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Towards 2030
 

Towards 2030

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Bev O\'Keefe

Bev O\'Keefe
Independent Practitioners Association Council (IPAC)

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    Towards 2030 Towards 2030 Presentation Transcript

    • Towards 2030…… A General Practice Perspective
    • This presentation – context and content
      • Towards 2030
      • Focus on the Patient…..
      • What works?
      • Future Trends
      • What do patients (consumers) expect?
      • Where to from here?
    • Focus on the Patient
    • Focus on the Patient, and the Relationship
    • Our future challenge is to...
      • Maintain patient focus within a culture of quality care…
      • While…..
      • Improving health outcomes
      • Safely
      • Efficiently
      • Maximising technological advances
      • “ Patient Centred Professionalism ”
    • “ Patient centred Professionalism”
      • Patient Centredness
      • Professionalism
    • Patient Centredness
      • Putting the role of the patient (consumer) at the centre of health care
      • ( cf providers or “systems”)
    • Patient Centredness Treating the patient, not just the disease
      • “ It is sometimes more important to treat the patient who has the disease than the disease the patient has”
      • Osler or Peabody?
    • Professionalism
      • Professional Competence
      • High Standards of Care
      • Maintained through Clinical Governance
      • “ Professionalism expresses a profession’s culture. It should epitomise good practice”
      • Donald Irvine, BMJ 2005
    • Clinical governance…..
      • Managing the gap between current practice and best practice .
    • Managing the gap between current practice and best practice.
      • Managing the gap
        • Personnel and processes
        • Good management and clinical support for general practice
        • New quality tools.
      • Current practice
        • Measuring performance and supporting change
      • Best practice
        • Information tools
        • Decision support
        • (guidelines, CME, facilitation)
    • What Works?
    • What Works..Primary Care Focus
      • Barbara Starfield has shown that:
      • “ Nations that adopt a primary care led approach to health care have lower costs, higher satisfaction amongst the population with their health care services, better overall health levels and lower costs of medication use”
      • .
    • Critical requirements
      • Clinical leadership
      • Ownership
      • Support
      • Relationships
      • “ Bottom Up” approach to Health Care
    • Organised General Practice
      • “ Organised General Practice (“OGP”) means:
      • “ groups of general practices, managers, and others working together in networks of cooperation and support , providing both individual and population oriented care for enrolled communities of patients.
      • OGP embraces new responsibilities including, for example, activities in public health, screening, illness prevention, disease management and resource management.
      • OGP accepts accountability for health outcomes and the best use of resources. OGP is supported at all levels by excellence in management services, to ensure optimum effectiveness and efficiency.”
    • COPD outcomes Respiratory bed days COPD project jointly implemented by ProCare eastHealth, First Health and Tainui
    • COPD outcomes Non- respiratory bed days COPD project jointly implemented by ProCare eastHealth, First Health and Tainui
    • Two Auckland hospitals: cardiology, respiratory and gen med admissions.
    • Winner -Service Organisation 2003 Rotorua Business Awards
      • Organised General Practice
    • Primary Health Care Strategy
      • Acknowledgement of Primary Care
      • A Vision for Primary Health Care
      • Involve Communities
      • Focus on Wellness
      • Reduce Health Inequalities
    • PHCS – New Opportunities Organised Primary Care
      • Local solutions
      • Build on the gains of OGP
      • Embracing a wider group of providers
      • Involving communities and iwi
      • Seamless care within DHBs
      • Wider determinants of health
      • Intersectoral Relationships
    • Primary Health Care Strategy
      • Enrolment
        • Makes explicit the relationship between provider and patient
        • Capitation
        • Effectiveness reduced because of accounting rather than clinical focus.
        • NHI
          • Duplication, process.
        • Geocoding
          • Used mainly for payment rather than a health care tool
    • PHCS – the progress .. “Disorganised” Primary Care?
      • 21 DHBs, 81 PHOs
      • Some excellent pockets of innovation
