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 carenetworks, large number of PPP (pharmacy, labs,private hospitals, General Practice)• In comparision to most OECD indicators we areperforming well and delivering value-for-money• Growth in NZers’ life expectancy is the highest inthe OECD• 19% of total government spending goes into voteHealth ($14 billion NZD)
Challenges• Living within our means: our rate of growth in health spend isunsustainable• Population ageing: increasing demands on health system (44%increase)• Increased chronic conditions – 80% of deaths are a result of heartdisease, 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 adevolved health and disability system
Primary Care Networks• From small individual businesses to 100 practice, 500,000 patientsjointly 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 drivenpressures– 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 currentbusiness and clinical models of care– System focused – to facilitate agreed outcomes – National HealthTargets– Community service delivery – manage and provide a range ofcommunity based services to support primary care– Health promotion/Public Health – drive a range of publichealth/population health based initiatives in a community setting– Quality improvement/variation management – clinical governance– Development of new models of care to meet current and futuredemands and expectations– Clinical and political leadership to drive system integration andimproved performance – accountability
500,000 lives4 million+ encountersHundreds of settingsLife long relationships60 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 servicesThe way to bring together the founding partners to ensure eachpartner is successfulVehicle to enable single contract/planPinnacleIncorporatedPrimary HealthCare LimitedMidlands HealthNetwork LimitedMidlands RegionalHealth NetworkCharitable TrustRole of Members of the GroupTui OraLimited Integrated health service organisation committed to enhancinghealth and wellbeing.General Practice network – sets the strategic framework, priorities, holdsand controls investment resources, monitors performance – Board electedfrom members – 350 GP members, 500 PN, 97 PMPinnacle provider arm for practice ownership –provides a vehicle to exploreand develop new practice models, support at risk areasManagement company – employs staff, develops and operatessystems, operates a range of direct to non-GP patient services via providerarm (the engine room for getting stuff done) – Pinnacle/IndependentGovernanceVehicle for connecting with strategic partners + single point for contractingwith Multi DHBs, MoH – Community/Provider/Independent GovernanceMHN Family
HealthyCommunitiesFit for purposeGeneral PracticeModels of CareMDTsIntegrationRight sizingprovider armsSustainabilityHospitalperformanceBSMC ServicesMDTperformanceProactivecareGeneral PracticeperformanceSelf care
• Building new business models• Building new models of care• Responding to demand• Creating a new workforce• Creating primary care leadership• Managing changeWalking the tight rope of expectation• Today’s business needs• Creating comfortable exits• Political, community and professionalexpectation
Locality & System PlanningPopulationNGO servicesPrimary CareHospital servicesFacilitiesFuture configuration
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 professionalorginsation, out plays the College, NZMA etc• Allows local inovation to flourish• Enables local contracting for a broader range of services ratherthan 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 bedeveloped – 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 nextgeneration vs coporate takeovers• Further development of self management CQI and harmreduction programs
The risk ofdoingnothing….Thechallenge ofchange…
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