Lessons from New Zealand: the benefits of general practice

networks

Aims: General Practice Primary Health Organisations (PHOs)

Minister

Ministry of Health

5 District Health Boards Midlands Alliance

GP Owners

Practice Staff

Network

PCNZ

Developed from Independent Practitioner Associations in 2002

as a model to increase access and develop wider, integrated

primary care provision based on population need

Not for profit trusts. Significant diversity in size, governance

and functions. Many operate though GP owned networks

Govt funding based capitation and agreed funding for

additional services. Plus a practice co-payment for over 13s.

Comparative minimum performance expectations from Ministry.

Network leadership sets the framework for quality, innovation

and support

Combined CCG, NHSE, LMC, Federation and CQC roles

The Pinnacle Network – Supporting 90 practices, 440k popn

• Regular ‘check-ins’ with practices – assigned senior staff and operational support teams. Approx. 9 practices to 1wte + GP liaison roles

• Problems identified due to frequent connections with the practices

• Practice Development Plans facilitate right conversations

• Centralised support to prevent duplication of work practices

Managing Today

Supporting Business as Usual

• Targeted funding of network QOF – benchmarking provided to practices

• Quarterly performance reports. Data informed conversations – highlights hotspots then discussed at liaison meetings with capacity to provide hands on support in practice

• Monthly clinical newsletter and sharing of best practice

Driving Quality

• Health Care Home Model – 10fte team providing intensive change management support to practices adopting the model.

• Practice leadership roles funded to create capacity and headspace

• Development of bespoke Patient Information System INDICI

• Training team to support practice roll out

Design and Development

Future proofing primary care

Network Challenges Managing business of today vs future proofing tomorrow’s primary care.

- investment in new models of care not seen by all practices as a priority

- tension between system leadership and acting on behalf of the practices

Relationship management with the less engaged practices – Executive Leadership Team targeted at these using informal dinners to facilitate productive dialogue and debate

Alliance contracting environment, but lack of direct funding to PHOs

Primary care could deliver more but funders consumed by hospital costs and specialists heavily unionised

Nurturing clinical leadership and engagement within the NZ cultural context

Success Factors and Learning Larger networks have significant management and organisational capacity. Smaller networks (<

200k popn ) struggle to drive change, invest in new developments and provide back office support

Non-statutory status enables nimble and flexible approaches; ability to push boundaries and innovate

Clinically led, managerially astute governance and leadership structures. Supported by commercially and politically astute independent directors

Knowing your membership – maintaining high level of practice intelligence critical to engagement and relationship management

Minimal system restructuring creates well established, high trust relationships that fosters productive collaboration and engagement

Large networks collaborating are changing the health system environment – National Health Care Home Collaborative