CARE ENHANCING PRIMARY We’re working together to achieve health equity. Moving General Practice from being part of the system to the heart of the system.

CARE ENHANCING PRIMARY FUTURE Progressively implement a more sustainable model of General Practice across Counties Manukau. With increased system capacity, even better engagement with community & care closer to the patient. NOW The way in which General Practice operates within Counties Manukau follows a traditional model - with 10-15 minute GP consultation remaining as the backbone of General Practice. This is not sustainable.

CARE ENHANCING PRIMARY Releasing capacity in General Practice teams to enable more integrated and coordinated engagement with complex patients Enabling practices to work in a more integrated way, to create capacity within their workflows to work more flexibly w/ complex patients. Better for us. Better for our patients. Better for our communities. Creating opportunities for patients to better engage with General Practice and to support self-management. Enabling real-time clinical information implementation & integration of technology platforms, to facilitate timely triage, proactive care & improved coordination. Reducing demand on hospital based services for unplanned and low acuity care

Transformational Change Programme Transformational Change Programme CARE ENHANCING PRIMARY Transformational Change Programme Transformational Change Programme Business Model Current Operating Model Current Capabilities Talent, Process, Technology, Data Business Model Target/Vision Operating Model Required Capabilities Talent, Process, Technology, Data

Transformational Change Programme CARE ENHANCING PRIMARY Transformational Change Programme Where we are currently Phase 1: Establish an Enhanced Primary Care model of care. Phase 2: Roll-out the Enhanced Primary Care model across a broader range of practices Phase 3: Implement the model and transform the experience for patients, community members and healthcare professionals

Potential Impact of Initial Phase CARE ENHANCING PRIMARY Total Enrolled Population 197,048 $ Total inpatient spend ($m) $148.68

CARE We all have a role to play to deliver Enhanced Primary Care. Module 1: Increasing Capacity CARE ENHANCING PRIMARY My practice has 30% more daily capacity by December 2016 “ ” We all have a role to play to deliver Enhanced Primary Care. Module 2: Increasing Efficiency “ My practice environment is optimised with no ‘choke points’ and minimal ‘hand offs’ by April 2017 ” Module 3: Increasing Capability Together we will involve people, whanau and families as an active part of their health team. Together we will help make healthy options easy options for everyone. Together we will provide excellent services that are well-supported to treat those who need us safely, with compassion and in a timely manner. “ My practice has practitioners all practicing at top of scope with use of HCAs and Health Coaches by July 2017 ” Module 4: Increasing Effectiveness “ My practice has is effective at preventing unnecessary ED and hospital presentations by September 2017 ”

An alliance initiative CARE ENHANCING PRIMARY

Module 1: Increasing Capacity Proposed Resource Requirements: Clinical Lead Change Manager Improvement Advisor IT and owners for technology requirements L&D for patient portal training support Timeframe to complete: 3 Months

My practice has 30% more daily capacity by December 2016 Increasing Capacity Step One: Map Acute Patient Journey for workflow optimisation Step Two: Telephone calls are away from reception Step Three: A telephony system with call counts is in place Step Four: Establish 2 hour morning telephone triage by GP Step Five: 50% of enrolled patients are signed up to patient portal and can use this for prescription reordering and results collection “ My practice has 30% more daily capacity by December 2016 ”

Module 2: Increasing Efficiency Proposed Resource Requirements: Clinical Lead Change Manager Building design and layout Advisor Improvement Advisor IT for technology requirements L&D for virtual consult training support Timeframe to complete: 3 Months

Increasing Efficiency Step One: Consultation room is standardised and available for any consultation Step Two: Building layout is optimised for current state Optimal future state designed Active sign posting – reception desk is a navigator Step Three: Clinical pre-work management is in place Step Four: Administration activities are only carried out by administrators Step Five: Virtual consultation is used with 10% of my patients “ My practice environment is optimised with no ‘choke points’ and minimal ‘hand offs’ by April 2017 ”

Module 3: Increasing Capability Proposed Resource Requirements: Change Manager Clinical Lead L&D for Improvement facilitation training Timeframe to complete: 4 Months

Increasing Capability Step One: Weekly MDT meeting established Step Two: Practice has a training improvement capabilities within the practice team Step Three: A nurse clinic is established Step Four: Scope of practice established for HCA /Health Coach Step Five: Cross disciplinary teams are in general practice including Pharmacist, Specialists “ My practice has practitioners all practicing at top of scope with use of HCAs and Health Coaches by July 2017 ”

Module 4: Increasing Effectiveness Proposed Resource Requirements: Change Manager Clinical Lead L&D for care plan and coordinator training IT technical resource Timeframe to complete: 4 Months

Increasing Effectiveness Step One: Care plan is in place for all ARI patients and for 50% of other chronic care patients Step Two: Care co-ordinators are in place for all ARI and other chronic care patients Step Three: Practice extended hours are offered Step Four: Patients have a range of practice visits and costs to choose from Step Five: Home visiting is available to patients “ My practice is effective at preventing unnecessary ED and hospital presentations by September 2017 ”

Increasing Effectiveness Step Six: Practice has access to a shared database to assist with population health and quality care management Step Seven: Home monitoring devices are available as part of planned proactive care and self management Step Eight: Partnership working for service delivery in place “ My practice is effective at preventing unnecessary ED and hospital presentations by September 2017 ”

Proposed Resource Model Role Functions FTE Total days per practice Programme Manager Programme co-ordination 1 26 PHO Lead Facilitator PHO Lead 2.5 65 Finance Advisor Financial model development Change Manager Change management expertise HR Advisor People and function mapping 0.5 13 Clinical Lead Clinical oversight Business Analyst Business process analysis Data Analyst Data analysis and reporting L&D resource support L&D resource and training Improvement advisor Improvement activity planning Communications Lead Integrated communications TOTAL CHANGE TEAM FTE 12 Per 10 Practices with days per practice based on 12 months