john macaskill-smith: general practice models in new zealand
TRANSCRIPT
Ensuring health for the future
Overview of the NZ Health system
• 4.2 million population
• 13.8 million GP visits, 65 million prescription items,
24 million lab tests, 1 million E.D. attendances
• Largely devolved system – Central ministry/ACC ,
20 regional Distrist Health Boards, 30 primary care
networks, large number of PPP (pharmacy, labs,
private hospitals, General Practice)
• In comparision to most OECD indicators we are
performing well and delivering value-for-money
• Growth in NZers’ life expectancy is the highest in
the OECD
• 19% of total government spending goes into vote
Health ($14 billion NZD)
• Co-payments in primary care
Challenges
• Living within our means: our rate of growth in health spend is
unsustainable – doubled in the previous decade
• Population ageing: increasing demands on health system (44% increase
in demand)
• Increased chronic conditions – 80% of deaths are a result of heart
disease, cancer, diabetes and tobacco related illness
• Increasing expectations from the public on health system performance
• Workforce ageing and changing expectations
• Fragmentation and differences in service performance across a
devolved health and disability system
Drivers for Change
Population
Workforce
Sustainability
Facilities
Demand increase from existing population
+ change in profile
MHN
- NGO, not-for-profit
- GP owned & governed
- 400 GPs
- 500 PNs
- 100 practices
- 500,000 patients
- $135 million - Covering 4 DHBs
- 100-40% geographical coverage
- Holds the contract with the crown,
sub contracts members - Regional Alliance contract
- GP, acute A&M, community nursing,
community mental health, PH, chronic
care
Ensure the future of high quality general practice….
Be a vehicle to enable the development of new models,
ownership etc to ensure sustainability of high quality GP.
Sustainable & leading edge primary care services
The way to bring together the founding partners to ensure each
partner is successful
Vehicle to enable single contract/plan
Pinnacle
Incorporated
Primary Health
Care Limited
Midlands Health
Network Limited
Midlands Regional
Health Network
Charitable Trust
Role of Members of the Group
Taranaki Primary
Health Provider
Incorporated
Turanga
Health
Tui Ora
Limited Integrated health service organisation committed to enhancing
health and wellbeing.
Delivering high quality primary healthcare through strategic
partnering and best practice clinical service delivery.
Network of General Practitioners, and through its partnerships
provides opportunities to improve access to services for Maori
and high need populations through the delivery of a wide range
of health services and programmes.
General Practice network – sets the strategic framework, priorities, holds
