Annual Business Plan 2016-2017 - WRHN | Whanganui ... Annual Plan 16...ora, te kaha, te...

Annual Business Plan2016-2017

Whanganui Regional

Health Network

Annual Business Plan 2016/17 | Whanganui Regional Health Network 1

Introduction

It is with pleasure that I introduce the 2016/17 Annual Plan for Whanganui Regional Health Network (WRHN). This Annual Plan partners and aligns with the integrated Māori Health Plan 2016-2017 that we have agreed and developed with the Whanganui District Health Board (WDHB).

The Māori Health Plan represents the second year of developing an integrated system approach, through both the WDHB and WRHN (as the sole Primary Health Organisation (PHO) in the region), working collaboratively and collectively to achieve health gain for Māori. The WRHN board members, the Iwi members in particular, recognise that health and wellness of the Māori population will not be achieved unless wider intersectorial strategies that are operational across our district are supported.

The plan describes the intersectorial objectives where we are participating and leading change, particularly in the areas of the development of the Children’s Action Team, a review of social housing for the most vulnerable in conjunction with the Whanganui District Council and an innovations project with the Health Promotion Agency (HPA) regarding alcohol harm reduction.

General Practice is intended to be the single most utilised place that connects individuals with the broader health and social system. Through applying a team approach, utilising better communication through IT solutions and WRHN supporting General Practice with enablers to ensure their patients get timely access to screening, assessment and treatment across the health system, we are optimistic that inequity for Māori will measurably decrease.

WRHN General Practice teams have closed the gap for Māori and are amongst the leaders for Māori patients receiving their flu immunisations, CVD screening, breast screening and Before School screening and immunisations. However, we can never be complacent and this document serves to guide us to set meaningful priorities that will make a difference.

WRHN board has identified four priority areas of focus for 2016/17; older persons (inclusive of long term conditions), child health, mental health and oral health. All priorities are relevant for Māori and in fact if we make a difference for Māori the whole population will benefit. WRHN is guided by our cultural principles and service values, and in turn we support our clinical leaders and General Practice members to strive to achieve our revised mission statement:

“Engaging with our community and health providers through effective partnerships and integrated systems to improve our population’s health and wellbeing.”

“Nohokotahi nga kaimahi hauora me nga Iwi, I runga I te whakapiritanga, ki te whakapiki te ora, te kaha, te maramamatanga me te rangimarie.”

Judith MacDonald Chief Executive


WRHN Governance Structure

Whanganui Regional Health Network was established in May 2003. It was established as a Trust, with not for profit status, governed by a board or Trustees. The Trust Deed details a set of objects which the board are required to align and deliver against.

The objects of the Trust are;

(a) Maintain and improve the health of the enrolled and casual population in the region and restore health of such people when they are unwell so far as is possible with available resources and priorities; and

(b) Provide Population Health services to protect, screen and improve peoples’ health status which will support a focus on maintaining wellness; and

(c) Provide assessments, treatment, health information and education of any episodes of ill health of the enrolled and casual population in the region; and

(d) Provide support and rehabilitation for the enrolled and casual population in the region with chronic health problems and or disability; and

(e) Undertake, collate and analyse research to gain greater understanding of the health needs of people living in the region; and

(f) Provide health services which are culturally appropriate and as far as practicable are acceptable to Māori living in the region; and

(g) Develop strategies to address the inequity in health status particularly for Māori, Pacific Island people and low income groups living in the region; and

(h) Establish systems and processes which monitor and evaluate the effectiveness of health care delivery and ensure people living in the region have access to a safe service in which the community has confidence; and

(i) Work in partnership with providers in the region to ensure a seamless and comprehensive primary health service which is accessible, timely and affordable for people living in the health district; and

(j) Promote and foster dialogue between both the community at large and the health care providers operating in the region and to allow for community involvement and input into decisions regarding the nature and quality of the services provided by the trust; and

(k) Engage in such other activities as the board determines will facilitate achievement of better health outcomes for people in the region.

Board of Trustees 2016

Dr Ken Young (Chair and GP) Dr Rick Nicholson (GP) Dr Tony Frith (GP TOIHA) Michael Sewell (business) John Maihi (Iwi) Barbara Ball (Iwi) Pat Cunniffe (community) Michael Lamont (business)


Aligned strategies and frameworks

Alongside alignment with the Māori Health Plan, this annual plan reflects WRHN’s desire to embed the strategic themes of the refreshed Primary Care Strategy (Ministry of Health 2016) and our locally adopted Health Promoting Practices Framework.

The refreshed Primary Care Health Strategy

The Primary Care Health Strategy has been revised and there have been five strategic streams identified as summarised below:

Strategic Themes

People powered • Developing an understanding of users of health services • Partnering with service users to design services • Encouraging and empowering people to be more involved in their healthcare • Supporting people’s navigation of the health system

Care closer to home • Providing health services closer to home • More integrated health services, including better connection with services in the wider

community • Seeing health as an investment early in life • A focus on the prevention and management of chronic and long-term conditions

High value and performance • The transparent use of information • An outcome-based approach • Strong performance measurements with a culture of continuous service improvement • An integrated operating model providing clarity of roles • The use of investment approaches to address complex health and social issues

One team • Operating as a team in a high-trust system • The best and flexible use of our health and disability workforce • Leadership and management training • Strengthening the role for people, families and whānau and communities to support health

promotion and care • More collaboration with researchers

Smart system • The increased use of analytics and systems to improve management reporting, planning,

delivery and clinical audit of healthcare services • The availability of reliable and accurate information, including on-line electronic healthcare

records at the first point of care • The healthcare system being a learning system that continuously monitors and evaluates

what is being done, with results shared for everyone to use for service quality improvement


Health Promoting Practices Quality Framework (HPPQF)

Integration of health promotion into the primary healthcare General Practice setting enables General Practices to focus on population health, with the aim of achieving better health outcomes for their patients, whānau and wider community.

The HPPQF is underpinned by the Ottawa Charter, using a settings-based approach to improve health promotion in the primary healthcare setting.

Coding has been used in this document to show the relationship between the five domains and the WRHN priority areas.

Code Domain

PH

Population health: Reducing inequalities and reaching the whole population a. Having a knowledge of health inequalities and population health b. Reaching and screening high need populations and those who may

not access healthcare or implement preventive actions (i.e. outreach services)

c. Having comprehensive systems and processes for screening and prevention of serious health conditions

d. Being aware of social and economic determinants of health

HE

Health education: Improving knowledge and awareness around health literacy, self-management education, health information and skill development

e. Health information f. Cultural competence g. Health literacy h. Self-management

WW

Workplace wellness: Creating healthy workplace environments where there is an emphasis on the following

i. Workplace wellness j. Team work k. Health promotion leadership l. Health promotion planning

CA

Community action and participation: Supporting practices to be involved in their community and linking with other relevant organisations

m. Partnerships with community groups n. Partnerships with other healthcare providers

A

Advocacy: Developing healthy public policy, which meets the healthcare requirements of the population

o. Participating in community planning with council or other organisations

p. Advocating for positive changes in public policy


The HPPQF can be used to guide General Practice teams when initiating health promotion activities and is supported by a self-assessment tool. This tool is designed to be completed by all practice staff, enabling discussion around the practices’ current strengths and areas of possible improvement, with regard to the five domains listed, and an opportunity to identify quality improvement tasks. Completing the self-assessment tool on an annual basis could indicate what progress has been made across the domains. Toolkits specific to current health priorities, including smoking cessation, diabetes, cardiovascular disease, immunisation and mental health, have also been developed. These toolkits contain information and ideas on training, tools, resources and networks that can be utilised to support the practices in achieving their goals in each area. The HPPQF self-assessment tool and toolkits are currently being customised for the Whanganui region, and Gonville Health Ltd will be a development site to trial the framework, prior to its being offered to other General Practice teams. The trial will include scoping what the mentoring and coaching support required by the practice would be, the resources required and developing links with other providers, i.e. public health and Iwi providers, and establishing who can work with the practice – predominantly around the areas of the framework involving workplace wellness, engaging with the community, and provision of advocacy.

(Ministry of Health 2015)


Self Management Support

What do we want to achieve?

Consumers have improved access and greater choice of self management tools and services available to them that are affordable, easy to use and culturally appropriate.

Why is this important?

Self management education and support, as part of a wellness plan, can improve a person’s ability to manage their condition/s, thus potentially improving clinical outcomes and quality of life.

Who will we work with?

Consumers, health providers, NGO’s and community groups, WINZ, lifestyle management providers, mental health, media

WRHN lead(s) Anne Kauika

OUR PERFORMANCE STORY 2016-17

How w ill we know if we are successful? Practice staff and other providers utilise self-management/self-care resources and tools. Referrals to the self-management. Programmes will increase by 50% from the 16/17 year. At least 75% of self-management programme participants self-report; increase in confidence, reduced stress, pain and fatigue, and increase physical activity after completing the programme.

How w ill we achieve this? Q1-Q4 Self-management/self-care options in all collaborative pathways. Q1-Q4 Workforce development across primary and secondary care to build knowledge and awareness of self-management concepts. Q1-Q4 Increase referrals to self-management and education programmes by;

• Quarterly visits to all practices and other providers

• Use of social media • Up to date information on PHinet and

website/s • Identifying high needs and Careplus

patients • Peer support role • Workforce support and development

Q1-Q4 Improve data collection and extraction (what do consumers and stakeholders want to know?). Diabetes peer support group/s established and meets at least monthly.


Health Promoting Practices Quality Framework


Practices adopt the framework to support the introduction of health promotion/prevention concepts within their everyday work; including building closer connections with consumers, the community and local providers.

Why is this important? Health promotion/prevention strategies across the continuum of care are important to support consumers to self-manage and have improved health outcomes. General Practices play an important role in people’s lives and are prime sites for wellness strategies. This framework is linked to cornerstone objectives so is a resource to support practices to achieve their cornerstone accreditation and do well in all areas.

Who will we work with? General Practice, health promotion providers, consumers, NGO’s and community groups, lifestyle management providers, media

WRHN lead(s) Anne Kauika


How w ill we know if we are successful? Twelve month review of baseline assessment shows improvements across all domains for Gonville Health as the pilot site. Health promotion (HP) providers engage with practices and support HP strategies, i.e. workforce training, HP displays, resources and information, community engagement support, etc. Practices use the framework to support their cornerstone accreditation.

