facilities, together with associated development timelines & funding sources. 5.5.2 Future information systems One of the key elements of the West Coast Integrated Family Health Centre project is the electronic integration of health services, supporting an integrated model of service delivery across a range of geographically isolated service delivery locations. We will ensure that the right level of access to clinical information is available at each point of care encountered by patients, and that all appropriate clinical information follows the patient from carer to carer as they travel through a patient centred network of care, all in a way that minimises waste and duplication and whist safeguarding patient privacy. Activities to support this approach include shared electronic clinical records between primary and community providers, hospital clinicians being able to access primary care clinical records, primary clinicians accessing summary information in the secondary care system (eg. discharge summaries, diagnostic results), medical telemetry (eg. videoconferencing, remote consultations and remote diagnosis). An individual‟s health information is a taonga – it has great value and is sacred to them. It is therefore essential to ensure that health information is secure and that a patient's wishes are adhered to regarding its availability. The PHO and DHB will develop clinical audit protocols and processes that ensure use is monitored and inappropriate access detected. This fits with national strategies around the development of integrated Electronic Health Records (EHR) and with patient access to the same. However, West Coast does not propose to be a leader in these major developments. Our approach is more tactical, as described in Appendix Fourteen, but this approach places us well to implement integrated EHR when it becomes available. Further information on IT support is provided in Appendix Fourteen. 5.6 Clinician engagement A wide range of clinicians from general practice, community nursing, allied health and secondary care have been involved in the development of this plan: Establishment of large advisory group including range of disciplines from community and hospital based services that met weekly over three months to provide input and feedback. Involvement of a large number of clinicians in each workstream (see details within each work plan in the appendices). Business case EoI V38 AC 25Feb10 Page 36
Two rounds of meetings with front line general practice teams, particularly focusing on models of care. Wide dissemination of draft documents for input. Input over three meetings of the PHO Clinical Governance Committee which includes clinicians, lay and iwi representatives. Input from the <strong>Primary</strong> Secondary <strong>Care</strong> Liaison (GP Liaison) committee at two meetings that focused on the EoI. One-on-one meetings with private practice owners. Meetings with community pharmacists. Two open meetings with Senior Medical Officers. Open meeting with all hospital based clinical leaders. Of note in this process was the acceptance by the majority of clinicians of the need to change, the willingness to embrace new models of care that provide better care (continuity, consistency, co-ordination), sooner care (improved access with decreased waiting times) and more convenient care (one stop shop approach). While there were some understandable concerns about what this might mean for future roles and working conditions, there was very little patch protection, a willingness to look outside the square, and a commitment to work together to develop new systems and processes of care. Change management strategies are described further in Section 10.2. Project advisory and reference group membership is detailed in Appendix Fifteen. 5.7 Community engagement Given the time frames of this EoI direct community engagement has been less than ideal. However the following consultation activities were able to take place: Presentation and discussion of the EoI with the DHB Board at two board meetings. Detailed discussion of the EoI papers at three PHO board meetings (on the board are representatives from the three Coast TLAs, representatives from both runanga and the Māori provider). Input over three meetings of the PHO Clinical Governance Committee which includes community, and iwi and Mori provider representatives. Representation on the EoI Advisory group from NGOs, Māori providers, DHB General Manager Māori. Open meeting with NGOs to explain the process and receive their feedback. Meeting with Greymouth mayor. If and when the business case is approved, wider community consultation will need to be undertaken regarding a number of the aspects that this business case envisages and/or proposes should change (in line with the DHB's statutory requirements). Given the West Coast Business case EoI V38 AC 25Feb10 Page 37
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 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: 5.5 Enablers A key aspect of this b
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
Page 73 and 74: ongoing GP shortage creating an env
Page 75 and 76: 10. What are the unintended consequ
Page 77 and 78: It is common for people with an acu
Page 79 and 80: Outcome measures Indicator Baseline
Page 81 and 82: determine ratio of nurses and GPs t
Page 83 and 84: C. Extended role for pharmacists:
Page 85 and 86: 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
Page 103 and 104:
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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