The Services to Improve access (SIA) Board Subcommittee was reconvened with additional membership and a new Chair in July 2006. The Board approved the committee Terms of Reference at that time and these include a requirement of the Chair to present an annual report to the Board “summarising the Committee activities during the year and any significant results and findings”.

Note: Click here to download a PDF of this report.

Current Committee membership

The Committee meets monthly for up to two hours.

In accordance with the Services Plan for Services to Improve Access (updated November 2006), SIA projects must have the following objectives, as “best practice”:

• To place the patient at the centre of health and social services delivery
• To empower patients and their whanau/families to actively participate in and manage their own health care
• To encourage equitable access to quality health services according to need and ability to benefit; and irrespective of ability to pay
• To provide health care based on the best clinical evidence within the limits of available resources.

Any intervention should:

• Not make inequalities worse
• Increase people’s control over their own lives
• Actively involve users of health services and communities
• Favour the least advantaged
• Take a comprehensive approach, targeting individuals, whänau ,population groups and the environment
• Foster social inclusion and minimise stigmatisation
• Be effective both in the short and long term
• Adapt to changing circumstances
• Work with and build the capacity of local organisations and community  networks.

Current Programmes

“Project One”
This is the principal project within the suite of SIA initiatives aiming to improve access to healthcare services for Maori, Pacific Island and low income people.  The overall concept enables the general practice teams to identify barriers to a patient/family/whanau accessing health care e.g. financial, transport, language, cultural, and to have access to funding to address these barriers. The project is about creating “pathways” to access general practice with three supporting components – Flexible Funding, Practice Nurse Intervention funding, and Partnership Community Workers supporting general practice teams.

Approximately 50% of practices within the PHO are now accessing this initiative. Three monthly patient outcome reports are provided by each surgery and these reports indicate appropriate use and innovative care being provided utilizing the flexible funding package, including significant linking with other providers and services

Frail Elderly
This initiative is designed to assist General Practice in caring for their frail elderly patients in the community. It is designed to help these patients access the right care in the right place without the financial burden that might otherwise reduce their access to care.

It is for:

• People who are frail and “only just” managing independently in the community.
• Patients who are becoming frail, and are likely to require extensive care. This is often the result of an illness or minor crisis, where frequent visits would be required.
• Vulnerable elderly people who have struggled at home and may have a combination of acute on chronic problems which are threatening to tip them over into residential care/hospital admission.

Following a successful pilot the project has been rolled out to all Partnership health practices. As of 24^th August 2007, 172 registrations have been received from 60 GPs.

Physical Health Improvement
The Physical Health Improvement Project provides additional funding to general practice teams for patients identified as having a mental illness but not routinely accessing Primary Care. The project targets those patients who do not have an ongoing relationship with general practice. It is intended that referrals to the programme are primarily initiated by workers in NGOs and Mental Health Services. Some clients will be identified by general practice teams who recognize individuals who may already be patients but who are clearly not seeking out regular care to deal with health concerns outside of an acute nature.

$500 funding is paid to the GP for them to use to improve the physical health of the patient. Use is at the GPs’ discretion but it is intended that the funds will be used over a 12 month period.

The programme was initially piloted in a small number of practices across Partnership Health, with 25 patients enrolled, between October 2006 and May 2007. The programme in now being rolled out in stages to all Partnership Health practices. Current referral groups include: Hereford Centre, Totara House, ComCare and the Forensic Community Team at Hillmorton Hospital. New referral groups are added as further sectors are brought onboard.

One-off funding for GPs: As the uptake was slower than expected in the first 12 months resulting in unused funds, GPs were invited to nominate one patient each into the project. Eight patients had received funding during the first two weeks in August.

Workforce Development
This suite of projects contributes to a Workforce Development Plan to be developed and implemented over the period July 2006 – July 2008, noting that primary care workforce capacity had been identified as a barrier to delivery of a comprehensive range of health care services.

The programme objectives are:

• To build capacity and capability within the general practice workforce
• To develop and implement new initiatives to prepare the workforce for the broad clinical responsibilities of delivering high quality care in a new environment
• To provide an effective and comprehensive solution for delivery of workplace initiatives within Partnership Health Canterbury.

Service Components include:

• Introductory Nursing Courses
• Orientation tools and resources for new nurses
• Return to Nursing programme support
• Medical and Nursing Student Clinical placements
• General Practice Scholarships for medical trainees
• Exploration of an agency role
• New Entry to Practice programmes
• Future Primary Care Team development

Progress has been made in all of these components. However it has proven easier to make a difference in the nursing sector within the current funding levels than in the medical workforce. A further proposal is currently being developed to seek a further injection of funding to specifically target general practice medical workforce issues. We have an aging GP workforce with few new entrants. This is of significant concern to the sustainability of a quality primary care service in the future.

Access to Care After Hours
This initiative is aimed at supporting the prospective identification of high needs patients who, due to financial, social and other barriers, do not currently access the services offered by the 24 Hour Surgery at a level consistent with optimal health outcomes. The initiative supports all high needs patients who:

• Are enrolled with a Partnership Health Canterbury affiliated general practice.

AND

• Have a history of frequent attendances at the Emergency Dept or their practice but be relatively infrequent presenters at the 24 Hour Surgery

AND

• Are prioritised according to age, ethnicity, health status, NZ Dep.

OR

• Are identified by their general practice team, Emergency Dept or Community Support Nurse as a high needs patient for whom a financial barrier is perceived to exist preventing the patient accessing after hours care.

The goal of this service is to improve the ability for high needs patients to access after hours care by:

• Proactively linking patients to their General Practitioner’s preferred after hours provider
• Reducing the cost to access after hours care
• Encouraging and strengthening the linkages between high needs patients and their general practice team
• Improving the patient’s understanding of what is available and when they should access after hours care.

