PHO fates murky in alliance era
Liane Topham-Kindleytophamkindley@xtra.co.nz
Business Angus Chambers
Some of the South Island's PHOs are uncertain about their future
in the new era of alliance relationships.
In Canterbury, the Government's Better Sooner More Convenient
care policy has resulted in the Canterbury Clinical Network
emerging as the decision maker about future primary care
organisation and spending.
The three PHOs - Rural Canterbury, Christchurch and Partnership
Health - remain part of the network but are unsure what its future
means for them.
Partnership Health chair Andrew Hornblow says the wish for greater
integration across the sector is becoming a reality and changing
the way Partnership works.
This has meant a more efficient, cost-effective and cohesive
approach, Professor Hornblow says. But it has also meant the PHO
has voluntarily ceded some of its independence.
For example, the PHO's funding streams are merged into a flexible
funding pool designed to improve contracting and fiscal information
for services to improve access, CarePlus and PHO management
fees.
Christchurch PHO chair Angus Chambers says in his annual report
that all this has had a significant impact on the PHO, which is no
longer able to initiate new patient care programmes from its main
funding streams as these must fund network activities.
PHO staff and GPs are increasingly taking part in the redesign of
primary care delivery in Canterbury.
"While there is uncertainty about the final legal structure of the
governance and administration of the Canterbury Care Network (CCN),
there will be uncertainty over the future of the PHO," Dr Chambers
says.
He also notes it is disappointing to see a significant amount of
money being spent on the CCN's administrative function, that would
otherwise have gone to primary care.
"One must hope the current increased investment in system design
and administration will result in a more efficient and effective
primary care environment."
In the annual report, chief executive Helen Johnson says the PHO's
ability to continue supporting the range of practice-based
programmes for its enrolled population is unclear.
Contracts with the DHB have been extended for an additional 12
months, but with the proviso of three months' exit-of-service
notice for all three PHOs.
"In other words, the Canterbury health industry is moving within
an incredibly challenging phase of change and collaboration under
the umbrella of alliancing," Ms Johnson says.
Rural Canterbury PHO chair Allan Marriott says the Canterbury
earthquakes have also affected many of the hoped-for changes.
At times he has felt the various groups in the CCN "may still be
pulling in different directions", but he acknowledges,"while we
have some different views, we are still at the table together and I
understand that's different from a lot of other areas".
From his point of view, a frustration is the lack of understanding
that, in rural communities, some things must be done or provided
differently.
As a result of the earthquakes, the PHO expects more people will
move to rural areas in the next few years, increasing demand for
services. It is pleased a rural workstream is being developed in a
service level alliance, but wants to ensure "rural" is represented
in other workstreams (eg, pharmacy and laboratory services).
The uncertainty faced by Canterbury PHOs is not mirrored among
peers in the top of the south. Kimi Hauora Wairau (Marlborough)
PHO's annual report states a critical event in the past year was a
meeting where DHB support was confirmed for two PHOs in the
region.
The three organisations are taking an alliance approach, reflected
in two-year contracts between the DHB and PHOs.
This extended tenure has generated greater trust and helped spark
innovation, although Marlborough PHO chief executive Christine
Smith says things are moving slowly.
Further south, the former nine Otago and Southland PHOs merged
into one new super PHO, Southern PHO as of 1 October 2010.
The majority of health programmes from the original PHOs continued
to be provided until 30 June. New services began to be rolled out
from 1 July with the focus on improving the health status of
high-needs patients.
Relationships are still a priority for this new PHO. Outgoing
chair Conway Powell highlights the need for a new relationship with
Southern DHB.
In his annual report, he says: "As a personal view, I believe the
full potential of a strong working relationship with Southern DHB
is yet to be achieved.
"It is neither effective, clinically useful [nor] conducive to a
good working relationship for a DHB to micromanage the clinical
programmes and other operational responsibilities of a PHO."
On the West Coast, the PHO is working with the DHB to implement
their business case for Better Sooner More Convenient primary
healthcare. An alliance leadership team is in place and plans are
being drawn up for an integrated family health centre in Westport
(New Zealand Doctor, 30 November).
West Coast PHO chair John Ayling says in his annual report that
implementation of the plan is under way, albeit a little behind
schedule because of the time taken to establish the various service
improvement teams.
Southern PHOs in the alliance era
•Canterbury's clinical network now leads decision making in
primary care, as PHOs lose some of their independence and ability
to fund programmes.
•Rural Canterbury communities are absorbing former residents of
Christchurch, increasing demand.
•Longer contracts are among changes for Nelson and Marlborough
PHOs, while progress on the BSMC business case is behind schedule
on the West Coast.