John Macaskill-Smith: Supporting general practice needs

Ensuring health for the future

Overview of the NZ Health system

• 4 million population

• 13.8 million GP visits, 65 million prescription items,

24 million lab tests, 1 million E.D. attendances

• Largely devolved system – Central ministry/ACC ,

20 regional Distrist Health Boards, 30 primary care

networks, large number of PPP (pharmacy, labs,

private hospitals, General Practice)

• In comparision to most OECD indicators we are

performing well and delivering value-for-money

• Growth in NZers’ life expectancy is the highest in

the OECD

• 19% of total government spending goes into vote

Health ($14 billion NZD)

Challenges

• Living within our means: our rate of growth in health spend is

unsustainable

• Population ageing: increasing demands on health system (44%

increase)

• Increased chronic conditions – 80% of deaths are a result of heart

disease, cancer, diabetes and tobacco related illness

• Increasing expectations from the public on health system performance

• Workforce ageing and changing expectations

• Fragmentation and differences in service performance across a

devolved health and disability system

Primary Care Networks

• From small individual businesses to 100 practice, 500,000 patients jointly governed networks.

• 1990s – organic growth of networks – Improving quality and reducing professional isolation

– Frustration around lack of practical relevance of professional bodies

– Collective bargaining around local and national contracts

• Mid 1990s “funder investment” & Policy Development – Ease of contracting with a group

– Introduction of capitation vs FFS

– Pharms and labs budget & risk holding contracts to cap demand driven

pressures

– Introduction and incentivisation to develop electronic records and claiming

– Development of primary care community services

Primary Care Networks (IPA – PHO – PCN)

• Operating over a broad spectrum

– Union – collective bargaining to maintain and protect current

business and clinical models of care

– System focused – to facilitate agreed outcomes – National Health

Targets

– Community service delivery – manage and provide a range of

community based services to support primary care

– Health promotion/Public Health – drive a range of public

health/population health based initiatives in a community setting

– Quality improvement/variation management – clinical governance

– Development of new models of care to meet current and future

demands and expectations

– Clinical and political leadership to drive system integration and

improved performance – accountability

500,000 lives

4 million+ encounters

Hundreds of settings

Life long relationships

60 years of unlearning

Ensure  the  future  of  high  quality  general  practice….

Be a vehicle to enable the development of new models,

ownership etc to ensure sustainability of high quality GP.

Sustainable & leading edge primary care services

The way to bring together the founding partners to ensure each

partner is successful

Vehicle to enable single contract/plan

Pinnacle

Incorporated

Primary Health

Care Limited

Midlands Health

Network Limited

Midlands Regional

Health Network

Charitable Trust

Role of Members of the Group

Taranaki Primary

Health Provider

Incorporated

Turanga

Health

Tui Ora

Limited Integrated health service organisation committed to enhancing

health and wellbeing.

Delivering high quality primary healthcare through strategic

partnering and best practice clinical service delivery.

Network of General Practitioners, and through its partnerships

provides opportunities to improve access to services for Maori

and high need populations through the delivery of a wide range

of health services and programmes.

General Practice network – sets the strategic framework, priorities, holds

and controls investment resources, monitors performance – Board elected

from members – 350 GP members, 500 PN, 97 PM

Pinnacle provider arm for practice ownership –provides a vehicle to explore

and develop new practice models, support at risk areas

Management company – employs staff, develops and operates

systems, operates a range of direct to non-GP patient services via provider

arm (the engine room for getting stuff done) – Pinnacle/Independent

Governance

Vehicle for connecting with strategic partners + single point for contracting

with Multi DHBs, MoH – Community/Provider/Independent Governance

MHN Family

Healthy Communities

Fit for purpose General Practice

Models of Care

MDTs

Integration

Right sizing provider arms

Sustainability

Hospital performance

BSMC Services MDT

performance Proactive care

General Practice performance

Self care

From funding to solutions

Reflection & Development

• Building new business models

• Building new models of care

• Responding to demand

• Creating a new workforce

• Creating primary care leadership • Managing change

Walking the tight rope of expectation

• Today’s business needs

• Creating comfortable exits

• Political, community and professional

expectation

Locality & System Planning

Population

NGO services

Primary Care

Hospital services

Facilities

Future configuration

An example – Model of Care

It went something like…..

Why Networks are important

• MoH and DHBs are too far removed from the “business end”

• System change vs small business management

• General Practice needs a busines and local professional

orginsation, out plays the College, NZMA etc

• Allows local inovation to flourish

• Enables local contracting for a broader range of services rather than just nationally agreed

– Front line General Practice

– Practice nursing

– Specialist nursing

– Mobile and district nursing

– Allied services

– Mental health

– Pop health services

What next for networks

• Alliance agreements are allowing broader roles to be

developed – community based outpatient services

• Commissioning of wider range of services

• Implementation of new models of care – Medical home

– Rural services

– Rusral hospital management

• Ownership and management of practices for the next

generation vs coporate takeovers

• Further development of self management CQI and harm reduction programs

The risk of

doing

nothing….

The

challenge of

change…