Lessening the burden on our healthcare system
Written by Tom Varghese
"In NZ’s future health system, your area will have one or more locality networks of healthcare providers in the community. This will still include people like your local GP, maternity carers, district nurses and optometrists; but the care they provide will be more seamless and accessible".
There is now widespread recognition that communities have a vital role in improving health and wellbeing. The communities people are born, live, work and socialise in have a significant influence on how healthy they are. There are many ‘assets’ within communities, such as skills and knowledge, that can be mobilised to promote health and wellbeing.
Through 2008 and 2009 both Auckland and Waitemata District Health Boards (DHBs), together with primary care, consulted extensively on their respective Primary Health Care Plans, achieved a high level of cross sector and community support for their plans and made a commitment to a neighbourhood/locality approach (see figure).
The recently announced health sector structural change promises that DHBs will disappear and primary and community care will be organised in locality network. Crucial to note that there is a lack of specific reference to rural people and communities as a priority population, despite rural health inequities being identified through the Health and Disability System Review.
A locality is geographically defined and encompass all people usually resident in the area. Locality approaches often have two related but distinct features: locality planning and provision. The idea is that localities offer general practice the opportunity to be a major stakeholder in an integrated primary and community care sector. This would allow peripheral drive whereby ideas and new models of care driven from localities are supported by a single, consistent purchaser. Health systems will be delivered through networks of providers with a focus on shared outcomes, specific to their community. That central oversight will ensure consistency across the country. In time, localities can work with their local hospitals to develop integrated patient journeys across the whole system.
The Government's health-reform planners are on the lookout for primary and community care networks to become prototypes for the new system to be based on localities. These 'prototypes' will provide an opportunity to create exemplars of leading practice and innovation and gather knowledge to inform future national roll out.
There is large swathe of data that needs to be translated into meaningful information and less still into a form that is able to inform decision making.
Two factors remain largely unanswered at this stage: Funding (the funding streams influence behaviour and incentives within he sector) and Contracting (signs pointing towards integrated models of care and patient journeys could be bolstered by contracting arrangements wrapped around these system changes).
