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Who to Tackle: prioritising the defensive line

Who to Tackle: prioritising the defensive line. RNZCGP/GPNZ Conference Auckland 1-4 September 2011 Dr Ros Gellatly , GP Liaison NMDHB, Clinical Advisor Electives NHB Mr Chris McEwan , Plastic Surgeon Waikato DHB, Clinical Leader Prioritisation,Electives NHB.

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Who to Tackle: prioritising the defensive line

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  1. Who to Tackle:prioritising the defensive line RNZCGP/GPNZ Conference Auckland 1-4 September 2011 Dr Ros Gellatly, GP Liaison NMDHB, Clinical Advisor Electives NHB Mr Chris McEwan, Plastic Surgeon Waikato DHB, Clinical Leader Prioritisation,Electives NHB

  2. Who to tackle: prioritising the defensive line At the end of today’s workshop you will have a useful decision tree which allows you to: • Balance competing needs in health care • Discuss this with patients • Define what you need from secondary care to support you • Join the movement to get primary care involved in prioritisation decisions i.e. support a primary care clinician led health system

  3. Fred: 72 year old man with prostatism, getting much more troublesome. Intolerant of terazosin. Otherwise well. Lives at home with wife who has early Alzheimers. Freda: 50 year old Maori woman with mitral valve disease from childhood rheumatic fever. She’s complaining of being more tired and you think her murmur is worse. Ferdie: 30 year old truck driver with carpal tunnel symptoms. Can’t take time off as no sick leave. Sole breadwinner and wife is expecting their third child.

  4. Who to tackle What happened the last time you referred? Informed discussion with patient about access, wait times, private options…or just kept quiet about the system?

  5. Who to tackle What would be useful for you to know from secondary care? Up-dated? Useful feedback with a returned referral? Ever thought of a better way to provide a service? Who to talk to? Them and Us vs We (with patients)

  6. Who to tackle • Decision point 1: What is best for this patient? • Decision point 2: Is this available in public health system?* • Decision point 3: How soon? • Decision point 2(b): Next best alternative?* * service design, unmet need

  7. Prioritising the defensive line.... Fred: 72 year old man with prostatism, getting much more troublesome. Intolerant of terazosin. Otherwise well. Lives at home with wife who has early Alzheimers. Freda: 50 year old Maori woman with mitral valve disease from childhood rheumatic fever. She’s complaining of being more tired and you think her murmur is worse. Ferdie: 30 year old truck driver with carpal tunnel symptoms. Can’t take time off as no sick leave. Sole breadwinner and wife is expecting their third child.

  8. Who to tackle • Developing tools for access in NZ • Experts mined for current implicit decisions made explicit and weighted • “Ethical rationing”; human rights, NZ values (clarity, timeliness, fairness) • Methodology based on: • Need • Ability to benefit-likelihood, quantum, duration • Impact on life • Consequence of delay • Risk

  9. Who to tackle: prioritising the defensive line • Decision 1 What’s best for this patient? • Decision 2 Is it available in public health? • Decision 3 How soon? • Decision 2b Next best alternative and needs data? Feedback or more information: ros_gellatly@moh.govt.nz chris_mcewan@moh.govt.nz

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