and controls investment resources, monitors performance – Board elected
from members – 350 GP members, 500 PN, 97 PM
Pinnacle provider arm for practice ownership –provides a vehicle to explore
and develop new practice models, supports at risk areas
Management company – employs staff, develops and operates
systems, operates a range of direct to non-GP patient services via provider
arm (the engine room for getting stuff done) – Pinnacle/Independent Governance
Vehicle for connecting with strategic partners + single point for contracting
with Multi DHBs, MoH – Community/Provider/Independent Governance
MHN Family
CQI core value
1.1 1.2 1.3 1.4 2.1 2.2 2.3 2.4 3.1 3.2 4.1 4.2 4.3 4.4 4.5 4.6 5.1 6.1 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 DAMRDAMR
HNCVRA
CVRA
HN
85.0% 85.0% 93.0% 93.0% 70.0% 70.0% 70.0% 70.0% 72.5% 72.5% 90.0% 90.0% 90.0% 90.0% 25.0% 25.0% 80.0% 80.0% 70.0% 70.0% 70.0% 70.0% 70.0% 70.0% 30.0% 30.0% 70.0% 70.0% 70.0% 70.0% 75.0% 75.0%
Pihanga Health ACHIEVEMENT 40 12 / 2685.7%
(0)
83.3%
(0)
75.0%
(3)
73.3%
(3)- - - -
72.5%
(0)
72.5%
(0)
96.6%
(0)
96.3%
(0)
33.9%
(313)
33.1%
(281)
8.6%
(92)
8.7%
(80)- -
73.6%
(0)
70.2%
(0)
88.9%
(0)
87.1%
(0)
65.2%
(19)
64.4%
(17)
46.5%
(0)
43.8%
(0)
43.0%
(95)
40.7%
(79)
39.0%
(76)
37.9%
(64)
66.9%
(121)
64.0%
(115)
Taupo Health Centre ACHIEVEMENT 40 12 / 26100.0%
(0)
100.0%
(0)
91.5%
(1)
100.0%
(0)- - - -
80.1%
(0)
77.0%
(0)
97.6%
(0)
96.7%
(0)
29.7%
(665)
35.8%
(305)
13.1%
(132)
14.1%
(62)- -
75.4%
(0)
66.0%
(8)
87.5%
(0)
91.3%
(0)
55.7%
(118)
53.6%
(46)
39.4%
(0)
36.4%
(0)
39.0%
(218)
38.6%
(76)
50.0%
(105)
45.0%
(50)
67.1%
(296)
57.7%
(198)
Taupo Medical Centre ACHIEVEMENT 36 12 / 2698.1%
(0)
95.7%
(0)
93.3%
(0)
100.0%
(0)- - - -
78.4%
(0)
74.5%
(0)
98.5%
(0)
98.0%
(0)
33.6%
(796)
39.9%
(364)
14.3%
(151)
16.4%
(62)- -
67.6%
(12)
57.4%
(25)
91.7%
(0)
88.2%
(0)
60.6%
(78)
56.2%
(39)
44.1%
(0)
43.4%
(0)
50.8%
(122)
51.9%
(43)
15.6%
(278)
17.9%
(102)
72.7%
(100)
62.6%
(167)
The Lake Surgery ACHIEVEMENT 70 18 / 26100.0%
(0)
100.0%
(0)
91.7%
(0)
100.0%
(0)- - - -
78.3%
(0)
73.4%
(0)
98.0%
(0)
96.4%
(0)
86.0%
(11)
83.2%
(9)
32.2%
(0)
33.6%
(0)- -
77.6%
(0)
77.2%
(0)
96.6%
(0)
100.0%
(0)
74.4%
(0)
79.7%
(0)
62.1%
(0)
47.3%
(0)
52.4%
(29)
42.2%
(18)
60.3%
(15)
59.6%
(6)
67.8%
(81)
66.2%
(29)
GOAL
ACHIEVEMENT54 / 104 4 / 4 4 / 4 2 / 4 3 / 4 - - - - 4 / 4 4 / 4 4 / 4 4 / 4 0 / 4 0 / 4 1 / 4 1 / 4 - - 3 / 4 2 / 4 4 / 4 4 / 4 1 / 4 1 / 4 4 / 4 4 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4
ACHIEVEMENT97.0%
(0)
94.3%
(0)
90.4%
(4)
93.4%
(3)- - - -
78.3%
(0)
74.6%
(0)
97.9%
(0)
97.1%
(0)
36.5%
(1785)
39.7%
(959)
14.4%
(375)
14.9%
(204)- -
72.5%
(12)
65.7%
(33)
90.6%
(0)
90.2%
(0)
60.8%
(215)
59.9%
(102)
44.4%
(0)
41.8%
(0)
45.0%
(464)
43.5%
(216)
37.0%
(474)
36.0%
(222)
69.4%
(598)
61.8%
(509)
GOAL
