Health Care Homes
What is the Health Care Home?
Health Care Home is a primary health care model that’s been designed to support the everyday needs of general practices, while keeping the focus on the most important thing — the patient.
Between 2014 and 2020, we’re expecting a 55 percent increase in demand for our GP services. Unfortunately, along with that, we’re also expecting a 30 percent decrease in capacity. That leaves us with a shortfall of 1.4 million consults— or translated into doctors, that’s 289 Full-Time Equivalent GPs. We’re simply not training or attracting the number of doctors that we need to bridge this gap.
There are a number of reasons for these upcoming challenges. A steadily aging population is bringing an increasing pressure to our GPs; with longer lifespans come many more complex health issues alongside the increasing demand for chronic disease management. Meanwhile, as the previous generation of GPs retire, the next are increasingly choosing to work parttime, exacerbating the shortfall. In addition, we also have an ageing nursing workforce adding to the pressures. There is also a growing gap between funding received by practices and actual costs, which means fewer resources to go around.
As the emerging generation of GPs go part-time they are also opting out of practice ownership. In just seven years the number of owner-operator GPs has dropped by 20 percent. With this becoming particularly acute in rural areas, there are strong implications for who is driving change.
To meet these challenges, we need to stop, pause and have a rethink. We need to hold on to the things that make general practice work, but not be afraid to make changes. With new technology, there is a very real opportunity here to build a model of practice that will ensure our ability to provide topquality primary care to our communities — but in new ways.
Health Care Home is our response to this changing primary healthcare ecosystem. It’s the approach we’re taking to help general practice and the broader primary care environment move into the future.
As well as the work with general practice to proactivly manage patients and increase access, Health Care Home also supports improved co-ordination of care across the health and social care system, wrapping an integrated extended care team around those people with more complex needs. Our vision, model and service plans are outlined in detail in our publication Health Care Home: Developing the Extended Care Team.
Under Health Care Home, the focus is on planning as much care as possible to ensure the right patient receives the right care in the right place by the right person. By making the best use of each clinical role and creating new ones to serve particular needs, practices can be more efficient and give our patients more customised and appropriate attention. Planning allows us to be more proactive in our care, which in turn allows for more preventative measures to be taken for many patients. The patient portal allows the patient to have more control of their care too.
With technology, we can start to move many aspects of primary care out of the consulting room. Not all patient medical care needs a face-to-face consultation, so if we can save those in-person appointments for those who really need them that’s a win for everyone.
Health Care Home also has some excellent advantages for the business side of general practice. Using ‘lean’ methodologies allows us to strip out many unnecessary aspects of the day-to-day workflow and standardise our routines and procedures as much as possible. When we can reclaim time that would otherwise be wasted, it can go to where it’s needed most — looking after our patients.
Traditionally, general practice has been largely a reactive and universal service, given in response to a patient seeking care in the form of a face-to-face appointment.
The decision about how the GP’s time is used is made between patients and the receptionist. Most patients are generally given the usual 15-minute appointment with their GP or nurse, irrespective of the complexity of need. This can mean clinicians run out of time, causing lengthy waits for other patients, or patients feeling frustrated that they haven’t had the time they need to discuss their needs and care.
For patients with complex health and social care needs, who typically need longer than the usual 15-minute appointments, the ‘Year of Care’ programme allows for comprehensive health planning over a full year. This is a proactive, multi-disciplinary team approach in which the team schedules in a patient’s appointments, reviews, specialist care and social care over a full year, appointing a care co-ordinator to the patient to monitor delivery of the plan. The ‘Year of Care’ takes the form of a partnership with the patient and their whanau, with the patient encouraged to take a leading role in setting and meeting their own health goals. Managing patients in this way is widely recognised as producing better outcomes, and it reduces the likelihood of urgent, ad-hoc treatment causing problems for other patient scheduling.
Developing new roles The primary care sector is beginning to deal with a serious shortfall in the number of GP consults. This puts a huge load on existing GP and nurses, which in turn makes it harder to attract new doctors and nurses to the sector.
By developing new roles, we are able to re-allocate tasks that might otherwise be done by GPs and nursing staff. In this way, we can ensure that patients are receiving care in a timely fashion while freeing up time for clinical staff to do what they’ve been trained for — as well as upskill. It also makes for an efficient business model, ensuring all clinicians are working at the top of their scope.
These new roles include: Medical Centre Assistants These are unregistered staff who undergo accredited training to support clinical staff by taking on lower-level nursing and administrative tasks to support clinical staff. These roles have no component of diagnosis or clinical judgement but have a large role to play in supporting clinical care allowing nurses especially to spend more time on direct patient care.
Thanks to the Patient Access Centre increasing their capacity, most practices employ medical centre assistants from their existing reception staff. Medical centre assistants may perform roles such as: • Greeting and rooming patients • Taking core health measurements, such as blood pressure, height and weight and ECGs • Providing smoking brief advice • Urine testing and phlebotomy • Planning and organising records and equipment for the following day’s procedures • Preparing packs for, and cleaning up after, minor surgeries • Preparing and stocking consulting rooms • Changing linen • Ordering stock and clinical supplies
Clinical Pharmacists These add a much-needed specialist skill set to the primary care team. A clinical pharmacist works with the clinical team to target patients with complex health and social care needs who are on multiple medications, ensuring that they maintain an optimal drug regime.
They work to support medicine reviews, compliance and education, and are integral to the Year of Care approach for patients with higher needs.
In addition, they may also: • Consult with patients, either face-to-face or over the phone, to review medications and answer any questions; these consultations are co-ordinated by the Patient Access Centre • Review all hospital discharge notes to check that patients have been given the correct medication and dosage • Follow up discharged patients to avoid any potential problems that could lead to re-admission to hospital • Order blood tests and refer patients for a GP consultation if necessary
Physician Associates An increasing number of practices are employing physician associates to supplement the clinical team members, especially when there are GP and nursing recruitment issues. Physician associates typically have spent two years in training at medical school following a health related profession or degree. They support GPs in patient diagnosis and management, taking on tasks such as test analyses, taking medical histories, performing examinations, and developing management plans. They work under the direct supervision of a doctor and are valuable when it comes to supporting timely unplanned care and chronic disease.
Nurse Practitioners Nurse practitioners are registered nurses who have specialist training in certain skills. Not only does this add specialist expertise to the team, it means that GPs have more time to target at those who need it most. They are invaluable in leading the Year of Care programme for the higher needs patients.
Health Care Home builds on this further, ensuring that all health and social care providers are ‘wrapped around’ those patients that need them in the most efficient way.