Vince Barry: Improving health through innovative community and primary healthcare

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Vince Barry, Chief Executive Officer, Pegasus Health, New Zealand discusses Pegasus Health's role in implementing transformational changes to primary and community services and developing integrated working across primary and secondary care.

This presentation was recorded at our conference Learning from new care models here and abroad on 3 October 2017. 

Transcript

When I talk about Pegasus and the Canterbury context, I’m talking about primary care because organisationally we’ve removed ourselves and our name as much as possible and worked, and built our own capabilities, as a way of contributing to the whole Canterbury health system.  

So these icons, beehives, and so those people who have been to New Zealand will know that our parliament buildings and Wellington, built in the shape of a beehive, they represent the structural reform or policy direction over 25 years.  The first one was a funder provider split in 1993 and so we religiously follow everything in the UK, just to show we’re part of a  great international experiment, but everything that fails in the UK will also fail down in New Zealand.  So we did that very well.  I think we probably improved on it from your perspective.  

But interesting, and most New Zealanders will, in health will say that was a dark time.  2001, the labour government came and reversed most of the policy changes that happened in 1993.  So we started that process that you guys, but introduced district health boards, but also for primary care introduced a strategy that delivered enrolment and capitation which has been part of your history here for quite a while, but that was quite significant because it shifted the emphasis around how you looked at from individuals to populations of people.  But in 2008, it wasn’t so much a structural reform that occurred, it was more around a policy direction around better, soon and more convenient care closer to home.  

Just touching on that funder provider split, it allowed general practice in Canterbury to become budget holders and so they built an enormous amount of capacity and capability over that time.  We started up an education programme, small group, peer led, education programme for GPs and it was based on this sort of concept, the most ethical use of finite resources and so what we needed to do was make sure that general practice teams were well equipped with the latest information, most up to date information and had the opportunity because there was such a distributed network of people to meet together, had now co-run our practice nursing programme, and also our community pharmacists.   

The other thing was our acute demand programme.  General practice in Canterbury recognised that there were a number of people that they saw each and every day, that if they could just intervene in their practice surgery, they could actually probably reduce attendance at the emergency department and a subsequent hospital admission.  So a very permissive high trust, low bureaucracy programme was put in place in 2000.  It’s matured over seventeen years where general practice can intervene.  They just ring into the coordination centre and they’ll make a response.  It’ll be access to a diagnostics, it might be getting someone to respite care, it might be as simple as getting people taxis to attend a certain event.  So, general practice, can’t intervene well enough they can refer people to acute nursing programme that will run seven days a week and up to 11 o’clock at night and another back up from there, is the 24 hour medical centre in which Pegasus owns and runs on behalf of general practice, there are six observations beds.   

So there’s about three levels of intervention before we actually need to think about sending somebody to hospital.  This has given general practice the confidence and also the respect to be able to intervene for more complex care closer to home and it’s been, it’s mindful. So when 2008 came along and the minister who was pretty active minister of health at the time, range the primary care networks and said, I don’t like what the DHBs and the hospital are doing, I want primary care to reorganise the system, I’m going to put, express an adventurous out and I expect you to respond to that because what I want to see is models of care that have primary care driving the healthcare system in New Zealand.   

So it was a pretty attractive phone call, if you’re sitting at a primary care network, and frustrated about what’s happening in your hospital system.  Here was the mechanism and the opportunity and that was highly unusual because our five or six other colleagues in the country at the time, delivered responses that EOI which were very much primary care centric but our view was that we spent all this time visioning and getting ourselves together, what we needed to do was actually now develop a system and take the opportunity of developing a system and the alliancing now has become the mantra for us and that was difficult because general practice to cede an enormous amount of autonomy and authority into that system, and trust that that was going to work and the rest is history.   

So all the components of care that are now available to general practice like shared records and electronic request management systems, many services available in general practice, are all because general practice managed demand and the funder responded by purchasing the services.  Just takes time and I’m not professing it’ll take 25 years, but you need to think about, if you start thinking about putting dates, I’ve got to have this done by 2020 or that done by 2022, I think you run the risk of failure.   You’ve just got to build some momentum, build system change and build momentum.  

We’ve achieved a hell of a lot, we’re very proud of what we’ve achieved, there’s a hell of a lot ahead of us.  So thanks very much.