Better Sooner More Convenient Primary Care - New Zealand Doctor

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Improving Access: increasing co-location of a range of primary, community and secondary services increasing multi-disciplinary working implementing navigator/Kaiawhina positions to provide practical assistance to access services implementing Māori nursing positions within each integrated family health centre increasing mainstream service effectiveness by increasing cultural competencies among non-Māori staff changing models of care to increasing nurse/allied health led services, including advancing development of nurse practitioners and working understanding orders. Improving pathways through care: reviewing pathways across through primary, community, secondary services across a number of disease states navigator/kaiawhina positions implemented to „navigate‟ patients through care. Take a population health approach: matching services to identified health needs, including Māori health needs increasing self-management education. 8. How will the intervention affect health inequalities? Inequalities in enrolments and utilization of services will reduce with the interventions, particularly with the focus on enrolment and access of the kaiawhina position, and the increasing responsiveness of mainstream services with specific Māori nursing positions within each Integrated Family Health Centre, and increasing cultural competencies among non Māori staff. Implementation of these initiatives will also reduce inequalities in health outcomes over time. 9. Who will benefit the most? Those enrolled in primary practice and utilizing primary health services will benefit the most from access to better sooner more convenient primary health services and improved quality of service and care pathways through primary-community-secondary health services Business case appendices V12 AC 25Feb2010 Page 4
10. What are the unintended consequences? There is the potential that improving access to better sooner more convenient primary health services and improved care pathways through primary, community and secondary health services will increase inequalities if Māori continue to have lower enrolments, and lower access rates to primary services. 11. What will you do to make sure it does reduce/eliminate inequalities? To ensure that implementation of Integrated Family Health Services reduce inequalities in enrolment, access and health outcomes for Māori, the following initiatives are included in the business case: Māori nursing positions will be established within each IFHC a kaiawhina with a focus on increasing Māori enrollments and access to primary services, including by providing practical assistance will be appointed in Greymouth Māori workforce development increasing cultural competencies among non Māori staff to improve mainstream service effectiveness increasing integration with kaupapa Māori health services matching services to identified Māori health needs increasing provision of culturally based self-management education continuing to measure access to services and health outcomes with ethnic comparisons so as to monitor improvements and make further changes as required. The Steering Committee overseeing the development of the business case has included the West Coast DHB (WCDHB) GM Māori Health and the CEO of Rata Te Awhina Trust, kaupapa Māori health service. A review of the work of all 15 work-streams has been undertaken by the WCDHB Māori health service staff. 12. How will you know if inequalities been reduced/eliminated? The following measures will be monitored to measure if inequalities have been reduced or eliminated: Māori enrolment in West Coast PHO (WCPHO) % of Māori not enrolled in the PHO utilization of GP/nurse appointments immunisation coverage rates: childhood and flu cancer screening: breast and cervix mental health assessments and brief intervention counselling Long Term Conditions Programme enrollments and outcome indicators for cardiovascular, respiratory and diabetes. Business case appendices V12 AC 25Feb2010 Page 5
Page 1 and 2:
Business Case Better, Sooner, More
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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
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Māori/Pacific Not Māori/Pacific D
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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 and 70: Devolved community based services w
Page 71 and 72: Appendices Appendix One: Health Equ
Page 73: ongoing GP shortage creating an env
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
Page 121 and 122: Committee‟s objectives 41 of prov
Page 123 and 124: - 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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