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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. Health Workforce New Zealand’s Role: Simplify and unify the health workforce development system

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Leading transformational change: Presentation to the 2011 General Practice Conference

4 September 2011

Brenda Wraight MEdPsych (Hons)


Health Workforce New Zealand

Health Workforce New Zealand’s Role:
  • Simplify and unifythe health workforce development system
  • National oversight for health and disability workforce planning, training and development
  • Whole of education continuum, whole of healthsystem view
  • Monitor and respond to national and regional workforce priorities and pressures
Health Workforce New Zealand’s Role (cont) :
  • Focus on inter-professional, connectedworkforces and services
  • Supporting workforce development through innovation projects and training subsidies
  • Facilitating and enabling change via partnerships
  • Nationally accessible workforce dataset, improvedinformation and analysis
Our overarching objectives
  • Improved recruitment and retention
  • a workforce with more generic skills
  • new roles & extension of existing roles
  • strengthened workforce relationships across health & education systems
  • ensuring high quality, integrated and best value training
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.
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
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.
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.
The process
  • Engagement with stakeholders - including current GPs, GP trainees, registrars
  • meetings with key groups such as ASMS, NZRDA, GP educators, ACEM, NZMA, MoH policy makers in primary care, DHB CMOs and COOs
  • a workshop on emergent models of care
  • establishing a reference group with wide sector representation
  • Development of and consultation on, discussion document
Discussion paper proposed:
  • Retaining the current three year duration of GPEP
  • six to eight months in hospital-based practice
  • 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
  • a compulsory academic component introduced to the programme,
  • Enhancing the current GPEP1 bursary
  • Amending the current assessment process
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.
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.
Next steps

September 2011 Decision-making by MOU partners

October 2011Finalisation of budgetary implications

February2012 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

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
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
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