ACHIEVEMENT54 / 104 4 / 4 4 / 4 2 / 4 3 / 4 - - - - 4 / 4 4 / 4 4 / 4 4 / 4 0 / 4 0 / 4 1 / 4 1 / 4 - - 3 / 4 2 / 4 4 / 4 4 / 4 1 / 4 1 / 4 4 / 4 4 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4
ACHIEVEMENT97.0%
(0)
94.3%
(0)
90.4%
(4)
93.4%
(3)- - - -
78.3%
(0)
74.6%
(0)
97.9%
(0)
97.1%
(0)
36.5%
(1785)
39.7%
(959)
14.4%
(375)
14.9%
(204)- -
72.5%
(12)
65.7%
(33)
90.6%
(0)
90.2%
(0)
60.8%
(215)
59.9%
(102)
44.4%
(0)
41.8%
(0)
45.0%
(464)
43.5%
(216)
37.0%
(474)
36.0%
(222)
69.4%
(598)
61.8%
(509)
City Medical Gisborne Ltd ACHIEVEMENT 77 14 / 26100.0%
(0)
100.0%
(0)
90.9%
(0)
83.3%
(1)- - - -
86.6%
(0)
86.3%
(0)
97.6%
(0)
96.2%
(0)
53.0%
(182)
51.6%
(109)
15.1%
(49)
13.1%
(34)- -
75.6%
(0)
74.3%
(0)
100.0%
(0)
100.0%
(0)
70.3%
(0)
68.2%
(4)
52.1%
(0)
52.0%
(0)
54.4%
(51)
54.6%
(22)
41.8%
(78)
43.1%
(39)
73.0%
(34)
70.1%
(33)
Desmond Road Health ACHIEVEMENT 46 11 / 2680.0%
(2)
84.6%
(0)
89.5%
(1)
85.0%
(2)- - - -
77.6%
(0)
74.4%
(0)
94.6%
(0)
93.7%
(0)
25.2%
(509)
25.3%
(297)
6.6%
(145)
6.5%
(85)- -
78.4%
(0)
75.1%
(0)
96.2%
(0)
93.8%
(0)
69.5%
(3)
67.5%
(6)
45.4%
(0)
40.1%
(0)
44.1%
(132)
44.7%
(55)
14.4%
(216)
16.9%
(100)
56.8%
(521)
55.1%
(215)
The Village Clinic Ltd ACHIEVEMENT 45 12 / 2687.5%
(0)
100.0%
(0)
91.7%
(0)
100.0%
(0)- - - -
89.2%
(0)
88.6%
(0)
98.6%
(0)
97.7%
(0)
55.4%
(87)
56.3%
(43)
20.7%
(11)
18.0%
(9)- -
78.2%
(0)
81.0%
(0)
75.0%
(0)
66.7%
(0)
68.6%
(3)
60.2%
(10)
28.4%
(3)
26.2%
(4)
60.0%
(16)
57.1%
(10)
40.3%
(37)
41.4%
(17)
61.1%
(131)
66.8%
(30)
Three Rivers Medical Centre ACHIEVEMENT 27 7 / 2680.5%
(4)
81.5%
(2)
92.2%
(1)
97.1%
(0)- - - -
70.0%
(109)
66.3%
(171)
94.8%
(0)
93.8%
(0)
20.3%
(1262)
19.9%
(964)
6.0%
(345)
5.6%
(267)- -
60.7%
(63)
57.3%
(62)
81.0%
(0)
80.0%
(0)
60.9%
(111)
59.0%
(91)
34.9%
(0)
33.7%
(0)
52.8%
(180)
52.4%
(126)
25.8%
(301)
27.0%
(210)
64.5%
(492)
60.7%
(406)
Waikohu Health Centre ACHIEVEMENT 58 13 / 2687.5%
(0)
85.7%
(0)
100.0%
(0)
100.0%
(0)- - - -
74.7%
(0)
73.3%
(0)
94.0%
(0)
93.7%
(0)
53.6%
(86)
53.2%
(80)
24.3%
(2)
22.9%
(5)- -
69.4%
(0)
69.2%
(1)
100.0%
(0)
100.0%
(0)
69.4%
(1)
67.0%
(4)
33.1%
(0)
33.9%
(0)
67.6%
(3)
67.3%
(3)
44.4%
(18)
46.2%
(16)
48.6%
(119)
50.0%
(97)
GOAL
ACHIEVEMENT57 / 130 3 / 5 4 / 5 3 / 5 3 / 5 - - - - 4 / 5 4 / 5 5 / 5 5 / 5 0 / 5 0 / 5 0 / 5 0 / 5 - - 4 / 5 3 / 5 5 / 5 5 / 5 1 / 5 0 / 5 4 / 5 4 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5
ACHIEVEMENT84.0%
(6)
84.5%
(2)
91.8%
(2)
94.2%
(3)- - - -
76.4%
(109)
72.2%
(171)
95.5%
(0)
94.3%
(0)
30.5%
(2126)
29.4%
(1493)
9.6%
(552)
8.8%
(400)- -
69.6%
(63)
65.7%
(63)
88.8%
(0)
88.5%
(0)
65.5%
(118)
62.3%
(115)
39.7%
(3)
36.7%
(4)
52.2%
(382)
52.8%
(216)
27.8%
(650)
29.6%
(382)
62.8%
(1297)
60.4%
(781)
GOAL
ACHIEVEMENT57 / 130 3 / 5 4 / 5 3 / 5 3 / 5 - - - - 4 / 5 4 / 5 5 / 5 5 / 5 0 / 5 0 / 5 0 / 5 0 / 5 - - 4 / 5 3 / 5 5 / 5 5 / 5 1 / 5 0 / 5 4 / 5 4 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5
