Better Sooner More Convenient Primary Care - New Zealand Doctor

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9 Evidence for this initiative HML Triage has been successfully implemented throughout <strong>New</strong> <strong>Zealand</strong>, now covering over one million people each night. Standing orders have been successfully implemented in Westland Medical Centre resulting in the majority of acute care and after hours care being provided by skilled nurses. 10 Risk analysis Risk Probability Impact Contingency plan Practices select not to Low Moderate Fund out of After Hours funding use HML triage Nurses unable to take time off to do standing Moderate High Provide courses at weekends and pay for attendance orders training Nurses unable to take Moderate Moderate Deliver papers on the West Coast time off to do PG Cert papers Triage 5 patients still go to ED Redirection to IFHCs Use vouchers for low socioeconomic Adapt community education campaign 11 Engagement Working group who developed this plan: Hecta Williams, Dr JD Naidoo, Nigel Ogilvie RN, Dr Martin Smith, Julie Lucas RN, Dr Rodger Mills, Karyn Kelly RN, Wayne Turp, Shona McLeod, Dr Vicki Robertson, Barbara Smith RN, Dr Greville Wood, Dr Carol Atmore, Dr Jocelyn Tracey. Other clinicians involved: Copy sent to every general practice for input by nurses and GPs. 12 Organisational accountabilities Shared DHB and PHO accountability in the after hours steering group. Business case appendices V12 AC 25Feb2010 Page 24
13 Costs Budget considerations: The DHB received $80,000 for implementing the after hours plan in 2009/10. It is expected that the same amount will be received in 2010/11. Postgraduate university fees for advanced nursing papers are covered by Clinical Training Agency funding. Note that separate funding is available from MoH for proof of concept of the benefit of telemedicine in remote sites. To June 10 Year one Income MoH after hours fund 80,000 80,000 Expenditure HML 18,000 36,000 Standing orders training sessions 24,400 30,500 PRIME support 2,000 3,000 Communication 10,000 5,000 ED vouchers 500 1000 Project management 25,000 4500 Total expenditure 79,900 80,000 Profit $100 $0 Business case appendices V12 AC 25Feb2010 Page 25
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
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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
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While doctor-nurse substitution has
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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 and 90: 4 Objectives to implement nur
Page 91 and 92: Review Buller after hours arrangeme
Page 93: Year three Community education camp
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
Page 141 and 142: Appendix Eight: Improved access to
Page 143 and 144: 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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Better Sooner More Convenient Primary Care - New Zealand Doctor

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