Better Sooner More Convenient Primary Care - New Zealand Doctor

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2 Executive summary The drivers for change are: Clinical sustainability: the current model of care in most health centres requires GP numbers we have not been able to achieve consistently on the West Coast for at least five years, and leads to long waiting times for appointments (often > three weeks) and lack of continuity and consistency of care. Limited integration of community services with primary care leading to lack of co-ordination and consistency of care and some duplication of services. Financial: primary care medical practices and community services owned by the DHB contribute significantly to the DHB overspend each financial year. Hospitals in Reefton and Buller together also contribute significantly to the DHB overspend each financial year. What will be different as a result of implementing this business case? Three Integrated Family Health Centres (IFHCs) will be established based in Westport, Greymouth and Hokitika with associated clinics in rural areas. Each of these will become a one-stop-shop in terms of accessing primary and community health services. We will bed in a team based partnership model for core general practice care so that the majority of first contact care and long term condition care is provided by appropriately skilled nurses supported closely by GPs and, in time, Nurse Practitioners (NPs). This is likely to mean resident (non locum) GP:patient ratios of 1:2000 and increased practice/rural nurse:patient ratios from 1:1180 to 1:900 (with additional GP and nurse time for more rural areas and to reflect teaching commitments). Development of a Māori team within each IFHC that will focus on improving access and health outcomes for Māori. Devolution of community nursing, allied health and mental health services into the IFHCs, or the IFH system, with integration of reception, appointments, electronic clinical records, care pathways and discharge planning, and consequent reduction of duplicate service provision. Full implementation of a best practice, proactive approach to the management of long term conditions (LTC), including mental health. Development of a strong primary care/community care organisation able to lead & manage the Integrated Family Health System (IFHS) within the available budget. We are committed to achieving important changes in health care, as reflected in the significant targets set out below. Business case EoI V38 AC 25Feb10 Page 4
Current situation By three years Waiting times for a routine appointment in Average of 10 days Maximum 3 days general practice Integrated Family Health Centres 0 3 Fully integrated community nursing and Not present In place primary care nursing Introduce nurse practitioners to skill mix Many nurses with 3 nurse practitioners potential as nurse practitioners interns Patients supported in the long term 1,419 2,500 condition management Reduction in Ambulatory Sensitive Hospitalisations (ASH) & inappropriate ED attendances ASH rates at NZ average ED Triage 5 = 81 patients/week 5% reduction in ASH rates 35% reduction in ED triage 5 PHO Performance Programme clinical 79% >90% indicators met Financial situation $5.4m deficit $1.4m deficit 2.1 Assessment criteria summary 1. The nature and expected magnitude of benefits that will flow from the proposed service improvement initiatives, including how the proposal expects to: Support the delivery of The key health targets are an integral part of this plan. Activities the Government‟s key to improve our performance and monitor changes have been health targets; incorporated in the planning documents as follows: shorter stays in emergency departments: See Appendix Three: Acute care improved access to elective surgery: See appendix Seven: Integration - HealthPathways increased immunisation: See Appendix Four: Keeping people healthy better help for smokers to quit See Appendix Four: Keeping people healthy better diabetes and cardiovascular services. See Appendix Five: Long term conditions Business case EoI V38 AC 25Feb10 Page 5
Page 1 and 2: Business Case Better, Sooner, More
Page 3: 1 Caveats/status This business case
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 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
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Option D: PHO/DHB jointly owned Pri
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The IFHS will need the ability to b
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Of note, a large proportion of the
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The DHB delegates decision making o
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Limited integration of community se
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10.4 Key milestones The table below
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Expanded pharmacy roles Improving a
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Devolved community based services w
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Appendices Appendix One: Health Equ
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ongoing GP shortage creating an env
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10. What are the unintended consequ
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It is common for people with an acu
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Outcome measures Indicator Baseline
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determine ratio of nurses and GPs t
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C. Extended role for pharmacists:
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11 Engagement Working group who dev
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Appendix B: Acutely unwell adult pa
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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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