Enhancing Primary Care

Problem Statement

General practice is facing a number of challenges, with increasing demand, greater complexity and sustainability issues, which make it unlikely that continuing to deliver general practice in the traditional manner will be a sustainable option. These include the following challenges.

• The size of the general practice workforce has not increased sufficiently to meet the demands of our growing and ageing population.
• The number of full-time equivalent (FTE) GPs per head of population has been decreasing, and a large cohort of GPs will be retiring in the next 10 years.
• CM Health already has the lowest number of GPs per capita, and practice nurse numbers have remained static for many years. From 2006 to 2015, there has been an increase of 22 FTE community-based nurses.
• The increasing burden of long-term health conditions is challenging the available capacity in general practices.
• The health sector is under growing financial pressure.
• The ability of the GP sector to transform its model of care is in itself a major constraint. This includes slow adoption of virtual consultations and the use of nurse practitioners, and a reluctance to dismantle the GP-centric model.

What are we trying to achieve?

To support general practices to develop a sustainable model of care that:

• increases system capacity and capability, and better engages and brings care closer to the patient
• over time, reduces demand for hospital-based services through a vision of “activated patient and whaanau working in partnership with activated clinicians working together to achieve better outcomes”.

What have we done?

We have support general practices through providing the following modules.

Module one: Increasing access

• Increasing patient access to practice services through introducing triaging, improving telephone call management and promoting uptake of patient portals.

Module two: Increasing efficiency

• Increasing practice efficiency by reviewing and optimising the practice environment and processes in order to enable better patient flow.

Module three: Increasing capability

• Ensuring practice team members perform service roles that match their capabilities and population demand.
• Developing workforce development plans relevant to the practice’s needs.
• Including patients and whaanau as part of the extended practice team.

Module four: Increasing effectiveness

• Ensuring practice has a process to understand the health needs of their enrolled population.
• Designing and implementing a model of care to proactively manage the health needs of the practice’s enrolled population.

What did we find?

The modules have demonstrably improved patient experience, reduced face-to-face visits and released clinical time.

There have also been demonstrable changes through introducing staff huddles, standardising consulting rooms and enhancing patient flow through practices.

Where to from here?

We will continue to support practices to implement a model of care that is patient-centric, increases system capacity and capability, and over time reduces demand for hospital-based services.