Better Sooner More Convenient Primary Care - New Zealand Doctor

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C. Extended role for pharmacists Task Investigate pharmacy access to MedTech Extend the Standing Orders aspect of the Improving Access to Acute Care project to include pharmacists as follows: In consultation with GPs select two conditions from the current Westland Medical Centre Standing Orders documentation that are appropriate for pharmacists. Formalise process for pharmacists to assess patients, document consultation, send copy of consultation note (formal GP referral forms are currently in use at some pharmacies) and prescription for retrospective signing to GP, review by GP and further education provided as required. Formalise a process for pharmacists to be remunerated. Provide half day training session for first two conditions. By when March May Year two A. IHI PDSA cycle to improve health centre delivery systems: evaluate success of this project to date identify remaining problem areas continue facilitated health centre workshops where outcome targets are not being met. B. Māori access: continue to monitor increases in Māori enrolments each quarter refine roles of Māori nurses, kaiawhina and health navigators. C. Extended role for pharmacists: evaluate success of standing orders pilot identify whether more conditions should be added provide further training as required. Year three A. IHI PDSA cycle to improve health centre delivery systems: continue to report on outcomes address any problem areas with more workshops. B. Māori access: evaluate impact; review & revise role/project as necessary. Business case appendices V12 AC 25Feb2010 Page 12
C. Extended role for pharmacists: identify whether more conditions should be added provide further training as required. 7 Capability and capacity This project will require dedicated time from health centre staff, particularly their Quality Improvement (QI) teams. Currently they have limited time to engage so where possible their time on this project will be back filled with locum cover. A skilled facilitator will be contracted to assist with this project. Capacity issues and desired numbers of GPs and nurses are addressed in the Workforce project. Support and training will be provided for the kaiawhina. Dedicated time from pharmacists will be required in order to provide greater first contact care. 8 Effect on inequalities The development of Māori nurse and kaiawhina positions will improve access for Māori to primary health care (see section on addressing inequalities). 9 Evidence for this initiative The IHI Breakthrough Series is an evidence based quality improvement approach 21 . It has been used in a number of settings with good results 22 and was successfully used on the West Coast in 2009 to implement the PHO Long Term Conditions Framework 23 . Different models of nursing care and enhanced roles for nurses have been implemented successfully internationally 24 , and in New Zealand 25 . 21 Wagner - find Wagner E, Austin B, Davis C, Bonomi A., Provost L, McCulloch D, Carver P, Sixta C. Quality Improvement in Chronic Illness care: a Collaborative approach. J Q Improvement 2001; 27(2):63-80. 22 Daniel D. Norman J. Davis C. Lee H. Hindmarsh M. McCulloch D. Wagner E. Sugarman J. A state-level application of the chronic illness breakthrough series. Joint Commission Journal on Quality and Safety. 2004; 30(2):69-79. 23 North D, Tracey J. Evaluation of the IHI Breakthrough Series Project for West Coast PHO. Jan 2010. 24 Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ 2002; 324: 819-23. Business case appendices V12 AC 25Feb2010 Page 13
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
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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 and 80: Outcome measures Indicator Baseline
Page 81: determine ratio of nurses and GPs t
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
Page 131 and 132: 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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