“True GRIT” the Evolvement of

Primary Health Nurse Practitioners

Lesley Pearson Primary Health Regional Manager

Silver Chain Purpose

The Silver Chain group exists to:

Build community capacity to optimise health and

wellbeing

Community capacity can be defined as “the collection of

characteristics and resources which, when combined,

improve the ability of a community to recognise, evaluate

and address key problems” (University of Queensland).

Health can be defined as “a state of complete physical,

mental and social and not merely the absence of disease

or infirmity” (WHO).

Shark Bay

Abrolhos Islands

Mingenew

Leeman

Eneabba

Beacon

Bencubbin

Brookton Hyden

Walpole

Eucla

Lancelin

The 12 Remote Area sites

SIHI Regions

• First Point of Entry into the Health

system

• Essential to the Health and

Wellbeing of a Community

• Supports Health Promotion and

Education

• Wide service access to vulnerable

groups.

• Delivers better health outcomes at

a lower cost

Primary Health …….

• State Government

funding

• Little understanding on

what the Primary Health

nursing products are and

what the cost is to deliver

• No one size fits all

• Non Recurrent Funding

• Health Reform

Silver Chain Country Primary Health

• Recent negotiations with Country

Health around Nursing posts have

reinforced the development of this

intelligence

• Nurse Practitioner pilot programs

require lobbying and transitional

planning around sustainability

• Primary Health generally has

inadequate information which effects

planning

• Ratio GP / 10,000 WA 6.4/ 7.9

• 1.5 Billion shortfall ( $180/individual)

A brief history…….

Contract Measurables

1. Collaboration and

Engagement

2. Economics

3. Business tools

4. Research

5. Innovation

6. Marketing

Deliverables

Deliverable One : Collaboration and Engagement

• Highest risk

• Testing ground

• Communication

• Relationships

• Engagement

• Contract

deliverables

Collaboration

• Different priorities

• Contract management

• Political pressures

• Changing health

environment

Relationships

• Working within complex

systems

• Frustrations

• Timely responses

• Competing priorities

• Sharing the intelligence

• Common strategic intent

Networking and Engagement

Deliverable Two: Health Economics

• Primary Health

support team

• Access to Group

Manager Business

development

• Finance business

partner

• Identification of the 4

products

1. Primary Health – NP

2. Primary Health

Emergency – NP

3. Primary Health –

Emergency RAN

4. Primary Health RAN

• Identify components that

deliver the product

The unit cost journey – the beginning

• Cost component analysis

– Direct staff costs

– Training

– Travel

– Consumables

– IT

– Building costs

– Depreciation

– Overheads

First cut

• Value proposition assumptions

– Customers and beneficiaries

– What does the market value

– What are our products

– What are the benefits for

customers

– Alternatives to our service

– Evidence of benefits

Second cut

• Reviewed the minimum cost of a

service and an „average‟ health

centre

• To analyse minimum service we

identified

– Staff mix and FTE

– Roster – on call

– Average number of call outs

– Minimum and maximum number of

clients

– Relief required

Third Cut

• Finance Business Partner

consulted

• Reviewed the true cost of all

PHRANs and PHNP staff

• Identified that demographics and

remoteness would effect unit cost

• Realised Primary Health Remote

could not provide 1 cost as per

metro HITH ($183)

• Exemplars identified based on

ARIA

Fourth Cut

• Lancelin – Inner Regional

• Walpole – Outer Regional

• Beacon – Remote

• Shark Bay – Very Remote

• EWB Hub- Remote

Exemplars for Unit Cost

1. NP roaming Primary

Health no relief cover

and no client transfer

2. NP Primary health and

Emergency Clinic based

3. RAN Primary Health

Emergency

4. RAN Primary Health only

Established Four Models

Shark Bay Primary Health and Remote NP

• Number of occasions of services in

– Prevention and Promotion

– Diagnosis and Treatment

– Scheduled services

• Attendance during

– Business hours

– After hours

– Weekend/public holiday

• Interhospital transfers

• Assumptions such as transport

costs

NP Shark Bay Inputs for exemplar site

• Four models per exemplar site

based on volume

• Inputs

– FTE

– Attendance

– Transfers

– Direct staff expenses

– Indirect expenses

• Accommodation to very remote i.e.