How w ill we achieve this? Q1-Q4 Gonville Health identified as a pilot site and supported to implement the framework and tools. Q1-Q2 The framework and tools are modified to meet our need in Whanganui and are made available via PHinet and website to all practices. Q2-Q4 Workforce development provided to interested practices and staff (training on framework and tools and then specific training on areas of need, i.e. determinants of health, cultural competence, health education, health literacy, community links). Q3-Q4 Support practices to identify QI initiatives using the self-assessment tool and utilise PDSA cycles to show change. Q1-Q4 Implement the Work Well programme at WRHN, Gonville Health, Taihape Health and WAM. Once established support other practices to come on board.


Collaborative Clinical Pathways (CCP) – Overview

What do we want to achieve? A connected comprehensive system to support best practice development using collaborative pathways.


Use of collaborative pathways improves population health outcomes in key areas through whole systems thinking. System changes will result in decreased duplication of information, improving communications between stakeholders, optimising existing community resources, increasing health literacy of the population.

Who will we work with? Key stakeholders including: consumers, General Practice teams, DHB, NGOs, Iwi providers and sub-regional alliances

WRHN lead(s) Julie Nitschke, Gerard Gregory, Dr Rick Nicholson, Sharon Duff

The integration of health services is a multi-factorial, multi-disciplinary process involving many work streams that are not all clinical. Recent publication and launch of a number of CCPs continues to highlight the value of a whole systems approach and of consumer co-design practices. At the same time, we have identified that improving the interconnectedness of healthcare providers/professionals and information systems are crucial to making an effective system-wide change. Within the collaborative pathway programme, there will continue to be a focus on;

• Supporting the implementation of a system-wide infrastructure, including resource allocations, workforce retention, IT system development and workforce sustainability for pathways that are under development or that have recently been implemented

• Developing and implementing the Cancer Pathways as part of the CCN Priority Cancer Pathways Implementation Project

• Reviewing published pathways • Using data to inform the development of smarter systems • The application of an ‘inequalities lens’ to ensure the pathway improves health

outcomes for Māori and Pacific people The coming year will continue to see pathways being identified, developed and reviewed, which will streamline systems across primary care, secondary care and community agencies. Collaborative Pathways are occurring within a rapidly changing IT environment and therefore priorities and approaches may change as information solutions become accessible and are affordable. Many of the 2016/17 priority areas outlined within this annual plan have associated collaborative pathways and the actions related to collaborative pathways are included within each priority area as appropriate.


Data and ICT Systems – Integrated Data

What do we want to achieve? Integration of data from primary and secondary healthcare services.


To create enriched datasets for use in multiple projects and reporting outputs.

Who will we work with? All practices, WDHB, WRHN, Child Action Team

WRHN lead(s) Phil Murphy


How w ill we know if we are successful? Development of standardised reporting deliveries, which are reproducible without significant input from the Information Analyst integrating both primary and secondary data, plus potential other sources. Where are we at now?

• Some integration around Ambulatory Sensitive Hospital Admissions (ASH) and Repeat Presenters is in place

• There is minimal scheduled delivery of

reporting to practices and stakeholders. Ad-hoc reporting exists as we familiarise ourselves with data and the current environment

• The HealthStat tool is currently being

rolled out

How w ill we achieve this? HealthStat data will contribute to integrated dataset by: Q1-Q4 Consolidating existing integrated data reports with new reporting from additional data availability. Q1-Q4 Producing standardised reporting suites, including research of best tools to deliver reporting.

10

Data and ICT Systems – hMael Implementation


hMael implementation across WRHN, General Practices and increasing utilisation of the system in the sector.


Facilitates improved electronic communication, including replacing outdated referral processes, e.g. swapping from fax where applicable. It will mitigate the risk of sensitive communications going missing or being sent to the wrong person.

Who will we work with? All practice managers, Child Action Team, NGOs

WRHN lead(s) Ben McMenamin, Phil Murphy, Karen Veldhoen


How w ill we know if we are successful?

• Complete rollout and utilisation of hMael tool within all General Practices

• Decreased workload within WRHN for practice communications

• Referral processes utilise hMael where

applicable, replacing fax • Users will be able to send hMael from

within Medtech Where are we at now?

• A few WRHN employees and a single practice are currently configured for hMael. It is not yet utilised in any way

• There is no current integration of hMael

into Medtech via advanced forms or otherwise

More information: http://www.patientsfirst.org.nz/services-products/hmael/

How w ill we achieve this? Q1 Create multiple user accounts via bulk process with hMael, where applicable. Engage as many practices as possible to rollout the new system. Q1-Q2 Education on the use of hMael to be provided to General Practices. hMael is used for communicating confidential files from WRHN and some reporting output from the Information Analyst. Q1-Q2 Successfully utilising the new hMael Application Programme Interface (API) in order to integrate with existing systems, e.g. Medtech using Advanced Forms. This will require third party development, e.g. Ken Leech, Patients First. Q2 hMael referrals are launched as part of Mental Health modular approach (see page 23).

11


How w ill we know if we are successful? HealthStat is activated within all participating practices and data feeds are working correctly. Data from practices are used to create analysis for WRHN, General Practices and beyond. Where are we at now?

• Confirming the contractual details with HealthStat

• There are no current installations feeding

data to WRHN More information: http://www.healthstat.co.nz

How w ill we achieve this? Q1 Contract review completed and implementation of tool has commenced. Initial data extracts are underway and automated loading has been implemented into the WRHN data warehouse. Proof of concept reporting is underway with the assistance of General Practices and champions. Q2 A suite of initial reports to support General Practice population health priorities has been developed. The initial reporting is to include:

• CKD risk stratification • Obesity profiling

Q3-Q4 Additional reporting requirements are prioritised and the initial suite expanded (an on-going CQI process).

PH

Data and ICT Systems – HealthStat

What do we want to achieve? The utilisation of the HealthStat tool for increased data availability.

Why is this important? Access to and analysis of detailed information from General Practice has the potential to contribute to numerous projects across the sector.

Who will we work with? All practices, WDHB, Child Action Team, and potentially further participants

WRHN lead(s) Phil Murphy

Patient Portal

What do we want to achieve? To encourage the uptake of Patient Portal in General Practices, implement the Manage My Health (MMH) software into participating practices and encourage the registration of their enrolled populations.

Why is this important? Patient Portal allows the patient access to their primary care record and empowers them to take some control of their health and wellbeing. It is one more step forward in the use of technology within health care.

Who will we work with? General Practice teams, Compass Health, Medtech, community

WRHN lead(s) Karen Veldhoen


How w ill we know if we are successful? By the number of practices participating in Patient Portal (PP) and by the number of their enrolled population who have been registered onto PP. Where are we at now? MMH implementation began in early 2015. This platform allows for practice participation in the Shared Care Record (SCR) and PP. To date, ten practices, WAM and Whanganui Hospital have come on board with the SCR, which went live 21 December 2015. As of February 2016, 87% of the enrolled population have a SCR. Three practices agreed to be pilots for PP: Aramoho Health Centre, Bulls Medical Centre and Gonville Health Ltd. Bulls started registering patients in early 2016 and Aramoho have been on hold due to Evolution implementation. The process is lengthy; requiring resource development, data gathering, staff training, multiple practice meetings and decision making, software implementation, testing and working through the technical issues.

How w ill we achieve this? Q1-Q4 Aramoho – Implementing recently developed Evolution PP guidelines – finalise software set-up, redevelop staff resources and train staff. Following testing, the practice will be encouraged to register patients. Support for technical issues will be provided.

Q1-Q4 Bulls – Implement MMH updates and provide ongoing support for the resolution of technical issues. Q1-Q4 Gonville – Set up MMH software and processes, develop supporting resources, educate staff, encourage patient registration and support the resolution of technical issues.

Q3-Q4 The pilot will be evaluated and a report written. Practices who have signed up to MMH will be able to participate in PP if they so choose and support will be offered to them to implement the software and set up processes.

HE CA

Improved PHO Enrolments


Increased total numbers of patients enrolled with WRHN/member General Practices, with the specific goal to increase numbers of Māori and Pacific patient enrolments

Why is this important? Patients that are enrolled with WRHN/member practices receive subsidised health care and targeted service

Who will we work with? General Practice teams, Outreach team, WAM

WRHN lead(s) Ben McMenamin, Phil Murphy, Sue Hina


How w ill we know if we are successful? The total number of patients and number of Māori and Pacific patients enrolled with a General Practice will increase. Where are we at now? The number of patients enrolled with WRHN by ethnicity:

How w ill we achieve this? Q1-Q4 Facilitate enrolment into General Practices through a range of contact points, such as WAM, WDHB, WRHN Outreach and Pregnancy and Parenting Services. Q1-Q4 Monitor and review the enrolment and General Practice utilisation rates for the total population, particularly Māori and Pacific patients. Q1-Q4 Facilitate patient enrolments into General Practices at all points of contact with whānau by Māori provider services. Q1-Q4 WRHN Māori Navigator will link with and support non-enrolled Māori identified through afterhour’s services and other WRHN services to enrol with a General Practice. Q1-Q4 Provide General Practice members with accurate enrolled population data quarterly. To monitor patient registers and to be informed regarding movement, so that they can offer capability for new enrolments in a timely way.

PH

WRHN Website Development

What do we want to achieve? Replace the static website with a Content Management System (CMS)


CMS will allow multiple staff to enter new content, rather than relying on one person to complete and make it easier for the consumer to get the content they need, through dynamic content from their search or filter parameters

Who will we work with? WRHN internal teams and General Practices

WRHN lead(s) Darin Bailey (IT lead)



• New WRHN website goes live and replaces current WRPHO website

• Website content is accurate and useful

• Website is utilised by both WRHN

stakeholders and the general public (to be measured by monitoring and reporting the number of website ‘hits’)

Where are we at now?

• Website is currently under development, but not ‘live’

How w ill we achieve this? The focus is placed on the content of the website and eliminates the need to have a technical web designer to add and modify the content. Q1 First candidate release, as a start, with more updates and additions required after the release. WRHN staff and General Practices will be encouraged to add desired content. Mental Health, Alcohol and Other Drugs service pages showcase ability for content to provide information for General Practice teams and consumers via integrated systems. Q2 Training – Once set up, the content of the CMS can then be updated by WRHN staff and General Practice staff, making it easier and faster to keep content current and improve the consumer experience.

HE


How w ill we know if we are successful? Screening indicator results will increase and equity will be achieved for Māori and Pacific patients. Where are we at now? Percentage of eligible population screened based on most recently available population health data.

