Health Care Home

Making good general practice even better

A new and innovative primary health care system designed to enhance patient care and ensure general practices remain sustainable is being made available across Hawke’s Bay.

Health Hawke’s Bay (PHO) is supporting participating general practices to implement Health Care Home (HCH).

The focus is on embedding person and whānau-centred care and improving health equity, while ensuring that general practices remain viable.

Already successful in other parts of New Zealand, the model introduces a range of roles and care options, which reduce time pressures on doctors while ensuring that patients get the right care, from the right person, at the right time.

Using proven new technologies, Health Care Home allows practices to move some aspects of primary care out of the consulting room. Not all patients need a face-to-face consultation with their doctor, so by better managing the situations that can be handled over the phone or by other clinical staff, GPs can save use the in-person appointments for those who really need them.

How Health Care Home works

A number of protocols work together to make best use of practice staff time, and ensure patients are triaged and treated appropriately. The process can be customised to each practice, to fit in with current management systems.

Managing changes to the way incoming telephone calls are handled can make a marked difference to efficiencies and patient care – particularly for those requesting same-day appointments.

Under the model, same-day appointment requests are referred to a GP who calls the patients back during scheduled phone triage time periods. They will assess how the patients’ situations need to be handled: Same day appointment; deferred appointment; referral to another provider (eg pharmacy); or advice dispensed over the phone.

Scheduled phone appointments can also be used for follow-ups to face-to-face appointments; consultations that don’t require physical examinations, and check-ups on the progress of chronic illness care plans.

The model works best if the phone reception is removed from the front reception, allowing front-of-house staff to focus on patients in the waiting room, and reducing phone call answering times.

The experience in other regions has been very positive, particularly around call abandonment. The new model has seen an average call wait time of 26 seconds, with a call abandonment rate of just 3.8 per cent, against a practice average of 18 per cent during the busiest times.

Who patients might see

The primary care sector is dealing with a serious shortfall in the number of GPs, which is putting a huge load on existing doctors and nurses, which in turn makes it harder to attract new doctors and nurses to the sector.

By developing an extended care team, with new clinical roles, tasks that might otherwise have to be done by GPs can be reallocated.

In this way, practices can ensure that patients are receiving care in a timely fashion while freeing up clinical staff to do what they have 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.

The new roles can include:

Health care associates

Unregistered staff who undergo accredited training to support clinical staff by taking on lower-level nursing and administrative tasks. They can:

  • greet and room patients
  • take core health measurements, such as blood pressure, height and weight and ECGs
  • provide smoking cessation advice
  • undertake urine testing and phlebotomy
  • plan and organise records and equipment for the following day’s procedures
  • prepare packs for, and clean up after, minor surgeries
  • prepare and stock consulting rooms
  • change linen
  • order stock and clinical supplies.

Clinical pharmacists

A clinical pharmacist works with the clinical team to target patients with complex health and social care needs who are on multiple medications, ensuring they maintain an optimal drug regime. They:

  • carry out medicine reviews, compliance and education
  • are integral to long-term planning for patients with higher needs (See Year of Care).

They may also:

  • consult with patients, either face-to-face or over the phone, to review medications and answer questions
  • review hospital discharge notes to check 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 as necessary

Physician associates

Physician associates have studied towards a health-related profession or degree. They support GPs through patient diagnosis and management, taking on tasks such as test analyses, recording medical histories, performing examinations, and developing management plans. They work under the direct supervision of a doctor.

Nurse practitioners

Nurse practitioners are registered nurses who have specialist training in certain skills and are able to take a lead role in specialist programmes for patients with long-term health issues (see Year of Care).

Year of Care programmes

For patients with complex health care and social needs, who typically need longer than the usual 15-minute appointment, the HCH ‘Year of Care’ programme allows for comprehensive health planning over a full year.

This is a proactive approach which sees the patient’s team schedule appointments (face-to-face and phone), reviews, specialist care and social care over a full year. A general practice care co-ordinator monitors the 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 lead 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.

Portals

More and more practices are using patient portals (both aligned with HCH and independently of the programme), allowing patients to access their own health information and make appointments on-line.

Dependent on general practice-set limits, patients can see their core medical information and lab results, send queries, request repeat prescriptions and track their healthcare goals — all on-line. This enables patients to take a more active role in their own care as they feel more involved and connected. With their information readily accessible, it also enables continuity of care wherever they are — even on holiday.

The system also allows nurses to spend less time on the phone advising patients’ test results and booking appointments, as this can all be done online at a time convenient to the patient.

Benefits of Health Care Home

Patient benefits:

  • care, treatment and processes are based around patients’ needs
  • reduced waiting times and faster answering of calls
  • more personalised attention from reception and medical staff
  • more same-day appointments when really needed
  • ease of access to a GP for a quick query or ongoing monitoring
  • clinical triage saves face-to-face appointments for those who really need it
  • greater support for ongoing condition management and better planning for prevention
  • the ability for patients to take a greater role in their own care and management.

Staff benefits:

  • professional expertise can be targeted at patient care and those who need it most
  • new roles reduce pressure on doctors and nurses
  • phone management protocols allow for less/better planned time on the phone so more time with patients
  • planning allows for less pressure and fewer ad-hoc decisions
  • a less stressed team is a happier and more cohesive one.

Health system benefits:

  • practices can ensure the right staffing capacity every day for urgent and planned care, reducing pressure on hospital services
  • more efficient systems and standard processes can reduce wasted time and wasted resources
  • greater long-term sustainability of primary care
  • shift of focus from treatment to prevention and greater level of patient self-management
  • equity improvement – improved health outcomes for Māori, Pasifika and low socio-economic populations.

The team

Health Hawke’s Bay (the PHO) has a dedicated change management team assisting general practices wanting to make the change; working alongside them as they make decisions about the nature and pace of their transformation.

Four Hastings practices have embarked on the journey (as at November 2019) and two more are working towards implementation. The next call for EOI will go out in 2020.