SDHB - 19 May 2009CPHAC

Ian Macara

CEO PHO Management Services Southland Ltd

Wendy Findlay

Chief Nursing Officer PHO Management Services Southland Ltd

“E rere kau mai te awa nui mai te kahui maunga ki Tangaroa”

“The river flows from the mountain to the sea”

Agenda

� Introduction

Primary Health Care Strategy 2001

� Southland PHOs Structure

� Southland PHOs Funding

� Southland PHOs Programmes

� Primary Health – Sector Capacity

� Vision for the Future

� Wales Study Tour

� Southland Primary Nursing Strategy

Introduction

Primary Health Care Strategy 2001

� New emphasis on population health, health promotion, prevention,addressing inequalities – strong recognition of the importance of these factors

� New funding (i.e. $2.2b over seven years 02/03 to 09/10)

� Priority for extra $ is in areas of high deprivation

� Lower fees for everyone

� Arguably the most effective spend of the health dollar is in health promotion, education, addressing determinants and prevention of the causes of poor health in the population?

� Burden of Chronic diseases (diabetes, cvd, cancer, chronic respiratory disease); and lifestyle and behaviour choices on health outcomes is a national problem/challenge, especially for the primary health sector

Introduction

Primary Health Care Strategy 2001

The foundation of Southland PHOs activity is the six key directions of the Primary Health Care Strategy:

� work with local communities and enrolled populations � identify and remove health inequalities � offer access to comprehensive services to improve, maintain and

restore people’s health � co-ordinate care across service areas � develop the primary health care workforce � continuously improve quality using good information

Primary Health Care Strategy 2001 – The Vision

PHOs in the health landscape

P O P U L A T I O N

PHOs and Primary Health PROVIDERS

Secondary Care

Tertiary Care

Southland PHOs Structure

Partnership model between Maori, Community and providers is successfully embedded and functional in our PHO Boards:

• Independent Chairman• Two Maori Directors - appointed by the local runaka• Community Directors – appointed by local community bodies

(minimum of two)• Two GPs – appointed by the PHOs local GPs• One Practice Nurse – appointed by local Practice Nurses

Present partnership structure for our PHOs’ ensures:• Genuine community participation in PHO governance• That communities have a meaningful voice• That the PHO responds to their community• That no one group is dominant • That the diversity of communities is reflected in PHO governance

and programmes• That our PHOs’ focus is on patients and community first

OWNERSHIP and MANAGEMENT

(Note – All Trusts, PHOs and PHO Management Services Southland Ltd are Charitable Organisations)

Eastern and Northern Southland

Health Trust

Invercargill – Te Ara a Kewa

Health Trust

1. Central Southland Hospital Charitable

Trust

2. Waiau Health Trust Ltd

3. Otautau Community Health Trust

4. Riverton Community Health Trust

5. Fiordland Health Trust

Wakatipu Health Trust

HOKONUI PHO

18,013 pts

4 GP practices

INVERCARGILL –

TE ARA a KEWA PHO

58,712 pts

23 GP practices

TAKITIMU PHO

14,443 pts

5 GP Practices

WAKATIPU PHO

15,650 pts

2 GP Practices

PH O M a n a g em e n t Se r v ic e s So u t h l a n d Lt d

25% Shareholding - by each PHO 4 x Directors – Chairperson of each PHO

106,818 enrolled patients 34 GP Practices

Southland PHOs Structure

PHO Management Services Southland Ltd (PHO MSSL):

Established 2007

Jointly and equally owned by the 4 PHOs – a proven collaboration:

Provides economies of scale, through combined “engine room” functions

Staff expertise is located together for a consistent approach e.g. projects, information sharing and workforce development

Jointly funded positions: Chief Nursing Officer, Maori Health Manager, Health Promotion Advisor, Performance Programme Coordinator, areappointed

Proven capability: e.g. Primary Mental Health Brief Intervention Service and HPV Immunisation are programmes being successfully managed within PHO MSSL

One point for contact to the Southland PHOs

Southland PHOs Structure

Clinical Leadership:

Governance level

Each PHO has 2 GP appointed and 1 Practice nurse appointed directors

Management level

One Clinical Governance Group covers the 4 PHOs – has 3 GPs, 2 Practice Nurses and 1 Pharmacist

Group provides expert clinical input into PHOs activities to inform PHO Boards’ decisions

Chief Nursing Officer – 1.0 f.t.e. (Funded 0.5 f.t.e. by SDHB)

Responsible for implementing the Primary Nurse Strategy

Clinical Advisor - GP appointment of 0.1 f.t.e. (4 hours/ week)

Provides GP expertise and advice at management level

Southland PHOs Structure

Maori Health:

Each PHO has its own Maori Health Plan All are approved by SDHB

Implementation Plans set out initiatives to address inequalities and improve health status for Maori

Our Maori Health Manager was appointed in late October 2008 Responsible for implementing Maori Health Plan projects

The Maori appointed directors on each PHO Board have formed the Maori Health Advisory Group

