Better Sooner More Convenient Primary Care - New Zealand Doctor

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and laboratory testing and pharmacies Identify potential areas of saving Implement programmes to align clinical and financial drivers 10.6 Work in progress items While this entire business case is a work in progress, we note that the following, in particular require further work and consideration: The linkages between Reefton and Buller /Greymouth based services. The linkages between South Westland and Hokitika / Greymouth based services. The nature of the future assessment and care co-ordination role/function at each IFHC relative to LTC management, frail elderly service co-ordination and mental health. The size and timing of service related savings. The organisational structure and governance arrangements. The activity based FTE model. 10.7 Risks and Mitigations The following risks and mitigations strategies have been identified. Risk description Mitigation Service continuity If clinical staff do not support the proposed changes then they may move elsewhere, jeopardizing service continuity. Keep staff informed and apply best practice change management techniques. Programme adequate funding and time to achieve shifts in models of care. Workforce Workforce may be unprepared to take on new clinical tasks or to work in new ways. Invest in workforce competency development. Decreased integration between primary/community and secondary care Devolution of community services to a primary care organisation may result in decreased integration with secondary care. DHB Financial impact DHB may retain fixed costs in the form of overheads and facilities and corporate services, but with reducing revenue. PHO Financial impact PHO may inherit services that run at large deficit, without ability to manage costs down. Invest in purposeful development of clinical pathways across primary and secondary care using an engagement approach. Contract SMOs to visit IFHCs and to deliver outpatient services from IFHCs. Allocate overhead costs to community services and require PHO to purchase back from the DHB those services for the initial 3 year period. Ensure change programme agreed prior to transfer. Agree transitional funds to cover deficit for the first 3 years. Business case EoI V38 AC 25Feb10 Page 70
Appendices Appendix One: Health Equity Assessment Tool - Integrated Family Health Centres ....................... 2 Appendix Two: Core general practice redesign ............................................................................................... 6 Appendix Three: Acute care................................................................................................................................ 18 Appendix Four: Keeping people healthy ......................................................................................................... 26 Appendix Five: Long term conditions ............................................................................................................... 38 Appendix Six: Integration - DHB community based services .................................................................. 52 Appendix Seven: Integration - HealthPathways .......................................................................................... 63 Appendix Eight: Improved access to diagnostics ......................................................................................... 71 Appendix Nine: Referred services.................................................................................................................... 79 Appendix Ten: Mental health.............................................................................................................................. 88 Appendix Eleven: Frail older people ................................................................................................................ 101 Appendix Twelve: Workforce ............................................................................................................................ 110 Appendix Thirteen: IFHCs - Facilities ........................................................................................................... 119 Appendix Fourteen: IFHCs – Information technology.............................................................................. 130 Appendix Fifteen: Project advisory and reference groups..................................................................... 139 Business case appendices V12 AC 25Feb2010 Page 1
Page 1 and 2:
Business Case Better, Sooner, More
Page 3 and 4:
1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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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 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: Devolved community based services w
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
Page 111 and 112: Clinical care Practice self managem
Page 113 and 114: and increases in the numbers of pat
Page 115 and 116: Ambulatory Sensitive Hospitalisatio
Page 117 and 118: % CVD on lipid lowering drugs, beta
Page 119 and 120: 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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Better Sooner More Convenient Primary Care - New Zealand Doctor

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