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
6.2 Locality Integrated Family Health Centres Each locality IFHC would operate a comprehensive set of locality Multi Disciplinary Team services under a unified management structure. In the first phase the likely components are: primary care services rural A&E services rural inpatient medical services (other than Grey) rural nursing services clinical nurse specialists (incl. diabetes and respiratory education and management) community / district / whanau / public health nursing services immunisation services (inc HPV & outreach) well child services (inc B4 school & VHT) Carelink/service co-ordination services home based care services community allied health services mental health brief intervention and co-ordination services sexual health services. In those districts where services are co-located, they are also integrated in the following ways 17 : single reception for all services common scheduling, allowing staff to book patient appointments with each team member, rather than „referring‟ 1 patient management system and 1 (electronic) clinical record (using MedTech in the absence of any other system) 1 operational IFHC manager (no separate „practice manager‟), supported by 1 nursing leader, 1 GP leader, and team leaders for specific services (eg. mental health), also supported by an office manager to cover admin requirements shared clinical and management decision making integrated policies & processes shared continuous quality improvement and professional development systems common catchment population/ boundaries a single combined services budget, includes nominal budget holding for pharms and labs. The locus of care is primary and community services, with access to other services (including hospital services) co-ordinated through these teams. The locality manger is accountable for financial and clinical outcomes hence all others are either subcontractors or employees of the IFHC locality manager. 17 In the virtual Westland IFHC some of these integration activities will still be realised Business case EoI V38 AC 25Feb10 Page 48
The core services are provided or purchased by the PHO. Some visiting specialists services are provided by the DHB. A number of other services could potentially be part of the IFHC. It is proposed that while these may not be included in phase one, initiatives to promote integration and shared decision making should commence in year one, on the understanding that a number of these might be devolved to the IFHC in year three. Detailed planning around these will commence in year two. Service AT&R services Maternity Mental health services Outpatient services NGO services Aged residential care Transport services Pharms, labs, radiology Development Close working relationships in IFHC, possible future devolution Close working relationships in IFHC, possible future devolution Close working relationships in IFHC, future devolution subject to achieving progress milestones Input to service planning and development, possible devolution of some first, follow ups and minor procedures Close working relationships in IFHC, possible future devolution Move to partial budget holding in NASC Interface Nominal budget holding with gain/loss sharing 6.3 Service outputs and outcomes We have developed a population based activity model to derive the expected number of visits, and service provision response for the major service categories given the population of each of the TLAs, and the proposed model of care. This model requires further validating but provides an indication of the FTEs required in each IFHC. Note that the model has not yet been adjusted to reflect different rurality / travel times issues. Expected volumes of services are shown in the table below: Summary Visits /year Service visits /yr Buller Grey Westland Total ACC 0.5 4,615 6,415 4,078 15,108 Immunisation 0.3 3,065 4,215 2,612 9,892 Scripts 0.5 5,000 6,900 4,415 16,315 General 3.7 37,900 51,000 31,930 120,830 Diabetes 0.1 668 845 559 2,072 CVD 0.1 760 930 597 2,286 COPD 0.0 328 397 257 982 B4 school chks 0.0 132 204 114 450 Sexual health 0.1 1,300 2,050 1,320 4,670 Pharms reviews 0.1 725 885 581 2,191 cvd risk asst 0.0 393 488 331 1,212 District nursing 0.7 7,080 8,730 5,600 21,410 Primary MH 0.1 1,058 1,436 954 3,447 Physio 0.3 2,830 3,770 2,506 9,106 Other - - - - - Total 6.4 65,854 88,265 55,852 209,972 Business case EoI V38 AC 25Feb10 Page 49
- 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 and 46: Preventative Acute LTC management R
- Page 47: Preventative Acute LTC management R
- 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
6.2 Locality Integrated Family Health Centres<br />
Each locality IFHC would operate a comprehensive set of locality Multi Disciplinary Team<br />
services under a unified management structure. In the first phase the likely components are:<br />
primary care services<br />
rural A&E services<br />
rural inpatient medical services (other than Grey)<br />
rural nursing services<br />
clinical nurse specialists (incl. diabetes and respiratory education and management)<br />
community / district / whanau / public health nursing services<br />
immunisation services (inc HPV & outreach)<br />
well child services (inc B4 school & VHT)<br />
<strong>Care</strong>link/service co-ordination services<br />
home based care services<br />
community allied health services<br />
mental health brief intervention and co-ordination services<br />
sexual health services.<br />
In those districts where services are co-located, they are also integrated in the following<br />
ways 17 :<br />
single reception for all services<br />
common scheduling, allowing staff to book patient appointments with each team<br />
member, rather than „referring‟<br />
1 patient management system and 1 (electronic) clinical record (using MedTech in the<br />
absence of any other system)<br />
1 operational IFHC manager (no separate „practice manager‟), supported by 1 nursing<br />
leader, 1 GP leader, and team leaders for specific services (eg. mental health), also<br />
supported by an office manager to cover admin requirements<br />
shared clinical and management decision making<br />
integrated policies & processes<br />
shared continuous quality improvement and professional development systems<br />
common catchment population/ boundaries<br />
a single combined services budget, includes nominal budget holding for pharms and labs.<br />
The locus of care is primary and community services, with access to other services (including<br />
hospital services) co-ordinated through these teams. The locality manger is accountable for<br />
financial and clinical outcomes hence all others are either subcontractors or employees of the<br />
IFHC locality manager.<br />
17 In the virtual Westland IFHC some of these integration activities will still be realised<br />
Business case EoI V38 AC 25Feb10 Page 48
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