Skip to main content

Main menu

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • Editorial Board
    • Editorial Fellowships
    • Outreach
    • Research into Publication Science
    • Advertising
    • BJGP Life
    • Feedback
    • Alerts
    • Conference
    • eLetters
    • Audio abstracts
  • RACE AND RACISM IN PRIMARY CARE
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Alerts

Search

  • Advanced search
BJGP Open
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
Advertisement
BJGP Open

Advanced Search

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • Editorial Board
    • Editorial Fellowships
    • Outreach
    • Research into Publication Science
    • Advertising
    • BJGP Life
    • Feedback
    • Alerts
    • Conference
    • eLetters
    • Audio abstracts
  • RACE AND RACISM IN PRIMARY CARE
Practice & Policy

Steps towards more integrated care in New Zealand: a general practice perspective

Les Toop
BJGP Open 2017; 1 (1): bjgpopen17X100845. DOI: https://doi.org/10.3399/bjgpopen17X100845
Les Toop
Head of Department of General Practice, University of Otago, , New Zealand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: les.toop@otago.ac.nz
  • Article
  • Info
  • eLetters
  • PDF
Loading
  • general practice
  • integration
  • alliancing
  • New Zealand

The imperative to better integrate health care in New Zealand started a quarter of a century ago and has accelerated in recent years, some of it recently showcased at the 4th World Congress on Integrated Care in 2016.1 There exist mature models of horizontal integration, patchy examples of effective vertical integration, and much talk from the highest levels of government of the need for more intersectoral integration. The concept of improving horizontal integration by co-location and collaboration is of course far from new, with many and varied primary care workers in New Zealand expressing the wish to develop closer working relationships in the 1990s.2 These collaborative sentiments were not always shared by national disciplinary leaders and politicians.3 The integrated family health centre or healthcare home model with innovative models of care is only now gaining momentum in parts of New Zealand4, but is yet to be trialled and evaluated at scale.

First steps for organised general practice in New Zealand

In the 1990s, competition in health was enshrined in policy by a hard-line, right-wing government with public hospitals rebranded as 'Crown Health Enterprises'. They were instructed to compete against each other and to deliver profits.5 Meanwhile, general practice was organising itself into collaborative independent practice associations (IPAs) to share after hours care, to negotiate collectively, to take back control of their own continuing education, to provide support for evolving computerisation, and to work together on other areas of mutual interest. The opportunity for several nascent IPAs to take on risk-sharing budgets for selected referred services, (principally medicines and laboratory tests), arose from a policy vacuum on primary care direction, spiralling expenditure and innovative thinking from the sector. In some places, budget holding proved to be very successful in the early years and provided those IPAs with the financial resources to begin developing more integrated services. Importantly, these initiatives were designed, owned, and implemented from the ground up. In Canterbury, the Pegasus IPA was formed in 1992. It was, and remains, the largest organised general practice network in the region. Pegasus quickly developed and self-funded a range of initiatives, including peer-led interdisciplinary education and quality improvement, together with a number of population health programmes, most of which continue today.6 Vertical integration was given a further boost with the introduction of an acute demand programme in 2000, which delivered care for selected higher acuity patients in the community, who previously would have been hospitalised. The key success factor was allowing general practice teams to decide what resources and services were required to safely replace a hospitalisation with care in the community. Coordination was provided by Pegasus and an immediate, no-questions-asked approach to funding approval achieved enthusiastic uptake and rapid results in decreased acute medical hospitalisations. This highly successful community-governed model, contrasting with the hospital-in-the-home outreach model much used in Australia, is now in its 17th year. It has established many local community partnerships, works closely with secondary care, and has been replicated extensively around New Zealand.7

In 2001, the now centre-left government launched a Primary Health Care Strategy 8 that, for the first time, encouraged universal patient enrolment with part payment of fees under a capitated formula. Most funding was to be distributed through new entities named primary health organisations (PHOs), which were allowed to form themselves from willing participants, but which were required to have community involvement in governance. Beyond the obvious advantages of the mutual responsibility that comes with enrolment, this change encouraged closer and more formal working relationships between primary care clinicians, community agencies, and non-governmental organisations.