The one Maori Health Advisory Group covers the 4 PHOs and meetsmonthly

Provides strategy guidance for PHOs and staff on Maori health issues

Are reviewing the SDHB LECG Maori Health Report: “Towards 2009 Maori Health Plan”

Southland PHOs Funding

Total Budget of $17,409m

Southland PHOs Funding Capitation Based Funding (CBF) = GP Fees

Southland GP Practice Fees (34 Practices) @ 1

Jan 09

Age Group Fee range Average

0 – 5 yrs $0 - $16 $6.85

6 – 17 yrs $10 - $38.20 $25.38

18 – 24 yrs $12 - $38.20 $26.97

25 – 44 yrs $12 - $45 $28.92

45 – 64 yrs $12 - $38.20 $26.50

65+ yrs $12 - $42 $28.14

Southland PHOs Funding

Southland PHOs Programmes

Successful Services to Improve Access Programmes continue:

Hokonui PHO:

Gore High School Clinic; Mataura Blood collection subsidy; Foot Clinics; Health Check Clinics @ specific events (e.g. Waimumu Field days)

Invercargill – Te Ara a Kewa PHO:

Community Nurse; SYHOSS clinical support; Transport – Bluff Medical Centre and Pacific Island vehicles; Breast Feeding Peer Support; TaiChi for elderly at Marae and Pacific peoples venue; Care Vouchers; Emergency Prescription subsidy; Marae and Community Health Days/Checks; PIACT Linkage Worker;

Takitimu PHO:

Regional Health Days, incl. Health Checks; Primary Health Linkage Worker + vouchers contract to NKMP; Travel assistance project;

Wakatipu PHO:

Glenorchy Health Clinics; Wakatipu High School Clinics;

Southland PHOs Programmes

Health Promotion Programmes:

Regional across all PHOs:

HYPE Programme – Healthy Youth ProgrammE : for referred youth and their families to address Obesity, Nutrition and Mental Health Wellness

Healthy Homes – Hokonui and Takitimu PHOs funded insulation retrofits to 50 homes in each region; this lead into the Southland Warm Homes project that all PHOs are supporting as a community partnership with local bodies, Power companies, EECA etc (addressing a key health determinant )

Health Promotion Advisor appointed – the PHOs recently welcomed Sue Price on to our staff. An updated Health Needs Analysis is a priority underway to support our PHOs regional Health Promotion Plan (working with SDHB)

Performance Programme, CarePlus, Primary Mental Health Brief Intervention Service, PCO (Palliative Care, PN Education, Annual Diabetic Reviews, Sexual Health, Research and Sabbatical and Rural Health and Development) HPV Immunisation programme

Primary Health - sector capacity

• General Practice and primary sector capacity is an issue

1.0 f.t.e. GP to enrolled patients. (As at 1 January 2009) Hokonui PHO 1/1988Invercargill – Te Ara a Kewa PHO 1/1610Takitimu PHO 1/1402Wakatipu PHO 1/1213Overall for Southland PHOs 1/1554

– Compares unfavourably to the NZRCGP recommended ratio of 1/1200

– The PHOs recognise this “burden” on General Practice and GPs

– We have an aging GP and practice nurse workforce (both groups average age is over 52 years)

– Lack of GP recruitment into Southland (except Wakatipu) over recent years

– Expectation of additional services delivery by general practice through PHO and DHB initiatives (PHO programmes/secondary care devolution of services into primary care) will be challenging

Primary Health - sector capacity

• PHO Projects are strongly focused to support General Practice and sustain health services delivery for patients and community in the primary sector:

– Primary Mental Health Brief Intervention Service

– Community Nurse and community clinics

– Community Mobile Nurse project (under preparation)

– Primary Nurse Strategy

Includes building nursing expertise and capacity across the primary health sector to support general practice and other health services providers

– Investigating the establishment of Integrated Community Health Centres (particularly in Invercargill) – i.e. general practice with allied health providers, and connections with health and disability NGOs → Multi-disciplinary teams → Primary Health Care Team(PHCT – vision of the Primary Health Care Advisory Council as Service

Model – May 2009 )

Vision for the Future

SDHB expectations can be achieved on specific projects:– Management of the Community Pharmaceuticals budget within PBF

future funding

– Managing “inappropriate” ED Attendances

– Shared clinical information across community and hospital settings

– Increasing PHO Scope to include other primary care providers

– Devolution of secondary services to the primary sector

– Reducing ambulatory sensitive hospital admissions

– SDHB Maori Health Report - “Towards 2009 Maori Health Plan”

– Integrated Community Health Centres

Southland PHOs have the commitment to lead these initiatives.

For these projects a partnership model between SDHB and PHOs, with general practice, pharmacists, providers, South Link Health and other parties as necessary; is strongly supported to

Vision for the Future

Working Collaboratively:

Our PHOs support the SDHB recommendation from last Thursdays

Board meeting that a partnership approach between SDHB, PHOs (incl. non-Southland PHOs), primary health providers and key organisations (incl. SLH , NGOs etc.); supported by a strong primary infrastructure; is essential to achieve the required primary health outcomes for Southland patients and communities

The Southland PHOs, me and my team are strongly committed to this vision

The GOAL