Towards 2030


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

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Towards 2030

  1. 1. Towards 2030…… A General Practice Perspective
  2. 2. This presentation – context and content <ul><li>Towards 2030 </li></ul><ul><li>Focus on the Patient….. </li></ul><ul><li>What works? </li></ul><ul><li>Future Trends </li></ul><ul><li>What do patients (consumers) expect? </li></ul><ul><li>Where to from here? </li></ul>
  3. 3. Focus on the Patient
  4. 4. Focus on the Patient, and the Relationship
  5. 5. Our future challenge is to... <ul><li>Maintain patient focus within a culture of quality care… </li></ul><ul><li>While….. </li></ul><ul><li>Improving health outcomes </li></ul><ul><li>Safely </li></ul><ul><li>Efficiently </li></ul><ul><li>Maximising technological advances </li></ul><ul><li>“ Patient Centred Professionalism ” </li></ul>
  6. 6. “ Patient centred Professionalism” <ul><li>Patient Centredness </li></ul><ul><li>Professionalism </li></ul>
  7. 7. Patient Centredness <ul><li>Putting the role of the patient (consumer) at the centre of health care </li></ul><ul><li>( cf providers or “systems”) </li></ul>
  8. 8. Patient Centredness Treating the patient, not just the disease <ul><li>“ It is sometimes more important to treat the patient who has the disease than the disease the patient has” </li></ul><ul><li>Osler or Peabody? </li></ul>
  9. 9. Professionalism <ul><li>Professional Competence </li></ul><ul><li>High Standards of Care </li></ul><ul><li>Maintained through Clinical Governance </li></ul><ul><li>“ Professionalism expresses a profession’s culture. It should epitomise good practice” </li></ul><ul><li>Donald Irvine, BMJ 2005 </li></ul>
  10. 10. Clinical governance….. <ul><li>Managing the gap between current practice and best practice . </li></ul>
  11. 11. Managing the gap between current practice and best practice. <ul><li>Managing the gap </li></ul><ul><ul><li>Personnel and processes </li></ul></ul><ul><ul><li>Good management and clinical support for general practice </li></ul></ul><ul><ul><li>New quality tools. </li></ul></ul><ul><li>Current practice </li></ul><ul><ul><li>Measuring performance and supporting change </li></ul></ul><ul><li>Best practice </li></ul><ul><ul><li>Information tools </li></ul></ul><ul><ul><li>Decision support </li></ul></ul><ul><ul><li>(guidelines, CME, facilitation) </li></ul></ul>
  12. 12. What Works?
  13. 13. What Works..Primary Care Focus <ul><li>Barbara Starfield has shown that: </li></ul><ul><li>“ 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” </li></ul><ul><li>. </li></ul>
  14. 14. Critical requirements <ul><li>Clinical leadership </li></ul><ul><li>Ownership </li></ul><ul><li>Support </li></ul><ul><li>Relationships </li></ul><ul><li>“ Bottom Up” approach to Health Care </li></ul>
  15. 15. Organised General Practice <ul><li>“ Organised General Practice (“OGP”) means: </li></ul><ul><li>“ 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. </li></ul><ul><li>OGP embraces new responsibilities including, for example, activities in public health, screening, illness prevention, disease management and resource management. </li></ul><ul><li>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.” </li></ul>
  16. 16. COPD outcomes Respiratory bed days COPD project jointly implemented by ProCare eastHealth, First Health and Tainui
  17. 17. COPD outcomes Non- respiratory bed days COPD project jointly implemented by ProCare eastHealth, First Health and Tainui
  18. 18. Two Auckland hospitals: cardiology, respiratory and gen med admissions.
  19. 19. Winner -Service Organisation 2003 Rotorua Business Awards <ul><li>Organised General Practice </li></ul>
  20. 20. Primary Health Care Strategy <ul><li>Acknowledgement of Primary Care </li></ul><ul><li>A Vision for Primary Health Care </li></ul><ul><li>Involve Communities </li></ul><ul><li>Focus on Wellness </li></ul><ul><li>Reduce Health Inequalities </li></ul>
  21. 21. PHCS – New Opportunities Organised Primary Care <ul><li>Local solutions </li></ul><ul><li>Build on the gains of OGP </li></ul><ul><li>Embracing a wider group of providers </li></ul><ul><li>Involving communities and iwi </li></ul><ul><li>Seamless care within DHBs </li></ul><ul><li>Wider determinants of health </li></ul><ul><li>Intersectoral Relationships </li></ul>
  22. 22. Primary Health Care Strategy <ul><li>Enrolment </li></ul><ul><ul><li>Makes explicit the relationship between provider and patient </li></ul></ul><ul><ul><li>Capitation </li></ul></ul><ul><ul><li>Effectiveness reduced because of accounting rather than clinical focus. </li></ul></ul><ul><ul><li>NHI </li></ul></ul><ul><ul><ul><li>Duplication, process. </li></ul></ul></ul><ul><ul><li>Geocoding </li></ul></ul><ul><ul><ul><li>Used mainly for payment rather than a health care tool </li></ul></ul></ul>
  23. 23. PHCS – the progress .. “Disorganised” Primary Care? <ul><li>21 DHBs, 81 PHOs </li></ul><ul><li>Some excellent pockets of innovation </li></ul><ul><li>Health gains slowed with structural reform </li></ul><ul><li>National inconsistency and variation of services </li></ul><ul><li>Cheaper to all, loss of targeted funding </li></ul><ul><li>Marginalisation of general practice </li></ul><ul><li>Loss of GP morale despite increased funding </li></ul><ul><li>Loss of leadership, ownership, relationships </li></ul>