Introducing the concept of alliancing: shared problems, shared solutions

Moving on a few years, and a change back to a centre-right government, it was becoming clear that the pace of change needed to increase to meet the changing demographics (of both the population and the health workforce) to address unacceptable inequities in health outcomes between the most and least advantaged. In response to a new policy document introduced in 2009, called Better, Sooner, More Convenient 9 volunteer groups, mostly in the geographic distribution of district health boards, submitted plans to develop more integrated services. The concept of alliancing was encouraged, and in Canterbury, this approach was adopted enthusiastically with the formation of the Canterbury Clinical Network. The measurable benefits of this new way of working and planning have been substantial, and some of these, together with their detailed workplan are publicly available.10 Acceleration and incentive was provided by the destructive Christchurch earthquakes in 2010–2011, which significantly reduced hospital inpatient capacity. The key success to the alliancing approach is seen as the commitment from all partners to own the problems, and plan and work together to find solutions. Clinicians from across the system work with funders, and multiple community agencies to redesign services with a shared focus on organising care that is integrated to provide 'best-for-patient', 'best-for-system' outcomes. Nationally, productive alliancing activity has been patchy, but there are some notable successes in progressing integrated care detailed on the General Practice NZ website.11 In parallel, horizontal and vertical integration have been facilitated by a number of collaborative IT developments, between general practice, secondary care, and local funders. HealthPathways12 and HealthInfo13 are prime examples. Developing the content of the care and referral pathways fosters strong primary and secondary care relationships. Locally adapted healthpathways have now been extended to most of New Zealand, much of Australia, and now has a foothold in the North East of England. HealthOne14 is a shared electronic record view of many parts of the health system (primary care, secondary care — inpatient and outpatient — pharmacy, radiology, laboratory, community nursing, and others). This platform will soon extend the visibility or relevant parts of clinical records to the whole South Island of New Zealand.

The beginnings of intersectoral integration

The current New Zealand government, championed by the new prime minister, is very enthusiastic about developing greater intersectoral collaboration, and has identified the need for, and commitment to, social investment in the most vulnerable and at risk populations who repeatedly require the services and attention of social welfare, education, and justice systems.15 Early social sector trials, which allow increased local autonomy in social service provision, are being evaluated.16 The recent introduction of a co-developed national system level measures framework to replace the previous single disease-based pay-for-performance programme, should also add incentive to integration organised through local alliances.17

In Canterbury, both horizontal and vertical integration are developing.18 Comprehensive intersectoral integration seems inherently sensible. Whether it is practically achievable, or simply a chimera, remains to be seen.

Notes

Provenance

Commissioned; not externally peer reviewed.

Competing interests

LT: Chair of Pegasus Health. Member of the Canterbury Clinical Network Alliance Leadership Team. Member of the Executive of General Practice New Zealand.

  • Received January 26, 2017.
  • Accepted January 29, 2017.
  • Copyright © The Authors 2017

