Locality Clinical

Partnerships

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

(Diagram source: Bevan 2009 referenced Ministry of Health 2011)

Profile of System Change

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.

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)

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

CMDHB Admissions Less Than 48 Hours

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Acute Elective Total

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

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

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

THE FOUR LOCALITIES

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%

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

Proportion of Locality Population

Defined as ‘High Need’

Locality % High Need

Eastern 7%

Franklin 26%

Mangere/Otara 81%

Manukau 53%

Total 48%

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%

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

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

Locality Clinical

Partnerships

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

LOCALITIES AND 20,000

DAYS

Localities20, 000 Collaborative

Franklin

Mangere/Otara

East

Manukau

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.

Focus on Franklin

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

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

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.

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

Franklin Locality Integrated Delivery Structure

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.

Questions and Discussion