Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix Two: Core general practice redesign 1 Aspirational statement West Coasters will be able to access appropriate primary health care in a timely manner. 2 Project overview This project addresses the important issue of access to core general practice care by redesigning general practitioner, nurse and health assistant roles and medical centre delivery systems, including appointment systems. The IHI Breakthrough Series PDSA quality improvement model will be used as the change management tool. This project also includes improving access to appropriate primary health care for Māori through developing roles for Māori nurses and kaiawhina. An expanded first contact role for community pharmacists is proposed. This project does not include integration of general practice with other community based nursing, allied health or NGOs, after hours care or recruitment and retention since these aspects are covered in other plans. 3 Problem definition In every consultation meeting with health providers from primary or secondary care, and with community representatives, the following two problems were seen as the most important to solve as part of this EoI process: long waiting times to be seen difficult for new arrivals to the West Coast to enrol in a health centre. Other related issues commonly raised were: lack of extended hours clinics to improve access for those with full time jobs lack of continuity of care, ie. seeing a different GP or nurse each time limited co-ordination/communication between GPs and nurses, sometimes resulting in inconsistency of care lack of community understanding of nursing roles and abilities. Business case appendices V12 AC 25Feb2010 Page 6
It is common for people with an acute health problem wanting an appointment to be seen by a GP, to wait three weeks to get an appointment in either Buller or in Greymouth (very urgent adult presentations and sick children are seen sooner). The perceived reasons for difficulties in accessing appointments are: lack of permanent GPs on the Coast heavy dependence on locums and difficulties at times attracting locums GPs in DHB owned health centres are on MECA contracts and so have three half days each week as non contact time variable development of nursing roles. General practice team roles To counter the GP shortage a number of initiatives have already been implemented: staffing remoter rural clinics with rural nurses as first line carers increased role for nurses in providing long term condition management, carrying out reviews and assessments and providing repeat prescriptions signed by the GP nurses seeing acute patients and then slotting in to see a GP or asking GP to sign a script as required nurses seeing patients and providing medications under standing orders GPs and nurses doing quick retrospective case note reviews of patients managed by nurses dividing the health centre enrolled population into subgroups with teams of one to two GPs (one permanent, one locum) and two nurses per subgroup phone triage of appointments to nurse or GP by either receptionist or by a nurse. Currently in many places on the West Coast nurses are providing a significant proportion of the kind of consultations that would elsewhere be done by GPs. While in some practices nurses with advanced qualifications have been employed, there has been extensive nurse training and/or standing orders have been implemented according to Ministry of Health guidelines, in others practices nurses are taking on an expanded role in order to meet patient needs, without adequate training, support or supervision. Currently while there are no nurse practitioners with prescribing rights on the West Coast, some nurses are working towards this qualification. Community Pharmacy The West Coast is well served by four community pharmacies who have assisted when GPs are not available by: managing minor ailments with over the counter (OTC) preparations providing up to two weeks medication as a pharmacy-generated interim prescription when a prescription for long term medications is required but the patient cannot get an appointment Business case appendices V12 AC 25Feb2010 Page 7
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
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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 and 74: ongoing GP shortage creating an env
Page 75: 10. What are the unintended consequ
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
Page 125 and 126: 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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