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Managing Long Term Conditions in the Wairarapa 26 th June 2007

Managing Long Term Conditions in the Wairarapa 26 th June 2007. "It is not the strongest species that survive, nor the most intelligent, but the most responsive to change". Charles Darwin. The Vision “ Wairarapa Ha Ora, Wairarapa Ora ” To create a Primary Care workforce

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Managing Long Term Conditions in the Wairarapa 26 th June 2007

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  1. Managing Long Term Conditions in the Wairarapa 26th June 2007

  2. "It is not the strongest species that survive, nor the most intelligent, but the most responsive to change". Charles Darwin

  3. The Vision “ Wairarapa Ha Ora, Wairarapa Ora” To create a Primary Care workforce that works !

  4. This presentation covers • What are we are aiming for? • The “Burning platform” creates an imperative for change • Long Term Conditions work pervades the PHO • Some examples of progress to date • Current focus of our LTC work • The Future

  5. “Aim” We want Primary Care that: • Delivers on the Primary Health Care Strategy • Provides care according to the best evidence • Maximises the potential of all our people – collectively and individually • People can access when they need to • Helps address health disparity in our community • Is responsive to population health objectives • Is adaptable to change in the future

  6. Why does this matter ? • Because we cannot manage the changing environment without a change in workforce & culture

  7. Growing pressure on GP workforce This graph does not include the impact of over 65 consults already being significantly above the national average in Wairarapa, and the fact that they are 20% longer than other consults

  8. Includes Nurse and GP consultations

  9. Managing Long Term Conditions in the Wairarapa • Care Plus • Primary Health Care Nursing development • SIA Packages of Care • South Wairarapa Nurse Practitioner • Practice Cornerstone accreditation • Outreach Clinics • CD Evolution software • Guidelines • Culture change in the practice • Maori outreach/liasion • PHO Performance Monitoring

  10. Care Plus • Care Plus in the Wairarapa is doing VERY well • This result comes from a lot of hard work • Care Plus has involved “culture change” in Practices • Care Plus is popular with patients – and is becoming more • popular with the practices • Care Plus is making a difference – but early indications are that it is • increasing the use of secondary services (not decreasing) • Issues - we are nearing 100% of the existing formula • - Does not deal with very high needs patients • - More effort re Maori/Pacific competency

  11. More older people in the Wairarapa • 83% of expected patients with 1,801 Care Plus patients from the 2167 eligible as at 30/5/07 • 15% of expected patients Maori/Pacific – 14% of actual to date • We will reach 100% of expected Care Plus patients early in 07/08 year

  12. We have improved Maori/Pacific access rates for many people

  13. We are even getting many Maori men through the Practice doors at rates ahead of the rest of the population

  14. PHO Year on year increase

  15. Primary Health Care Nursing is key to LTC • We have achieved to date: • Our focus is on creating a Practice Team – not a devisive approach • Care Plus – Sexual Health – School/Outreach Clinics have all contributed • Lots of CPD for Nurses over the past three years • A big shift in all Practices – most now have higher Nurse:GP ratio • The future plans: • The PHC Nursing Development plan is in place – Nursing Conference • South Wairarapa Nurse Practitioner project • Outreach clinic development • New models of care will emerge More older people in the Wairarapa

  16. South Wairarapa Nurse Practitioner project • Recruiting a very experienced Family Practice NP from USA • She will work clinicaly part time in the three SW practices modelling NP behaviour to • Nurses • GPs • The Public • She will also • Mentor Practice Nurses • Help with redesigning the model of care delivery • This is a three year project that has national attention – likely to be other projects • that she can draw support from around the country • The Practices know that they have to change – but are so busy just keeping afloat that • some help is required

  17. So what is our current focus ?

  18. Our focus is: • Inter practice culture change and relationship building • Creating IT and information consistency across all the practices • Developing education and training in these areas

  19. The key is a practice team motivated & equipped to use their skills and their available information to get the best possible result for their community • We need to be able to measure how well we are doing at this too! • Team Climate Inventory taken

  20. The next three years will see a continued focus on developing Long Term Conditions management capability at Practice level • IT systems • Use of information • Workforce development • Culture change • Measuring and reporting results • Evaluation

  21. Wairarapa Community PHO Aspiring to a collective vision for the health of our community

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