Better Sooner More Convenient Primary Care - New Zealand Doctor

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dispensing nurse generated, unsigned scripts with a formal agreement that a GP will take full responsibility and sign within one week. Māori access Māori access to care, as shown by the percentage of the census population enrolled in a health centre, has also been an issue, previously in the Buller region and now in Greymouth. For two years a kaiawhina was employed by the PHO in the Buller region to enhance relationships between the health centres and the Māori community. 4 Objectives: The objectives of this plan are: to improve access to first contact core general practice team care (access to long term condition management is addressed in the Long Term Conditions project) to reduce waiting times for general practice appointments to improve continuity of care to improve co-ordination of care to develop a team approach with patients seen by GP or nurse according to health need to implement the above through providing a facilitated learning environment for health centres in each region to redesign their delivery systems to improve access and continuity of care to improve access to care through expansion of the role of community pharmacist to improve access for Māori through health centres working closely with local kaiawhina. 5 Benefits and gains Output measures Indicator Baseline Target – Year 2 Year 3 Yr 1 Facilitated regional planning sessions 0 6 4 2 % of health centres with extended 0% 25% 50% 60% hours clinics % of health centres with drop in nurse 37% 50% 50% 50% clinics for acute problems % of health centres with weekly clinical 88% 100% 100% 100% review meetings between GPs and nurses Number pharmacists dispensing using 0 0 4 6 „standing orders‟ Number of Māori nurses employed 4 5 6 7 Number of Kaiawhina employed 1 1 2 2 Business case appendices V12 AC 25Feb2010 Page 8
Outcome measures Indicator Baseline Target – Yr 1 Year 2 Year 3 Nurse:GP consultation ratio 0.78:1 1:1 1.2:1 1.5:1 Waiting time for adult with acute Same day Same day Same day Same day problem, eg. short of breath, to be seen Average waiting time for adult needing 3 monthly check and script Winter 10 days 7 days 4 days 2 days Summer 5 days 4 days 3 days 2 days % of health centres enrolling new patients 88% 100% 100% 100% Measure of continuity of care – to be developed % of Māori enrolled in PHO Buller: 95% Gymth: 76% Wstlnd: 95% Number of triage 5 seen at Greymouth ED 07.00-15.30hrs Mon - Fri TBC TBC TBC TBC Buller: 95% Gymth: 85% Wstlnd: 95% Buller: 95% Gymth: 95% Wstlnd: 95% 43/week 40 35 30 Community satisfaction survey results TBC TBC TBC TBC 6 Deliverables / activities The business case modeling around the financial sustainability of general practice assumes a move to a strategy whereby experienced practice and rural nurses see most general patients (including dispensing under standing orders), and GPs provide back-up support, supervision and are available to see complex patients whose diagnosis and care plan is less clear. Currently a version of this model of care is in place at some practices, but often in an unplanned way – as an ad hoc response to a shortage of GPs. This model of care accepts that the West Coast generally has ratios of 1 GP to 2000 patients, and provides the necessary supports in the form of additional practice nurses and consistent policies and processes to make this model safe and rewarding for patients and staff. However this model is not yet set in stone and if alternatives are proposed that have as good or better outcomes in terms of access, safety of care and financial viability, they will be considered. This plan uses the IHI Breakthrough Series PDSA methodology to develop and implement plans within each health centre, with sharing of ideas, progress and outcomes between health centres. This methodology harnesses clinical leadership to develop and trial new initiatives using PDSA cycles to Plan (a potential solution), Do (implement), Study (review the effectiveness of the solution) and Act on the outcome (either try a new solution or imbed the trialed one so that it Business case appendices V12 AC 25Feb2010 Page 9
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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
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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 and 76: 10. What are the unintended consequ
Page 77: It is common for people with an acu
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
Page 127 and 128: 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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