Presentation

And know that place for the
first time.
Dr Harry Pert
September 2012
Little Gidding TS Eliot.
We shall not cease from
exploration
And the end of all our
exploring
Will be to arrive where
we started
And know the place for
the first time.
1

The Present
Ranolf Medical Centre
10,500 patients
8 PNs, 8 GPs & 6 Admin
220 Consultations(52k pa)
371 Rx items (80k pa)
15 Imaging requests (3k pa)
158 Lab test items (48kpa)
2

Nursing:
Planned preventive care
Planned LTC management
Health promotion
Acute assessment & triage
Professional development
Student nurses.
Nurse Regularly Involved in Care
100
75
50
25
42
27
23
18
25
57
33
37
16
56
51
0
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
3

Information capacity:
Use of Health IT
Percent reporting EMR
Percent reporting seven or more of 14 IT functions*
100
75
98
92
89
79
100
75
87
83
72
59
50
42
50
25
28
23
25
32
19
8
0
0
NET NZ UK AUS GER US CAN
NZ UK AUS NET GER US CAN
4

Payment:
Blended payments
Capitation
Patient co-payment
FFS
P4P
Salary
Payments: where next?
Proportionate
universality
Less reliance on
FFS
Career pathway
Advanced
competency
5

Medicines:
Pharmacy on site
Shared IT and
records
Quality and safety
Drug Prices for 30 Most Commonly Prescribed Drugs,
2006–07 US is set at 1.0
1.0
1.00
0.8
0.77
0.76
0.63
0.6
0.51
0.49
0.45
0.44
0.4
0.34
0.2
0.0
US CAN GER SWIZ UK AUS NETH FR NZ
6

Medicines:
Medical, Medication, or Lab Test Errors
Occurred Outside Hospital
100
75
82
86 84
79 80
86
79
88
68
79
86
50
25
0
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Percent reported error occurred outside hospital
7

Quality of Care from Doctor
100
75
50
76 74
67
49
54
84
59
43
69
79
74
25
0
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Percent rated care received in past 12 months from regular doctor as very good/excellent
Connecting clinics, schools, pharmacy,
hospital, lab, and x-ray
8

The Past
11

Who were these doctors?
England
UK
1783 1841
Physicians 363 1,776
Surgeons 89
Apothecaries 105
Surgeon-
Apothecaries
2,607 19,106
From mediaeval guild to modern
profession
12

The Medical and Physical Journal
Feb 9 1809
If he is destined to follow his
profession, as a general practitioner of
medicine in the country…..
The growth of scientific medicine,
13

of frustration with quakery,
“The cry throughout the political
world has long been that of
reform, and we cannot be
surprised that a voice so
popular should be heard within
the sphere of medicine
especially as so many evils
confessedly exist win our
profession…”
London Medical Gazette 1841
"Doctor Double-Dose killing two
birds with one stone.“
of hospitals,
14

and of tension between specialism and
generalism.
“common disorders of
general practice were best
pursued in country practice
where the apprentice can
best see the ultimate
results of treatment. In the
country he can study men
as well as patients”
And an ‘epistemological rupture’.
Michel Foucault
The third Day after the Wether
happened to be very warm he
changed his Thick Waistcot for
a Linning one and being
careless sat a quarter day in a
Room that was wett the same
evening he found himself not
well and a little Feverish and
thirsty for which he Went to
Bed & Drank Plentifull of Sack
Whey. The Next morning he
was very horse and out of
order.
His appearance was florid, his
complexion clear. He
complained of a slight
headache and a sore throat.
His pulse was full and rather
frequent, the tongue white, the
tonsils slightly inflamed, the
parotid glands were very much
enlarge, the bowels were
confined, and there was a little
oppression about the chest.
15

Patient Centred Clinical Method
16

Option grid
17

8000
7000
6000
5000
4000
3000
2000
1000
0
International Comparison of Spending on Health, 1980–2008
Average spending on health
per capita ($US PPP)
United States
Norway
Switzerland
Canada
Netherlands
Germany
France
Denmark
Australia
Sweden
United Kingdom
New Zealand
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
16
14
12
10
8
6
4
2
0
Total expenditures on health
as percent of GDP
United States
France
Switzerland
Germany
Canada
Netherlands
New Zealand
Denmark
Sweden
United Kingdom
Norway
Australia
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
41
41
Source: OECD Health Data 2010 (June 2010).
Christchurch 22 Feb 2011 12:51
21

The challenge to the New Zealand Health
System
22