Primary Care Planning
The Future of Primary Care - Towards 2010: Capacity, Sustainability, Collaboration and Innovation.
Further information is available in the Future of Primary Care - Towards 2010 documents:
Capacity
Building Capacity of Primary Health Organisations to Meet Population Health Objectives.
A key feature of the Government’s Primary Health Care Strategy (2001) was the establishment of Primary Health Organisations (PHOs) as local structures with responsibility for organising the delivery of health services to meet the needs of their enrolled populations. Considerable time and energy has been invested in the creation of PHOs.
There are four PHO in the MidCentral District Health Board (MDHB) district. They are geographically based and with new investment from both the MoH and MidCentral DHB, they are already gaining in capability. However this is only the beginning. In order to make real gains in population health and reduce some of the inequities between our populations we need to ensure the primary care sector is well organised, knowledgeable and effective. PHOs need to be empowered to fulfil their responsibility to the health needs of their communities.
There are three potential pathways to develop the sector:
- NGO and other primary health care providers work with PHOs on a collaborative basis to meet the health needs of our communities
- Distributed with virtual teams
- NGO and other primary health care providers are coordinated locally by PHOs
The first approach is the Ministry of Health’s preferred pathway. Development is likely to be piecemeal and inconsistent (rather than planned) and the timeframes are likely to be long. There is a risk that the momentum achieved to date will be lost. The second and third options provide opportunities for more planned, managed and timely development but present a number of practical and philosophical issues for the key stakeholders.
Sustainability
A Vision for Primary Care in 2015: Implications for General Practice.
This portrays a vision of General Practice within a reconfigured primary care setting.
Drivers for change are introduced as well as the theme that size matters in general practice configuration, arguing that lack of capacity in primary care has been a key driver for the traditional aggregation of services in and around the hospital. Other trends such as convergence of personal and public health, and future workforce issues are also discussed.
The reader is taken forward to 2015 and suggests that the current vision has been implemented, describing the drivers and key issues which led to a successful transition. It links the issue of perceived lack of capacity for GPs to perform a different role to the prospect of new and larger facilities providing a pivotal “trigger” in transforming both the clinical and business model of general practice. It emphasises the importance and potential for information technology to both enable and support the change process.
GPs now perform the role of a community generalist, providing clinical leadership and interventions for minor surgery, chronic disease management and emergency medicine as well as being available to fulfil the traditional role as family doctor.
Shifts in emphasis and redesign could only be achieved by way of well planned and well implemented infrastructure development within community based health service sectors. While infrastructure development includes leadership, workforce development, IT development and more, none of this would have happened without a major re-think of health facilities.
The implications of such a change on funders and providers are illustrated.
The reader is then brought back to the present and the report describes in more detail the factors which contribute to successful change. Options for GP amalgamation are outlined; a more detailed approach to facilities development is given, along with a potential blueprint for Mid Central. Examples of integrated services enabled by scale, organisational design and IT are also described. An emphasis on variety, and that “one size does not fit all” is a recurring theme.
Collaboration
Enhanced Quality of Care Through More Effective Collaboration.
As it is currently configured, the health system is struggling to meet demand. Fundamental changes methods of service delivery will be required if the system is to adequately respond to anticipated epidemiologic and demographic pressure.
The Hospitalist system currently in place has several vulnerabilities which impact upon its ability to maintain and increase capacity. These vulnerabilities relate to information transfer and to the working relationships which exist between medical practitioners in the primary and secondary sectors.
Modest changes in the nature of working relationships related to communication, task allocation and teamwork have the potential to significantly increase capacity, improve quality of services and enhance job satisfaction. The rationale for and scope of such changes are discussed in this document
Innovation
The Health Incubator Concept
The MidCentral DHB has been at the forefront of strategic development in the sector and has developed a strategic framework to guide future investment. A key part of this is the establishment of a mechanism to allow new health opportunities and innovation to thrive in the district. This paper introduces and explains the rationale behind this mechanism being the establishment of a health incubator.
Business incubators have become relatively common in New Zealand and are building a solid track record for developing and growing new businesses. Some health related areas have emerged from these incubators but in the main health related opportunities sit outside the scope of the current business incubators.
The establishment of a health incubator in the district would allow the DHB to create an environment where health related business opportunities and innovation can flourish. The benefits of this would include:
- Population health gains from new services and processes
- Generation of new revenue streams for the DHB
- An environment for health innovation
- Local and regional economic benefits
- Enhanced collaboration across organisations, sectors and government agencies
- Enhanced MidCentral DHB brand recognition
- Relationships developed with a wide variety of organisations and individuals.
The proposed health incubator outlined in this document has four operational areas and these are underpinned with best of class support services available to all projects and initiatives operating within the health incubator. The four operational areas are:
- Business start ups – new business opportunities with revenue generating potential
- Health innovation – new initiatives to improve health outcomes
- Infrastructure projects – to facilitate the development of a best of class infrastructure
- Relationships and marketing – develop effective and productive relationships with individuals and organisations.
One of the most critical aspects to a well functioning incubator is the ability of the Board to support and champion the incubator’s mission and objectives. The health incubator will be no different and it is vital that an effective and highly motivated Board is developed.
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