Engaged.. but not yet married: GP Liaisons in New Zealand

“Engagement” Clinical engagement- current buzz word Fit together to work like cogs- engage the clutch Hold my interest-engage my attention Public declaration-two create a unit

The situation in late 1990s Waiting lists, never never Inconsistency of access What can we continue to afford?

Electives Policy: a stake in the ground-Principles Patients know they will receive treatment Clarity Patients know when they will receive treatment Timeliness Patients want to be treated equitably Fairness Right treatment, right place, right person Quality

Seven Strategies to deliver the policy Nationally consistent clinical assessment Increase the supply of elective services Give patients certainty Improve the capability of public hospitals Better liaison between primary and secondary sectors Actively manage sector performance Build public confidence

Electives policy 2010 moving forward Health target- Increase access to elective surgery and improve access to outpatient/specialist advice New models/pathways of care Clinical leadership Within financial environment

Seven Strategies to deliver the policy Nationally consistent clinical assessment Increase the supply of elective services Give patients certainty Improve the capability of public hospitals Better liaison between primary and secondary sectors Actively manage sector performance Build public confidence

The model: GPLs GPs who liaise-experienced, extended networks, GP/consultant relationship local priorities Operational- elective services (and other services) Strategic –intelligence

The model: GPLs A practical way to get clinician engagement and connect two parts of the health system to better serve patients

GPLs : Introduction to Principles of Prioritisation Workshop RNZCGP 19/3/10

GPLs Operational Wait list review GP advice Production planning (demand/capacity management) Communications Process improvement and new pathways across primary/secondary interface-facilitating change

Impact on waiting list

Operational : Communications GPs visit ED and see what actually happens Real-time updated waiting times Advice about management – written, phone, lists of local GPs with specific skills, best ways to contact the consultant Letters….

The eye specialist wrote.. Dear Re:National Referral Guideline We wish to remind you of the national referral guidelines as they apply to ophthalmology, as there have been some incidences in recent times of these referral guidelines not being followed. The referral guideline clearly state that all cases considered by the referring practitioner to be immediate or urgent must be discussed with the specialist (or registrar) in order to get appropriate prioritisation and a time for the patient to be seen. The above therefore assumes that if no contact has been made then the referral of that patient is deemed to be not immediate or urgent. Referral letters which by the above definition therefore will be for semi urgent or routine cases are therefore triaged every week or two and the patient receives a confirmatory letter regarding their likely waiting time which would be hopefully similar to what the referral practitioner advised them on the basis of the referring guideline.

The eye specialist wrote… Routine or semi urgent referrals:The patient should be informed in writing following the triage of the referral letter as to what the likely time period for an appointment is and indication is given in this letter that if the situation should change then they should seek the attention of the referring practitioner in case the urgency has changed.

The GPL translated… Current waiting times: –Semi Urgent-2 Months –Routine-6 Months URGENT  Phone ophthalmologist Non-urgent  refer eye OPD  triage 1- 2 weeks to determine timeframe to be seen After hours  refer patient back to own GP to arrange further appointment

Facilitating change with GPLs Waiting list, backlog, unhappy patients, unhappy GPs, unhappy hospital staff…. Develop a solution with both sides together Trial it Roll out Maintain Managed wait, happier patients, GPs rest easy at night, hospital staff job satisfaction

Recent examples… Problem: blocked outpatient access  Access to diagnostics pilots Example: DBI 439 requests, only 95 FSA Problem: inefficient referrals  E referral/discharge Example: Single point access for patients with large bowel symptoms Problem: workforce capacity  Alternative models of care Example: ORL GPwSIs/FSA

Strategic Planning and implementing projects across the interface e.g. H1N1/ pandemic planning Intelligence sharing- DHB managers, PHOs, Clinical governance New models in primary care Complaints and potential in sentinel event management across the boundary

Sentinel events across the interface Lost referrals Events in primary care resulting in impact in secondary care and vice versa Secondary care sentinel event system, Primary care sentinel event management: developed separately….not joined up yet

GPLs: success factors Paid time in the day Change facilitators Live in both worlds-translators, cultural ambassadors Knowledge transfer Flexibility, “no boundaries” Linkages, networked Credibility with colleagues, colleague to colleague

Primary care portfolio manager

GPLs in NZ… (and Australia) Discussion Your examples to learn from, questions to ask and answer

Engaged… Understand the success factors in the GPL model –Consider this practical approach to clinician engagement in alternative pathways of care –Appreciate differences in perspective between primary and secondary care Reflect on attempts in NZ to minimise inequity of access and unintended consequences of change Could this approach help you?