Better Sooner More Convenient Primary Care - New Zealand Doctor

Of note, a large proportion of the current loss in community and primary care services is driven
from service provision in the Buller/Reefton Territorial Local Authority (TLA). This reflects
losses at both the medical centres and from the provision of hospital and residential care
services.
9.2 Addressing affordability
Clearly the projected losses are unsustainable. The DHB has indicated a target reduction in the
deficit of 50% at the end of three years, and 100% within 5 years. We have adopted a target
reduction of 65% of the primary/community deficit within 3 years, with full deficit eradication
within 5 years.
This will require tough decisions to be taken, and will inevitably involve reductions in services in
some areas, as well as efficiency and effectiveness gains.
The options for achieving these savings are still under discussion, and will be subject to
consultation, but the table below outlines the size of the possible gains that can be made over
three years based on a preliminary assessment.
The financial sustainability initiatives include:
$0.5m estimated to be able to be saved by reducing administration and management
FTEs through primary and community co-location and service integration.
$1.5m estimated to be able to be saved by service reconfigurations, relocations and
reductions.
$1.1m savings through adopting a team based model of general practice care and moving
to a 1:2000 GP ratio, partly offset by costs of $0.6m associated with moving to a 1:900
practice nurse ratio.
$0.23m estimated to be saved through reduced use of secondary care follow ups.
$0.1m from reductions in ASH admissions.
$0.25m from referred services management initiatives.
$0.5m gain to the community provider from a realistic price for rural inpatient bed
services.
Each of the possible initiatives has been scoped at a conceptual level, but will require further
work and some will require consultation and clinical validation before they can be confirmed.
Some savings could be made quite quickly, while others savings will not be realised until new
facilities are in place.
Transitional arrangements
The intention is that the DHB will provide transitional funding on an abating basis to cover the
deficit over the first five years of operation – at the end of which the operations will be
breakeven or better. The transitional funding reduces from $4.6m in year 1 to $1.3m in year 3.
Business case EoI V38 AC 25Feb10 Page 59