How w ill we achieve this? Q1-Q4 Support General Practices to record population health data accurately, so that results reflect what is actually occurring. Q1-Q4 Ensure all available data sources (e.g. the WRHN Population Health Data Extract, Dr Info, Karo) provides timely and accurate data reporting. Q1-Q4 Support General Practices to record ethnicity information reliably and accurately, so that equity results can be reported on with accuracy. Q1-Q4 Provide General Practices with clear information about data sources, the limitations of each data source and an explanation on why results can vary between sources. Q1-Q4 Create monthly Population Health reports that are generated from data from all sources, which are timely sent to each General Practice via WRHN’s secure messaging system. Q1-Q4 Present and discuss reports at monthly Population Health meetings, to encourage feedback from General Practices about results and possible improvements to reports.

PH

Population Health Reporting

What do we want to achieve? Improved health outcomes (and equity) through supporting General Practice teams to achieve population health targets


Regular review of data allows WRHN and General Practices to track progress against screening indicators and identify gaps in equity. Data can be used to engage General Practices in CQI and system changes to encourage increased achievement against screening indicators

Who will we work with? General Practice teams, Outreach team, Dr Info, Karo Data Management, Ken Leech,

WRHN lead(s) Ben McMenamin, Phil Murphy

Increased Childhood Immunisation

What do we want to achieve Sustain childhood immunisation rates in the WDHB region at or above target rates, with no inequity between populations

Why is this important? Immunisation can protect people against harmful infections, which can cause serious complications, including death. It is one of the most effective and cost-effective medical interventions to prevent disease

Who will we work with? General Practice teams, Paediatric ward, MoH, NIR, IMAC, Public Health, WDHB immunisation steering group, Plunket, Tamariki Ora, WAM, A&E, Iwi providers, CYPS, TKR & early childhood centres, NGOs

WRHN lead(s) Sue Hina


How w ill we know if we are successful? We reach and maintain our 8 month target immunisation rate (95%) and our 2 year immunisation rate target (95%). Where are we at now? As at 31/12/2015 8 Month Immunisation

2 Year Immunisation

How w ill we achieve this? Q1-Q4 In collaboration with the Population Health meeting, new practice level feedback reports that focus on our target populations are to be trialled. Q1-Q4 The population that decline immunisations will be monitored with specific strategies, to try and keep the number at the lowest level possible. General Practices are being encouraged to concentrate on families declining their baby’s 6 week immunisation making a special effort to re-check at each subsequent immunisation due date. Q1-Q4 National Immunisations Register (NIR) and our Outreach Immunisation service (OIS) continue to provide a targeted service, working specifically with those children overdue for their immunisations, with an emphasis on those who are not connected to a General Practice or are Māori and Pacific people. Q1-Q4 Newborn enrolment processes will continue to be enhanced and monitored.

Q1-Q2 Continue to strengthen links with Iwi providers, NGOs, early childhood centres and Child, Youth and Family to encourage the uptake of immunisation among the most vulnerable groups. Q1-Q4 Continue to attend and contribute to the WDHB strategic immunisation group.

PH CA

Child Health – Increased Breastfeeding

What do we want to achieve? Support increased breastfeeding for our population of new mothers

Why is this important? Breastfeeding helps lay the foundations of a healthy life for a baby and also makes a positive contribution to the health and wider wellbeing of mothers and whānau/families

Who will we work with? Childbirth education providers, Well Child providers, Midwives, lactation consultant

WRHN lead(s) Janine Spence, Chloe Mercer



• 75% of babies/pēpe are exclusively/fully breastfed at six weeks

• 60% babies/pēpe are exclusively/fully breastfed at three months

• 65% babies/pēpe are

exclusively/fully breastfed at six months


• An overall rate of 68% at six weeks with 67% of Māori

• An overall rate of 69.4 % at

three months with 52% of Māori • An overall rate of 61% at five

months with 45% of Māori

How w ill we achieve this? Q1 Complete a review of pregnancy and parenting breastfeeding education content. Create video clips with successful breastfeeding parent voice-overs, as part of work with the Women’s Network. Q1-Q4 Identify/provide and support a Māori presenter to provide education on breastfeeding from a cultural viewpoint. Q1-Q4 Continue to support the Breast Feeding Community Initiative (BFCI) policy and procedure, including advising clients accessing WRHN services (immunisations, pepi-pods and wahakura) where they can source breastfeeding support. Q2 Work with General Practice teams to improve identification of new mothers with complex breastfeeding issues and ensure there is lactation consultant support in General Practices. Continue to promote key messages connecting breastfeeding with reduction in childhood illnesses and protection against childhood obesity. Q1-4 Support Maternal Quality and Safety Group Initiatives to increase breastfeeding rates.

PH CA

Improving Oral Health

What do we want to achieve? Improve oral health in our children/tamariki through increased focus on improved ‘Lift the Lip’ processes at General Practice

Why is this important? Oral health impacts on overall health and major inequities are evident within our population in terms of access of services and rates of tooth decay

Who will we work with? Dental unit – Preschool Oral Health Facilitator

WRHN lead(s) Janine Spence


How w ill we know if we are successful? Children/tamariki will have reduced decay rates and higher engagement in oral health services. Where are we at now? Consistent achievement of 100% enrolment rates. But high Did Not Attend (DNA) results at dental clinics of 33% for preschoolers.

How w ill we achieve this? To reduce DNA rates by ensuring dental units have up to date demographic information to enable follow-up as required. Q1 Review current B4SC ‘Lift the Lip’ processes and develop a quality improvement plan, including key measurements, communication and process guidelines in collaboration with General Practice teams. Q2-Q4 Implement the quality improvement plan including regular communication and information sharing with General Practice teams. Q1-Q4 Monitor the effectiveness of early intervention through regular auditing of General Practices to determine how many children have had a ‘Lift the Lip’ examination at their most recent consultation. Q3 Provision of education for General Practice teams (at WIPE).

PH CA

0%10%20%30%40%50%60%70%80%

2012 2013 2014

Caries Free at 5 years old

All Maori 5-year oldChildrenAll Pacific 5-year oldChildrenAll "Other" 5-year oldChildren


How w ill we know if we are successful? Fewer children reach the criteria for obese at 4-5 years through B4School (B4Sc) Check programme. Where are we at now? In the six months ending January 2016, 10% of children at B4Sc checks were obese. The obesity rate for Māori children is twice that of European, while the rate for Pacific children is four times the rate of European.

Data obtained from B4Sc check 2012-2015

How w ill we achieve this? All families/whānau/caregivers of 4-5 years olds who are identified as obese, will have planned strategies in place to support the reduction of weight through healthy lifestyle interventions. Q1 Review the B4Sc referral pathway and develop of a set of recommendations to improve. Q2 Work with stakeholders to implement recommendations from the referral pathway review. Strategies may include:

• Making use of social media and social mobilisation tools

• Increasing the confidence and skills of General Practice teams working with obese children

• Improved audit and feedback cycles • Developing tools to help front line staff

with difficult conversations about childhood obesity

• Decrease inequities between populations

Q1-Q4 Participate as a stakeholder in the development of a cross sector strategy, including a healthy eating policy in preschools. Q1-Q4 Monitor the B4Sc equity of service to Māori and Pacific people families, ensuring all have access to strategies, including dietician support and Active Families programmes.

Childhood Obesity – Maternal and Child Health

What do we want to achieve? Identify the risks of developing childhood obesity and reduce the incidence of childhood obesity

Why is this important? Childhood obesity can lead to ongoing weight issues and increase the risk of chronic illness, such as diabetes, as well as affecting overall confidence and participation in physical activity

Who will we work with? WDHB, Active Family-Sport Whanganui, Healthy Families partnered organisations, Community Dietician, General Practice teams, Well Child providers, Iwi health organisations.


PH CA HE

Reducing Avoidable Hospitalisation (ASH) Rates for Tamariki 0-4

What do we want to achieve? Reduced ASH rates for children/tamariki with a focus on those who are asthmatic and/or eczema prone

Why is this important? Encourage self-management of condition by parents to reduce hospitalisation and or ED visits

Who will we work with? General Practice teams, paediatric ward staff

WRHN lead(s) Janine Spence, Sarah Murphy


How w ill we know if we are successful? The ASH rate would drop to 7343:100000. An increased utilisation of Map of Medicine and associated advanced forms. Where are we at now? 11319 :100000

How w ill we achieve this? Q1-Q4 Continue to offer families of children admitted with ASH eczema and/or asthma. WRHN services including pharmaceutical review from WRHN and Healthy Homes referral (if eligible). Support families to enrol with General Practices, Well Child/Tamariki Ora (WCTO), Oral Health, Newborn Hearing and the National Immunisation register. Q1-Q4 Support General Practice teams by providing regular data and encouraging systematic review of all ASH-related admissions, including recalls for the influenza immunisation, Healthy Homes referral and/or a pharmaceutical review where needed from the practice. Q1-Q4 Promote and review the current utilisation of and adherence to asthma and eczema Collaborative Pathways. Q4 Review WAM systems and develop an audit process to determine ASH incidence from consultations and the impact of ‘free under-13s’ on ED presentations. Q4 Clinical Governance Group to monitor utilisation rates of ‘free for under-13s’ to ensure that Māori are accessing services of General Practices and WAM.

- 2,000 4,000 6,000 8,000

10,000 12,000 14,000

Axis

Titl

e

ASH Rate per 100,000 Whanganui DHB 0-4 age group

5 years to June 2015

Other

Maori

- 2,000 4,000 6,000 8,000

10,000 12,000

ASH Rate per 100,000 Whanganui v National

0-4 age group 5 years to June 2015

WhanganuiTotal

Q1-Q4 Provide strategic direction and recommendations to improve the ear, nose and throat triaging system, General Practice referral guidelines, to ensure the system offers patients the most effective clinical management that is received at the right time and right place.

PH CA

Reducing Sudden Unexplained Death in Children (SUDI)

What do we want to achieve? Reduction of SUDI deaths to 0.4/1000 live births

Why is this important? To prevent avoidable deaths in children from Sudden Infant Death Syndrome


LMC, Well Child providers, General Practice, Māori health services, Family Start and Whānau Ora services, social agencies, including WINZ and CYFs and health promotion



How w ill we know if we are successful? The SUDI rate will decrease to 0.4/1000 live births. Where are we at now? Current death rate of 3.8 Māori infants per 1000 (8) between 2007-11. Across the population a total of 2.0 infants per 1000.

