Better Sooner More Convenient Primary Care - New Zealand Doctor

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In early years, the IFHS community provider is likely to continue to purchase some corporate services from the DHB, though it may need to assess the viability of doing so beyond the first year, in order to continue its momentum towards breakeven. The transitional funding, and resulting forecast revenue and expenditure are set out in the table below: Integrated primary & community revenue and expenditure forecast IFHC + DHB wide community Start point year 1 year 2 year 3 Base revenue - 21,765,061 - 21,765,061 - 21,765,061 - 21,765,061 Service changes - 547,500 - 690,000 - 690,000 Transitional funding - 4,600,000 - 2,100,000 - 1,300,000 Total revenue - 21,765,061 - 26,912,561 - 24,555,061 - 23,755,061 Base expenditure 27,007,811 27,007,811 27,007,811 27,007,811 service changes - 142,500 - 2,479,992 - 3,316,420 Net expenditure 27,007,811 26,865,311 24,527,819 23,691,392 Profit / loss -5,242,750 47,250 27,242 63,669 9.3 Impact on the DHB The DHB provider arm is currently incurring a loss of some $5.75 million on its primary and community services. This loss would reduce to nil in year one as both the revenue and expenditure are transferred to the PHO. The DHB funder would incur new costs associated with paying the transitional funding amount (starting at $4.6 million in year 1 and abating to $1.3 million in year 3) and a proposed higher price for rural inpatient bed services to reflect the actual cost of provision. Overall, in year 1 there is a net financial gain to the DHB of $0.5 million (representing the PHO surplus contribution defraying current losses), while by year three the net fiscal gain for the DHB increases to $3.95 million (ie. the difference between the current loss of $5.75m and the forecast transitional funding of $1.3m plus about 0.5m in higher bed day prices). This equates to around a 68% improvement in the fiscal impact on the DHB bottom line for these services. Over the following two years the transitional funding amount would reduce to zero. Critical assumptions Important assumptions in this business case include: Transitional funding support is made available from the DHB on an abating basis over 5 years. Funding flexibility – to allow savings in one area to offset losses in others. Savings on referred services and secondary care derived from changes to primary care are passed back to the PHO/community provider to offset losses. Business case EoI V38 AC 25Feb10 Page 60
The DHB delegates decision making on the service change/reduction proposals to the PHO/community provider to expedite decision making (or takes financial responsibility for any delays in approval). The DHB will bear the cost of any redundancies of community based staff over the initial 3 year period. From that point, responsibility will shift to the PHO/community provider. The DHB will retain ownership of major capital items such as hospital facilities, and the PHO will pay for use of the same Current revenue and expenditure associated with the provision of the identified community service will transfer from the DHB to the PHO. Decisions will be taken by 31 July 2010 on those service changes/reductions that will require community/staff consultation before finalizing – so that changes can be implemented before the beginning of year two. Business case EoI V38 AC 25Feb10 Page 61
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
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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 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59: Of note, a large proportion of the
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
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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
Page 207 and 208:
8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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