Where to locate your lay health navigators?

Dr Fiona Doolan-Noble

Overview

∎Health System NZ

∎Primary Health Organisations (PHO);

∎The West Coast;

∎The West Coast PHO;

∎Benefits of co-location within the WCPHO;

∎Issues of co-location within the WCPHO;

∎Issues of co-location in general practice;

∎Discussion.

New Zealand Health System

∎ 20 District Health

Boards;

∎ 32 Primary Health

Organisations;

∎Other providers

include public health

entities, disability

support etc.

Primary Health Organisations (PHO) in

New Zealand

∎ A PHO provides primary health services either directly or through its provider members – GP practices.;

∎ These services are designed to improve and maintain the health of the enrolled PHO population, as well as having responsibility for ensuring that services are provided in the community to restore people’s health when they are unwell. The aim is to ensure GP services are better linked with other health services to ensure a seamless continuum of care;

∎ PHOs are funded by district health boards (DHBs) – top slice.

The West Coast

Population profile

West Coast PHO

∎Number of GP practices: 5 general

practices and 8 nurse led rural clinics;

∎All but one is Very Low Cost Access (VLCA);

∎Enrolled population: 29, 727

Services provided by WCPHO

∎GrX and GrX+;

∎Brief intervention counselling (BIC);

∎Smoking cessation;

∎Living well with diabetes;

∎BetaMe weight loss programme;

∎Funded clinical programes, e.g. CVRA & diabetes checks, LTC programme,

∎Palliative care;

∎Health Checks for clients of the corrections department;

∎Contraception and sexual health;

∎Mums4Mums – Breast feeding peer support;

∎Community health promotion;

∎Healthy lifestyle ambassador awards;

Clinical Governance

∎ 2 General Practitioner representatives;

∎ Practice nurse representative;

∎ Practice manager representative;

∎ Community representative;

∎ Iwi representatives;

∎ Poutini Waiora representative;

∎ Pharmacist representative;

∎ Representative of secondary care clinical advisory committee;

∎ Community and Public Health Medical Officer –ex-officio.

Benefits of co-location

∎Navigators role benefits from close relationship with the other professional staff within PHO, allowing them to provide an exceptional range of services to the client. Eg: mental health team, GrX, smoking cessation, improved access to other services etc.

∎Peer support from the other PHO staff is greatly appreciated. Navigators can support them as well. Safety of the PHO umbrella.

Benefits of co-location

∎ Resources to support our role. Cars, mobile phones, laptops, stationery, are all allocated, recorded, updated, etc. by the the PHO administration team. This mahiwould otherwise take up precious ‘navigator time’.

∎ Outstanding work location; community based, easy access for clients, building accessible and parking reasonable.

Benefits of co-location

∎ Collegial support of each other as lay people working within a health system;

∎ Collective problem solving key;

∎ Sharing of resourcing; sharing of workload if one navigator is running late or is carring a greater workload;

∎ Clients told they are a team of three – no such things as ‘my patient’;

∎ Data collection and analysis;

∎ PHO teams well recognised as extension of practice team; not a referral source.

Strengths of the team

∎Varied backgrounds;

∎Nimble/reactive/proactive;

∎Care closer to community

∎Stable HN workforce 10yrs+

∎ ‘How can I help you today’; whether client or health professional;

∎Great advocates for improved self-management for clients/whanau;

∎Great problem solving capability.

Team vulnerability

∎ Workload;

∎Expectations – clients and health

professionals;

∎Employing staff with long term conditions

– sickness;

∎ Hard to get team together due to dual

locations – Greymouth and Westport.

Challenges into the future

∎ Now exhausted our health navigator

resource – 4.5 FTE no further funding

available;

∎Rural remote challenge to provide

equitable care to all West Coasters

Karamea to Haast;

∎ Population profile of West Coasters;

∎ Sustainability/future proofing the service.

Barriers and facilitators to co-location

within general practice

∎Lack of appropriate office space within practices;

∎Cost of adding additional space;

∎Being co-located in ‘a’ practice can mean mal-distribution of support across other practices;

∎Lack of staff collaboration in practices where navigator not collocated;

∎Cost of seeing navigator.Ferrante, JM, et al. Translating the patient navigator approach to meet the needs of primary care. JABFM 2010, 23; 6: 736-744

∎“Who fulfils the patient navigator role and

the setting of care can greatly affect how

patient navigation is operationalised, the

types of patients who are assisted and the

services provided”.

Ferrante, JM, et al. Translating the patient navigator approach to meet the needs

of primary care. JABFM 2010, 23; 6: 736-744