Leading transformational change: Presentation to the 2011 General Practice Conference

1. Leading transformational change: Presentation to the 2011 General Practice Conference 4 September 2011 Brenda Wraight MEdPsych (Hons) Director Health Workforce New Zealand

2. Health Workforce New Zealand’s Role: • Simplify and unifythe health workforce development system • National oversight for health and disability workforce planning, training and development • Whole of education continuum, whole of healthsystem view • Monitor and respond to national and regional workforce priorities and pressures

3. Health Workforce New Zealand’s Role (cont) : • Focus on inter-professional, connectedworkforces and services • Supporting workforce development through innovation projects and training subsidies • Facilitating and enabling change via partnerships • Nationally accessible workforce dataset, improvedinformation and analysis

4. Our overarching objectives • Improved recruitment and retention • a workforce with more generic skills • new roles & extension of existing roles • strengthened workforce relationships across health & education systems • ensuring high quality, integrated and best value training

5. HWNZ outcomes in 2011 • By the end of 2011, all of the HWNZ short-term targets will have been met in regard to a sustainable and fit for purpose health system. • Key outcomes for highlighting: • A shift in workforce culture and improved morale, engagement and retention. • A future proof workforce planning and training process. • A recast of the primary care workforce to enable a shift in the model of care.

6. HWNZ Priorities 2011/12 and beyond • Bringing health services closer to home - community and home care, the carer workforce and self care • Increasing the number of Maori and pacific people in the health and disability workforce • Strengthening and integrating the health workforce in primary care - general practice, pharmacy, allied health • Health care professionals working to the top of scope • A more visible and “tangible” education and health sector continuum • Aged care, mental health & addictions, rehabilitation

7. Reform of GP training: HWNZ, MCNZ, RNZCGP collaborative • 2010 Memorandum of Understanding between HWNZ, the RNZCGP and the Medical Council of New Zealand to • assess the existing General Practitioner Education Programme (GPEP) and Rural Hospital Medicine Programme in the light of New Zealand’s emergent health workforce requirements, • redesign these programmes to meet these emergent requirements, and • implement the redesigned General Practitioner vocational training programme progressively from January 2012.

8. MOU intended outcomes include: • the mode of delivery of GP Education Programme (GPEP) • including some hospital based training in GPEP • changing the assessment process • identifying incentives for doctors to enter GPEP • funding all years of GPEP • improving alignment of GPEP with Rural Hospital Medicine training, and • aligning GPEP with training in other vocational scopes such as Accident and Medical and Emergency Medicine.

9. The process • Engagement with stakeholders - including current GPs, GP trainees, registrars • meetings with key groups such as ASMS, NZRDA, GP educators, ACEM, NZMA, MoH policy makers in primary care, DHB CMOs and COOs • a workshop on emergent models of care • establishing a reference group with wide sector representation • Development of and consultation on, discussion document

10. Discussion paper proposed: • Retaining the current three year duration of GPEP • six to eight months in hospital-based practice • the option of developing enhanced skills within the current scope of general practice, by undertaking advanced competency modules initiated during GPEP2 or GPEP3 and completed once Fellowship is attained • a compulsory academic component introduced to the programme, • Enhancing the current GPEP1 bursary • Amending the current assessment process

11. Progress to date: • enhancing the existing GPEP1 bursary from January 2012 • development of advanced competency modules (ACM) which link education of GP registrars and Fellows to training in other disciplines and includes some hospital-based practice (mental health and addictions module commenced development, care of the elderly pending) • demonstration sites involving DHBs employing GPEP registrars have been evaluated successfully by HWNZ and the model is under consideration for roll-out nationally (2013) • the Division of Rural Hospital Medicine supporting extending the scope of RHM practice to several of the smaller provincial hospitals • the RNZCGP has enhanced the educational content of the GPEP2 programme by requiring registrars’ participation in formal learning groups.

12. feedback has identified a number of critical issues: • there are very substantial externalities affecting GP education and that without change in these areas change in GPEP is likely to be at the margins. • The issues include: • agreement on the scope and nature of general practice • the timing of changes vis-a-vis the emergence of new models of service delivery (with new roles and associated funding) • the availability of funding to support the existing or revised GPEP and • capacity within general practice and DHBs to accommodate changes.

13. Next steps September 2011 Decision-making by MOU partners October 2011Finalisation of budgetary implications February2012 new GPEP1 intake with enhanced bursary March 2012 linked to Regional Training networks first advanced competency module(s) implemented Ongoing 2012 - advanced competency module (ACM) development - design & implementation planning for major changes (academic components, assessment framework, training within other specialist scopes and employment of GPEP registrars) 2013 Implementation of major changes

14. 4 Regional Training Hubs • to co-ordinate health workforce planning, education and training. Underway from 1 July 2011 • focus on medical training from PGY1 to vocational registration; but most are including a multi-disciplinary approach • Professional colleges and registration authorities responsible for content and accreditation of training programmes • Integrates regional workforce plans, career planning, and administers Voluntary Bonding scheme and HWNZ Advanced Trainee Fellowship • HWNZ provides strategic direction on health workforce priorities, monitoring and oversight. Hubs report to HWNZ through NHB reporting and accountability framework • link with: NHB; NHITB; Centre of Excellence in Health Care Leadership; National Simulation Training Network; South Island Tertiary Alliance

15. Career planning • From January 2012 HWNZ requires career plans to be in place for all trainees it funds • Resources (guidelines, tools, enhanced workforce information) to assist trainees, mentors and employers developed an online • Many organisations already do career planning in whole or in part - builds on existing processes • Intention is for a supportive process, with involvement of senior clinicians, owned by the trainee • HWNZ is not prescriptive about the process used, however these should not to be linked to assessment or selection processes • Career planning for older and retiring clinicians is recommended

16. Examples of a “tangible” education and health sector continuum • “Pipeline” for Maori and pacific students through Health Science Academies • TEC and HWNZ alignment of investment plans to ensure numbers of students in undergraduate programmes aligned to health system needs in 2020 and beyond • Advanced modules for primary care clinicians in eg aged care, mental health and addictions • Self care, home and community care, carer workforce, unregulated, and regulated workforce - patient journey • Person / whanau -centred care – patient navigators, whanau ora, managed care / care coordination • Interprofessional / interdisciplinary learning and practice • Continuum of learning for clinical leadership