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Leading transformational change: Presentation to the 2011 General Practice

Conference

4 September 2011

Brenda Wraight MEdPsych (Hons)Director

Health Workforce New Zealand

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Health Workforce New Zealand’s Role:

Simplify and unify the health workforce development system

National oversight for health and disability workforce planning, training and development

Whole of education continuum, whole of health system view

Monitor and respond to national and regional workforce priorities and pressures

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Health Workforce New Zealand’s Role (cont) :

Focus on inter-professional, connected workforces and services

Supporting workforce development through innovation projects and training subsidies

Facilitating and enabling change via partnerships

Nationally accessible workforce dataset, improved information and analysis

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Our overarching objectives

1. Improved recruitment and retention

2. a workforce with more generic skills

3. new roles & extension of existing roles

4. strengthened workforce relationships across health

& education systems

5. ensuring high quality, integrated and best value

training

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HWNZ outcomes in 2011

By the end of 2011, all of the HWNZ short-term targets will have been met in regard to a sustainable and fit for purpose health system. Key outcomes for highlighting:

A shift in workforce culture and improved morale, engagement and retention.

A future proof workforce planning and training process.

A recast of the primary care workforce to enable a shift in the model of care.

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HWNZ Priorities 2011/12 and beyond• Bringing health services closer to home - community and

home care, the carer workforce and self care

• Increasing the number of Maori and pacific people in the health and disability workforce

• Strengthening and integrating the health workforce in primary care - general practice, pharmacy, allied health

• Health care professionals working to the top of scope

• A more visible and “tangible” education and health sector continuum

• Aged care, mental health & addictions, rehabilitation

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Reform of GP training: HWNZ, MCNZ, RNZCGP collaborative

2010 Memorandum of Understanding between HWNZ, the RNZCGP and the Medical Council of New Zealand to

• assess the existing General Practitioner Education Programme (GPEP) and Rural Hospital Medicine Programme in the light of New Zealand’s emergent health workforce requirements,

• redesign these programmes to meet these emergent requirements, and

• implement the redesigned General Practitioner vocational training programme progressively from January 2012.

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MOU intended outcomes include:

• the mode of delivery of GP Education Programme (GPEP)

• including some hospital based training in GPEP

• changing the assessment process

• identifying incentives for doctors to enter GPEP

• funding all years of GPEP

• improving alignment of GPEP with Rural Hospital Medicine training, and

• aligning GPEP with training in other vocational scopes such as Accident and Medical and Emergency Medicine.

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The process

1. Engagement with stakeholders - including current GPs, GP trainees, registrars

2. meetings with key groups such as ASMS, NZRDA, GP educators, ACEM, NZMA, MoH policy makers in primary care, DHB CMOs and COOs

3. a workshop on emergent models of care

4. establishing a reference group with wide sector representation

5. Development of and consultation on, discussion document

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Discussion paper proposed:

1. Retaining the current three year duration of GPEP

1. six to eight months in hospital-based practice

2. the option of developing enhanced skills within the current scope of general practice, by undertaking advanced competency modules initiated during GPEP2 or GPEP3 and completed once Fellowship is attained

3. a compulsory academic component introduced to the programme,

4. Enhancing the current GPEP1 bursary

5. Amending the current assessment process

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Progress to date:

• enhancing the existing GPEP1 bursary from January 2012

• development of advanced competency modules (ACM) which link education of GP registrars and Fellows to training in other disciplines and includes some hospital-based practice (mental health and addictions module commenced development, care of the elderly pending)

• demonstration sites involving DHBs employing GPEP registrars have been evaluated successfully by HWNZ and the model is under consideration for roll-out nationally (2013)

• the Division of Rural Hospital Medicine supporting extending the scope of RHM practice to several of the smaller provincial hospitals

• the RNZCGP has enhanced the educational content of the GPEP2 programme by requiring registrars’ participation in formal learning groups.

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feedback has identified a number of critical issues: • there are very substantial externalities affecting GP

education and that without change in these areas change in GPEP is likely to be at the margins.

The issues include: • agreement on the scope and nature of general practice• the timing of changes vis-a-vis the emergence of new

models of service delivery (with new roles and associated funding)

• the availability of funding to support the existing or revised GPEP and

• capacity within general practice and DHBs to accommodate changes.

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Next steps

September 2011 Decision-making by MOU partners

October 2011 Finalisation of budgetary implications

February 2012 new GPEP1 intake with enhanced bursary

March 2012 linked to Regional Training networks

first advanced competency module(s) implemented

Ongoing 2012 - advanced competency module (ACM)development - design & implementation planning for major changes (academic components, assessment framework, training within other specialist scopes and employment of GPEP registrars)

2013 Implementation of major changes

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4 Regional Training Hubs

•to co-ordinate health workforce planning, education and training.

Underway from 1 July 2011•focus on medical training from PGY1 to vocational registration; but

most are including a multi-disciplinary approach•Professional colleges and registration authorities responsible for

content and accreditation of training programmes•Integrates regional workforce plans, career planning, and administers

Voluntary Bonding scheme and HWNZ Advanced Trainee Fellowship •HWNZ provides strategic direction on health workforce priorities,

monitoring and oversight. Hubs report to HWNZ through NHB

reporting and accountability framework•link with: NHB; NHITB; Centre of Excellence in Health Care

Leadership; National Simulation Training Network; South Island

Tertiary Alliance

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Career planning

From January 2012 HWNZ requires career plans to be in place for all trainees it funds

Resources (guidelines, tools, enhanced workforce information) to assist trainees, mentors and employers developed an online

Many organisations already do career planning in whole or in part - builds on existing processes

Intention is for a supportive process, with involvement of senior clinicians, owned by the trainee

HWNZ is not prescriptive about the process used, however these should not to be linked to assessment or selection processes

Career planning for older and retiring clinicians is recommended

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Examples of a “tangible” education and health sector continuum

“Pipeline” for Maori and pacific students through Health Science Academies

TEC and HWNZ alignment of investment plans to ensure numbers of students in undergraduate programmes aligned to health system needs in 2020 and beyond

Advanced modules for primary care clinicians in eg aged care, mental health and addictions

Self care, home and community care, carer workforce, unregulated, and regulated workforce - patient journey

Person / whanau -centred care – patient navigators, whanau ora, managed care / care coordination

Interprofessional / interdisciplinary learning and practice Continuum of learning for clinical leadership

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