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nz.doctor.co.nz 26 May 2016 | A Counties Manukau pilot scheme will see 11 practices making changes set to save the DHB millions of dollars.

The Enhanced Primary Care I scheme aims to make practices more efficient, including in deal ing with acute patients, by in troducing and assessing changes within each practice.

Over the next 18 months, 11 practices will take part in a $1.5 million pilot for the scheme.

Practices so far confirmed as being involved in the pilot are Beachlands Medical Centre, Pakuranga Medical, Greenstone Family Clinic, Mangere Family Doctors, South Seas Healthcare, Papakura Marae Clinic and Otara Union Health.

Each practice will be given $10,000 by the DHB and the same from its PHO, and is expected to contribute $10,000 of its own time and resources.

The remaining funding is for advisory costs, project management, analytics and provision for innovation opportunities, Counties Manukau Health's primary care advisor and GP Campbell Brebner says.

Improvement facilitators, trained by the DHB's research arm Ko Awatea, will work with each practice, first looking at current performance, then suggesting changes and measuring impacts.

If successful, the DHB will invest $5 million over 10 years on broadening the scheme to 40 practices and predicts savings of nearly $20 million overall, Dr Brebner says.

The savings projection is derived from the impact of avoided costs such as admissions, readmissions and presentations to ED.

While changes will depend on each practice, he suggests activities like doctor phone-triage services for the first half hour of each day could work in reducing visit numbers.

Call centres, patient portals and email consultations are other examples he says could be relevant.

The success of changes will be monitored by the DHB based on data collected by the practice, such as patient visits, consultation times and referrals to hospital, Dr Brebner says.

A better service for patients is the main focus, he says, rather than financial benefit.

Online commentary on a New Zealand Doctor story questioned whether the scheme is simply "cost shifting" on the part of the DHB.

Commenting on the story, one GP asked, "Has anybody done an analysis of the cost or the impact on services already provided by general practice, or is this simply based on an assumption that 'general practice can do this, so they will do this?'" Another commenter, referring to a similar scheme in Northland, said while he was open to different models of care possibly allowing GPs to work more efficiently, the financial risk seemed to be ignored.

"Taking staff out of consulting time to 'bat away' 25 per cent or more of consults is a potential practice killer, for some. In addition to this, some of my colleagues are very reluctant to increase their potential liability by being pressured to triage away sick patients," he wrote.

Dr Brebner, however, says such concerns consider the cash register too much and do not consider the increased enrolments the scheme should create for practices.

Counties Manukau DHB chief executive Geraint Martin says the DHB has no interest in putting GP incomes at risk.

The feedback he gets from general practice is that it could be run more efficiently and he says the DHB would not be going forward with the plan without being confident it was something the practices were interested in.

The plan sits within a broader context of overall improvements to the health system, and he hopes to eventually see it as business as usual rather than anything special.

Republished with permission of New Zealand Doctor. To subscribe to go www.nzdoctor.co.nz

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