Person Centred Medical Neighbourhood

Person Centred Medical Neighbourhood Readiness Program 

Person Centred Medical Neighbourhood (PCMN) is an opportunity for practices to adopt a more innovative model of care delivery by focussing on the needs of the patient first and using teams, data and effective communication to improve service delivery.  This is known as a 'person centred care' model. Person centred care is about delivering the right service to the right person in the right place at the right time.  It is about proactive care - not reactive care.  Person centred care often involves practice transformation, but we believe that this model of care can help our health system cope with increasing demands and decreasing relative resources.

A highly functioning, well-integrated practice will demonstrate the following key features:

  • Person centred care
  • Comprehensive care
  • Coordinated care
  • Accessible care
  • Focus on quality and safety


What does the Person Centred Medical Neighbourhood Readiness Program involve?

The Person Centred Medical Neighbourhood Readiness Program (PCMNRP) assesses your practice for 'change readiness'. The program helps your practice to design, implement and review your quality improvement activities, as well as assisting your practice in complying with new QI PIP and the new RACGP standards for general practice (pages 88-108).

Step 1

A CESPHN Project Officer will come to your practice and meet with as many members of the team as possible and make a short presentation about the changes to the PIP and the 5th Edition Standards and the philosophy of person centred care.

Step 2

The next step is for your team to complete an assessment tool in the form of an online survey which will take no more than seven minutes to complete. This survey will provide your initial benchmark and will examine factors in your practice such as leadership, data use and patient management. The overall goal of the assessment tool is to gauge how ready your practice is for a person centred model of care. 

Step 3

You will be able to discuss the findings of your survey with a Project Officer, at which point a QI leader and team will be identified and the Project Officer will discuss QI activities appropriate for your practice. The Project Officer will be able to assist in establishing your QI benchmarking, as well as providing guidelines on the time and resource commitment required. Even if your practice is new to QI, our team members will be able to guide you towards achieveable goals and projects. 

Step 4

Throughout the program monthly information sessions will be held at CESPHN offices in Mascot, and we encourage as many members of your QI team as possible to attend. We have a combination of industry experts and group feedback to help you on your transition to person centred care.

Step 5

CESPHN will be able to provide feedback on your team's progress throughout your QI activities as well as providing guidance on how to improve your outcomes. Every QI activity needs to ensure there are stages for review which allow for the identification of obstacles, the review of targets already met and to celebrate successes of the activity. 

Step 6 

This final step is a chance to review the activity as a whole, and evaluate successes and areas for improvement. After 6 months we will ask your practice to repeat the initial assessment tool, and compare results with the first capture. This will let us evaluate the improvements in leadership, data use and QI teams. Practices currently participating in the PCMNRP have already shown marked improvement in these areas. 

What outcomes can my practice expect from the Patient Centred Medical Neighbourhood Readiness Program?

We aim to help your practice identify a change enabler or leader. Leadership is a skill not necessarily found at the top. Leaders are vital for change and we must help you find the leader in your practice. We will then build a system to support and encourage that leader and facilitate them to enable change at the practice.

We will also show you how to clean, process and report your data to help you improve clinical outcomes, practice profitability, increase patient satisfaction and improve practitioner confidence. 

Person centred care also revolves around teams. We will help you to build teams that work effectively and help teach your patients that there is a team at the practice who are responsible for their health, not just their GP.

Quality Improvement is rapidly becoming a permanent feature of General Practice. Accreditation and the new QI PIP both involve QI which leads into person centred care. We believe this is the future of General Practice. The PCMNRP will set you up with the skills to manage your own QIAs, efficiently and effectively. We use a version of the 'Plan Do Study Act' Model, which was developed by the Australian Healthcare Collaboratives. Remember, baby steps are important so there is no need to feel overwhelmed, even a small improvement is an improvement. We are more interested in helping you change the culture of your practice than the change itself.

How can my practice get involved?

CESPHN is looking for practices to enrol in Wave 2, which will start late 2018. To express your interest, please fill out the pdf EOI form (467 KB) and email to Catherine Scardilli.