• 140 Pepi-Pods distributed during the 2015-16

• 23 Wahakura distributed

How w ill we achieve this? Q1-Q4 Increase the distribution of Pepi-Pod and Wahakura to 300 whānau per year. Q1-Q4 As part of all WRHN services used by pregnant woman and/or their whanau support, ensure there is consistent messaging around safe sleeping and provision of ABC and appropriate referral to other services. Provision of wrap-around services Māori women identified as ‘at-risk’ through the Early Pregnancy Assessment Tool:

• Increase the number of Māori women engaging with pregnancy and parenting education

• Review and prelaunch of Kaupapa Māori Pregnancy and Parenting service

• Interdisciplinary case management of at-risk pregnant women

• Referrals to Healthy Homes • Provision of antenatal education • Provision of safe sleeping messages at

every opportunity • Timely access to Pepi-Pods/Wahakura • Early enrolment to LMC services

Q1-Q4 Review of ED attendance, to ensure those without a GP are supported to engage with primary care services.

HE PH CA

0

20

40

60

Q1 Q2 Q3 Q4 Q1 Q2

Antenatal Education Attendances1 July 2013 - 31 December 2015

Maori Other Total

Antenatal Pregnancy and Parenting

What do we want to achieve? Provide accessible, timely and appropriate antenatal education classes

Why is this important? To prepare pregnant woman and their support people for the arrival of their child and provide education around safety and wellbeing of mother and baby

Who will we work with? LMC’s, midwives, antenatal educators, Well Child providers, oral health providers



How w ill we know if we are successful? WDHB target is 30% of total women birthing per annum attend antenatal education classes. Where are we at now?

Births at Whanganui Hospital by ethnicity

Q3 Q4 Q1 Q2

Māori 66 66 63 81 Other 97 105 104 114 Total births 163 171 167 195 Percentage of Māori births

40% 39% 38% 42%

Programme attendances by ethnicity Māori 8 7 6 12 Other 32 33 28 27 Total 40 40 34 39 Percentage of Māori attendees

20% 18% 18% 31%

Percentage of attendees enrolled in programme who did not attend by ethnicity Māori 33% 0% 33% 29% Other 6% 6% 26% 4% Percentage of attendees compared to births by ethnicity Māori 12% 11% 10% 14.8% Other 33% 31% 44% 24% Total 25% 23% 20% 20%

How w ill we achieve this? Q1 Form working group of stakeholders to recreate the discontinued Te Mana o Kuarawaka programme; review and develop recommendations around the current format of antenatal class delivery. Q1 Commence Waimarino pregnancy and parenting classes. Q1-Q2 Create video clips of services, such as SUDI prevention, Wahakura, Well Child service, quit smoking, etc. Use professionals in the videos and show in antenatal education settings and on the WRHN website. Q2-Q3 Start Te Mana o Kuarawaka programme. Review of the quality of programmes running – all participants invited to provide feedback via survey monkey and/or paper based responses. This will incorporate population health feedback. Q3 Investigate the need for pregnancy and parenting education delivery in Marton area. Q3 Wakawhetu training is completed by the primary health team.

Reduce Prevalence of Tobacco


Reduction of the prevalence of smoking in our community, with a focus on reducing smoking rates of priority groups where inequity exists

Why is this important? Tobacco remains the lead cause of preventable death

Who will we work with? Te Oranganui , General Practice teams, Heath Solutions Trust, WDHB, Tobacco Advisory Group and other stakeholders

WRHN lead(s) Chloe Mercer, Dr John McMenamin


How w ill we know if we are successful? A decrease in the prevalence rates of smokers is recorded. There is an increase in priority groups accessing Stop Smoking Services. There is an increase in General Practices recommending pharmacotherapy for smoking cessation. Where are we at now? There is a smoking prevalence rate of 18.5% (9292 individuals) of the population aged 15 and above. Of the current smokers identified overall, 40% (3765) are Māori. The smoking prevalence rates by ethnicity are; Māori 35% (3765 individuals), Other 14% (5316 individuals), Asian 6% (62 individuals), Pacific 16% (149 individuals). As shown on the next page, prevalence rates vary by age group, with the peak occurring at 25–29 years and beginning to decrease substantially from 45 years.

How w ill we achieve this? Q1-Q2 New Ministry of Health Regional Stop Smoking Service contract begins (to be provided by WRHN and partners); the service is in place and transition activities for the service occur in line with the agreed project plan.

• The service maintains a 4-week quit rate of 505 of clients

• A minimum of 5% (520) of current smokers access the new service (equitably) in first year

Q1-Q2 A new model for funding and approach for General Practice is developed and implemented, including training. The model aims to:

• Increase rate of recommending pharmacotherapy for smoking cessation

• Increase rate of referrals to stop smoking services

Q2-Q4 All (WRHN) employed staff working with patients undertake refresher for ‘tobacco ABC’. Q1-Q4 General Practices meet and maintain IPIF tobacco targets supported by stop smoking services and the WRHN population health team.

Q2-Q4 Development of a smoking cessation Collaborative Pathway, to support the roll-out of a realigned General Practice model.

CA PH WW

Cervical Screening


To increase the overall cervical smear rate and to achieve equity in the numbers of women from all populations who have a cervical smear completed within the recommended timeframe.

Why is this important? Achieving equity will mean that Māori and Pacific people enjoy the same level of health status as non-Māori.

Who will we work with? General Practice teams, outreach team, Family planning, Iwi providers, NSCP, WDHB, MoH, Public Health

WRHN lead(s) Sue Hina, Sarah Collier, Ben McMenamin


How w ill we know if we are successful? 80% of woman aged 20-69 will have completed a cervical screen within the previous three years. Where are we at now? The percentage of women who have had cervical screening completed in the last three years:

How w ill we achieve this? Q1 Support General Practice teams to review and improve their recall and screening processes via two workshops. Q1 Deliver the annual ‘smear taker update’ to support smear takers to remain up to date on all information and/or any developments. Q1-Q4 Embed cervical screening reports into those provided by General Practices using the population health meetings, to guide the type and structure of these reports. Q2 Utilise September, national cervical screening month, as an opportunity to raise awareness of the importance of cervical screening. This includes community clinics being available during this month. Q1-Q4 The Outreach team will follow-up, by a combination of letter, phone calls and face to face home visits, priority women who have not had a cervical smear. Transport, personal support and education will also be delivered as required.

PH CA

Cardiovascular Disease (CVD) Risk Assessment


Maintain achievement of CVD Risk Assessment 90% target, by ensuring all eligible patients have had screening completed in the last five years. Ensure that Māori and Pacific patients are screened at the same rate as total population

Why is this important? Screening for CVD risk supports early identification and intervention for high risk patients

Who will we work with? General Practice, Outreach team, Population Health meeting group

WRHN lead(s) Ben McMenamin, Phil Murphy


How w ill we know if we are successful? 90% of the CVD Risk Assessment target will be maintained and equity will be achieved for Māori and Pacific people patients. Where are we at now? The percentage of eligible population screened based on most recently available population health data:

How w ill we achieve this? Q1-Q4 Creation of a Collaborative Pathway for suspected stroke and stroke rehabilitation, with a focus on the provision of community rehabilitation services. Q1-Q4 Provide General Practices with regular feedback on what their achievement targets are via monthly population health data reports – results shown by ethnicity. Q1-Q4 Support General Practices to identify patients who have not been screened for CVD, using tools such as Dr Info, Patient Dashboard and Appointment Scanner. Q1-Q4 Support General Practices to identify patients who will need to be screened for CVD in the coming year, using the same tools. Q1-Q4 Discuss the results and trends at monthly Population Health meetings. Q1-Q4 Ensure patients who have been identified with high risk factors are receiving best practice treatment modalities and access to lifestyle support enablers, e.g. dietetic advice, referral to Green Prescription, referral to Piki te Ora.

PH CA



• 75% of the over 65yrs population receives the influenza immunisation

• An increase in the number of children under 4 years old vaccinated

• An increase in the number of pregnant women vaccinated

• 75% of WRHN staff will be vaccinated for influenza

Where are we at now? Data to the end of April 2016 show our Region has reached an immunisation rate of 66%.There are another 2 months in which to deliver the funded vaccinations. Influenza Vaccination

How w ill we achieve this? Q1-Q4 General Practice teams will receive updates as to how well their practice is performing. Practices with low level of uptake will receive extra help as required. Practices will be encouraged to prioritise Māori and Pacific people, pregnant women and children under 4 years old, as well as people with co-morbidities. The Manaaki Te Whānau Outreach Team will assist Iwi providers as requested to immunise Kaumatua. An annual influenza update will be delivered at the WIPE session in February 2017. All WRHN staff to be offered free influenza vaccinations.

WW PH

Influenza

What do we want to achieve? Meet the national influenza immunisation targets and internal workforce targets.

Why is this important? The impact of influenza includes General Practice consultations, hospitalisations and deaths, with the burden of disease in the very young, the elderly, pregnant women, people with co-morbidities, Māori, Pacific people and those from low income groups. The annual influenza vaccination for these groups is the single most important measure for preventing influenza infection and mortality.

Who will we work with? General Practice, Iwi providers, rest homes, WDHB infection control, Iwi providers, WDHB Immunisation Steering, whanau, WAM, A&E, WDHB clinical wards, WDHB Maternity Unit

WRHN lead(s) Sue Hina

Mental Health


Develop a Collaborative Clinical Pathway and associated modular wellbeing approach which improves the identification, management and outcomes for adults (19+) experiencing Mental Health, Alcohol and Other Drug (MH & AOD) related issues, and provides a wider platform for a whole of person approach.

Why is this important? Mental health and physical health are closely interconnected and an integrated whole-person approach is needed to address the inequities which exist.

Who will we work with? WDHB, General Practice teams, MH & AOD service providers, NGOs, Whanganui Rising to the Challenge work streams

WRHN lead(s) Chloe Mercer, Alex Loggie (WDHB), Julie Nitschke


How w ill we know if we are successful? A modular approach is embedded in all General Practices and;

• There is an increase utilisation of community pathways

• There is a decrease in the number of referrals to secondary care declined

• There is an increase in the uptake of self-management programmes and e-therapy

• There is increased screening for post-natal depression

• Meets other project outcome expectations

Where are we at now? The development of an advanced form(s) is underway. Baselines will be established once data available.

