Better Sooner More Convenient Primary Care - New Zealand Doctor

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Similarly Glendenning 12 observes that integration is more likely when the following are present: joint goals tight knit highly connected professional networks high degree of mutual trust joint arrangements which are part of „core business‟ rather than marginal integration at the edges joint arrangements covering operational and strategic issues and shared or single management arrangements. Degeling and Erskine 13 describe the importance of changing governance arrangements if true integration of services is to occur: “Efforts to establish and maintain networks [voluntary connections across organisational boundaries] are often purely rhetorical. …all too often tangible achievements on the ground are minimal …” (pg 35) … “Despite their membership in a network, for most network partners their employing organisation remains their primary affiliation.” (pg 36) “Put simply, effective joined-up “local-to-local” collaboration requires equivalent joinedup governance at the centre …” (pg 36) “… there is evidence showing how trust and network stability depend on the extent to which network partners (by way of contracts) have formalized what they can expect of each other and have established robust governance arrangements through which partners can be held to account. … These findings suggest that a network‟s effectiveness depends to a large extent on the degree to which its membership has been able to institutionalize both its internal operations and its independent existence from its sponsoring organisations.” (pg 37) “… the more that service settings (as between primary, acute, community and social services) are constituted as separate and distinct organisations, the more beliefs will differ about what should be done and who is best placed and equipped to do it. The “service gaps” than then result are unlikely to be resolved by, for example, “better networking”. Because the new service models for long-term conditions of necessity challenge the biases of existing approaches to service delivery in acute, community and social care settings, mere administrative solutions (such as the establishment of a network) are rarely able to produce what is required. Rather policy and funding authorities are likely to find that success will depend on the extent to which they have set in place new institutional arrangements and patterns of resource allocation … that will support the required forms of service integration between different service settings.” (pg 41) 12 Glendenning, C (2002) „Breaking down barriers: integrating health and care services for older people in England‟, Health Policy 65: 139–151. 13 Degeling P, Erskine J. Chapter 2. <strong>New</strong> models of long-term care and implications for service redesign. In Rechel B, Wright S, Edwards N, Dowdeswell B, McKee M. Investing in hospitals of the future. World Health Organisation, on behalf of the European Observatory on Health Systems and Policies Investing in hospitals of the future. 2009 Business case EoI V38 AC 25Feb10 Page 40
Nick Goodwin, Kings Fund 14 , in his recent presentation to the Ministry of Health concluded from the international literature that: “There is a lack of rigorous evaluations of polyclinics in other countries. Contextual differences are important. Co-location of professionals is not sufficient to guarantee integrated care - in the same polyclinic, and between polyclinics and hospitals. Risks to professional development and motivation. Issues of patient choice and continuity of care, and how these are to be safeguarded within a polyclinic-based system Caution needs to be exercised in basing policy on international experience. “ His advice for successful integration was: “Strong clinical leadership – quality focus Team working Cluster services & diagnostics around patient needs Investment in change management & process redesign Maximise benefit of new technologies and IT” The writings of these people have guided the development of the models of integrated care in this business case. In addition a large number of other reports and journal articles are referred to in the Evidence section of each of the work plans in the appendices. 5.9 Quality, safety and evaluation Quality philosophy The integrated family health system will take a quality improvement and systems approach to all activities. Quality improvement will be an integral part of the annual business plan, for each IFHC and the overall organisation. The focus will be on activities that relate directly to improved health outcomes and reducing inequalities. Quality framework The framework used to categorize quality improvement activities is as follows 15 : 14 Nick Goodwin. Powerpoint presentation to Ministry of Health, Wellington. 15 March 2010 15 Adapted from the Voyage 2 Quality in primary care framework being developed by the Wellington School of Medicine Business case EoI V38 AC 25Feb10 Page 41
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 and 36: 5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39: While doctor-nurse substitution has
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
Page 87 and 88: Appendix B: Acutely unwell adult pa
Page 89 and 90: 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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