Primary Health Care Strategy – Implementation Plan Stephen McKernan Director General of Health

Better, sooner, more convenient 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 Not a system: evaluation of the health reforms System leadership and strategic planning: Ministry review Lack of collaboration across DHB boundaries: Health & Disability Commissioner reports

Better, sooner, more convenient 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

Better, sooner, more convenient 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

Better, sooner, more convenient 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

Better, sooner, more convenient 6 What platform do we build on? 80 PHOs established since m 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 < 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

Better, sooner, more convenient 7 Life expectancy gap between Māori and non-Māori (1951 – 2006)

Better, sooner, more convenient 8 Unmet need for GP services (any reason), adults by gender NZ Health Survey, 1996/97, 2002/03, 2006/07

Better, sooner, more convenient 9 How well is New Zealand managing CVD risk?

Better, sooner, more convenient 10 Trends in smoking (NZ Health Survey)

Better, sooner, more convenient 11 Acute Coronary Syndrome… Diabetes 4,711 4,040

Better, sooner, more convenient 12 PHO Performance Programme

Better, sooner, more convenient 13 PHO Performance Programme

Better, sooner, more convenient 14 Government Priority Major Areas Reduce Endless Waiting Towards Better, Sooner and More Convenient Primary Care Improving Performance and Quality Strengthening the Health Workforce