MHN Model of care

Drivers for Change

A Failing P ublic P rivate P artnership Exiting generation of business owners Emerging generation with different expectations yrs of passive incremental disinvestment A growing gap between capacity and need Failed understanding of the nature of the PPP System too focused on building and maintaining Hospital services A primary care sector without a plan

The Journey

Current Model of Care

Patient Focused Future State

Key Changes All onstage space shared between all clinical staff Standardised supplies/trolleys More space – training and clinical services MCAs - rooming Clinical Pharmacist Offstage space for all staff Tripled the number of terminals Reduced waiting space Single phone system across all sites Access across all sites to patient information Online patient portal

Offstage for MCA Offstage for Nurses Standard rooms Offstage for Drs Self management areas Reduced waiting area

The PAC Tool box Multi site transparency – scheduling and real time availability of clinical staff General Enquires Results + out bound campaigns Care access –8-9am Dr triage –Virtual (nurse, pharmacist, Dr) –Planned virtual (nurse, pharmacist, Dr) –Face to face (nurse, pharmacist, Dr) DHB Clinical information – CWS Other

Inbound Volumes Higher level of calls earlier in the week And also earlier in the day (8-10am) Average 2,000 inbound calls per week

F2F Virtual

Demand 30 = 35 = 45 Others experience through implementing similar changes 9% decrease in F2F primary care consultations 90% increase in secure messaging/e health 12% increase in telephone consults 8% increase in speciality referrals 5% decrease in medical and surgical referrals 29% decrease ED and urgent care 11% decrease in avoidable hospitalisation Cost neutral across the whole system

Phased development

Locality Planning Creating and maintaining multi dimensional views of geographical based grouping of populations, health burden and provider capability Redesigning service delivery models – SLaTs Mapping future growth/decline Stocktake of structures and systems Planning the rebuild Bridging the private equity of structures and workforce with public service funding

Service Level Alliance Teams Defined outcomes Ensure a continuum of care between primary and secondary services Prioritise people who are at risk, disengaged or who have significant barriers to services Whole of system approach –Multidisciplinary Integration and co-location where appropriate

New Service Models SLATs - Governed by the ALT Clinician led – based on needs not history –Diabetes, CVRM –Radiology –Growing Generations – 0 -17yrs –Primary and Community Nursing –Mental Health –Smoking Cessation –Older Persons

Key evaluation measures 1.To understand the patient’s experience of and satisfaction with accessing their health care via the IFHC model; 2.To understand the impact of working within an IFHC model for GPs, Practice Nurses and practice management staff in terms of professional and personal career progression and satisfaction; 3.To determine if application of the IFHC model has changed the pattern of secondary care acute demand from the IFHC enrolled population; 4.To determine whether application of the IFHC model has changed the pattern of service utilisation in primary care and in terms of referrals to secondary care services; and 5.To determine the commercial viability and sustainability of the IFHC model, as implemented by MHN, to manage future health service demand in primary and secondary care. 6.To review the health benefits of the IFHC model by examining a range of health measures