Better Sooner More Convenient Primary Care - New Zealand Doctor

While doctor-nurse substitution has the potential to reduce doctors' workload and
direct healthcare costs, achieving such reductions depends on the particular context of
care. Doctors' workload may remain unchanged either because nurses are deployed to
meet previously unmet patient need or because nurses generate demand for care where
previously there was none. Savings in cost depend on the magnitude of the salary
differential between doctors and nurses, and may be offset by the lower productivity of
nurses compared to doctors.”
The results of the changes of the model of care outlined in this plan will be monitored carefully
in regards to both patient safety and cost to the health system.
The need for new models of integrated care for the aging population and those with long term
conditions has been well described by Rosen and Ham 11 :
“With an aging population and an increasing prevalence of chronic disease, ever more
people require care and support services from organisations that cross the boundaries
of health, social care, housing and voluntary organisations. A wealth of studies report
that people with chronic, complex health problems – particularly older people – are often
confused by the array of services they are faced with, receive duplicate interventions,
and find it hard to understand where to turn with specific problems. They value
initiatives to co-ordinate care and simplify their journey through the health and social
care systems.
Equally, with pressure to deliver elective care in community settings and prevent
avoidable ill health, integration and collaboration between generalists and specialists –
GPs, consultants, specialist nurses and other clinicians – is increasingly important.”
They advise that any project involving integration of services:
Makes improved patient care the main objective of every proposal.
Develops clearly articulated and shares goals.
Involves local primary care networks and clinicians in developing the strategy.
Takes time and effort to build the relationships, trust and clinical leadership required in
integrated teams.
Measures clinical and social outcomes so that the effect of changes can be reviewed and
programmes modified.
Is careful to unbundle the true costs of any services before devolution occurs.
Develops robust governance arrangements from the start.
Establishes the right incentives for services and clinicians to want to be involved.
11 Rosen R, Ham C. Integrated Care: lessons from evidence and experience. Report of the 2008 Sir Roger Bannister
Annual Health Seminar by R Rosen, Nuffield Trust , C Ham, University of Birmingham
Business case EoI V38 AC 25Feb10 Page 39