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Locality Clinical
Partnerships
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Locality Clinical Partnership Objectives
� Deliver Better, Sooner, More Convenient
Healthcare
• Reduce avoidable hospitalisations
• Improve clinical quality
• Deliver more integrated healthcare
• Improve management of long term conditions
• Deliver better value healthcare
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(Diagram source: Bevan 2009 referenced Ministry of Health 2011)
Profile of System Change
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Demand
• CMDHB has both the highest population growth
rate and the highest ageing rate in the country.
• Counties is forecast to run out of hospital beds in
mid 2013 based on current growth patterns
• Middlemore hospital is already too often full
• Our ED sees nearly 100,000 people per year.
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Supply and Demand Imbalance
350
400
450
500
550
600
650
2010 2011 2012 2013 2014 2015 2016 2017
Nu
mb
er
of
me
d/s
urg
/AO
U/M
SS
U b
ed
s
Year
Projections of bed demand against planned beds for medical and surgical
services in Middlemore Hospital
Existing & planned beds
Existing & planned beds (subjected to
approval)
Projected demographic and non-
demographic growth (high growth)
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Some of this Demand is Amenable to
Better Ways of Doing Things
• 15,000+ CMDHB potentially avoidable
hospitalisations in 2010
• That’s 40 admissions a day…
• Many admissions are for short periods of
assessment and diagnosis – some of which could
occur elsewhere, or could be assessed in an APU
and then transfer to a local package of care
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CMDHB Admissions Less Than 48 Hours
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Acute Elective Total
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Better Management of Chronic
Conditions
• 30% of people are not on life preserving
medications year after a coronary event
• 12,000 people with diabetes have HBA1c >8
(64mml), leading to avoidable blindness,
amputations, renal disease and hospital admissions
• Variable clinical governance, capacity and outcomes
in primary care
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Diabetes Outcomes
Variation by Practice
-1.2
-1.0
-0.8
-0.6
-0.4
-0.2
-
0.2
0.4
0.6
0.8
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76
Vari
ance
of H
bA1c
Practice
HbA1c Changes for Diabetes Patients after One Year in CCM Programme - All Ethnicities
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Inequalities: CMDHB Maori Life
Expectancy Gap is 10 Years
65.0
67.0
69.0
71.0
73.0
75.0
77.0
79.0
81.0
83.0
85.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Life
exp
ect
an
cy a
t b
irth
3 y
ea
r ro
llin
g a
ve
rag
e
Maaori CM Maaori NZ Pacific CM Pacific NZ
Non-Maaori/non-Pacific CM Non-Maaori/non-Pacific NZ Total CM Total NZ
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THE FOUR LOCALITIES
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Enrolled Populations of CMDHB
Service Localities, Q3 2011
Locality Total% of pop enrolled
in CM practices Rank
Eastern 102,590 23% 3
Franklin 45,570 10% 4
Mangere /
Otara138,230 31% 2
Manukau 156,870 35% 1
Grand
Total443,250 100%
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Ethnicity of PHO Locality Enrolled
PopulationsEastern
Other
Asian
Indian
PacificMaaori
European/
Other
Franklin
Other
Asian
Indian
Pacific
Maaori
European/
Other
Mangere&Otara
Other
Asian
Indian
Pacific
Maaori
European/
Other
Manukau
European/
Other
Maaori
Pacific
IndianOther
Asian
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Proportion of Locality Population
Defined as ‘High Need’
Locality % High Need
Eastern 7%
Franklin 26%
Mangere/Otara 81%
Manukau 53%
Total 48%
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Within Each Locality, Practice
Age Structures Vary
Locality% of locality
0 – 14 yrs
% of
locality
15 – 44 yrs
% of locality
45 – 64 yrs
% of
locality
65+ yrs
Eastern 20% 40% 27% 13%
Franklin 25% 37% 25% 13%
Mangere/
Otara30% 46% 18% 6%
Manukau 24% 42% 23% 10%
CMDHB 25% 42% 23% 10%
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DHB PHO 1, 2, 3, 4
Management support – enablers, IS, reporting, project management
AgreementAlliance Agreement
Mandates:
• Locality clinical network –
broad interest based
membership
• Leadership group –
clinically led, focused on
service integration, better
value healthcare, and
quality improvement
• Risk and gain sharing and $
commitment
• Management support, incl
analysis and reporting
Locality clinical network
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Key Features of Localities
• A return to more generalist community health care where:• The focus is on Integration of Primary and Secondary services• Clusters of population are served by multidisciplinary community
health teams • General practice teams work seamlessly with the community health
services • There is a focus on shared patient records and common booking
systems• Whaanau Ora networks are established that help high needs
families navigate the system • The GPs, nurses, Senior Medical Officers (SMO), Allied Health,
community health workers and patients all form a valued part of the local healthcare team
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Locality Clinical
Partnerships
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Benefits
Population
• Early access to the
right care closer to
home.
• A sustainable health
care system with
capacity to care
• Greater say in local
healthcare priorities
• Improved health and
social outcomes for
communities
Workforce
• De-burdening of hospital services delivering care that could be delivered locally.
• Enhanced roles for community and primary care
• Opportunities to work closer to home
• Enhanced professional relationships and teamwork
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LOCALITIES AND 20,000
DAYS
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Localities20, 000 Collaborative
Franklin
Mangere/Otara
East
Manukau
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Locality Clinical Partnerships: Overview
Locality Clinical Partnerships to commission and review the work
�An opportunity to create a clinically led integrated healthcare system that bridges
the divide between primary care, community health services and secondary care.
�Enhancing primary care to make it more accessible, comprehensive and proactive.
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Focus on Franklin
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Enhanced Services
Health of Older People
• Increased bed capacity for assessment, treatment
and rehabilitation services at Pukekohe and Franklin
Hospital
• Expanded GP access to Community Geriatric
Specialist Services (CGS)
• Community based Rapid Response Team
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Enhanced Services
People with long term or chronic conditions:
• A new community based cardiac and pulmonary
rehabilitation programme at Pukekohe Hospital
• Community based specialty outpatient clinics,
improved diabetes service delivery
• Enhanced multi-disciplinary care for patients at
risk, use of credible risk assessment tools,
clinical pathways and improved integration of
inherent opportunities community pharmacy.
• Primary led Palliative Care programme
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Enabler Services
• Workforce upskilling and development, GPs with special
interests (GPSIs)
• Alliance partnership expectations will enhance
relationships between primary and secondary health
professionals.
• System Integration and Co-ordination, expansion of the
‘Franklin Central’ control and co-ordination hub with
links to Middlemore Central.
• Expansion of POAC and ATD opportunities for primary
care.
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Integrated Delivery
• Joint appointment with ProCare of a GM Franklin
• Will report to both ProCare and CMDHB
• Will manage both CMDHB community, home care staff
and ProCare staff in Franklin
• Will be responsible for pulling staff from both services
together to design integrated ways of doing things
• Will oversee the development of shared information
and booking systems
• Reaching health outcome targets
• Start slow – more changes over time
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Franklin Locality Integrated Delivery Structure
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Opportunities for Healthcare Staff
• Developing virtual or collocated team with primary care
– Joined up assessment, care planning and delivery
– Information sharing
• Use of alternatives to specialist consults: GPs with special
interest, shared care, e-consults, teleconsults, telehealth
• More services (diagnostics, simple procedures, assessments)
available locally – more localised roles
• General opportunities for up skilling, delegation of routine tasks
to non-regulated workforce
• Higher acuity in community and home based settings – use of
virtual wards, rapid response teams, expanded POAC.
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Questions and Discussion