Playing the advantage in policy: maximising the opportunities and benefits of primary care in the NZ

health system

Department of Primary Health Care and General Practice University of Otago – Wellington – New ZealandTony Dowell

Department of Primary Health Care and General Practice Wellington School of Medicine and Health Sciences

Benefits and Opportunities

• Celebrating what we do best– High quality integrated primary care and clinical general

practice to enrolled populations– Keeping care patient focused + built on relationships

• Effective working across the primary / secondary sector

• Two BIG policy opportunities• Long term condition management• Children

– Life course approach• elective waiting lists

Policy Benefits of current primary care system

• General Practice fundamental platform for Primary Health Care in NZ

• Access to primary care • Continuity of Care• Enrolment• Local delivery and organisation of health care• Teamwork • Present role mix is working ‘reasonably well’• Good access to treatment / medication • Good access to IT

The Heart of General Practice PolicyThe whole person - family

Time and history

Place

The world and its uncertainty

Partnership

Primary Health Organisations

                    

Policy opportunities at a systems and organisational level

• Enhanced referral systems – EHR• Evolving primary care team roles

– Physician assistant– Primary care coordinator (e.g mental health)

• Finding the place for public health as part of primary care

• Getting policy joined up in:– Lifestyle – alcohol , obesity, recreational drugs– Child health (Well child / Midwifery – see later)

Changing numbers and types of organisation

Changing numbers and types of organisation

PHO No 1

PHO No 2

Better Sooner More Convenient

Policy Opportunity 1Long Term Condition

Management

Diabetes, Arthritis, Depression, COPD Stroke, IHD etc ….

Diabetes care

• ‘for this i don’t know how much you know or don’t know about diabetes but it’s ‘

• Multiple consultations• Multiple providers• Check list management

of risk factors• ? How effective and

coordinated

There’s not enough time ?

Redesigning long term condition consultations

• Time is sufficient but used without coordination within the PHCT

• Professional isolation of primary health care team members

• Reduplication of information out of context from patients needs or experience

• Checklist approach to care sometimes prevents the main issues being addressed

Policy opportunity 2Child health

‘Jack’ - 9 Years

• Father in jail• 2 siblings, • Mother 29: medical condition, unable to sustain a job though trying – in and out of jobs• Overweight• Learning difficulties at school• Bullying in the playground

Medical history:- Multiple visits to GP and A +M

Asthma, eczema, chest infections, skin infections, injuries, 10 hospital admissions – bronchilitis (baby x2) asthma (x3), broken leg, head injury, cellulitis (x2), dental abscess

The intervention potential

Age

80 +

60-80

40-60

20-40

0-20

Developing risk factors

Established risk factors

Established disease

The early early years

Policy Solutions

Not one single solution but principles are simple:Utilisation of enrolment policy and systems

more effectivelyAccess to primary care 24/7Integration at many levels and across sectorsFunding and policy to support child

population-based approaches

Maternal and child health

• Antenatal engagement • Early enrolment• Access to care• Know the population, utilise the PMS

• Identification of ‘vulnerable’• Referral and relationships with local services

• Integration with maternity and well child health

TimeTeamwork

Systems and I.T.

Thank you