1. Community and Primary Healthcare Nursing Service Models What’s possible and Lessons Learnt PRIMARY AND COMMUNITY HEALTH NURSING HUI ON 16 APRIL 2015 Anushiya Ponniah (anushiya@xtra.co.nz)anushiya@xtra.co.nz

2. It's far more important to know what sort of person has a disease than to know what sort of disease a person has. Hippocrates, 400 BC

3. Outline Context Overview - paper on community and district nursing service models and lessons Common emerging themes Relevance to primary care and integration The possibilities…

4. Integrated primary healthcare nursing What does ‘integration’ mean? No single, accepted definition of integrated healthcare Most include references to care co-ordination, seamlessness, person centeredness, and whole-of- system working together New models of care development What does ‘models of care’ mean? Northland’s guidance on models of care Ministry of Health on consistent themes from national and international literature about models of care

5. Ministry of Health (2015) Consistent themes from national and international literature about models of care Personalised and flexible Effective prioritisation function Accessible and equitable service outcomes for all Effective decision making Integrated and coordinated care Access to relevant information Collaborative approach Move from supply/demand to needs based model Sustainability Team based approach Person/Whanau centred Reflective of community needs, resources and culture Environment

6. Integrated and Innovative Models of Community Nursing Care, NZ Nurse Maude o Specialist and Generalist (palliative, home dialysis, district nursing) o Horizontal integration of services (Home based care, nursing, allied health, residential care, dementia facilities, palliative care, hospice, care coordination, school nursing, occupational health nursing etc.) o Nurse led clinics (wound, stoma, infusion, diabetes, dietician) o GP relations (networks and geographical teams) o Technology and education (CRISTA and NZ Institute of Community Healthcare) Lessons o Collaboration at the heart of service model o Enablers are seen as basic must have (technology, education, coordination) o Specialist and generalist distinction o Home based care team’s input and working with DNs

7. Integrated and Innovative Models of Community Nursing Care, NZ Healthcare Hawkes Bay o Access to Medtech system, shared patient notes, book doctor appointments o Assigned to practices but employed by DHB o Service model to be finalised in April 2015 after 18 month pilot Lessons o Improved relationships – partnership o Patient experience – connected care between nursing and GPs

8. Integrated and Innovative Models of Community Nursing Care, NZ Counties Manukau Localities Model - CHS Integration o Proactive planned care for at risk individuals o Unplanned rapid (urgent) care o Short term reablement, rehabilitation recovery care o Coordinated access to long term care Lessons o First contact care type service o Break the funding barriers – the business case o Flexible roles

9. Integrated and Innovative Models of Community Nursing Care, International Royal District Nursing Service (Australia) o Homeless persons programme o Hospital in the home programme o Consumer directed care o Nurse led clinics o Customer Service Centre – 24/7 resolve first contact o RDNS Institute Lessons o Person first before patient o HiTH funding o Research, trials and evidence based care o Technology and telehealth

10. Integrated and Innovative Models of Community Nursing Care, International Regional Redesign of Community Nursing, Northern Ireland o First contact care - rapid response at point of entry o Continuing care – proactive case management of chronic disease o Public health approach – prevention strategies and self management Lessons o First point of contact o Fundamental role shift in defining nursing titles to patient needs o Flexible to work across boundaries and new settings o Person centred, needs based and use of patient pathways o Devolved power to teams of nurses o Underpinned by public health principles and thinking

11. Common Themes Multi disciplinary approach and intense case management for some Specifically established network of services alongside general practices Generalist nursing with specialist input Nurse led specialist clinics for ambulatory clients Use of smart technologies Education, training and research support for nurses 24/7 contact centres or telephone support

12. Key elements of effective primary care Barbara Starfield Harry Rea Compre hensive Continuity First contact accessibi lity Coordinati on Commu nity Compassi on

13. Declare the past diagnose the present foretell the future Hippocrates, 400 BC

14. The possibilities… Imagine a healthier communities Challenging because it is a complex social issue that impacts on health and well being of our community. What would that picture look like? How much of it is about health as we know it? What is our role as health workforce, nurses and leaders? Public health approach – how will we prevent history occurring? Promote Self management - how do we empower people? First contact care – the freedom to do whatever is required for the person Free nursing care – what would this mean for our communities?

15. A patient is a person before they are a patient Conclusion

16. Thank you anushiya@xtra.co.nz