Department of Primary Health Care and General Practice

1. Playing the advantage in policy:maximising the opportunities and benefits of primary care in the NZ health system Department of Primary Health Care and General Practice University of Otago – Wellington – New Zealand Tony Dowell

2. Benefits and Opportunities • Celebrating what we do best • High quality integrated primary care and clinical general practice to enrolled populations • Keeping care patient focused + built on relationships • Effective working across the primary / secondary sector • Two BIG policy opportunities • Long term condition management • Children • Life course approach • elective waiting lists

3. Policy Benefits of current primary care system • General Practice fundamental platform for Primary Health Care in NZ • Access to primary care • Continuity of Care • Enrolment • Local delivery and organisation of health care • Teamwork • Present role mix is working ‘reasonably well’ • Good access to treatment / medication • Good access to IT

4. The Heart of General Practice Policy The whole person - family Time and history Place The world and its uncertainty Partnership

5. Primary Health Organisations

6. Policy opportunities at a systems and organisational level • Enhanced referral systems – EHR • Evolving primary care team roles • Physician assistant • Primary care coordinator (e.g mental health) • Finding the place for public health as part of primary care • Getting policy joined up in: • Lifestyle – alcohol , obesity, recreational drugs • Child health (Well child / Midwifery – see later)

7. Changing numbers and types of organisation

8. Changing numbers and types of organisation PHO No 1 PHO No 2

9. Integrated Family Health Centre Better Sooner More Convenient

10. Policy Opportunity 1 Long Term Condition Management Diabetes, Arthritis, Depression, COPD Stroke, IHD etc ….

11. Diabetes care • ‘for this i don’t know how much you know or don’t know about diabetes but it’s ‘ • Multiple consultations • Multiple providers • Check list management of risk factors • ? How effective and coordinated

12. There’s not enough time ?

13. Redesigning long term condition consultations • Time is sufficient but used without coordination within the PHCT • Professional isolation of primary health care team members • Reduplication of information out of context from patients needs or experience • Checklist approach to care sometimes prevents the main issues being addressed

14. Policy opportunity 2Child health

15. ‘Jack’ - 9 Years • Father in jail • 2 siblings, • Mother 29: medical condition, unable to sustain a job though trying – in and out of jobs • Overweight • Learning difficulties at school • Bullying in the playground Medical history: • Multiple visits to GP and A +M Asthma, eczema, chest infections, skin infections, injuries, 10 hospital admissions – bronchilitis (baby x2) asthma (x3), broken leg, head injury, cellulitis (x2), dental abscess

16. The intervention potential Age 80 + 60-80 40-60 20-40 0-20 Established disease Established risk factors Developing risk factors

17. The early early years

19. Policy Solutions Not one single solution but principles are simple: • Utilisation of enrolment policy and systems more effectively • Access to primary care 24/7 • Integration at many levels and across sectors • Funding and policy to support child population-based approaches

20. Maternal and child health • Antenatal engagement • Early enrolment • Access to care • Know the population, utilise the PMS • Identification of ‘vulnerable’ • Referral and relationships with local services • Integration with maternity and well child health

21. TimeTeamwork Systems and I.T.

22. Thank you