Eucla (Depreciation New Building)

Price on volume

Shark Bay Very Remote ARIA 10.78 Volume FTE

Shark Bay – Very Remote, all services

Shark Bay – Triage 1-5

• Triage 1 Resuscitation

• Triage 2 Emergency

• Triage 3 Urgent

• Triage 4 Semi Urgent

• Triage 5 Non Urgent

Triage 1-5 cost assumptions

SIHI Nurse Practitioners New Frontiers

Merredin Primary Health NP SIHI RA4

Primary Health Only

• Strategic thinking

• Clinical Leadership

(MDT)

• Wound Care

• Stoma Therapy

• Mentoring

• Staff development

• Triage 3,4,5

• Scheduled Services –

Primary Health clinics

• Diagnosis and

Treatment – e.g.

immunisation, mental

health, adult chronic

disease

• Women‟s Health

• Telehealth

Primary Health Only

EWB Merredin hub – Remote ARIA 6.32

$-

$100

$200

$300

$400

$500

$600

$700

$800

1,183 887 592 296

Un

it C

ost

Volume

Volume

NP PH

NP PH/AE

RAN PH/AE

RAN PH

$-

$200

$400

$600

$800

$1,000

$1,200

$1,400

1,183 887 592 296

Un

it C

ost

Volume

FTE

Model 1

Model 2

Model 3

Model 4

Model EWB Merredin hub

• Medicare income 30%

• Travel 1,000km / week

• Volume 1183 increasing

• Agreed assumptions around

the product

• Political benefit for investment

• Bilateral PHC conversations

state and commonwealth

SIHI Nurse Practitioners

• Price on volume is limited in

use for remote locations

• FTE cost analysis does not

determine the product

requirements for this

modelling

• Both models have

limitations

• Business financial

modelling with Private

practice is critical

Deliverable Two findings to date

• Best Practice

• COMCARE

• Smartphones

• Flablets

• Samsung tablets

• PHCG committee

• Operational Manual

Deliverable: Three Business Tools

• Silver Chain QOL Client

feedback

• UWA/Silver Chain

• DOHA

• CRANA

• Contract and reporting

• DOH and WACHS

Deliverable Four : Research

• Improved Health Access

• Reduced client travel

• Power of story telling Case

studies ( built into to all

levels reporting)

• Poor Care coordination

Deliverable Four : Findings

• Health Navigator

• Integrated record systems

linkages Best Practice

• Business system flow

across agencies ( client

records)

• NP modelling innovating

changes to Remote Primary

Health

• Financial analysis

Deliverable Five: Innovation

Deliverable Six: Marketing

• Phone applications

• Pilot trials

• Political

• Media

• Merchandise

• Targeted to community

Marketing

• Developing Applications

for products

• Facebook

• Webpages

• You-tube

• Twitter

• On line appointments

Marketing

• Posters in ED

• Local Media

• Proposed Film series

• Story telling-Bill‟s story

• Royalties for Regions

• Logos

• Conferences

Marketing Outcomes

Contract Negotiations:

• SIHI contract ends June 2016

linkages into clinical Strategic

planning 2020

• Aged Care NP contract ends

June 2014

• Discussions with Medicare

Local re a business model with

GP practice and Primary

Health NP Aged Care/Primary

Health

Future: Sustainability

Nurse Practitioner Future

• Candidacy program

• Medicare payments

• Stronger business

acumen

• Consumer Choice

• Private Health Insurers

• Primary Health Marketing

• Value add proposition to

Government