Primary care

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Primary care Community Health Innovation Plan

• The future of primary care in Europe
• Southampton, September 15th 2008

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Why an innovation plan for PC CH?

• 25 years from previous reform
• Government mandate to reinforce integral care to
  persons through PCCH and better care to
  dependents and chronic patients
• Need for change

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How it was organized?

• Director committee (DGPA, DGSP, CatSalut, ICS)
• Permanent Comission (31 members)
• Advisory Board (40 members)
• Work groups coordinators (12 leaders)
• Work groups (94 participants)
• External advisors (national and international)
• Bilateral contacts with the health sector
• Change management and communication plan

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Primary Care Innovation Plan
Innovation results
PROFESSIONAL VIEW
CITIZEN VIEW
HEALTH SYSTEM VIEW
Current situation
Goals
Actions
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• Health professionals perspective

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HEALTH PROFESSIONALS
Current situation
Goals

• Territorial health teams (PCCH)
• Skill mix empowerment
• Nurses as referents and with direct access
• Management autonomy for PCTs
• Professional accountability of care processes
• Balanced work and personal life
• Individualised CPD

• Lack of integration of PCTs
• Doctors as referents
• Doctors induce nurse activity and dependance
• Little organizational autonomy for PCTs
• Variability of care processes
• Rigid working hours and shifts
• Training, teaching and research policies no
  aligned

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• Citizen perspective

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CITIZEN
Current situation
Goals

• Fragmented and heterogenous accessibility
• Doctors as referents
• Access to health records limited to professionals
• Excessive delegation of own health
• Medicalised care
• Paperwork

• Integrated care
• Health professionals as referents
• Share health information and give access to
  individuals
• Selfcare responsibility
• Health as a personal value
• Less burocracy

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• Health system perspective

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HEALTH SYSTEM
Current situation
Goals

• DoH Catsalut strategic planning
• Lack of shared care culture between providers.
• Incompatibility of health information systems
• HR management maladapted to community needs.
• Lack of citizen participation in decision
  entities

• Integrate strategy through Director plans
• Integrate community services for each territory
• Interoperability of HIS
• Talent and knowledge management
• Citizen participation in health councils

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ACTIONS FROM PROFESSIONAL VIEW

• Activate team skills and professional autonomy
• Health and territory team collaborate to develop
  care processes
• Increase resolution capacity of PCTs
• Nurses and doctors share gatekeeping, self-care
  promotion and acute and cronic care.
• Nurse activity supported by regulation on
  diagnosis, prescription, tests and referrals.
• Organisational autonomy budget management,
  agenda, shifts
• Professional accountability health outcomes
• Accreditation of PCTs to improve quality and
  patient safety
• Training oriented to professional development
• Flexibility in working hours partial or
  increased dedication.

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ACTIONS FROM CITIZEN VIEW

• Citizens actively co-produce health with health
  professionals.
• Priority and proaction for complex patients
• Doctor and nurse of reference
• Health teams guarantee the care and cure
  processes
• Improve accessibility through a One Window model
• Shared health record with risk prediction feature
• Case management nurses to avoid readmissions and
  emergencies
• Prevention and e-visits to reduce demand
• Expert patients and self-care (Health Channel)
• Health promotion programmes involving the
  community and local governments
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ACTIONS FROM CITIZEN VIEW

• Prevention to reduce demand
• Expert patients
• Information to foster self-care (Health Channel)
• Health promotion programmes involving the
  community and local governments
• E-prescription and one prescription form
• Alternatives to the traditional encounter
• E-visit
• Telephone visit
• Videoconference

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ACTIONS FROM HEALTH SYSTEM VIEW

• Coordinated strategic plans (mental health, women
  health, long-term care, specialised care,
  emergency care)
• Integrated care for personal, family, public
  health, specialised and emergency care froma
  community and territorial perspective.
• Diagnostic tests purchased from PCCH
• Agreement for specialist election and resolutive
  capacity at territorial level.
• Shared clinical record for Integrated Community
  Services providers and access to hospital
  records.
• Clinic leadership and HR and knowledge management
  decentralised to health teams
• Citizen participation in DoH and territory health
  councils

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Summing up

• To be delivered on September 15th at 1645 in the
  parallel session Primary Health Care Organisation