What is being provided to your patients to complement your work.
I have worked in Clinical Services provision in three PHOs – Procare, Pinnacle and now Tu Ora Compass, for just over one year. Through that experience I have noted there are similarities and differences in terms of the contracts held, the approaches taken, and the outcomes delivered. Not an unusual picture in the New Zealand health system.
A constant has been the potential that Clinical services contract delivery holds in terms of being one of the answers to the pressures and capacity issues that currently face General Practice. The Clinical Services team works, for the most part with people who are enrolled in a general practice and are very happy with the service they receive there, but for a number of reasons, benefit from a clinical service available to them. For example the current Mental Health model which is providing therapists in general practice, supporting easy access for patients.
Additionally, the clinical services team provides the ability to road test numerous innovative ideas and ways of working, which can be subsequently rolled out into daily operation by the clinical services team or become part of general practice day to day work, such as the current Falls project and High Tech Imaging which will be rolled out soon.
Sexual Health is an example of a community based clinical service. The service is based in Cuba St and is free. As the only secondary sexual health service to be based in the community this highly accessibility can often times result in high volumes of referrals and walk-in patients. To manage this demand we will be working with a very experienced Sexual Health Project Manager from the UK, during October and November, to review and realign the service to ensure the specialist knowledge and expertise, available through this service is utilised in the best possible way for patients.
Lots of opportunities to improve on existing services and introduce new opportunities to support what is already available. Should keep me busy for a few more years.
General Manager Clinical Services
In search of the sweet spot
I was never a good student of economics – a subject I found quite dry. However, one thing I did learn was that there is an inverse relationship between supply and demand – when one goes up the other goes down. Consumers and providers usually find a sweet spot somewhere in the middle which becomes the agreed price. Government funding policy tampers with the natural order of things and when this happens the effects are generally: an increase in use of the product; a decrease in supply; a deterioration of quality; and, the emergence of black markets.
As capitation negotiations between policy makers and Primary Care leaders begin in earnest, it’s timely to reflect on what changes might mean for supply and demand and finding our sweet spot!
Price is constrained by government policy. This is a good thing for the consumer as it aims to achieve affordability at the point of care. However, when this is coupled with policy that is likely to drive up demand the impact on the sustainability of traditional general practice, from both a monetary and workforce perspective is significant.
In Wairarapa we have the highest rate of GP and nurse consults in the country. This is not necessarily a bad thing if it is sustainable for general practice team and results in better health outcomes for our people. The challenge for us is that we are delivering our service in a traditional model and not taking advantage of new ways of working to meet the increased demand.
Like in other markets, price for health service drives not only our demand, but also our supply. We are experiencing reduced supply in terms of our primary care workforce and because funding is not keeping up with demand, the future workforce is less attracted to general practice.
Our workforce is delivering high quality health care, but there are segments of our community who continue to miss out. As primary healthcare teams battle with increasing demand and reduction of supply we face inequities. By increasing capacity in primary care and working smarter, it’s possible to focus more effort on those who need our services most.
The black market of unregulated, unsanctioned health apps and websites are now advising and guiding the care of some of our patients. It is predicted that self-diagnosis technology will have the most significant technological impact on our patients over the next five years. These tools are filling the gap. This is not necessarily a bad thing, but how do we make sure our patients are accessing good quality advice and guidance through these tools?
The answer is to change and adapt, to develop new ways of delivering our service that create capacity, are appealing to the workforce, sustain high quality service provision and support the use of modern technologies.
Later in April, Compass Health will be presenting Health Care Home to Wairarapa DHB. If successful this will enable us to build on the positive experiences of practices in the CCDHB region and invest in new ways of working. Our patients will experience better levels of service, easier access to urgent and unplanned care, more effective proactive care for those with high needs, scheduled routine and preventative care and our practice teams will be working smarter not harder. The platform will be in place to embrace new technologies and support integration of services across the sector.
The time is right for us in Wairarapa. We will avoid the challenges of leading edge implementers and early adopters, yet gain the advantages of the early majority.
If we can sort out our supply side, as the policy makers increase demand, we can make Primary Care equitable, affordable and a sustainable future employment option.
Director Primary Care, Wairarapa