Better Sooner More Convenient Primary Care - New Zealand Doctor

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Financial strength and viability; Change management ability and experience in the health sector across the primary and secondary sector; Information management experience that enables new models of care, and improves quality and efficiently deliver services. GP Liaison Helen Reriti, RN, Clinical Manager, WCPHO Also involved from a DHB perspective have been: Vicki Robertson, FRANZCOG, Chief Medical Officer Jane O‟Malley, PhD, Director of nursing and midwifery Maureen Frankpitt, Nurse manager community and primary health care Karyn Kelly, Associate Director of Nursing, Clinical Practice Development Janette Anderson, Physiotherapy team leader (see also Section 5.6). This business case has been costed on a preliminary basis and opportunities to reduce expenditure towards breakeven identified. However, we note that these potential initiatives and costings are subject to further review and consultation before decision can be taken. West Coast DHB is substantially in deficit. Its primary and community services are responsible for a considerable proportion of the DHB‟s projected deficit. (see Sections 4.2 and 9.). The PHO is in a position of financial strength and has allocated funds for change management. (see Section 10.3.). Both DHB and PHO senior management have an in depth understanding of the local situation and of both drivers and barriers to change. In addition, both organisations draw on outside expertise as required, including the likes of LECG and PHOcus on Health. These two organisations have assisted with the development of this plan, and have extensive experience in change management in primary and secondary care throughout <strong>New</strong> <strong>Zealand</strong>. The PHO has a considerable track record of utilizing enrollment and clinical services data to identify service gaps, and to design and implement responses/projects to address such gaps. The PHO has made successful use of the PHO Performance Programme to assist practices with their continuous quality improvement initiatives. GP facilitation has been key to this success. Specific information systems developments have been prioritized, beginning with the adoption of MedTech 32 as the PMS and clinical notes platform for all community and primary care services. (see Appendix Fourteen: IFHCs – information technology) 3. The strength of relationships between the various parties, and partnership arrangements with key stakeholders, including; The degree of engagement and/or Wide consultation has occurred with front line staff: GPs, primary care nurses, secondary care clinicians, community nurses, allied Business case EoI V38 AC 25Feb10 Page 8
support from DHBs, specialist clinicians, practitioners from a range of disciplines; Experience in meaningful engagement with consumers and the community. health, and with DHB senior management team (see Section 5.6). While given the time frames this has not been extensive, input from community, iwi and Māori providers has been obtained (see Section 5.7). Each IFHC will establish a community reference group who can assist in the development of plans for their districts. These groups will include local mayors (or their representation), community leaders, business leaders and iwi leaders. Business case EoI V38 AC 25Feb10 Page 9
Page 1 and 2: Business Case Better, Sooner, More
Page 3 and 4: 1 Caveats/status This business case
Page 5 and 6: Current situation By three years Wa
Page 7: staffed on a capacity model - in wh
Page 11 and 12: 10.4 Key milestones................
Page 13 and 14: Annual government health funding pe
Page 15 and 16: Ambulatory Sensitive Hospitalisatio
Page 17 and 18: The base populations of the three d
Page 19 and 20: Māori/Pacific Not Māori/Pacific D
Page 21 and 22: 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
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Expanded pharmacy roles Improving a
Page 69 and 70:
Devolved community based services w
Page 71 and 72:
Appendices Appendix One: Health Equ
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ongoing GP shortage creating an env
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10. What are the unintended consequ
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It is common for people with an acu
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Outcome measures Indicator Baseline
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determine ratio of nurses and GPs t
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C. Extended role for pharmacists:
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11 Engagement Working group who dev
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Appendix B: Acutely unwell adult pa
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4 Objectives to implement nur
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Review Buller after hours arrangeme
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Year three Community education camp
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13 Costs Budget considerations:
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established. This group now oversee
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Output measures Tobacco control / s
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Improving immunisation coverage - h
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Year three Continued joint plan
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extending health promotion activiti
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Immunisation Coverage Funder Provid
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The Community Health System Deliver
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Clinical care Practice self managem
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and increases in the numbers of pat
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Ambulatory Sensitive Hospitalisatio
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% CVD on lipid lowering drugs, beta
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Health navigators/ kaiawhina: chan
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Committee‟s objectives 41 of prov
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- 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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