1. Goal. Aligning nursing practice with community need.
Funding streams, employment arrangements and service delivery patterns will support nurses to adopt an integrated approach to practice and incorporate population and personal health strategies into service delivery
NB subsumes old recommendation of innovative practice |
The Ministry could consider the structure of Care Plus funding with a view to ensuring all patients have equal access to services, as far as possible.
Opportunities for monitoring the impact of Care Plus could be explored through the reporting associated with the performance monitoring framework.
A separate funding stream is probably required for HUHC patients, who appear to be a different group of patients to those targeted by Care Plus. National utilisation distribution data could be used to fine-tune the capitation funding formula, and to check these assumptions.
The Care Plus criteria could be revisited to make sure that services can reach patients that need them within the contractual criteria. The combination of ‘two or more chronic conditions' and the requirement that each require ‘intensive clinical management' may be too restrictive.
Many Care Plus services could be efficiently delivered as part of a home-visiting programme. Any Ministry of Health development work on home visiting should consider how such a service would work with Care Plus.
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Automated identification of patients who would benefit from programme such as Care Plus.
All identified patients consistently encouraged with their self management plan by all members of the multi-disciplinary team.
Mandated sharing of medical information across healthcare settings and multidisciplinary teams.
Uninterrupted client time and adequate space for nurses delivering Care Plus.
The ability to make the nursing financial contribution to primary health care visible and accessible for future nursing innovation development.
Well developed IT systems that interface with existing patient information systems for professionals delivering chronic conditions care.
A comprehensive directory of available community resources that interfaces with existing IT systems.
Integration of chronic illness care funding that is person specific rather than fragmented into
many individual programmes with competing and overlapping criteria.
Mechanisms such as media campaigns to increase nursing visibility in the care of people with chronic conditions.
A nationwide approach to clinical outcome measurements that goes beyond enrolment numbers.
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System Organisation.
- Personal outcomes
- Population outcomes
- Measuring effectiveness of nursing against personal outcomes and population outcomes
- Reframe CarePlus
- Costing and accounting for nursing
- Capitation accessibility } Critical issues for resolution to support
- Legislation / enrolment } behaviour change
- Change focus of general practice from income generated to outcome generated
- Bundle funding eg CP/SIA/HUHC to support holistic nursing service
- Development of tangible outcomes for nursing care e.g.
• Lab values
• Screening uptake
• SF36
• Subjective assessment
• Level of nursing
• Quality indicators
• PACIC
Support salaried model of practice of nurses as mechanism towards integrated nursing team
Information Systems
- Who owns people's health record
- Who can talk to who and how
- Mechanism for storing health assessment data
Self-Management Support – Nurse care coordination
Linking to education
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Decision Support - determining the configuration of nursing nationally
National sharing of effective tools eg PARR
Agreed national process for care plus re design
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2. Goal. Governance and Leadership.
Primary health care nurses will be equal partners alongside other professional groups and community representatives in governance of primary health care organisations.
Primary Health care nurses will have clear, accessible, integrated nursing leadership to encourage and promote change and facilitate the development of new roles and models of practice. |
DHBs that have chronic care management programmes could consider how these can be linked to Care Plus Mechanisms for encouraging the use of pooled resources could be explored by DHBs and PHOs; for example, providing incentives for PHOs maintaining a shared Care Plus workforce and operating via referrals or practice visiting. This could reduce costs by reducing duplicated resources among PHOs (eg, Care Plan development and maintenance, workforce training, and referral systems).
If Care Plus were to continue it would be worth considering whether some specific elements should be required in order to qualify for funding. Enrolment in a CCM programme could be one requirement, or at least the construction of a detailed Care Plan, possibly with specified components.
Guidance on the status of conditions that require routine monitoring as Care Plus qualifying conditions would be helpful. |
The implementation of a Care Plus coordinator role. This person would provide leadership, programme development and clinical coaching at a PHO level, and be part of a national Care Plus coordinator network.
A nationwide mechanism of sharing information about successful programmes.
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Delivery System Design.
- Nursing oversight of nursing
- Every DHB to have PHC DON
- Governance over nature of nursing services
- Review nursing employment models
- Review the efficacy of capitation to support behaviour change
- Sharing innovation and success in focused manner
Community Linkages nurses partnering consumers as basis for practice design especially for self management support |
3. Goal. Education and Career Development
Postgraduate education will support all levels of primary health care practice and be recognised in a national, standardised career pathway for primary health care nurses. |
It would be useful to conduct qualitative research to explore incentives and barriers to independent nursing practice within the primary health care team.
Primary health care nurses need access to short, affordable training courses to allow them to deliver chronic care services most effectively, including prescribing, to maximise the role they could play in the delivery of Care Plus.
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Modularised nursing education in self management skills, goal setting, and chronic conditions management that is delivered nationally, and at a PHO level and is available via distance learning methods such as on-line learning or by DVD .
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Education.
National consistency
Practice tools
Delivery mechanism
Ensuring nurses have appropriate skills and knowledge in self-management
Increased workforce capability at generalist PHC level |
