Integrated Primary Health Care

1. “A whole of system approach to primary health care ” Integrated Primary Health Care

2. 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 Key Challenges for the Health System

3. 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 provided health care are increasing Increasing Demand on Limited Health Resources

4. 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 What Does the Evidence Tell Us ?

5. 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 Definitions

6. Based on the premise that Acollective 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

7. 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

8. 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) Primary Health Model for Integrated Planning and Services

9. GSAHS Primary Health Model for Integrated Planning and Services 1 Local Council University NGO’s Private Sector Human Services Management Meeting CE & Chairs Divs of GP GSAHS Strategic Meeting GSAHS Senior Executive Meeting STRATEGY Area Health Advisory Council Meeting Shared Planning Shared Strategies Shared Projects IPHCC RHS Population Health 2 Area Management Meeting Directors & CEOs Divs of GP GSAHS Op/Strat Mting Clinical Ops Strategic Information Meeting STRAT/OPS P&CH Acute Mental Health Population Health Area Clinical Networks 3 Local Service Network Meeting Local Division Meetings Local Service Delivery Cluster Integrated Service Delivery Meetings OPERATIONAL Cluster Health Advisory Committee Cluster Clinical Teams 4 Local Services Local GPs Local Management and Clinical Teams OPERATIONAL Local Health Advisory Committee Local Clinical Teams

10. 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 do we need to change?

11. 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?

12. 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 challenges?

13. 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 policy enablers?

14. 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 physical enablers?

15. 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. What are some other enablers?

16. 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. Models of Integrated Primary Health Care Health One NSW Rural Primary Health Program

17. 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. Health One NSW

18. 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. Rural Primary Health Program

19. 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 Health One NSWand RPH Focus

20. Thank You Questions?