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
8 Contracting arrangements 8.1 Role of the IFHS The Integrated Family Health Service (IFHS) would lead the development of community and primary care services, and would be accountable to the DHB for the financial and clinical outcomes of the delegated services. It would work closely with the DHB to achieve a smooth interface with secondary services, including the development of integrated care pathways between primary and secondary services (building off the Canterbury DHB pathways). The two would also share corporate support services in the interim. The IFHS will both employ staff directly, and will contract with individual providers to achieve the outcomes. It will establish district development and support services (in many cases jointly with the DHB) to ensure professional development and support for specific workforce groups (eg. allied health staff) and will put in place overall policies an processes (eg. use of HML to triage all after hours calls, use of common standing orders policies). The IFHS will be in a good position to compare performance between the three IFHCs and address issues at an early stage. The IFHS also has the role of prioritizing service provision – taking the tough decisions about what will not be provided so as to live within the available funding. An advantage of an NGO entity in this respect is its inability to run continuing deficits and to rely on the Government as a funder of last resort. 8.2 Annual health service plan The proposal is that an annual health services plan be agreed between the DHB and IFHS, setting out: inputs outputs outcome targets reporting schedule information access arrangements facilities leases payments from and to the DHB services to be provided quality standards sharing of corporate costs. Business case EoI V38 AC 25Feb10 Page 56
The IFHS will need the ability to balance gains and losses across service lines. Hence a flexible contract arrangement on a funding for outcomes basis is proposed. Specifically the provider will have the flexibility to use gains in one service area to offset losses in others. The DHB and IFHS provider will jointly review and reach agreement on major service delivery decision that will impact on each other, including a review of inpatient services at Buller. Provided satisfactory progress is being made, then mental health service responsibility will be contracted to the IFHS from the end of year three. This will allow other changes to be bedded in. 8.3 Contracted providers within IFHCs. The proposed approach to engaging the workforce within the IFHCs has three major components: Existing private providers continue to operate as semi-autonomous businesses within IFHCs, but will enter into a collective agreement (possibly an alliance style contract) that involves shared corporate and facility based services, and collective vision, and alignment of clinical processes, policies and pathways. Other services within IFHCs will be provided by the IFHS. In addition, the PHO will play a role as a facilitator of integration within each IFHC. Business case EoI V38 AC 25Feb10 Page 57
- 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 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: Option D: PHO/DHB jointly owned Pri
- 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
The IFHS will need the ability to balance gains and losses across service lines. Hence a flexible<br />
contract arrangement on a funding for outcomes basis is proposed. Specifically the provider will<br />
have the flexibility to use gains in one service area to offset losses in others.<br />
The DHB and IFHS provider will jointly review and reach agreement on major service delivery<br />
decision that will impact on each other, including a review of inpatient services at Buller.<br />
Provided satisfactory progress is being made, then mental health service responsibility will be<br />
contracted to the IFHS from the end of year three. This will allow other changes to be bedded<br />
in.<br />
8.3 Contracted providers within IFHCs.<br />
The proposed approach to engaging the workforce within the IFHCs has three major<br />
components:<br />
Existing private providers continue to operate as semi-autonomous businesses within<br />
<br />
<br />
IFHCs, but will enter into a collective agreement (possibly an alliance style contract)<br />
that involves shared corporate and facility based services, and collective vision, and<br />
alignment of clinical processes, policies and pathways.<br />
Other services within IFHCs will be provided by the IFHS.<br />
In addition, the PHO will play a role as a facilitator of integration within each IFHC.<br />
Business case EoI V38 AC 25Feb10 Page 57
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