1. “Better, Sooner, More Convenient” Primary Health Care PSAAP Meeting 23 July 2009

2. Better, sooner, more convenient 2 Goals: Develop a more personalised primary care system Provide services closer to home Make Kiwis healthier Reduce pressure on hospitals

3. Better, sooner, more convenient 3 Proposals in Chapter Three Include: The retention of universal subsidies for GP visits Establishment of Integrated (multi-disciplinary) Family Health Centres (IFHC), which would provide a full range of services including specialist assessments by GPs with special interests, minor surgery, walk-in access, chronic care, increased nursing and allied health services, + selected social services Movement of some hospital based services to these Centres Specially trained nurses acting as case managers for non-health agencies to support at-risk families PHOs and general practice to have a greater role coordinating the ongoing care of their patients More treatment and diagnostic services will be devolved to primary care DHBs to be held accountable for devolution of services to general practice and IFHCs

4. Better, sooner, more convenient 4 The implementation approach A staged EOI process that facilitates early adopters to move, and enables others to engage in subsequent annual waves. Early adopters would demonstrate: Capability and capacity – critical mass & ability to deliver large scale change over time Clinical leadership & involvement of a wide range of health professionals, GPs, nurses (practice & other community nurses), pharmacists, midwives, physiotherapists, podiatrists, DHB support and partnership Commitment to public reporting, training of health professionals, consumer and community input, Whanau Ora approaches ……….and could be assisted by consortia that bring together the range of skills required to support large scale change

5. Better, sooner, more convenient 5 Actions & Timeline Review of policy settings: enrolment, devolved services, funding arrangements, global budgets & delegated funding (risk mgt), performance management & accountability arrangements2009 Issue EOI (aim to cover 15% of NZ population)Late 09 Select preferred “first wave movers”March 10 Service implementation commencesJune 10 ……………..and then further EOIs on an annual basis RFP process to select consortia to support change management processes09/10

6. Better, sooner, more convenient 6 The achievements to date include……….

7. Better, sooner, more convenient 7 Capital & Coast DHB Can demonstrate: Increasing numbers of GPs and Practice Nurses since 2001 – with the greatest increase being in very low fees practices Increased utilisation rates An increase of 9% (since 2007) in the % of 2 year old children fully immunised Declining trends in ED attendance rates, since 2005, for people enrolled with PHOs Diabetes - flat or decreasing numbers of admissions, despite increased numbers of people with diabetes ASH admissions have declined, particularly for people enrolled with PHOs Primary Health Care in C & C DHB Final Report June 2009

8. Better, sooner, more convenient 8 And then there’s the funding pressures ……..

9. © The Treasury 9 Source: The Treasury Core Crown revenue and expenses 2009 BEFU Revenue 2009 BEFU Expenses 30 35 40 45 50 55 60 65 70 75 80 200420052006200720082009201020112012 $billion Year ending 30 June Forecast 2003

10. © The Treasury 10 Some scenarios.... 10

11. Better, sooner, more convenient 11 PHO Capitation Expenditure