This project has been introduced to general practice over recent months. Feedback was positive in the main, but objections were raised by some on the following grounds:

a) Those practices that provide their own extended hours services felt the project disadvantaged them and their patients. The funding has since been extended to cover these practices for their enrolled patients.

b)  Some commented that the project had used a very “blunt tool’ for targeting those in greatest need.

c) Some felt that the fees charged to patients attending after hours was so low it may encourage them to at wait and utilise this service instead of appropriately accessing their general practice team.

Diabetes Project
Partnership Health Canterbury’s Diabetes Direction incorporates direction from SIA, CarePlus, Maori Health and Health Promotion. Whilst funding comes from services to improve access, the committee does not oversee or monitor this activity. This activity resides with the PHO Health Promotion Project Manager, and a new Diabetes Direction paper for the PHO is currently being written. My understanding is that progress has been made in the area of the Community Podiatry, High Risk Feet Project with podiatrists having been trained, and assessment forms and referral processes developed in partnership with the Diabetes Centre. A project launch is anticipated for September 21^st.

Maori Health Plan
Again, whilst the funding for this project sits within Services to Improve Access, the committee does not monitor or oversee this work. Oversight of the plan and its implementation has been contracted to He Oranga Pounamu.

Hepatitis C Clinic support
Eighteen months ago several organisations (Rodger Wright Centre [RWC], Hepatitis C Resource Centre [HCRC], Needle Exchange New Zealand) with a vested interest in IDU health and hepatitis C prevention and management, proposed the inception of a hepatitis C community clinic. The clinic is running as a pilot project and based at the Rodger Wright Centre, and offers a point of entry to free comprehensive hepatitis C identification and management. It aims to reduce barriers to IDU health care, improve hepatitis C health outcomes and optimise access to treatment (within a shared-care framework with GPs and CDHB treatment providers) for the targeted population.

GP Care Methadone Programme
This project was approved by the Board in August 2007, to support gazetted GPs to maintain a high quality service for patients on methadone, keeping both patients and GPs safe. Support includes a committee comprising three GPs, the Pegasus Clinical Leader of Mental Health, two representatives from the ChCh Methadone Programme, a psychiatrist and a consumer representative. Since 2004 patient numbers in the programme have gone from 35 to 117, with an additional 18 patients successfully counted off methadone with no relapse to date. The impacts of the programme extend into wider society as lives are rendered more functional, with impacts such reduced spread of infection from sharing of IV needles and reduced criminal activity.

It is proposed that future funding recognition of the programme by the CDHB is sought.

Whanau Link Project
This project was successfully piloted by Pegasus Health for the twelve month period up to July 2007 and has since been funded through SIA and extended to Partnership Health practices.

The service aims to:

• Reduce inequity of health outcomes for Maori
• Improve access to primary care, and effectiveness of service
• Increase the perceived need for and the value of general practice to Maori

The service is delivered by a Whanau Link Coordinator who works with general practice teams and other community groups to target and support the care of Maori who are enrolled with Partnership Health practices but not accessing care appropriately, and those who are currently not enrolled. Access to general practice is enhanced and practical support and resources provided for practices to understand and overcome barriers to access for this group. At the time of writing a contract for this service is not yet in place.

Youth Sexual Health
SIA funding was made available to contribute to the extension of this general practice project to those aged under 21 years until values are firmed up by the CDHB.

Electives Process
In 2006/2007 SIA funding was utilised to support people who were removed from the CDHB waiting list. Almost 5000 people were removed and through this activity 400 of the highest priority (as advised by general practice) received care either funded by the PHO and delivered in the community, funded by the CDHB and delivered privately by St Georges or Southern Cross, or subsequently by being reinstated and treated with urgency by the CDHB hospital provider.

This activity led to a proposal to redesign access to secondary care services by utilising a community based referral management service. This proposal was accepted by the CDHB Executive Management Team and is commencing as a project.

Proposals considered but not approved

Aranui Nursing Project: Proposal declined. Another funder since identified.

Interpreter Services: Further funding stream found.

Sleep Apnoea Clinic: Linked to Electives project.

City Mission GP Project: Further source of support identified.

Proposals currently being considered

Extension to Workforce Development Project (seeking further funding to be specifically targeted at the medical workforce issues). This is on hold until budget determined.

Medlife (now known as Healthilife): seeking support for the establishment of a governance / advisory group to work with an entrepreneurial organisation to progress a web based lifestyle / health support programme.

Further Activity

Discretionary Funding
This is in fact a funding pool that is separate to SIA, yet has obvious links. To this end the committee has provided input and advice into the development and implementation of the programme.

Hospital parking charges
TLA representatives have sought and been granted speaking rights at a Christchurch City Council meeting in September to object to the substantial increase in parking charges at Ch Hospital.

Gambling addiction
A submission was made to the Christchurch City Council on this issue.

Closing Words

It is my view that the SIA Committee has worked well together to fulfil its purpose of assisting the Board in the implementation and on-going delivery of the “SIA Service Plan Update, February 2006” within approved financial budgets. Concern has been raised on occasion with regard to delayed start to delivery of some projects, however the committee has recognised and acknowledged that the context in which we function is complex and in most cases delays have been necessary to lay the ground for effective delivery at practice level and beyond. Contracting delays have also impacted on service delivery in some cases. The departing CEO has recommended close monitoring by the committee of project delivery and the committee will note this.

The committee terms of reference indicate a twelve month term for the Chair. It is silent on provision for a further term. I am happy to fulfil a second term should the Board and committee wish.

I thank the committee members for their commitment and contribution through out the past year. All have made significant contribution and the varied perspectives offered are valued highly.

NB: A current budget update is not available at time of submitting this paper to the Board.