On the right track? How HealthPathways are improving care in Canterbury, New Zealand

Today, The King's Fund publishes a case study on the quest for integrated care in Canterbury, New Zealand. It's an ongoing six-year journey that has involved creating a vision; putting in place the processes to achieve that; and changing many things in the way primary care, the hospital and social care work. This has produced demonstrable improvements in hospital effectiveness and social care demand.

One of the more innovative items has been HealthPathways – a set of agreed local guidelines on what family doctors should do before referring patients for an outpatient consultation.

At first sight HealthPathways looks merely like another set of guidelines for treatment or the Map of Medicine. But the way it has been constructed, and what it contains, makes it much more than that. Developed from 2008, it is a set of highly applied and detailed local agreements on best practice. The agreements inform GPs not just about what needs to be done before a patient is referred, but precisely where they can get the services they need (such as X-rays, lab tests and physiotherapy) from the public or private sectors.

The pathways are based on the best international evidence. But where the availability of local services cannot meet this need, the pathways strive to be explicit about that, explaining why a higher referral threshold has been set.

To critics, this might look like the ultimate in cookbook medicine. But it has empowered GPs to do appreciably more in general practice and has helped to ensure that only those patients who need an outpatient appointment get one. Referrals are monitored: those that do not follow the pathway are rejected. GPs have to do more so that the patient arrives at hospital better 'worked up'. Consultants are working more intensively because more of the patients who turn up really need to be seen. But the result has been better use of hospital resources and a more professionally satisfying life for GPs. It has also produced better communication between specialists and general practitioners as cases can be discussed with the pathway open on each of their computers. With almost 500 pathways in existence, GPs can now more easily tackle the cases they might see only once every year or so.

But Dr Graham McGeoch, who was heavily involved in the design of HealthPathways, and others in Canterbury say the process of creating the pathways has been as essential as the outcome. It has forced hospital specialists and GPs to sit down together and overcome prejudices and misunderstandings. For example, GPs need no longer ask 'why are you following up on my patient for five years when I could be doing this, and you could be seeing the patient I can't get in?' – when the consultant thought that follow up was what the GP wanted.

Doctors in Canterbury are clear that HealthPathways is not a cookbook others can simply lift off the shelf and adopt: the communication between hospital specialists and general practitioners that it has forced has been an essential element in its success. But its results have been sufficiently impressive for others in New Zealand and Australia to attempt to replicate it.

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Comments

#40838 Jason Trethowan
Chief Executive Officer
Barwon Medicare Local

We are one of many primary health care organisations in Australia (Medicare Locals) implementing health pathways in local communities. We identified system gaps where medical specialist services had high waiting lists, we recognised General Practice had the capacity to manage more patients without referring on and that Outpatient services were not discharging back to primary health care (when they can be).

The value so far is that we have created an even playing field for medical specialists and GPs to agree on local pathways. Allied Health are also able to be part of the pathway development and create awareness of their services.

GPs like health pathways as it isn't protocol / tick box medicine. The pathways are a series of memory joggers and a succinct way of empowering them to support patients closer to home.

Learn more about us at www.barwonml.com.au

#40848 Miriam Kingsley
Map of Medicine

The latest addition to Map of Medicine’s portfolio is Map Referrals (http://www.mapofmedicine.com/solution/referralmanagement/). Map Referrals brings together high quality evidence-based, locally customised pathways integrated into the GP’s workflow, alongside locally customised referral guidance, criteria thresholds and local referral forms. Together, they are driving a reduction in inappropriate referrals and supporting efficiencies in the GP workflow. Map Referrals provides transparency across the care continuum in terms of cost-effective, high-quality assessment and diagnosis, and clarity on the referral options available to clinicians and patients. Clinicians can make the right decision, first time

Map of Medicine is the premier evidence-based local care pathways solution that is improving the quality of care across the UK, New Zealand, Australia and the Middle East. We have partnered with dozens of local health communities to develop more than localised 1,800 care pathways, and provide clinical decision support that is actionable at the point of care, integrated with clinical systems.

#40859 david oliver
consultant physician
royal berks

Dear Miriam
We have Cochrane Reviews, we have NICE guidelines and NICE quality standards,. we have clinical guidelines from professional societies and colleges. None of these organisations seek any profit. Can I ask you to explain what Map of Medicine adds to these internationally recognised guidelines and whether Map of Medicine is a for profit organisation? Or whether you have data to demonstrate that healthcare professionals use Map of Medicine over NICE/Cochrane/Professional Guidelines. It would be worth being very clear about this

David Oliver

#40900 Marty Kehoe
Chair
Westhill Men's Shed - Aberdeen, Scotland

I've noticed that Canterbury has started up over 20 Men's Sheds this year with a focus on men's health. I am wondering how much this will help in delivering services locally. We are the first community Men's Shed in Scotland (there are a number in England) and we have had a lot of interest from health and social services. We operate as an independent charity with over 60 regular visitors providing a place where (mainly retire) men can go to share skills and enjoy the company of others. There is a wide range of ages, abilities and capabilities and the ethos is men helping each other. We are a far cry from a traditional "day centre" service provision and see ourselves as a new way of meeting the challenges of an active, ageing population.

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