Better Sooner More Convenient Primary Care - New Zealand Doctor

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ecomes business-as-usual). Input is also provided by expert speakers and reports of successful initiatives in other places. Implementation plan: to June 30 A. IHI PDSA cycles methodology to improve health centre delivery systems: identify team(s) in each health centre to work on this project with at least one nurse, one GP and the practice manager in each team facilitate one workshop for health centre teams in both Greymouth and Westport facilitate two team workshops with each health centre identify the current patient pathway for common types of presentation to general practice as per the Stratified Levels of Care model in the Primary Health Care Advisory Council report 20 (see Appendix A) reach consensus on the desired patient pathways (see Appendix B for potential change in patient pathway for acutely unwell adult) implementation of at least two PDSA cycles in each health centre that may include the following initiatives to improve the patient pathway: - increased role for nurses as first contact; - triage systems for deciding who patient needs to see and length of appointment; - GPs providing back up for a nurse team (patients make appointments with nurses, GP provides input and advice at the end of nurse consultations); - implementation of standing orders (see Acute Care plan); - longer booked consultations with GPs for complex patients; - GP and nurses divided into smaller teams within the health centre, each with its own designated population; - development of the nurse practitioner role within practice teams; - regular clinical meetings of GP and nurse teams; - shared review of clinical notes for high needs patients; - e-mail and phone consultations; - extended hours clinics during the week; - drop in nurse clinics; - development of a health assistant role; - using Dr Info for recall letters; - provide focused education for frequent flyers development of data definitions and collection mechanisms for measuring continuity of care and community satisfaction with services identification of training needs of nurses and arrange for Nursing Post Graduate Certificate Health Assessment paper to be delivered on the Coast in 2010 (see Acute Care paper) 20 Primary Health Care Advisory Council. Progress Report of the Council‟s work to provide advice to the Ministry of Health and District Health Boards on Primary Health Care Service Models. Nov 2009 Business case appendices V12 AC 25Feb2010 Page 10
determine ratio of nurses and GPs to patient population (see Workforce project) address recruitment and retention issues (see Workforce Project). B. Improving access and outcomes for Māori: implement a time-limited Greymouth based version of the kaiawhina project that was successful in engaging Māori in Buller with the medical centre there: - ascertain roles of various players (health centres, Māori health provider, PHO); - implement kaiawhina role to address Grey district enrolment of Māori; - provide appropriate training and support identify/recruit one Māori nurse in each practice. Develop part of her/his role to focus on improving access and health outcomes for meeting the needs of Māori patients, providing a whanau ora approach and improving Māori engagement in services and clinical programmes link health navigators in each health centre with Māori nurses so that they can provide community based support for hard to reach patients. C. Extended role for pharmacists Formalise arrangements between practices and pharmacies for pharmacists to provide interim prescriptions when GPs not available to sign prescriptions. Year one: A. IHI PDSA cycle to improve health centre delivery systems Task Four facilitated workshops in each health centre to review PDSA cycles and implement new ones Review progress on outcome measures and feed back into quarterly planning sessions Monthly meetings with health centre delivery systems redesign teams to provide support Three regional workshops to share ideas across health centres Health centre newsletters to explain new systems Develop community education programmes about care of common minor ailments By when Quarterly Quarterly Monthly August, Nov, Feb August April B. Māori access Task Roles of Māori nurses defined Kaiawhina commences Review level of Māori enrolment By when July July Quarterly Business case appendices V12 AC 25Feb2010 Page 11
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
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support them. Help with understandi
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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 and 78: It is common for people with an acu
Page 79: Outcome measures Indicator Baseline
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
Page 129 and 130: “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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