Media Release

1 December 2006

Evaluation of the Care Plus Programme

An independent evaluation of the Care Plus programme shows it is generally well supported by health professionals around the country and is making a difference for many patients with long term conditions.

First proposed by general practice groups as the Ministry rolled out its Primary Health Care Strategy, Care Plus was piloted in three Primary Health Organisations (PHOs) in 2003/04, then rolled out nationally in July 2004. It basically gives extra funding to PHOs to improve the care of people identified as having high and complex health needs.

The Ministry of Health's Chief Clinical Advisor, Dr Sandy Dawson, says the national rollout aimed to improve the management of chronic conditions for individuals, reduce inequalities, provide cheaper services for patients with high health needs and to improve teamwork within PHOs.

Currently eligibility is determined by a doctor or nurse assessing the patient against a number of criteria

• their ability to benefit from 'intensive clinical management in primary care' (at least two hours of care from one or more members of the primary health care team) over the following six months
• either has two or more chronic health conditions that cause a significant disability or has a significant burden of morbidity,
• has a terminal illness,
• has had two acute medical or mental health related admissions in the past 12 months,
• has had six first level service or similar primary care visits in the past six months or
• is on active review for elective services.

The evaluation by CBG Research Ltd has found that 80% of all PHOs across the country were delivering Care Plus in some or all of their practices in April of this year.

Dr Dawson says while the evaluation shows that enrolment growth has been slower than expected. Care Plus is reaching many of the people we wanted it to, particularly those with chronic high needs like diabetes and heart disease.

"Care Plus patients surveyed felt their care had improved under the programme, and that it was more structured."

"The evaluation also signals some areas for further investigation. For example, Care Plus in its current form may not be well suited to patients needing intensive primary health care interventions over a short period of time, such as the mentally health problems and the terminally ill. We will be looking at all the findings in more depth through the Primary Health Care Strategy Implementation joint work programme with DHBs, and exploring options for addressing some of the issues and recommendations."

Mark Jones, Chief Advisor Nursing, says nurses play a key role in the Care Plus programme, managing patients' long term conditions.

"Nurses are best placed to deliver many of the services that fall under the Care Plus programme. Most nurses support the programme and in many instances, Care Plus is nurse-led or is exclusively a nursing service."

Mark Jones says the evaluation also suggests that nurses need access to short, affordable training courses to allow them to deliver chronic care services most effectively, including prescribing, to maximise their role in the delivery of the programme.

"The Ministry will be working with nurse leaders to look at ways of providing primary health care nurses with greater access to education in the prevention and management of long term conditions".

The full CBG review is available on the Ministry of Health's website

ENDS

Background Information

The Care Plus initiative originated from a proposal from the Independent Practice Association Council (IPAC) to replace the Access and Interim PHO population-based funding formulae with a way of targeting individual 'priority patients'.

PHOs that fully implement Care Plus receive an extra 10% capitation funding and PHOs are able to decide how to use this funding to provide services through the practices, for the identified individuals.

For further information, please contact
Victoria Evans
Media Advisor
Ph: (04) 4962036