How w ill we achieve this? Q1 Development of modules completed and trialled in two General Practices. Mental Health and AOD Collaborative Pathway published and launched. Funding is reviewed and supports the new approach (extended consultations/nurse clinics available to General Practice teams utilising this new approach). Expert resources accessible within the community setting. Q2-Q4 The developed modular approach and associated education, and funding package is rolled out to all General Practices. Q2 A review of current youth mental health services, including making recommendations towards the development of a broader approach of service delivery that is in line with Adult Mental Health services.

PH CA HE

Long Term Conditions (LTC)


An integrated system that enables self-management of long-term conditions and improved health literacy and health connectivity of the population

Why is this important? To improve population health through working collaboratively

Who will we work with? Key stakeholders DHB, NGO, Iwi providers, sub-regional alliances

WRHN lead(s) Julie Nitschke (Long-term conditions lead) Jude MacDonald (Cancer services lead)



• Collaborative Clinical Pathways align with national strategy and best practice

• Contributory Measures (IPIF) are agreed upon

• The development and use of

pathways will be enablers to achieve national targets

• Provision of services closer to home • Cancer services meet national

target expectations • There are effective and cohesive

communication strategies across the system and district with all stakeholders related to cancer services

• The revised Careplus programme

will enable General Practices to better match the priority needs of their enrolled population based on risk factors and end of life pathology and assign subsidised care accordingly

How w ill we achieve this? Q1-Q4 Publish and implement Chronic Obstructive Pulmonary Disease (COPD), Asthma and Chronic Kidney Disease Collaborative Pathways and associated service models within the primary healthcare setting. Q4 The Diabetes Collaborative Pathways based on the ‘Living well with Diabetes’ national framework stocktake has begun. Q1-Q4 Develop and implement Collaborative Pathways for congestive heart failure, fitness for surgery and cellulitis. Q2-Q4 Develop a localised sub-regional Collaborative Pathway for Breast Cancer and Gynaecology. Q4 Develop a localised Hepatitis C Collaborative Pathway Q1-Q4 Monitor that the workforce investment funded within the chronic disease contract matches the needs and priorities of the total population.


• The Careplus programme does not provide General Practices with sufficient information for the workforce to prioritise subsidies or access to discounted service when their LTC or end of life care requires it most

• The clinical workforce deployed in the community operates with variability, which can create unintended consequences for patient care

Q1-Q4 WRHN will facilitate Local Cancer Network integrated and intersectorial meetings to monitor compliance with national service standards, 62-day cancer target compliance, monitor breast and cervical screening performance and that the investment in skin lesion removal in primary care matches need. Q2-Q4 Implement the revised Careplus programme, with a focus on General Practice members identifying their enrolled population with the highest risk factors and matching Careplus resources and subsidies to priority patients. Q1-Q4 In collaboration with WDHB, mobilise a coordinated clinical nursing and allied health workforce in the community that aligns and strengthens access, early intervention strategies and effective and coordinated healthcare across the system.

PH CA HE

Health of Older People (65+)

What do we want to achieve? Integrated care for health of the older person in the community

Why is this important? We have an ageing population and people are living longer. There is a lack of sector-wide connectedness which supports older people to live safe, quality lives in their own homes.

Who will we work with? DHB, NGOs, General Practice teams and the community

WRHN lead(s) Julie Nitschke, Rebecca Casey



• A reduction in the number of persons over 50 who present acutely with hip fractures

• A strengthened and responsive rest

home programme is in place • A effective peer support programme

in place Where are we at now?

• 78 falls resulting in the need for acute hospitalisation were recorded in the last year

How w ill we achieve this? Q1-Q4 Participate in the review of the district-wide falls prevention programme and lead the review of the associated Collaborative Pathway. Q1-Q2 Review the Dementia Collaborative Pathway and embed an Advance Care Planning Pathway. Q2 Strengthen rest home education programmes and peer support networks, to meet sector needs and increase connectivity and responsiveness in the maintaining the health of older people. Q1-Q2 Review and report local data regarding falls to inform system-wide improvements. Q3-Q4 The End of Life and Frailty Collaborative Pathway development has begun.

PH CA

Alcohol


Develop and test a strategy to support increased Alcohol Structured Brief Intervention (SBI) in community settings and ensure a supportive infrastructure in primary care to decrease alcohol related-harm.

Why is this important? Alcohol has a wide-range of social and health related effects on people of all age, including Foetal Alcohol Spectrum Disorder (FASD), contributing effect in family violence is a contributor to accidents and falls, worsens the effects of chronic conditions, creates interference with sleep cycles and is a contributor to mental health disorders.

Who will we work with? Health Promotion Agency, WDHB, Business sector and stakeholders

WRHN lead(s) Judith MacDonald, Chloe Mercer, Dr John McMenamin


How w ill we know if we are successful? The development and testing of a WDHB Alcohol Strategy with partners. Where are we at now? This is a new work stream which builds on the existing General Practice programme. Current screening and intervention rates for ABC Alcohol within WRHN General Practices are:

• 56% of all patients 15+ have alcohol consumption recorded

• 10% of those screened have

been recorded as drinking above guidelines

• 43% of those drinking above

guidelines have been recorded as receiving brief advice or referral

How w ill we achieve this? Q1-Q4 Partner with HPA and regional partners to produce a scoping document, including: • Engage with a number of local small

construction companies to partner with WRHN • Identify and scope the extent of workplace

issues and or risk associated with alcohol • Identify barriers to the current process • Quantify risk (real and potential) • Evaluate the health system’s performance and

opportunities for improvement • Identify solutions that may already exist

nationally and how they might be applied and/or accessed locally

• Survey the workplace culture in relation to alcohol/drink driving/social club activity, etc

• Test and trial small-scale solutions and evaluate effectiveness and applicability to a wider population

• Agreeing on referral pathways to connect efficiently to assistance, education and training

• Evaluation of the project from workplace and provider perspectives with recommendations

• Review and update General Practice ABC Alcohol advanced form and improve screening rates (integrate as part of modular approach)

PH CA

Workforce Development

What do we want to achieve? Increased capacity and capability of the primary healthcare workforce as services are shifted closer to home

Why is this important? To ensure the workforce has the knowledge to improve health literacy, uses smart systems, uses and role models best practice

Who will we work with? Key stakeholders DHB, NGO, Iwi providers, sub-regional alliances

WRHN lead(s) Julie Nitschke, Janice Handley, Albert Robertson



• A minimum of 50% of General Practice nurses have completed their Performance Development and Recognition Programme (PDRP)

• A minimum of one nurse per practice

has completed Chronic Kidney Disease (CKD) and Chronic Obstructive Respiratory Disease (COPD) competencies

• There is recognition of the importance

of, and interest in, NETP placements in primary care

• A community nursing model is in place • Preparing nurses to prescribe in the

primary health setting

• Data demonstrates use of Map of Medicine and associated tools

• Specialty long-term condition nurses

deliver services closer to home and grow the confidence and capability of the primary workforce


• 10% of primary nurses have currently completed their PDRP

How w ill we achieve this? Q1-Q4 Supporting and encouraging the adoption by General Practice of the Ko Awatea national e-learning platform. Q1-Q4 Embedding of NETP and PDRP within General Practice teams as a part of succession planning. Q1-Q4 Renal Nurse Practitioner assists in increasing the knowledge and capability of General Practice teams in identifying and managing CKD and supports patients and whānau to improve their health literacy and self-management capacity. Q1-Q4 The development and implementation of a community model of nursing to increase the knowledge and capability of the sector. Q1-Q4 Co-design, education and marketing of system changes and best practice.

PH CA HE

Intimate Partner Violence/Child Abuse and Elder Abuse


Support clinicians and allied staff to be able to confidentially identify and manage family violence, and to contribute to a reduction in abuse within our community


Family violence is identified as a significant yet preventable public health problem in New Zealand


General Practice teams, WDHB Family Violence Coordinator, Violence Intervention Network, CYF and other stakeholders

WRHN lead(s) Janine Spence, Chloe Mercer, Practice Facilitators


How w ill we know if we are successful? General Practice teams will have the ability to detect potential signs of harm associated with intimate partner violence and abuse of vulnerable children and older people. Practices will have the tools to know how and where to refer clients as appropriately. The General Practice workforce will receive specialist support from the WRHN Children’s Team professional workforce to ensure potential child abuse and neglect is identified and appropriately responded to. WRHN will support General Practices in accessing services. Where are we at now? WRHN has up-to-date policies and procedures regarding both child and family/whānau abuse. These policies have been shared with General Practices. People who work with children have all had a more comprehensive police check, as required by the Vulnerable Children’s Act. WRHN is an active member of the Whanganui Children’s Team Governance Group.

How w ill we achieve this? Q3-Q4 Offer regular training sessions around intimate partner violence, child abuse and elder abuse to General Practice teams. Q1-Q2 Review the advanced form and remove duplicate forms from General Practices. Implement quality measures to measure use of form across General Practices. Q3 Implement processes to ensure that all WRHN clinicians report back to GPs on all intimate partner violence, child abuse and/or neglect and elder abuse disclosure received. Q1-Q4 CE will chair Whanganui Children’s Team Governance Group for the duration of the endorsement by the local governance group. Q1-Q4 WRHN will resource two lead professionals from the ‘Services to Improve Access’ resource in 2016/17. Q1-Q4 A plan is in place to ensure that all practices have child protection policies and establish and strengthen a culture of supporting child protection.

PH CA HE

Gonville Health Ltd – A WRHN Subsidiary History

Gonville Health Ltd (GHL) was established in 2007 in response to a number of catalysts: 1. The disestablishment of two medium sized

General Practices, which left 3,393 patients without a primary healthcare provider

2. Large numbers of patients who reside within the Gonville/Castlecliff area presenting at WAM without a primary healthcare provider

3. Community identification for the need of a Gonville community hub with inclusion of a range of collegial services

4. Being responsive to the needs of a specific high needs population

5. Recognising the changing General Practice environment and offering a transition process for general practitioners who were not ready to purchase in to a practice but had long term interests in the Whanganui community

For many years GHL has been a safety net for the people of Whanganui, who have been left without a primary healthcare provider and who are typically the most vulnerable population. The Gonville Centre (pharmacy, library, community room and health centre), was established following community engagement and planning. This centre was created to become a hub of the Gonville community, providing a model of wrap-around care that involved all sectors, e.g. education, health, social and community participation.

Purpose

Gonville Health Ltd is a Very Low Cost Access (VLCA) practice that serves an enrolled population of 6,041 (67% high need) patients and is responsible for their First Contact Care. This includes preventative health screening and support, routine primary healthcare, long term condition management, increasing health literacy and supporting patients with self-management of their conditions.

