Better Sooner More Convenient Primary Care - New Zealand Doctor

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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, Greymouth IFHC Buller Westland Centred on Greymouth, some outreach to Reefton?. Pop 14,000, budget $$$$$ Nominal budget holding for referred services pharms, labs… Infrastructure: Integrated reception, common scheduling, 1 patientt record, 1 manager, , 1 nurse leader, 1 GP leader, integrated policies & processes, (common catchment); charter committing multiple tenants in facility to collaborate on model of care Core <strong>Primary</strong> & community team Staffing - 3 separate medical centres initially, divided into teams of 5-7 (i.e., with 2-3,000 patients per team) Programs Greymouth Family Health 2,000 patients; 1 team Medical staff: 1 GP Nursing staff: 2 practice nurses Greymouth Medical Centre 6,000 patients; 2-3 teams Medical staff: 3 GPs Nursing staff: 6 practice nurses High St Medical Centre 6,000 patients; 2-3 teams Medical staff: 3 GPs Nursing staff: 6 practice nurses Nurse practitioners Nursing staff across the 3 practices: district nurses, well child/school nursing, enrolled nurse/aids, Allied health (public & private) across 3 practices: physiotherapists, midwives, pharmacist, MH therapist, MRTs Support across the 3 practices: community health worker/navigator/ kaiawhina roles Administration across the 3 practices: reception, office manager Service co-ordination: NASC, discharge planning, LTC care management, Immunisation outreach, MH assessment and co-ordination Home based care: personal care, meals on Pharmacy services, medication reviews wheels 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 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 46
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, Westland Virtual IFHC Buller Grey Covering both Hokitika and South Westland. Pop 8,500, budget $$$$$ Nominal budget holding for referred services pharms, labs… Infrastructure:, common scheduling?, 1 pt record, co-ordinated management & clinical leadership (details to be determined), integrated policies & processes, common catchment; current separate facilities remain (very different geography, and existing modern buildings, make a physical IFHC unlikely; there's also already a high degree of integration of the nursing workforce in South Westland already) Core <strong>Primary</strong> & community team Staffing - 2 separate medical centres – with the Hub and integrated community services at Hokitika Programs Westland Medical 5,500 patients; 1-2 team Medical staff: 2 GPs Nursing staff: 4.5 practice nurses South Westland 1,700 patients; 1 team Medical staff: 1 GP Nursing staff: 5 practice/rural/(district) nurses Nurse practitioners Nursing staff across the 2 practices: district nurses?, well child/school nursing, enrolled nurse/aids, Allied health (public & private) across 2 practices: physiotherapists, midwives, pharmacist, MH therapist, MRTs Support across the 2 practices: community health worker/navigator/ kaiawhina roles Service co-ordination: NASC, discharge planning, LTC care management, Immunisation outreach, MH assessment and co-ordination Home based care: personal care, meals on Pharmacy services, medication reviews wheels 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 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 47
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 and 44: Quality domains Each new initiative
Page 45: 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
Page 95 and 96: 13 Costs Budget considerations:
Page 97 and 98:
established. This group now oversee
Page 99 and 100:
Output measures Tobacco control / s
Page 101 and 102:
Improving immunisation coverage - h
Page 103 and 104:
Year three Continued joint plan
Page 105 and 106:
extending health promotion activiti
Page 107 and 108:
Immunisation Coverage Funder Provid
Page 109 and 110:
The Community Health System Deliver
Page 111 and 112:
Clinical care Practice self managem
Page 113 and 114:
and increases in the numbers of pat
Page 115 and 116:
Ambulatory Sensitive Hospitalisatio
Page 117 and 118:
% CVD on lipid lowering drugs, beta
Page 119 and 120:
Health navigators/ kaiawhina: chan
Page 121 and 122:
Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
Page 125 and 126:
qualifications and skills. Where ca
Page 127 and 128:
6 Deliverables / activities Impleme
Page 129 and 130:
“With an aging population and an
Page 131 and 132:
Differences between revenue generat
Page 133 and 134:
Appendix Seven: Integration - Healt
Page 135 and 136:
It is expected that HealthPathways
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Year two implement the process to
Page 139 and 140:
Low uptake by primary and secondary
Page 141 and 142:
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
Page 149 and 150:
Appendix Nine: Referred services 1.
Page 151 and 152:
them by technical errors or lack of
Page 153 and 154:
Identify patients that would benefi
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• Provision of patient specific m
Page 157 and 158:
12 Organisational accountabilities
Page 159 and 160:
emain under the care and management
Page 161 and 162:
Service user pathways in an optimal
Page 163 and 164:
Model for shared care pathways deve
Page 165 and 166:
Implementation plan: to June 30 Dev
Page 167 and 168:
Year two Review progress, outcome m
Page 169 and 170:
10 Risk analysis Risk Probability I
Page 171 and 172:
Appendix Eleven: Frail older people
Page 173 and 174:
ehab and treatment programmes that
Page 175 and 176:
Year one: Maintain and continue the
Page 177 and 178:
Māori have a higher incidence of m
Page 179 and 180:
11 Organisational accountabilities
Page 181 and 182:
There are often vacancies for allie
Page 183 and 184:
6 Deliverables / activities Program
Page 185 and 186:
Professional development: Provide
Page 187 and 188:
Mainstream arguments are concerned
Page 189 and 190:
Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192:
A key possibility is that land at t
Page 193 and 194:
This option is effectively a Greenf
Page 195 and 196:
7 Westland IFHC Facilities options
Page 197 and 198:
Year two Substantive-IFHC in Greymo
Page 199 and 200:
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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