Primary Health Care Strategy

1
Primary Health Care Strategy Implementation
Plan
Stephen McKernanDirector General of Health
2
The health system is experiencing a number of
pressures, which will intensify

• Current pressures
• Workforce shortages at all levels
• Service failures
• Cost growth
• Safety and quality
• Health Targets
• Inequity of access
• Decisions in the national interest
• Pressures will intensify in the future
• Population growth, redistribution and ageing
• Increasing risk and prevalence of long term
  conditions
• Risk of a second wave of health inequalities
  associated with obesity
• Managing within an affordable funding path
• Effective utilisation of the available workforce
  
• Effective application of technological advances
  and
• Rising consumer expectations

3
Likely service configuration changes have been
identified

• Acute secondary and tertiary inpatient services
  will consolidate into a smaller number of centres
• Smaller district hospitals will use clustering,
  regional services and networks to expand their
  critical mass
• Services will shift between professional groups
  and to lower levels of care
• Primary health care will have a greater role in
  prevention, delivery of traditionally secondary
  based services, and improved access to specialist
  diagnostic testing
• Information technology will enable an increase in
  integration and self management

4
Challenges

• Sustainability funding, clinical, workforce,
  demand/supply
• Workforce capability/capacity
• Trust and relationships professional, PHO, DHB,
  MOH
• Clinical leadership, governance
• Performance improvement variability,
  incentives/levers, measures, public info
• National leadership versus local autonomy.
  ?centralised policy
• Coordinated responses information, service
  equity. ?sector oversight
• Change in a commercial environment environment
  that encourages progress and development
• Reduced rate of funding growth
• Collaboration in a devolved environment
  consensus difficult, variable
• Collective good vs lowest common denominator
  responses. ?Decision making processes needed

5
Possible direction

• Earned autonomy for capable PHOs
• Stronger clinical governance balanced
  organisational governance
• Clinical networks to drive performance/quality
• Flexibility on funding use
• Outcomes based contracting models improved
  accountability measures
• Partnership models with DHBs
• Strong locality focus, geographic?
• Delegated funding
• Extended range of services
• Minimum population
• Multiple contract models
• Incentives for capital investment for larger
  practices to develop integrated service delivery
  models

6
What platform do we build on?

• 80 PHOs established since 2002
• 4.0m people enrolled and patient satisfaction
  remains high, by international comparisons
• Access
• 50 reduction in schedule fees
• Very low cost access 1.16m New Zealanders
• Children lt 6 years 77 free
• Cheaper pharmaceuticals for all
• Greater use of services
• Services
• More focus on chronic conditions
• Innovative new approaches, and greater use of
  nurses
• Improving performance
• Practice accreditation Cornerstone/Te Wana
• PHO Performance Programme overall improvement,
  but significant variation
• Quality Improvement Committee
• Health Targets

7
Life expectancy gap between Maori and
non-Maori(1951 2006)
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Unmet need for GP services (any reason), adults
by gender
NZ Health Survey, 1996/97, 2002/03, 2006/07
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How well is New Zealand managing CVD risk?
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Trends in smoking 1996-2007(NZ Health Survey)
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Acute Coronary Syndrome
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PHO Performance Programme
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PHO Performance Programme
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Government Priority Major Areas

• Reduce Endless Waiting
• Towards Better, Sooner and More Convenient
  Primary Care
• Improving Performance and Quality
• Strengthening the Health Workforce