Principles of Gonville Health • Responsiveness to patients

and families/whānau • Identifying the practice

population and their specific needs

• Be a safe practice and workplace

• Create links with social marketing and campaigns

• Provide links to community • Be involved in local promotion

of public policy, i.e. licensing laws, road safety

WRHN has 100% shareholding for GHL, however GHL is a stand-alone business with its own Board of Directors. The mandate is that GHL maintains clinical leadership and community governance. The Board of Directors are: • Dr Alan Mangan (chair) • Darren Hull • David Robertson • Judith MacDonald • Nanette Pirikahu-Smith

Goals for 2016/17 – Aligned to specific actions and measures

• Health Promoting Practices framework are developed for and embedded in GHL • GHL has active participation with the Gonville community, in a way that reflects the

unique nature of GHL and the population • GHL engages with community leaders who support a consumer approach to quality

improvement within the practice • A culturally competent team is empowered to operate in manner that reduces

inequity for GHL patients • Promoting the benefits of breastfeeding for new babies and mothers • Improve oral health in our children/tamariki • Identify and reduce child obesity risk factors • Reduce ASH rates for children/tamariki with a focus on children with asthma and/or

eczema • Reduction of SUDI deaths • GHL will respond to system developments that support improved mental wellness for

the population • The GHL team are proactive and have processes to reduce the risks related to

intimate partner, child and/or elder abuse • The Whānau Ora philosophy and practices are embedded in GHL • GHL provides a long-term conditions service that supports care planning and self-

management for patients with complex co-morbidities • Virtual consultations are established in an aim to mitigate patients that might

otherwise ‘slip through the gaps’ • Achieve population health targets and aim to align equity across the population • Provision of a walk-in/same day clinic that is modelled in a way that will improve

access • GHL maintains enrolment numbers as an indication of patient satisfaction which

results in financial viability • GHL actively manages viability and cash flow • GHL responds to the changes specified in IPIF • Cornerstone Accreditation is achieved • The GHL workforce is invested in to increase capability and capacity • The GHL team are partners in articulating the vision, mission and values of GHL • GHL meets the obligations of the Health and Safety at Work Act 2015 • GHL moves towards being an invested, high-functioning and sustainable team

Gonville Centre Vision To be a centre that provides a platform to individuals and their whanau to realise their

potential to self-determine their future by integrating a number of health and social services

Whanganui Accident and Medical (WRHN Subsidiary) History Whanganui Accident & Medical (WAM) clinic is a subsidiary company of the Whanganui Regional Health Network (WRHN). It was originally established as a means to provide the Whanganui community and its visitors with improved access to primary and urgent after-hours healthcare, to complement existing primary healthcare services and to provide support to the local primary healthcare workforce in a climate challenged by constant change.

In 2008, the Whanganui District Health Board (WDHB) and the WRHN took steps to improve collaboration between primary and secondary services for the good of the community. This was achieved through the re-design of the hospital campus to allow for the co-location of the Emergency Department and Whanganui Accident & Medical clinic; in essence creating a one-stop-shop for consumers, to an improved access to a variety of services.

Purpose Whanganui Accident & Medical’s model of care has continued to evolve in order to promote efficiency of systems, to accommodate an increasing demand for services within current workforce constraints. At the heart of all changes has been the desire to provide an innovative service, which promotes access to appropriate primary healthcare services, is responsive to the needs of the community it serves, aims to reduce inequalities in health and empowers individuals to realise a greater level of self-determination to positively influence their own health and wellbeing.

Both the WDHB and WRHN have made the commitment to embark on a new level of partnership to promote efficiency of systems and improve service delivery. This philosophy of service delivery is referred to as being the ‘Yellow Space’. It considers the needs of patients and their family/whānau to be central to any decision making. It acknowledges the duplication and inefficiencies which occur within the current framework, and embraces concepts of integration and collaboration, to ensure a more coordinated service to improve health outcomes and the overall experience for patients and their families.

Goals for 2016/17 Priority area one: One team, working towards a common purpose

• Modification of triage desk/booth and waiting room • Utilisation of accurate data to understand patient flow and ensure a service which

reflects needs, and can manage vulnerable patients and whānau • Focus on workforce development to enhance capacity, capability and diversity

Priority area two: People powered

• Embedding of use of transfer of care tool, to ensure that all patients are provided care plans prior to leaving

• Population health screening in line with agreed key performance areas • Implementation of a process for ensuring engagement with high risk and vulnerable

consumers following discharge, and the implementation of an interactive feedback process

Priority area three: Value and performance • Increased utilisation and engagement with Collaborative Pathways • Maintenance of processes to ensure the attainment of accreditation • On-going engagement with consumers • Use of Shared Care Record, Patient Portal and Carestream and other enablers

Priority area four: Workforce

• All staff have the opportunity to develop skills to ensure a high level of cultural competence

• Scope of nurses is expanded through a supportive workforce development programme

• Continue to foster and maintain WAM as a training site • Development of orientation resources

Priority area five: Financial sustainability

• Ensure smart business systems to ensure a break even position • Increase focus on prevention and recovery of debt

WAM Governance

WRHN has 100% shareholding for WAM, however WAM is a standalone business with its own Board of Directors. The mandate is that WAM partners with GP members to deliver their 24/7 service obligations. This mandate is restricted to those practitioners who have authorised WAM and contribute to the afterhours roster (this is now not inclusive of all city practitioners within Whanganui city).

The Board of Directors are: • Michael Sewell (chair) • Dr Rick Nicholson • Dr David Rogers • Carla Donson • Julie Nitschke • Judith MacDonald

Taihape Health Ltd (WRHN Subsidiary) History Taihape Health Limited (THL) was established in February 2011 by Whanganui Regional PHO to provide a wide range of Primary Healthcare Services, following the closure of the local rest home and the exit of the previous service providers. THL is a Fully Integrated Family Health Centre providing Medical, Primary Healthcare Nursing, Midwifery, Allied Healthcare services and Services for Older People. THL works in partnership with other local healthcare and social service providers to ensure patients receive coordinated and patient centred services. Purpose The purpose of THL is to provide affordable, accessible and high quality healthcare services for the populations of Taihape, Waiouru and the wider rural area. In particular, THL strives to be responsive to the needs of Māori and to close the inequality gap in health that has been identified. Goals for 2016/17 THL’s key goals for 2016/17 year are about building on and embedding the initiatives commenced in the previous year, including achieving IPIF targets and providing a high quality service that decreases the number of people meeting the criteria for high needs populations to within 3% of the total population. Maternal and Child Welfare:

a) THL provides Lead Maternity Care, post–natal inpatient services (when required) and Pregnancy and Parenting education. THL is seeking to improve the quality of the care received by women, so that they are enabled to provide a strong foundation for their babies and their families. Our midwifery team recognises that breastfeeding can give babies the best start in life and promotes strong ‘breast is best’ messages. THL will work with our partners at Mokai Patea Services (MPS) to ensure wahine are being provided with the same information, in a way that is culturally acceptable for local Māori. THL will continue to ensure that women and babies in the care of the midwifery service are also enrolled with a General Practice for ongoing healthcare and support. This year THL, in conjunction with MPS, will survey consumers of the maternity services to ascertain their opinion of antenatal classes, in the hope they can be made more relevant and sensitive to the needs of women. THL will supply the materials for course participants to make ipuwhenua as part of the class or THL will

supply ipuwhenua to those who complete the course if more appropriate. THL in conjunction with the Birth Educator will ensure the classes are widely marketed, including on social media.

b) A key focus for THL is identifying and protecting vulnerable children, and we have contracted Jigsaw Whanganui to support this aim by bolstering the social work resources and expertise in the area. THL will continue to facilitate the Jigsaw team parenting programmes twice a year. The funding for this initiative has been allocated from the Community Health Services contract: Community Based Services.

c) THL and Otaihape Health Trust have entered into a partnership to fund housing insulation in our region – $5000 dollars was contributed by each organisation. This will be repeated in the 2016/17 year.

Contributing to the Health of Older People:

a) THL has initiated a new programme designed to support older people to live in their homes longer. The Community Activity Programme provides social interaction, physical activities and outings in a group setting. The feedback from consumers has been excellent to date. The programme is funded by a fee for service directly from the MoH and is supplemented by THL Primary Care surplus. We have the opportunity in 2016/17 to grow and develop this programme.

b) THL allied health team will commence a Falls Assessment Programme in conjunction with Taihape Older & Bolder Inc.

THL Governance WRHN has 100% shareholding for Taihape Health Ltd, however THL is a standalone business with its own Board of Directors. The mandate is to partner with the community to assess and meet the changing needs of the enrolled and casual population, and offer services across the district from hubs at Taihape and Waiouru. The Board of Directors are: • Dr Ken Young (chair) • Dr Antonia Hughes • Barbara Ball • Norman Richardson • Judith MacDonald

Services To Improve Access (SIA) 2016/17 (Consultation Document July 2016)

Historically WRHN has used SIA to fund a combination of system investments (such as suicide prevention campaigns) that focussed on (1) purchasing priority services from organisations for delivery, (2) funding a WRHN workforce that had a ‘system lens’ (i.e. the Manaaki Hauora team) and (3) General Practice-specific priorities such as rural youth clinics, HQ checks and VLCA practices.

It is proposed for 2016/17 that the SIA spend differentiates between practices with >60% of patients considered to have high needs and other practices. Spending of SIA at other practices will be equitable regionally and will acknowledge high needs patients enrolled at these practices. Criteria for funding has been developed (see below) and practices will be required to develop service plans to access funding.

