Better Sooner More Convenient Primary Care - New Zealand Doctor
Better Sooner More Convenient Primary Care - New Zealand Doctor Better Sooner More Convenient Primary Care - New Zealand Doctor
6 Business model 6.1 Business concept The business concept involves the development of Integrated Family Health Centres (IFHCs) based at Westport, Greymouth and Hokitika, with satellite clinics at the surrounding rural centres. The IFHCs would be run by the West Coast Integrated Family Health Service (IFHS). The preferred options for the future organisational structure of the IFHS involve a not-forprofit, non-government organisation, which may or may not be the PHO in a modified form, or a new entity jointly owned by the existing PHO and DHB. For the sake of brevity, these various options are shortened to "the IFHS" in this document, and that phrase should be read as "whatever form of NGO/Trust takes on the provision of community/primary services in the future". The IFHS would employ many staff and contract with others. The IFHS would also provide district wide community services that are not based at a particular IFHC. Over time more services would be devolved to the IFHS, as it builds experience and improves performance. The range of services to be provided in and through IFHCs comprises: the services historically provided by general practices - management of acute and chronic primary presentations by enrolled patients the services historically provided by the non-hospital/community based subset of the DHB provider arm - district/community nursing and allied management of complex patients, including post discharge. The building of new facilities is likely to be required in Greymouth and Westport, while renovations will be required in Reefton. Facilities changes in Hokitika and South Westland are not planned at this stage. Services will continue to be delivered in each of the three Territorial Local Authority districts: Buller (Westport), Grey (Greymouth) and Westland (Hokitika). Current smaller/outlying clinic locations include: Karamea Ngakawau Reefton Moana Whataroa, Hari Hari, Franz Josef, Fox Glacier and Haast. The approach is described in broad terms in the schematic over page and then reviewed in more detail below. Business case EoI V38 AC 25Feb10 Page 44
Preventative Acute LTC management Restorative West Coast Integrated Family Health Network West Coast DHB services: Grey Rural Hospital Centre of Excellence, Mental Health, ATR, other secondary services West Coast PHO District wide community health services: clinical nurse specialists, some allied health, Buller IFHC Greymouth IFHC Westland IFHC Centred on Westport, outreach to Karamea, Ngakawau, Reefton. Pop 10,000, budget $$$$$ Nominal budget holding for referred services pharms, labs… Infrastructure: Integrated reception, common scheduling, 1 pt record, 1 manager, 1 nurse leader, 1 GP leader, integrated policies & processes, common catchment. Core Primary & community team Staffing Programs Medical staff: GPs/rural hospital medicine specialists and nurse practitioners Nursing staff: practice nurses, rural nurses, district nurses, well child/school nursing, , enrolled nurse/aids, Allied health: physiotherapists, midwives, pharmacist, mental health therapist, MRTs, Support: community health worker/navigator / kaiawhina roles Administration: reception, office manager Service co-ordination: NASC, discharge planning, LTC care management, Immunisation outreach, MH assessment and co-ordination Home based care: personal Inpatient beds Pharmacy dispensing services, medication care, MOW reviews Mental health services: local CMHT, link to primary MH, visiting MH specialist teams Visiting specialist clinics (medical, nursing, allied health). Visiting Age care AT&R Centred on Greymouth, outreach to…, pop 13,500, budget $$$$$$ As for Buller – services customised in size & range to fit local population needs Centred on Hokitika with outreach to …., pop 8,500, budget $$$$$ As for Buller – services customised in size & range to fit local population needs Shared District Wide Support Services Clinical leadership: nursing, medical & allied health professional development, clinical governance, supervision, performance review, education, standing orders, etc Service commissioning: needs assessment, programme development and implementation across localities for LTCs, acute/after hours, mental health, etc, Corporate services: Finance, IS, HR, property, supply chain management. = provided by DHB = provided by IFHS Business case EoI V38 AC 25Feb10 Page 45
- 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 and 40: While doctor-nurse substitution has
- Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
- Page 43: Quality domains Each new initiative
- 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
- Page 91 and 92: Review Buller after hours arrangeme
- Page 93 and 94: Year three Community education camp
Preventative<br />
Acute<br />
LTC management<br />
Restorative<br />
West Coast Integrated Family Health Network<br />
West Coast DHB services: Grey Rural Hospital Centre of Excellence, Mental Health, ATR, other secondary services<br />
West Coast PHO District wide community health services: clinical nurse specialists, some allied health,<br />
Buller IFHC<br />
Greymouth IFHC Westland IFHC<br />
Centred on Westport, outreach to Karamea, Ngakawau, Reefton. Pop 10,000, budget $$$$$ Nominal<br />
budget holding for referred services pharms, labs…<br />
Infrastructure: Integrated reception, common scheduling, 1 pt record, 1 manager, 1 nurse leader, 1 GP<br />
leader, integrated policies & processes, common catchment.<br />
Core <strong>Primary</strong> & community team<br />
Staffing<br />
Programs<br />
Medical staff: GPs/rural hospital medicine specialists and nurse practitioners<br />
Nursing staff: practice nurses, rural nurses, district nurses, well child/school<br />
nursing, , enrolled nurse/aids,<br />
Allied health: physiotherapists, midwives, pharmacist, mental health therapist,<br />
MRTs,<br />
Support: community health worker/navigator / kaiawhina roles<br />
Administration: reception, office manager<br />
Service co-ordination: NASC, discharge planning, LTC care management, Immunisation outreach,<br />
MH assessment and co-ordination<br />
Home based care: personal Inpatient beds Pharmacy dispensing services, medication<br />
care, MOW<br />
reviews<br />
Mental health services: local CMHT, link to primary MH, visiting MH specialist teams<br />
Visiting specialist clinics (medical, nursing, allied health).<br />
Visiting Age care AT&R<br />
Centred on Greymouth,<br />
outreach to…, pop 13,500,<br />
budget $$$$$$<br />
As for Buller – services<br />
customised in size & range<br />
to fit local population<br />
needs<br />
Centred on Hokitika with<br />
outreach to …., pop<br />
8,500, budget $$$$$<br />
As for Buller – services<br />
customised in size &<br />
range to fit local<br />
population needs<br />
Shared District Wide Support Services<br />
Clinical leadership: nursing, medical & allied health professional development, clinical governance, supervision, performance review, education, standing orders, etc<br />
Service commissioning: needs assessment, programme development and implementation across localities for LTCs, acute/after hours, mental health, etc,<br />
Corporate services: Finance, IS, HR, property, supply chain management.<br />
= provided by DHB = provided by IFHS<br />
Business case EoI V38 AC 25Feb10 Page 45
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