Better, Sooner, More Convenient Primary Health Care

1. Better, Sooner, More Convenient Primary Health Care Dr Ashley Bloomfield, 15 April 2010

2. Better, Sooner, More Convenient Primary Health Care The Government’s vehicle for improving the primary health care system; clinically-led and patient-centred, providing value for money, with a focus on Health Targets. Goals include: • Developing a more personalised primary health care system • Providing services closer to home • Making Kiwis healthier • Reducing pressure on hospitals • Shifting funds to the frontline • Consolidating structures • Decreasing bureaucracy

3. The BSMC Process • In October 2009, MOH called for Expressions of Interest (EOIs) from primary health care groupings to accelerate implementation of new service delivery models • More than 70 EOIs received by November 2009. 9 were selected for business case development National Maori PHO Coalition Alliance Health+ Greater Auckland Integrated Health Network Midlands Network Eastern Bay of Plenty PHO MidCentral PHOs Wairarapa Community PHO Canterbury Clinical Network West Coast PHO • ……………..covering more than 2.5 million enrolled New Zealanders • Business cases received 1 March 2010

4. Start here • Integrated Family Health Centres • General pratice consolidation, where appropriate • Extended hours of opening • Improved access to urgent care • Improved care for people with chronic conditions • Nurse walk-in clinics • Self-care and services in the home • Improved care of the frail elderly • Progress towards primary-secondary service integration, including the shifting of some • Keeping people healthy (prevention) • Whanau ora as appropriate We expect to see some of the following in all business cases:

5. Business Case Assessmentand Next Steps • All 9 business cases received on 1 March 2010. Huge effort by those involved in pulling these together. • Business cases considered by Assessment Panel 22 – 25 March. • Feedback provided to assist in further development. • Work now underway on implementation plans – final approval will follow. • Improvements begin on 1 July 2010 – some may start sooner The Assessment Panel Members: Dr Ashley Bloomfield (Chair), Dr Jim Primrose, Graham Drury, Mike Grant, John Dunlop, Dr David Jansen, Judith MacDonald, Dr Paul McCormack, Chris Mules, Vicky Noble, Professor Harry Rea, Dr Jonathan Simon

6. Issues Raised by Assessment Panel • Clinical engagement • A whole of system approach • Broader primary health care challenges • DHB leadership • Localism vs regionalism • Avoiding new structures • Diversity within clear national parameters

7. The nine business cases……..

8. National Māori PHO Coalition: • Whanau Ora centres – Māori providers delivering to Māori communities, using existing facilities • Whanau Ora assessment, providing integrated support • Extended opening hours for working families • Free after hours access to primary care

9. Alliance Health+ • Focus on Pacific population • First Integrated Family Health Centre (IFHC) open by July 2010; 3 by the end of July 2011 • Consolidation of PHOs • Nurse-led services – chronic care management responsibility given to nurses/nurse triage • Identification of services that meet the needs of their population – especially diabetes, CVD in the community and immunisation • Collaboration to provide after hours services. Electronic access to patient notes across providers, after hours providers

10. Greater Auckland Integrated Health Network (GAIHN) • Strong focus on reducing acute demand, reducing hospital stays and achieving the Health Targets for Auckland • Alternative to IHFCs = Community Health Hubs, adding significant scale and capability to the Auckland health system, functioning as a support hub to a group of practices serving about 100,000 people • Invitation to GPs to enable telephone and email consultations • Local health networks also proposed

11. Midlands Regional Network • Regional primary care funding entity contracting directly with all practices/providers in region • 9 IFHCs will be implemented within first year, established in existing premises • Wider range of services available from the 9 IFHCs • Broader use of nurses proposed in early childhood and school settings

12. Eastern Bay of Plenty • 2 IFHCs and 1 Whanau Ora centre • Process underway to merge the three existing PHOs into one by end of 2010 • Good clinical engagement and DHB engagement • Strong focus on improving immunisation rates

13. MidCentral • Establishment of 5 IFHCs: Tararua, Horowhenua, Otaki, Feilding, Palmerston North • Aspirational health targets to reduce presentations to Emergency Dept and avoidable hospital admissions for over-65’s • PHO consolidation • A central referral system • Nurse walk-in clinics • Chronic care model roll-out within three years

14. Wairarapa • Reduction in Emergency Dept attendance • Lower avoidable outpatient and First Specialist consultations through improved GP access to diagnostics and telephone, email and Skype consultations • Maintaining frail elderly in own homes longer, improved access to aged care support and medical care through IFHC • Improved diagnostics • Improved extended hours coverage • Expanded roles for nurses, community pharmacists and clinical pharmacists.

15. Canterbury • A cluster approach being taken in central Christchurch with 8 IFHCs in rural Canterbury within next three years • An urgent care initiative being rolled out • Focus on improving immunisation and smoking cessation Health Targets • Very strong primary and secondary clinical leadership and engagement with 400 clinical and community participants in business case • Very good IT capacity

16. West Coast • IFHCs to be established in Buller, Greymouth and Hokitika • Extended services will be provided through IFHCs • Integration of District Nursing, Allied Health and NASC function with primary health care • Direct primary care access to additional diagnostics including CT and musculoskeletal ultrasound • Implementation of new service delivery models

17. What will be different? • More services in local communities • First specialist assessments • Outpatient follow-ups • Easy access to X-Rays • Minor surgery • Nurse-led walk-in clinics • Multi-disciplinary team delivery – nursing/pharmacist/allied health • Extended opening hours • Practice consolidation - Integrated Family Health Centres • Whanau Ora services • More safe sharing of information

18. Enabling Policy framework • How to enable significant change, particularly given fiscal environment • Focus on increasing flexibility while preserving accountability: • Contracting arrangements • Flexible funding • Outcomes-based monitoring

19. Contracting framework • Nationally consistent across business cases • Relationship focus – based on alliance principles • Clinical leadership • Single system approach - integration • Joint decision-making and accountability • Open information sharing • Low bureaucracy • Ability to evolve

20. Proposed Alliance approach Over-Arching “District/Regional Alliance” Work streams Urgent Care Alliance Framework Link to Over-Arching Alliance Monitoring Frail Elderly Service Design/Feedback • Service Expectations • Funding • Terms and Conditions Long Term Conditions

21. Over-Arching “XYZ/District/Region Alliance” • Alliance Framework • Scope • Transition Plan [Service] Level Alliance Link to Over-Arching Alliance Documentation [Service] Provision Agreement • Service Expectations • Funding • Terms and Conditions

22. Other policy proposals • Monitoring framework • Small set of national outcome measures • Business case specific indicators to be developed • Consultation process to refine and develop • Flexible funding pool • Consolidate some current funding streams • Remove detailed central specification and enable business case flexibility to tailor approach • Implemented through contracts