Better Sooner More Convenient Primary Care - New Zealand Doctor

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% pts discharged of transferred from ED within 6 hours % ringing HML who need local GP/nurse assessment 100% >95% >95% >95% TBC 6 Deliverables / activities Implementation plan: to June 30 HML Triage: Draw up contract with HML Triage to provide after hours nurse phone triage for every practice. HML visits every practice and Greymouth ED to gather information on local systems and capability. Ensure practices have good systems in place to care for patients who need follow-up care the next day, eg. phone consultations, acute appointment slots, walk in clinics. Ensure all practices receive regular reports from HML and all systems are working appropriately. Community education campaign – four to six weeks later: Content: if you are unwell after hours ring your general practice and you will receive advice from an experienced nurse regarding what you should do. Do not go straight to the emergency department unless it is an emergency. Involve St John in campaign. Design campaign methodology: newspaper articles, pamphlets, radio messages, practice newsletters. Campaign also tailored towards Māori and Pacific Island communities. Implement campaign. Redesign Greymouth after hours arrangements: Practices will see their own urgent patients during the day instead of these patients being seen at the duty practice. There will be a duty practice but it will see only urgent out of town or non-enrolled patients (often re-directed from ED). The newly established academic practice will be on-call in the evenings (Mon, Tues, Wed) with GP registrars seeing patients under the supervision of Dr Willet or Dr Wood. Town practices will roster Thursday evening call. Weekends will be covered by all practices allocated on the basis of capitation population. This should result in a more equitable allocation of on-call and reduce the number of GP patients presenting at ED because urgent appointments will be available at each practice. Business case appendices V12 AC 25Feb2010 Page 20
Review Buller after hours arrangements: The practice closes at 5 pm and any urgent presentations from about 4:30 to 5:00 are directed to Buller Health ED. Buller Health ED is staffed by a GP until 5:30 and may stay on duty until 10:00 pm if required. An after hours co-ordinator supervises a mix of RNs and ENs who staff ED. GPs are on call for Triage 1 and Triage 2 patients. The decision to call the GP for other triage levels is made by the team leader on duty. Weekend emergency clinics operate on Saturday, Sunday and Public Holidays from 10:00 to 11:00 am and again at 5:00 to 6:00 pm. x-ray services are provided 24/7 on an on call basis between 4:30 pm and 8:30 am. Nurse education: Identification of training needs of the nurses providing after hours and acute primary care (24 practice nurses and 12 rural nurses). Arrange for Nursing Post Graduate Certificate Health Assessment paper to be delivered on West Coast in 2010, with funding from after hours budget if required. Arrange access to further PRIME training for new staff on PRIME call out roster as required, with support for travel and accommodation costs. Standing orders: Develop standard processes for the use of standing orders in practices. Adopt content of the Westland Medical Centre standing orders for Coast-wide use. Select which standing orders. Establish subcommittee to oversee development of standing orders training. Develop a curriculum to provide training on each standing orders over 2010/11. Develop the lesson plan for the first training session. Run the first two training sessions for 6-8 standing orders in both Westport and Greymouth. Fund nurses to attend training sessions. Visit each practice to discuss the use of standing orders and obtain written agreement to use the standard processes and content from all GPs. Plan and run second training session in both regions. Co-ordination with ED: Install a copy of MedTech in a computer in ED. Change patient registration form/casualty sheet on arrival to include consent for access to their MedTech notes for that hospital visit. Ensure privacy considerations are met. Obtain agreement from practices. Create link into DHB practice server. Evaluate community cellulitis management project and extend to all practices. Business case appendices V12 AC 25Feb2010 Page 21
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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
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LEVERS VISION Better, sooner, more
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providing the majority of care). Th
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The Community Health System Deliver
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To better integrate the support pro
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5.5 Enablers A key aspect of this b
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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 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: 4 Objectives to implement nur
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
Page 133 and 134: Appendix Seven: Integration - Healt
Page 135 and 136: It is expected that HealthPathways
Page 137 and 138: Year two implement the process to
Page 139 and 140: 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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