  24. 24. Visits to General Practice <ul><li>50,000 individual consults per day </li></ul><ul><li>>10 million consults per year </li></ul><ul><li>>15 million clinical decisions documented </li></ul><ul><li>80% population visit in 12 months </li></ul><ul><li>90% in 2 years </li></ul><ul><li>Average 3 visits per year </li></ul>
  25. 25. Future Trends
  26. 26. Vision - IPAC 1999 <ul><ul><li>‘… .. the development of an effective primary care led health system delivering improved health and accident outcomes for patients and populations through organised general practice ’ </li></ul></ul>
  27. 27. <ul><li>“ Medicine looks likely to change more in the next 20 years than it has in the last 200” </li></ul><ul><li>BMJ Nov 1999 </li></ul>
  28. 28. 2030… <ul><li>Cannot be predicted with certainty </li></ul><ul><li>Microsoft only predicts 5-10 yrs out! </li></ul><ul><li>Future health system will reflect society – </li></ul><ul><li>social, economy, politics, technology, </li></ul>
  29. 29. Trends - Societal <ul><li>Ethnic and cultural diversity </li></ul><ul><li>Single parent homes </li></ul><ul><li>Ageing </li></ul><ul><li>Alternative medicine </li></ul><ul><li>Consumerism - patient rights </li></ul><ul><li>Convenient care </li></ul><ul><li>Higher expectations and patient education </li></ul>
  30. 30. Trends - Economic <ul><li>Globalisation </li></ul><ul><li>Public/private balance in health care </li></ul><ul><li>Rising costs of health care </li></ul>
  31. 31. Trends - Political <ul><li>PHCS – where to from here? </li></ul><ul><li>Population vs personal health </li></ul><ul><li>Unstable public funding, regular reform </li></ul><ul><li>Health Boards vs hospital boards </li></ul><ul><li>National vs Labour? </li></ul>
  32. 32. Trends – General Practice <ul><li>Larger practices </li></ul><ul><li>Multidisciplinary teams </li></ul><ul><li>Many service delivery models </li></ul><ul><li>Feminisation </li></ul><ul><li>Work/life balance of gen x/y </li></ul><ul><li>Information critical to continuity of care and delivery of care </li></ul><ul><li>Wider scopes of practice </li></ul><ul><li>Interact with wider primary care team - PHO </li></ul>
  33. 33. Patient Expectations
  34. 34. Patient Expectations –Health <ul><li>Health Status </li></ul><ul><li>changing life expectancy </li></ul><ul><li>(disability, chronic illness, mental illness </li></ul><ul><li>mortality rates) </li></ul><ul><li>maintain wellness </li></ul><ul><li>improved health outcomes </li></ul>
  35. 35. Patient Expectations-Primary Care <ul><li>Quality care by competent professionals </li></ul><ul><li>Convenience of care, close to home </li></ul><ul><li>Safe care </li></ul><ul><li>Affordable care </li></ul><ul><li>Participation in their Health Care </li></ul><ul><li>Integrated services, shaped around them </li></ul><ul><li>Co-ordination of services by trusted team </li></ul>
  36. 36. Patient Expectations <ul><li>Information </li></ul>
  37. 37. What next for General Practice in New Zealand? Keep it between me and my GP!!
  38. 38. Patient Expectations - Information <ul><li>Accessible </li></ul><ul><li>Accurate </li></ul><ul><li>Control over who views information and when </li></ul><ul><li>Confidentiality </li></ul><ul><li>Consent </li></ul><ul><li>Security </li></ul><ul><li>Appropriate sharing </li></ul>
  39. 39. Patient Expectations - Information <ul><li>Integrated </li></ul><ul><li>Transferrable </li></ul><ul><li>Educational tool </li></ul><ul><li>Communication tool </li></ul>
  40. 40. Where to From Here?
  41. 41. Keep it simple!!! <ul><li>Focus on consumer (patient centred) </li></ul><ul><li>Strong primary care led sector </li></ul><ul><li>Hospitals for acute illness </li></ul><ul><li>Clinical leadership and ownership </li></ul><ul><li>Management support for clinicians </li></ul><ul><li>Govt sets policy, builds good relationships </li></ul><ul><li>Keep administration simple </li></ul><ul><li>Flexible models of care, local solutions </li></ul>
  42. 42. Information Systems towards 2030… <ul><li>Excellent systems that communicate! </li></ul><ul><li>Reliable, flexible, user friendly </li></ul><ul><li>Multiple processes triggered by single interaction </li></ul><ul><li>Designed primarily for needs of patient care </li></ul><ul><li>Keep database close to source </li></ul><ul><li>Databases in practice or “healthcare home” in primary care (accuracy,safety) </li></ul><ul><li>Address legitimate needs of funders and policy makers with appropriate view </li></ul><ul><li>Address clinical governance needs of professionals with appropriate view </li></ul>
  43. 43. Patient Information towards 2030… <ul><li>Identifiable clinical information based in practice, directly accessible to patient </li></ul><ul><li>Episodic clinical information directed to the practice database </li></ul><ul><li>Patient information selectively accessible by patient or between clinicians throughout journey within the system </li></ul><ul><li>Patient held information </li></ul>
  44. 44. <ul><li>“ Information is not Knowledge” </li></ul><ul><li>Albert Einstein 1879 - 1955 </li></ul>
  45. 45. <ul><li>“ 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.” </li></ul><ul><li>Dr Carl Sagan </li></ul>
  46. 46. Keep IT between me and my GP! Keep “IT” between me and my GP!!