Better, sooner, more convenient health care in Midlands

Funding requirements (total picture)8Primary health does not exist in isolation.The challenge for primary health is to shift to a wellness model of care. This shift will bear fruitdirectly in terms of better, sooner, more convenient access to primary heath services; it will also havea major impact on the prevalence of chronic conditions and the resulting acute demand.It is this reduction on demand in the secondary system that makes the implementation of structuressimilar to the Midlands IFHC model commonplace in countries where economic triggers supportshifts in funding from secondary to primary, if they reduce the overall cost of healthcare.A good example of this is the Group Health Medical Home model. Because the Group Healthsystem funds services through the line, they are able to allocate additional funds to the delivery ofprimary health in the knowledge that a healthier community will lead to reduced demand, and cost,in the secondary environment resulting in a net gain to Group Health.Our response to the challenge of contributing to a reduction in acute demand is similarly not for theoverall system to spend more. However, we do need to be able to shift resources and funding toPrimary Health when and where it will unlock an overall system-wide cost saving.It should also be recognised that changes in the performance of Primary Care may lead to shifts inthe funding requirements within the District Health Boards’ portfolio of services and providers.Where these shifts result in a saving to the secondary system we propose the creation of a rebatestructure to allow Primary health to continue to reinvest in activities that will create an overall savingfor the health system.It is therefore proposed that the devolution of funding is made within a partnering arrangementwith the individual District Health Boards where the total funding within any particular District HealthBoard area is economically neutral, and the efficiencies within the service delivery can be appliedwhere they best deliver better, sooner, more convenient health care.The collaboration between Primary and the District Health Boards will provide;• A holistic view of funding and planning across the health system.• A shared common vision for the provision of health services.• The most efficient use of funding.• The avoidance of duplication of health service activity.• A simpler contracting environment for allied health providers.• Improved health system performance.118