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

References

  1. 1.↵
    1. International Foundation for Integrated Care
    WCIC4 – 4th World Congress on Integrated Care, Wellington, New Zealand. http://integratedcarefoundation.org/. accessed 20 Feb 2017.
  2. 2.↵
    1. Toop LJ,
    2. Hodges I
    (1996) Primary care teamwork in the Christchurch area part 1: health professionals actual and preferred levels of inter disciplinary contact and collaboration. N Z Fam Phys 23:42–49. http://www.otago.ac.nz/christchurch/otago633959.pdf.
    OpenUrl
  3. 3.↵
    1. Toop LJ,
    2. Nuttall J,
    3. Hodges I
    (1996) Barriers to greater collaborative teamwork in primary care in the Christchurch area. N Z Fam Phys 23:51–59. http://www.otago.ac.nz/christchurch/otago633958.pdf.
    OpenUrl
  4. 4.↵
    1. CompassHealth
    (2016) Future vision: health care home, health care neighbourhood. (Planning for 2020). http://gpnz.org.nz/wp-content/uploads/Health-Care-Home.pdf. accessed 20 Feb 2017.
  5. 5.↵
    1. Upton S
    (1991) Your health & the public health. http://www.moh.govt.nz/NoteBook/nbbooks.nsf/0/93E9C76187239F264C2565D7001869CC/$file/your%20health%20and%20the%20public%20health.pdf. accessed 20 Feb 2017.
  6. 6.↵
    1. Pegasus Health (Charitable) Ltd
    What we do. http://www.pegasus.health.nz/direct-to-patient-services. accessed 20 Feb 2017.
  7. 7.↵
    1. Our health system
    (2014) Programme profile: acute demand management services (ADMS). http://www.cdhb.health.nz/What-We-Do/Projects-Initiatives/Acute-Demand-Management-Services/Documents/Acute%20Demand%20Management%20Service.pdf. accessed 20 Feb 2017.
  8. 8.↵
    1. Ministry of Health, Manatu Hauora
    (2001) Primary health care strategy. http://www.health.govt.nz/publication/primary-health-care-strategy. accessed 20 Feb 2017.
  9. 9.↵
    1. Ministry of Health, Manatu Hauora
    (2011) Better, sooner, more convenient health care in the community. http://www.health.govt.nz/publication/better-sooner-more-convenient-health-care-community. accessed 20 Feb 2017.
  10. 10.↵
    1. Canterbury Clinical Network
    Transformation of health in Canterbury. http://ccn.health.nz/OurHealthSystem/HowitBenefitsOurPeople.aspx. accessed 20 Feb 2017.
  11. 11.↵
    1. General Practice NZ
    Integrated care — key links. http://gpnz.org.nz/research-and-innovation/integrated-care-key-links/. accessed 20 Feb 2017.
  12. 12.↵
    1. HealthPathways Community
    What is HealthPathways. http://www.healthpathwayscommunity.org/About.aspx. accessed 20 Feb 2017.
  13. 13.↵
    1. Healthinfo Canterbury Waitaha
    About Healthinfo. http://www.healthinfo.org.nz/index.htm?About-HealthInfo.htm. accessed 20 Feb 2017.
  14. 14.↵
    1. HealthOne
    About HealthOne. http://healthone.org.nz/home/about-healthone. accessed 20 Feb 2017.
  15. 15.↵
    1. The Treasury
    Kaitohutohu Kaupapa Rawa. http://www.treasury.govt.nz/statesector/socialinvestment. accessed 20 Feb 2017.
  16. 16.↵
    1. Ministries of Social Development (MSD), Justice, Health, Education and New Zealand Police
    Final evaluation report. Social sector trials — trialling new approaches to social sector change. http://www.msd.govt.nz/documents/about-msd-and-our-work/work-programmes/initiatives/social-sector-trials/msd-social-sector-trials-evaluation-report-may-2013.pdf. accessed 20 Feb 2017.
  17. 17.↵
    1. Ministry of Health
    Manatu hauora. system level measures framework. http://www.health.govt.nz/new-zealand-health-system/system-level-measures-framework. accessed 20 Feb 2017.
  18. 18.↵
    1. The King's Fund
    The quest for integrated health and social care: a case study in Canterbury, New Zealand. https://www.kingsfund.org.uk/publications/quest-integrated-health-and-social-care. accessed 20 Feb 2017.
View Abstract
Back to top
Previous ArticleNext Article

In this issue

BJGP Open
Vol. 1, Issue 1
April 2017
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending BJGP Open.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Steps towards more integrated care in New Zealand: a general practice perspective
(Your Name) has forwarded a page to you from BJGP Open
(Your Name) thought you would like to see this page from BJGP Open.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Steps towards more integrated care in New Zealand: a general practice perspective
Les Toop
BJGP Open 2017; 1 (1): bjgpopen17X100845. DOI: 10.3399/bjgpopen17X100845

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Steps towards more integrated care in New Zealand: a general practice perspective
Les Toop
BJGP Open 2017; 1 (1): bjgpopen17X100845. DOI: 10.3399/bjgpopen17X100845
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • First steps for organised general practice in New Zealand
    • Introducing the concept of alliancing: shared problems, shared solutions
    • The beginnings of intersectoral integration
    • Notes
    • References
  • Info
  • eLetters
  • PDF

Keywords

  • General practice
  • integration
  • alliancing
  • New Zealand

More in this TOC Section

  • Communicating with people with hearing loss: COVID-19 and beyond
  • New models of care in general practice for the youth mental health transition boundary
  • COVID-19 and international primary care systems: Rebuilding a stronger primary care
Show more Practice & Policy

Related Articles

Cited By...

Advertisement

@BJGPOpen's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Latest articles
  • Authors & reviewers

RCGP

  • British Journal of General Practice
  • BJGP for RCGP members
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP Open
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP Open: research
  • Writing for BJGP Open: practice & policy
  • BJGP Open editorial process & policies
  • BJGP Open ethical guidelines
  • Peer review for BJGP Open

CUSTOMER SERVICES

  • Advertising
  • Open access licence

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Open Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: bjgpopen@rcgp.org.uk

BJGP Open is an editorially-independent publication of the Royal College of General Practitioners

© 2021 BJGP Open

Online ISSN: 2398-3795