How will we achieve the ‘locality approach’ with our new health system?
Written by Tom Varghese
For a while now, there has been a strong case to take a second look at the structure of NZ’s health system. Earlier this year, the government announced a major restructure of New Zealand’s health system. DHBs will be replaced by primary and community care organised in locality networks.
Across the world, the level of development of primary care as part of the healthcare system varies substantially. Many countries are instituting policies to hold primary care practices accountable for managing chronic conditions and meeting clinical standards. Traditionally, healthcare systems of countries focused on acute, episodic care, addressing the needs of inpatients. Many are now moving towards holistic care, to a healthcare system that takes into consideration the ageing population and the corresponding increase in chronic diseases.
However, it is not possible to create effective primary care systems using a “one size fits all” approach, or put into practice one recipe, as systems are dependent on context. Upcoming government policy changes will drive a fundamental shift of care from hospitals to more community-based settings. There is a growing expectation that this shift will be supported by the development of a comprehensive network of integrated care facilities in which primary, community and secondary care services are co-located, referred to by some as ‘polyclinics’.
In practice, significant effort would be needed to realise the potential benefits of integrated care. Co-location alone might not be sufficient to generate co-working or integration of care. The primary focus should be on developing new pathways, technologies, and ways of working rather than new buildings. Services will need to be contracted based on clear quality standards to ensure that the benefits of the new models of care are realised.
To maximise accessibility, choice of location is critical, polyclinics should ideally be developed in natural transport hubs. Where this is not possible, finding ways to integrate services more effectively within existing facilities or on existing sites would be preferable to developing a polyclinic in a less accessible location.
The absence of clinical and managerial leadership in these facilities will inhibit new ways of operating. In practice, overseas evidence suggests that shifting services into the community can lead to equivalent or higher unit costs unless care pathways are redesigned, and hospitals can reduce their unit costs. Scheduling of services will need to be carefully planned to ensure the effective utilisation of building space and staff time. Developing polyclinics is also likely to require transitional funding.
New locality developments should not simply be a response to a new national target, but a well-thought-out element of a broader strategic plan that responds to local needs and helps fill the current gaps in the evidence base.