      • Health gains slowed with structural reform
      • National inconsistency and variation of services
      • Cheaper to all, loss of targeted funding
      • Marginalisation of general practice
      • Loss of GP morale despite increased funding
      • Loss of leadership, ownership, relationships
    • Visits to General Practice
      • 50,000 individual consults per day
      • >10 million consults per year
      • >15 million clinical decisions documented
      • 80% population visit in 12 months
      • 90% in 2 years
      • Average 3 visits per year
    • Future Trends
    • Vision - IPAC 1999
        • ‘… .. the development of an effective primary care led health system delivering improved health and accident outcomes for patients and populations through organised general practice ’
      • “ Medicine looks likely to change more in the next 20 years than it has in the last 200”
      • BMJ Nov 1999
    • 2030…
      • Cannot be predicted with certainty
      • Microsoft only predicts 5-10 yrs out!
      • Future health system will reflect society –
      • social, economy, politics, technology,
    • Trends - Societal
      • Ethnic and cultural diversity
      • Single parent homes
      • Ageing
      • Alternative medicine
      • Consumerism - patient rights
      • Convenient care
      • Higher expectations and patient education
    • Trends - Economic
      • Globalisation
      • Public/private balance in health care
      • Rising costs of health care
    • Trends - Political
      • PHCS – where to from here?
      • Population vs personal health
      • Unstable public funding, regular reform
      • Health Boards vs hospital boards
      • National vs Labour?
    • Trends – General Practice
      • Larger practices
      • Multidisciplinary teams
      • Many service delivery models
      • Feminisation
      • Work/life balance of gen x/y
      • Information critical to continuity of care and delivery of care
      • Wider scopes of practice
      • Interact with wider primary care team - PHO
    • Patient Expectations
    • Patient Expectations –Health
      • Health Status
      • changing life expectancy
      • (disability, chronic illness, mental illness
      • mortality rates)
      • maintain wellness
      • improved health outcomes
    • Patient Expectations-Primary Care
      • Quality care by competent professionals
      • Convenience of care, close to home
      • Safe care
      • Affordable care
      • Participation in their Health Care
      • Integrated services, shaped around them
      • Co-ordination of services by trusted team
    • Patient Expectations
      • Information
    • What next for General Practice in New Zealand? Keep it between me and my GP!!
    • Patient Expectations - Information
      • Accessible
      • Accurate
      • Control over who views information and when
      • Confidentiality
      • Consent
      • Security
      • Appropriate sharing
    • Patient Expectations - Information
      • Integrated
      • Transferrable
      • Educational tool
      • Communication tool
    • Where to From Here?
    • Keep it simple!!!
      • Focus on consumer (patient centred)
      • Strong primary care led sector
      • Hospitals for acute illness
      • Clinical leadership and ownership
      • Management support for clinicians
      • Govt sets policy, builds good relationships
      • Keep administration simple
      • Flexible models of care, local solutions
    • Information Systems towards 2030…
      • Excellent systems that communicate!
      • Reliable, flexible, user friendly
      • Multiple processes triggered by single interaction
      • Designed primarily for needs of patient care
      • Keep database close to source
      • Databases in practice or “healthcare home” in primary care (accuracy,safety)
      • Address legitimate needs of funders and policy makers with appropriate view
      • Address clinical governance needs of professionals with appropriate view
    • Patient Information towards 2030…
      • Identifiable clinical information based in practice, directly accessible to patient
      • Episodic clinical information directed to the practice database
      • Patient information selectively accessible by patient or between clinicians throughout journey within the system
      • Patient held information
      • “ Information is not Knowledge”
      • Albert Einstein 1879 - 1955
      • “ Knowing a great deal is not the same as being smart; intelligence is not information alone but also judgement, the manner in which information is collected and used.”
      • Dr Carl Sagan
    • Keep IT between me and my GP! Keep “IT” between me and my GP!!