Agreed Principles:

1. SIA is an annual funding stream considered within the planning cycle for the period of 1 July – 30 June

2. WRHN and General Practice activity must benefit the target population and not be used for investment in infrastructure or to support the operational cost of running a business

3. Where outcomes have positive learning for the entire population and/or General Practice members, this information is shared with everyone

4. WRHN may prioritise successful projects for investment and access for the total population in following periods

5. A timeline for application and acceptance will be communicated and adhered to in the future

6. A transition approach will apply in the 2016/17 period 7. WRHN will support General Practices by compiling practice-specific population data

that defines priority groups and variances which may indicate any unmet requirements

8. SIA is not an investment solution for system-wide gaps that should or could be delivered by other contractual mechanisms

9. WRHN will enable the commissioning of projects through the provision of skills, resource and workforce development if the project was scored as a priority need for the General Practice and/or population

10. Population health profiling will be a key aspect in development of all funding proposals

11. SIA funding can be used to extend or continue existing services, however WRHN must ensure that the same activity is not funded twice

12. “SIA funding cannot be used to reduce co-payments across the whole enrolled population, however under special circumstances a portion of SIA funding may be used to reduce co-payments if an Access PHO (now known as VLCA practices) is experiencing significant financial difficulty. In this situation the PHO must meet the following criteria:

• Are access-funded • Proven financial difficulty in providing first contact services for access funded

practices

• Charge low patient co-payments • Have agreement and approval of the DHB with support from the Ministry.”*

*as detailed in PHO contract

WRHN seeks to create a process that will grow General Practice/Network collaboration and nurture collective accountability for the strategic outcomes against which WDHB and WRHN are measured nationally, such as IPIF, contributory measures (local) and health target measures, now and into the future.

A proposed menu of measures will include:

1. Transitioning community mental health extended consultations. This contract is moving its focus from a resourced counselling model to extended GP consultations model. However in 2016/17 there is a need to fund a transition.

2. Provision of subsidised health checks – currently funded from SIA and includes a menu of patient subsidised appointments and expanded to include (but not limited to):

• CVD risk assessment • Cervical screening (for women not in the priority funded contract but who

meet SIA criteria) • Sexual health screening • Youth health assessment • Dementia assessment • Advance Care planning • Smoking cessation (particularly targeting pregnant women) • Alcohol assessment

MANDATORY CRITERIA (Any practice proposal must demonstrate it meets all of these criteria )

CRITERIA Measures 1.1 Targeted to high needs persons in WRHN enrolled population

identified as Māori/tangata whenua, Pacific peoples and/or people living in NZDep index 9 – 10 decile areas.

100%

1.2 Service or activity is directed at improving health of these target groups and improving their access to primary health care services and in particular aligns with IPIF priorities and

targets.

Aligns with priority patient profile for that practice

1.3 Service is not funded through any other mechanism. 100%

1.4 General Practice project plans are required specifically to demonstrate capacity and capability (workforce and skills) to

deliver outcomes.

The practice may partner with the PHO to support

capacity

1.5 Project plans demonstrate quality improvement approach including agreed outcome(s).

Definitive measures that define what success looks

like for that population

• Polypharmacy assessment • Care plans for patients who frequently present at ED/WAM • COPD assessment including spirometry tests • Diabetes management extended consultations

3. The impacts of clinical pathways facilitated by Map of Medicine for General Practices

associated with meeting best practice standards.

General Practice WRHN

$9.28 5121 high need patients

per capita of high needs $47,518









$20,000

Avoidable hospitalisationsBulls, Taihape and

Waimarino

General Practice High Needs Patients (see below) $647,840

General Practice High Needs Patients

Budget SIAAllocation 2016/17

Aramoho Medical 4495 $20.72 $93,141Bulls 1328 $20.72 $27,517East Care 974 $20.72 $20,182Jabulani 1247 $20.72 $25,839Moore 384 $20.72 $7,957Springvale 1314 $20.72 $27,227Stewart Street 2830 $20.72 $58,640Taihape 1428 $20.72 $29,589Wicksteed 3361 $20.72 $69,643TOIHA 5121 $20.72 $106,112Gonville 4044 $20.72 $83,795Castlecliff 1573 $20.72 $32,594Waimarino 2099 $20.72 $43,493St Johns 1067 $20.72 $22,109Total 31,265 $647,840

VLCA Gonville

2016/17 SIA Investment DescriptionBudget 2016/17

VLCA TOIHA

VLCA Castlecliff

VLCA Waimarino

VLCA Taihape

WRHN Vulnerable Children Response 2.0 FTE and expenses $170,556

Rural Youth Clinics (Marton/Taihape/Waimarino)

Free access youth clinics (parity with city YST clinic) $20,000

Pneumovax vaccineTarget group - representing

admissions/clinical protocol

Rural Cellulitis Programme $5,000

$110,640

Total Revenue and Expenses $1,106,402 $825,206 $281,196

Practice Volume of High Need Patients

Amount per high need patient

SIA Overhead Costs Overhead, depreciation, facility and other costs

WHANGANUI PRIMARY HEALTH NETWORKBUDGETED PROFIT & LOSSFOR THE YEAR 2016/17

2016 2017Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget

PHO CONTRACTS Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun$ $ $ $ $ $ $ $ $ $ $ $ $

FIRST CONTACT CAREIncome 871,145 871,145 871,145 871,145 871,145 871,145 871,145 871,145 871,145 871,145 871,145 870,570 10,453,168Expenses (871,145) (871,145) (871,145) (871,145) (871,145) (871,145) (871,145) (871,145) (871,145) (871,145) (871,145) (870,570) (10,453,168)FCC NET SURPLUS / (DEFICIT) 0 0 0 0 0 0 0 0 0 0 0 0 0

MANAGEMENT SERVICESReceipts Management 38,346 38,346 38,346 38,346 38,346 38,346 38,346 38,346 38,346 38,346 38,346 38,346 460,149Receipts BU Sundry 1,909 1,909 1,909 1,909 1,909 1,909 1,909 1,909 1,909 1,909 1,909 1,909 22,906Receipts IT Support 2,108 2,108 2,108 2,108 2,108 2,108 2,108 2,108 2,108 2,108 2,108 2,108 25,294Receipts Subsidiary/GP Support 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 54,000Workforce Recovery 23,156 23,157 29,468 22,539 22,539 28,851 22,539 22,539 28,851 22,539 22,540 28,851 297,569Overhead Recovery 47,876 47,876 55,765 47,258 47,258 55,148 47,258 47,258 55,148 47,259 47,259 55,148 600,511Facility Recovery 4,207 4,207 4,207 4,207 4,207 4,207 4,207 4,076 4,076 4,076 4,076 4,076 49,829Income 122,102 122,102 136,303 120,867 120,867 135,068 120,867 120,736 134,937 120,736 120,737 134,938 1,510,259

Governance & Advisory Services (15,154) (15,154) (16,241) (15,272) (15,154) (16,241) (9,737) (15,154) (16,241) (15,154) (15,154) (16,241) (180,899)Personnel Costs (62,993) (62,993) (62,993) (62,993) (62,993) (95,716) (62,993) (62,993) (62,993) (62,993) (62,993) (95,803) (821,447)Business Unit (25,942) (27,942) (26,480) (25,942) (23,992) (24,530) (23,992) (23,992) (24,530) (23,992) (23,992) (24,531) (299,854)Information Technology (21,116) (21,116) (21,116) (21,116) (21,116) (27,485) (21,116) (21,116) (21,116) (21,116) (21,116) (27,485) (266,130)Expenses (125,204) (127,205) (126,830) (125,322) (123,255) (163,973) (117,838) (123,255) (124,880) (123,255) (123,255) (164,060) (1,568,330)

MANAGEMENT NET SURPLUS / (DEFICIT) (3,102) (5,103) 9,473 (4,455) (2,388) (28,905) 3,030 (2,519) 10,057 (2,518) (2,518) (29,122) (58,071)

SERVICES TO IMPROVE ACCESSIncome 93,033 93,033 93,033 93,033 93,033 93,033 93,033 93,033 93,033 93,033 93,033 93,033 1,116,402SIA Youth Clinic (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (20,000)SIA INR Testing (417) (417) (417) (417) (417) (417) (417) (417) (417) (417) (417) (417) (5,000)SIA VLCA Practices (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (13,590) (163,082)SIA High Needs Patients (6,078) (6,078) (6,078) (51,084) (51,084) (44,215) (51,084) (51,084) (51,084) (51,084) (51,084) (44,215) (464,251)SIA Ratana Clinic (217) (217) (217) (217) (217) (217) (217) (217) (217) (217) (217) (217) (2,609)SIA Respiratory (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (1,667) (20,000)SIA Cellulitis Project (417) (417) (417) (417) (417) (417) (417) (417) (417) (417) (417) (417) (5,000)SIA Vulnerable Children (8,257) (8,257) (8,257) (14,672) (14,672) (21,541) (14,672) (14,672) (14,672) (14,672) (14,672) (21,541) (170,556)SIA General (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (9,303) (111,640)Expenses (41,613) (41,613) (41,613) (93,033) (93,033) (93,034) (93,033) (93,033) (93,033) (93,033) (93,033) (93,034) (962,138)

SIA NET SURPLUS / (DEFICIT) 51,421 51,421 51,421 0 0 0 0 0 0 0 0 0 154,264

HEALTH PROMOTIONIncome 19,739 19,739 19,739 19,739 19,739 19,739 19,739 19,739 19,739 19,739 19,739 19,739 236,862Expenses (21,867) (21,867) (21,867) (21,867) (21,867) (30,207) (21,867) (21,867) (21,867) (21,867) (21,867) (30,207) (279,083)HP NET SURPLUS/ (DEFICIT) (2,128) (2,128) (2,128) (2,128) (2,128) (10,468) (2,128) (2,128) (2,128) (2,128) (2,128) (10,468) (42,220)

CARE PLUSIncome 96,193 96,193 96,193 96,193 96,193 96,193 96,193 96,193 96,193 96,193 96,193 96,193 1,154,315Expenses (79,666) (74,211) (76,078) (98,818) (98,818) (99,951) (98,818) (98,818) (98,818) (98,818) (98,818) (99,951) (1,121,583)CARE PLUS NET SURPLUS / (DEFICIT) 16,527 21,981 20,115 (2,625) (2,625) (3,758) (2,625) (2,625) (2,625) (2,625) (2,625) (3,758) 32,732

Total

RURAL PRACTICEIncome 35,338 35,338 35,338 35,338 35,338 35,338 35,338 35,338 35,338 35,338 35,338 35,338 424,058Expenses (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (35,338) (424,058)RP NET SURPLUS / (DEFICIT) 0 0 0 0 0 0 0 0 0 0 0 0 0

INTEGRATED PERFORMANCE INCENTIVE MANAGEMENTIncome 0 0 78,894 0 0 78,894 0 0 78,894 0 0 78,894 315,578Expenses (10,939) (10,939) (64,587) (10,939) (10,939) (67,819) (10,939) (10,939) (64,587) (10,939) (10,939) (67,819) (352,327)IPIF NET SURPLUS / (DEFICIT) (10,939) (10,939) 14,307 (10,939) (10,939) 11,075 (10,939) (10,939) 14,307 (10,939) (10,939) 11,075 (36,749)

