Towards 2030
1 like566 views
This document discusses trends and expectations for general practice and primary care in New Zealand towards the year 2030. It outlines that patients will expect quality, convenient, affordable and integrated care from competent professionals. There will be a focus on patient-centeredness, with information systems that communicate clinical information securely between providers and allow patients to access their own records. The future of primary care will rely on strong clinical leadership within a system that is primary care-led and flexible to meet local needs.
Towards 2030
- 1. Towards 2030…… A General Practice Perspective
- 2. This presentation – context and content Towards 2030 Focus on the Patient….. What works? Future Trends What do patients (consumers) expect? Where to from here?
- 3. Focus on the Patient
- 4. Focus on the Patient, and the Relationship
- 5. Our future challenge is to... Maintain patient focus within a culture of quality care… While….. Improving health outcomes Safely Efficiently Maximising technological advances “ Patient Centred Professionalism ”
- 6. “ Patient centred Professionalism” Patient Centredness Professionalism
- 7. Patient Centredness Putting the role of the patient (consumer) at the centre of health care ( cf providers or “systems”)
- 8. Patient Centredness Treating the patient, not just the disease “ It is sometimes more important to treat the patient who has the disease than the disease the patient has” Osler or Peabody?
- 9. Professionalism Professional Competence High Standards of Care Maintained through Clinical Governance “ Professionalism expresses a profession’s culture. It should epitomise good practice” Donald Irvine, BMJ 2005
- 10. Clinical governance….. Managing the gap between current practice and best practice .
- 11. Managing the gap between current practice and best practice. Managing the gap Personnel and processes Good management and clinical support for general practice New quality tools. Current practice Measuring performance and supporting change Best practice Information tools Decision support (guidelines, CME, facilitation)
- 12. What Works?
- 13. What Works..Primary Care Focus Barbara Starfield has shown that: “ Nations that adopt a primary care led approach to health care have lower costs, higher satisfaction amongst the population with their health care services, better overall health levels and lower costs of medication use” .
- 14. Critical requirements Clinical leadership Ownership Support Relationships “ Bottom Up” approach to Health Care
- 15. Organised General Practice “ Organised General Practice (“OGP”) means: “ groups of general practices, managers, and others working together in networks of cooperation and support , providing both individual and population oriented care for enrolled communities of patients. OGP embraces new responsibilities including, for example, activities in public health, screening, illness prevention, disease management and resource management. OGP accepts accountability for health outcomes and the best use of resources. OGP is supported at all levels by excellence in management services, to ensure optimum effectiveness and efficiency.”
- 16. COPD outcomes Respiratory bed days COPD project jointly implemented by ProCare eastHealth, First Health and Tainui
- 17. COPD outcomes Non- respiratory bed days COPD project jointly implemented by ProCare eastHealth, First Health and Tainui
- 18. Two Auckland hospitals: cardiology, respiratory and gen med admissions.
- 19. Winner -Service Organisation 2003 Rotorua Business Awards Organised General Practice
- 20. Primary Health Care Strategy Acknowledgement of Primary Care A Vision for Primary Health Care Involve Communities Focus on Wellness Reduce Health Inequalities
- 21. PHCS – New Opportunities Organised Primary Care Local solutions Build on the gains of OGP Embracing a wider group of providers Involving communities and iwi Seamless care within DHBs Wider determinants of health Intersectoral Relationships
- 22. Primary Health Care Strategy Enrolment Makes explicit the relationship between provider and patient Capitation Effectiveness reduced because of accounting rather than clinical focus. NHI Duplication, process. Geocoding Used mainly for payment rather than a health care tool
- 23. PHCS – the progress .. “Disorganised” Primary Care? 21 DHBs, 81 PHOs Some excellent pockets of innovation Health gains slowed with structural reform National inconsistency and variation of services Cheaper to all, loss of targeted funding Marginalisation of general practice Loss of GP morale despite increased funding Loss of leadership, ownership, relationships
- 24. Visits to General Practice 50,000 individual consults per day >10 million consults per year >15 million clinical decisions documented 80% population visit in 12 months 90% in 2 years Average 3 visits per year
- 25. Future Trends
- 26. Vision - IPAC 1999 ‘… .. the development of an effective primary care led health system delivering improved health and accident outcomes for patients and populations through organised general practice ’
- 27. “ Medicine looks likely to change more in the next 20 years than it has in the last 200” BMJ Nov 1999
- 28. 2030… Cannot be predicted with certainty Microsoft only predicts 5-10 yrs out! Future health system will reflect society – social, economy, politics, technology,
- 29. Trends - Societal Ethnic and cultural diversity Single parent homes Ageing Alternative medicine Consumerism - patient rights Convenient care Higher expectations and patient education
- 30. Trends - Economic Globalisation Public/private balance in health care Rising costs of health care
- 31. Trends - Political PHCS – where to from here? Population vs personal health Unstable public funding, regular reform Health Boards vs hospital boards National vs Labour?
- 32. Trends – General Practice Larger practices Multidisciplinary teams Many service delivery models Feminisation Work/life balance of gen x/y Information critical to continuity of care and delivery of care Wider scopes of practice Interact with wider primary care team - PHO
- 34. Patient Expectations –Health Health Status changing life expectancy (disability, chronic illness, mental illness mortality rates) maintain wellness improved health outcomes
- 35. Patient Expectations-Primary Care Quality care by competent professionals Convenience of care, close to home Safe care Affordable care Participation in their Health Care Integrated services, shaped around them Co-ordination of services by trusted team
- 37. What next for General Practice in New Zealand? Keep it between me and my GP!!
- 38. Patient Expectations - Information Accessible Accurate Control over who views information and when Confidentiality Consent Security Appropriate sharing
- 39. Patient Expectations - Information Integrated Transferrable Educational tool Communication tool
- 40. Where to From Here?
- 41. Keep it simple!!! Focus on consumer (patient centred) Strong primary care led sector Hospitals for acute illness Clinical leadership and ownership Management support for clinicians Govt sets policy, builds good relationships Keep administration simple Flexible models of care, local solutions
- 42. Information Systems towards 2030… Excellent systems that communicate! Reliable, flexible, user friendly Multiple processes triggered by single interaction Designed primarily for needs of patient care Keep database close to source Databases in practice or “healthcare home” in primary care (accuracy,safety) Address legitimate needs of funders and policy makers with appropriate view Address clinical governance needs of professionals with appropriate view
- 43. Patient Information towards 2030… Identifiable clinical information based in practice, directly accessible to patient Episodic clinical information directed to the practice database Patient information selectively accessible by patient or between clinicians throughout journey within the system Patient held information
- 44. “ Information is not Knowledge” Albert Einstein 1879 - 1955
- 45. “ Knowing a great deal is not the same as being smart; intelligence is not information alone but also judgement, the manner in which information is collected and used.” Dr Carl Sagan
- 46. Keep IT between me and my GP! Keep “IT” between me and my GP!!