Integrated Primary Health Care

“A whole of system approach to primary health care ”

Key Challenges for the Health System

• A growing, ageing population

• Rising health risks and levels of chronic disease

• Some groups experience persistently poor health

• A shortage and maldistribution of health professionals

• State and Commonwealth involvement in health care funding and service delivery can lead to discontinuities and fragmentation.

• Health care costs are rising faster than general economic growth

Increasing Demand on Limited Health Resources

Chronic health conditions 80% of overall disease burden by 2020

Ageing population People 75 and over account for 79% of overnight bed growth Increase in Acute LOS from 5.2 days in 99/00 to 5.5 in 03/04

chiefly attributed to older patients

PaCH sector non admitted patient activity 20% increase from 00/01-04/05

Community expectations for accessible, locally providedhealth care are increasing

What Does the Evidence Tell Us ?

The key to managing demand for health services is a systematic approach to• Health promotion• Preventative care• Coordinated, continuing care for complex conditions

Effective Integrated PaCH service provision can• Improve health status • Reduce health inequalities

Those countries with well developed PaCH sectors have healthier populations and lower health costs

Definitions

What do we mean by Integrated ?

“A whole of system approach to health care, which achieves better health outcomes with optimal use of resources”

This involves:

• Bringing together common functions within and between organisations to solve common problems

• Developing a commitment to shared vision and goals

• Using common resources and technologies to achieve these goals

Primary Health Model for Integrated Planning and Services

Based on the premise that

A collective approach to health service delivery between key stakeholders will have substantially more value in addressing the challenges facing rural health than those stakeholders operating in isolation.

The best health outcomes will be achieved through

A system that is structured so that all residents have access as close to home as possible to a core level of quality primary health services that are effectively linked to secondary and tertiary services

Primary Health Model for Integrated Planning and Services

Applies to all areas of health service delivery From services for children and families, with a strong illness, prevention and wellness focus

To services for people who are chronically ill, with a much stronger treatment and maintenance focus

Includes all partners in the planning and delivery of Health Care

Including those who do not provide direct client care such as universities and local government

Primary Health Model for Integrated Planning and Services

The model is integrated both

Vertically – between different organisational levels(e.g. GSAHS Executive through to cluster level)

And

Horizontally – across GSAHS and partner organisational structures and levels(e.g. GSAHS Executive and the Coalition of Greater Southern Divisions of General Practice)

In order to work collaboratively on the delivery of shared services(e.g. primary health care services)

Human Services

ManagementMeeting

Local CouncilUniversity

NGO’sPrivate Sector

AreaManagement

Meeting

LocalService

Network Meeting

Local Services

CE & ChairsDivs of GP

GSAHSStrategicMeeting

Directors & CEOs

Divs of GPGSAHS

Op/Strat Mting

Local Division Meetings

Local Service Delivery

Local Management

and Clinical Teams

OPERATIONAL

Local Health

Advisory Committee

ClusterIntegrated

Service Delivery Meetings

OPERATIONAL

Cluster Health

Advisory Committee

Clinical OpsStrategic

Information Meeting

STRAT/OPS

Local GPs

GSAHS Senior

ExecutiveMeeting

STRATEGY

Area HealthAdvisoryCouncil Meeting

SharedPlanning

Shared Strategies

Shared Projects

IPHCCRHS

P&CH

LocalClinicalTeams

ClusterClinical Teams

Area Clinical

Networks

Mental Health

Acute

PopulationHealth

PopulationHealth

GSAHS Primary Health Model for Integrated Planning and Services

1

3

2

4

What do we need to change?

We need to transform a compartmentalised system into one which:

• Regards itself as an integrated single entity that serves the client

• Where the roles and responsibilities of health care workers are based on ability, access and efficient team work

• With a primary focus on evidenced based quality client care

• That plans and delivers health care in partnership with all local/regional health providers and the community.

What are some challenges?

• Accountability for different components of the Health system is split between State and Federal Governments

• Public and private health providers have unique drivers

• Organisational and professional cultures can work against integrated models.

• “Ownership” of particular health functions by particular professions, sometimes enshrined in law.

•Fears of loss of autonomy/ inequitable power amongst potential partners.

What are some challenges?

• Reluctance to expose practice to external partners

•Different frameworks for practice which influence how service planning is approached

•Different frameworks for practice which determine preferred clinical pathways and care plans.

•Long memories and the long term impact of previous policy and practice decisions.

•A health workforce under pressure – making a change takes thought and energy!

What are some policy enablers?

• Federal and State Government support with COAG, specifically funded programs and increased policy development.

• NSW IPaCH policy 2007-2012

•MOU between the Alliance of the Divisions of General Practice and NSW Health

• GSAHS and the Coalition of Greater Southern Divisions of General Practice Heads of Agreement

What are some physical enablers?

• Co-location – shared facilities, basing staff in the most appropriate facility

•Shared information infrastructure to enable real time clinical information sharing

•Shared access to training and professional development opportunities

•Job swaps

What are some other enablers?

•A willingness and commitment to address challenges practically and realistically

•An evolutionary approach to change - taking it bite by bite

•A readiness to recognise the views of others, accord them respect and work with them to achieve solutions

•Solid and appropriate governance structures for shared clinical and service delivery.

Models of Integrated Primary Health Care Health One NSW

Rural Primary Health Program

Through improved access to comprehensive Primary Health Care Services, health maintenance and improved health outcomes will be achieved. (Wakeman – a systematic Review of Primary Health

Care Delivery Models in Rural and remote Australia 1993-2006)

Aim:

To provide patient-centred, continuing, coordinated and comprehensive care through a strong, integrated and sustainable primary and community health sector.

Health One NSW

HealthOne NSW is model for delivering

Integrated Comprehensive Primary Health

Care services through a co-located centre.

The aim is to increase the capacity of the primary and community care sector to provide equitable, accessible and comprehensive care by integrating general practice and state government funded community health services in local communities in a single location.

Rural Primary Health Program

• RPH is a model for delivering Integrated Comprehensive Primary Health Care services through a framework that links the program and positions at all levels with a client centred continuum of care focus.

• The model works at the operational level to support Primary and Community Health in achieving an integrated multidisciplinary approach to service delivery.

Health One NSWand RPH Focus

To build on the strengths of health professionals such as general practitioners and community health providers working in partnership to enhance:

• Health promotion and preventative care• Early detection and intervention strategies• Continuing and coordinated care for those with

chronic and complex- Team management• Equity and Access for local communities

Thank You

Questions?