TOTAL PHO CONTRACTS 51,778 55,232 93,187 (20,148) (18,080) (32,056) (12,663) (18,211) 19,610 (18,211) (18,211) (32,273) 49,955

CLINICAL CONTRACTS

HEALTHY HOMESIncome 2,500 2,500 2,500 2,500 2,500 2,500 2,500 2,500 2,500 2,500 2,500 2,500 30,000Expenses (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (2,500) (30,000)HH NET SURPLUS/DEFICIT 0 0 0 0 0 0 0 0 0 0 0 0 0

TARGETED POPULATION HEALTH OUTCOMESIncome 5,564 5,564 5,564 5,564 5,564 5,564 5,564 5,564 5,564 5,564 5,564 5,564 66,768Expenses (5,361) (5,361) (5,361) (5,361) (5,361) (7,462) (5,361) (5,361) (5,361) (5,361) (5,361) (7,462) (68,531)TPHO NET SURPLUS / (DEFICIT) 203 203 203 203 203 (1,898) 203 203 203 203 203 (1,898) (1,763)

VLCA SUSTAINABILITY Income 0 0 20,846 0 0 20,846 0 0 20,846 0 0 20,846 83,385Expenses 0 0 (20,846) 0 0 (20,846) 0 0 (20,846) 0 0 (20,846) (83,385)VLCAS NET SURPLUS / (DEFICIT) 0 0 0 0 0 0 0 0 0 0 0 0 0

MANAAKI TE WHANAUIncome 37,910 37,912 37,914 37,916 37,918 37,920 37,922 37,924 37,926 37,928 37,930 37,932 455,052Expenses (33,935) (33,936) (33,936) (33,936) (33,936) (43,789) (33,937) (33,937) (33,937) (33,937) (33,937) (43,790) (426,943)IMMCO NET SURPLUS / (DEFICIT) 3,975 3,976 3,978 3,980 3,982 (5,869) 3,985 3,987 3,989 3,991 3,993 (5,858) 28,109

MENTAL HEALTH EARLY INTERVENTIONIncome 27,748 27,748 27,748 27,748 27,748 27,748 27,748 27,748 27,748 27,748 27,748 27,748 332,971Expenses (27,813) (27,633) (27,633) (27,633) (27,633) (32,806) (27,633) (27,633) (27,633) (27,633) (27,633) (32,806) (342,123)MHEI NET SURPLUS / (DEFICIT) (66) 114 114 114 114 (5,058) 114 114 114 114 114 (5,058) (9,153)

SKIN LESION PROJECTIncome 23,750 23,750 23,750 23,750 23,750 23,750 23,750 23,750 23,750 23,750 23,750 23,750 285,000Expenses (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (23,750) (285,004)SL NET SUPRLUS / (DEFICIT) 0 0 0 0 0 0 0 0 0 0 0 0 (4)

CERVICAL SCREENINGIncome 10,758 10,758 10,758 10,758 10,758 10,758 10,758 10,758 10,758 10,758 10,758 10,758 129,099Expenses (10,192) (10,192) (10,192) (10,192) (10,192) (11,507) (10,192) (10,192) (10,192) (10,192) (10,192) (11,507) (124,939)CS NET SURPLUS / (DEFICIT) 566 566 566 566 566 (749) 566 566 566 566 566 (749) 4,161

SLEEP APNOEAIncome 6,807 6,807 6,807 6,807 6,807 6,807 6,807 6,807 6,807 6,807 6,807 6,807 81,680Expenses (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (6,436) (77,226)SA NET SURPLUS / (DEFICIT) 371 371 371 371 371 371 371 371 371 371 371 371 4,454

GONVILLE CENTREIncome 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 114,005

Community Room Expenses (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (1,711) (20,529)Gonville Health Expenses (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (5,340) (64,086)Gonville Land Expenes (154) (154) (154) (154) (154) (154) (154) (154) (154) (154) (154) (154) (1,844)Expenses (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (7,205) (86,458)

GC NET SURPLUS / (DEFICIT) 2,296 2,296 2,296 2,296 2,296 2,296 2,296 2,296 2,296 2,296 2,296 2,296 27,547

SMOKING CESSATIONIncome 48,050 48,050 48,050 48,050 48,050 48,050 48,050 48,050 48,050 48,050 48,050 48,050 576,600SC Expenses (48,322) (48,322) (48,322) (48,322) (48,322) (48,459) (48,322) (48,322) (48,322) (48,322) (48,322) (48,459) (580,138)SC NET SURPLUS / (DEFICIT) (272) (272) (272) (272) (272) -409 (272) (272) (272) (272) (272) -409 (3,538)

STRENGTHENING FAMILIESIncome 6,179 6,179 6,179 0 0 0 0 0 0 0 0 0 18,536Expenses (7,389) (7,389) (7,389) 0 0 0 0 0 0 0 0 0 (22,168)SF NET SURPLUS / (DEFICIT) (1,211) (1,211) (1,211) 0 0 0 0 0 0 0 0 0 (3,632)

FRACTURE LIAISON SERVICEIncome 7,630 7,630 7,630 7,630 7,630 7,630 7,630 7,630 4,713 4,713 4,713 4,713 79,889Expenses (6,305) (6,305) (6,305) (6,305) (6,305) (8,925) (6,305) (6,305) (6,305) (6,305) (6,305) (8,925) (80,896)FLS NET SURPLUS / (DEFICIT) 1,325 1,325 1,325 1,325 1,325 (1,295) 1,325 1,325 (1,592) (1,592) (1,592) (4,212) (1,007)

TAIHAPE HEALTH LIMITEDIncome 75,850 75,850 75,850 75,850 75,850 75,850 75,850 75,850 75,850 75,850 75,850 75,850 910,194Expenses (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (75,850) (910,194)TH NET SURPLUS / (DEFICIT) 0 0 0 0 0 0 0 0 0 0 0 0 0

LONG-TERM CONDITIONSIncome 74,116 74,116 74,116 74,116 74,116 74,116 74,116 74,116 74,116 74,116 74,116 74,116 889,387

Recovery Expenses (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (13,341) (160,090)BSMC Expenses (9,024) (9,023) (9,023) (9,023) (9,023) (13,157) (9,023) (9,023) (9,023) (9,023) (9,023) (13,157) (116,545)CKD Expenses (300) (300) (300) (300) (4,613) (4,613) (4,613) (4,613) (4,613) (4,613) (4,613) (4,613) (38,100)MWST Expenses (12,565) (12,645) (12,645) (12,645) (12,645) (17,211) (12,645) (12,645) (12,645) (12,645) (12,645) (17,211) (160,795)Pharms Expenses (12,921) (12,921) (12,921) (12,921) (12,921) (15,975) (12,921) (12,921) (12,921) (12,921) (12,921) (15,975) (161,159)Diabetes Expenses (22,217) (22,217) (22,217) (22,217) (30,842) (32,556) (30,842) (30,842) (30,842) (30,842) (30,842) (32,556) (339,033)Older Person Strategy Reserves (5,475) (5,475) (5,475) (5,475) (5,475) (8,098) (5,475) (5,475) (5,475) (5,475) (5,475) (8,098) (70,942)Map of Medicine (25,451) (25,451) (25,451) (25,451) (25,451) (34,786) (25,451) (25,451) (25,451) (25,451) (25,451) (34,786) (324,084)Expenses (101,293) (101,373) (101,373) (101,373) (114,311) (139,736) (114,311) (114,311) (114,311) (114,311) (114,311) (139,736) (1,370,747)

LTC NET SURPLUS / (DEFICIT) (27,177) (27,258) (27,258) (27,258) (40,195) (65,620) (40,195) (40,195) (40,195) (40,195) (40,195) (65,620) (481,361)

PREGNANCY & PARENTINGIncome 9,886 9,886 9,886 9,886 9,886 9,886 9,886 9,886 9,886 9,886 9,886 9,886 118,632Expenses (14,736) (14,736) (14,736) (14,736) (14,736) (17,474) (14,736) (14,736) (14,736) (14,736) (14,736) (17,474) (182,308)P&P NET SURPLUS / (DEFICIT) (4,850) (4,850) (4,850) (4,850) (4,850) (7,589) (4,850) (4,850) (4,850) (4,850) (4,850) (7,589) (63,676)

UNDER 13s AFTER HOURSIncome 14,511 14,511 14,511 14,511 14,511 14,511 14,511 14,511 14,511 14,511 14,511 14,511 174,129Expenses (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (13,693) (164,314)U13s AFTER HOURS NET SURPLUS / (DEFICIT) 818 818 818 818 818 818 818 818 818 818 818 818 9,815

ENT PROJECT Income 4,358 4,358 4,358 4,358 4,358 4,358 4,358 0 0 0 0 0 30,505 Expenses (4,137) (4,137) (4,137) (4,137) (4,137) (5,894) (4,137) 0 0 0 0 0 (30,719)ENT NET SURPLUS / (DEFICIT) 220 220 220 220 220 (1,537) 220 0 0 0 0 0 (214)

INFORMATION AND DATA PROJECTSIncome 0 0 0 0 0 0 0 0 0 0 0 0 0

Expenses (9,846) (9,846) (9,846) (9,846) (9,846) (12,006) (9,846) (9,846) (9,846) (9,846) (9,846) (12,006) (122,475)ID PROJECTS NET (DEFICIT) (9,846) (9,846) (9,846) (9,846) (9,846) (12,006) (9,846) (9,846) (9,846) (9,846) (9,846) (12,006) (122,475)

TOTAL CLINICAL CONTRACTS (33,648) (33,547) (33,545) (32,332) (45,268) (98,545) (45,264) (45,483) (48,398) (48,396) (48,394) (99,915) (612,736)

FINANCING INCOME/ EXPENSESIncome 2,480 2,480 2,480 2,480 2,480 2,480 2,480 2,480 2,480 2,480 2,480 2,480 29,761Expenses (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (1,488) (17,862)FINANCING NET SURPLUS / (DEFICIT) 992 992 992 992 992 992 992 992 992 992 992 992 11,899

NET SURPLUS/ (DEFICIT) 19,121 22,677 60,634 (51,489) (62,357) (129,610) (56,936) (62,703) (27,796) (65,615) (65,613) (131,196) (550,882)

Annual Business Plan 2016-2017 - WRHN | Whanganui ... Annual Plan 16...ora, te kaha, te...

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Transcript of Annual Business Plan 2016-2017 - WRHN | Whanganui ... Annual Plan 16...ora, te kaha, te...