ACHIEVEMENT84.0%
(6)
84.5%
(2)
91.8%
(2)
94.2%
(3)- - - -
76.4%
(109)
72.2%
(171)
95.5%
(0)
94.3%
(0)
30.5%
(2126)
29.4%
(1493)
9.6%
(552)
8.8%
(400)- -
69.6%
(63)
65.7%
(63)
88.8%
(0)
88.5%
(0)
65.5%
(118)
62.3%
(115)
39.7%
(3)
36.7%
(4)
52.2%
(382)
52.8%
(216)
27.8%
(650)
29.6%
(382)
62.8%
(1297)
60.4%
(781)
Central Medical Centre ACHIEVEMENT 31 10 / 26100.0%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
82.3%
(0)
78.1%
(0)
83.5%
(106)
86.4%
(8)
57.7%
(36)
60.0%
(8)
16.2%
(10)
16.0%
(2)- -
73.8%
(0)
66.7%
(0)
77.8%
(0)
100.0%
(0)
67.9%
(3)
58.1%
(4)
15.7%
(23)
6.5%
(7)
52.8%
(21)
40.0%
(8)
26.3%
(35)
33.3%
(4)
65.2%
(77)
63.6%
(11)
City West Medical Centre ACHIEVEMENT 135 24 / 26100.0%
(0)
100.0%
(0)
100.0%
(0)
0.0%
(0)- - - -
88.3%
(0)
83.3%
(0)
99.8%
(0)
100.0%
(0)
95.7%
(0)
100.0%
(0)
70.0%
(0)
90.0%
(0)- -
87.7%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)
75.7%
(0)
72.2%
(0)
41.7%
(0)
55.6%
(0)
81.1%
(0)
90.9%
(0)
34.9%
(37)
63.6%
(1)
87.2%
(0)
87.1%
(0)
Devon Medical Centre ACHIEVEMENT 138 24 / 2696.2%
(0)
100.0%
(0)
95.5%
(0)
100.0%
(0)- - - -
91.4%
(0)
91.2%
(0)
92.8%
(0)
92.2%
(0)
91.8%
(0)
95.3%
(0)
46.2%
(0)
51.8%
(0)- -
87.9%
(0)
82.5%
(0)
89.3%
(0)
100.0%
(0)
71.5%
(0)
76.2%
(0)
32.3%
(0)
38.6%
(0)
74.3%
(0)
76.7%
(0)
39.9%
(97)
50.9%
(11)
76.7%
(0)
85.5%
(0)
Family Health Centre ACHIEVEMENT 93 14 / 2666.7%
(1)
0.0%
(1)
100.0%
(0)
0.0%
(0)- - - -
81.9%
(0)
80.8%
(0)
99.2%
(0)
98.4%
(0)
73.0%
(37)
82.5%
(4)
20.0%
(11)
22.8%
(1)- -
87.4%
(0)
85.3%
(0)
90.0%
(0)
100.0%
(0)
65.5%
(14)
60.6%
(7)
38.1%
(0)
39.4%
(0)
46.6%
(54)
44.4%
(14)
32.6%
(71)
50.0%
(7)
87.1%
(0)
89.2%
(0)
Inglewood Medical Centre - Dr
FinniganACHIEVEMENT 21 9 / 26
88.9%
(0)
100.0%
(0)
66.7%
(1)
0.0%
(0)- - - -
79.6%
(0)
72.5%
(0)
93.6%
(0)
92.8%
(0)
13.7%
(162)
17.0%
(34)
4.2%
(44)
4.3%
(10)- -
65.6%
(4)
52.9%
(3)
50.0%
(1)
0.0%
(1)
54.0%
(18)
45.0%
(5)
68.1%
(0)
65.0%
(0)
46.0%
(24)
26.3%
(8)
36.7%
(30)
41.2%
(5)
41.7%
(245)
35.9%
(40)
Inglewood Medical Centre - Dr
JonesACHIEVEMENT 29 13 / 26
100.0%
(0)
0.0%
(0)
100.0%
(0)
0.0%
(0)- - - -
80.5%
(0)
80.5%
(0)
92.2%
(0)
91.6%
(0)
72.2%
(26)
71.9%
(6)
16.0%
(13)
15.6%
(3)- -
81.9%
(0)
75.0%
(0)
60.0%
(1)
0.0%
(0)
58.9%
(14)
27.3%
(5)
54.3%
(0)
81.8%
(0)
45.9%
(26)
40.0%
(3)
24.1%
(53)
25.0%
(4)
48.5%
(178)
53.6%
(15)
Parklands Medical Centre ACHIEVEMENT 41 14 / 2694.7%
(0)
91.7%
(0)
100.0%
(0)
100.0%
(0)- - - -
91.6%
(0)
91.5%
(0)
93.3%
(0)
93.2%
(0)
31.9%
(226)
32.4%
(119)
7.7%
(67)
8.7%
(34)- -
77.6%
(0)
77.0%
(0)
66.7%
(0)
77.8%
(0)
52.5%
(63)
52.1%
(25)
51.7%
(0)
44.3%
(0)
52.7%
(52)
44.4%
(32)
31.3%
(104)
36.8%
(29)
69.1%
(74)
63.8%
(54)
Patea & District Community
Medical TrustACHIEVEMENT 109 13 / 26
66.7%
(3)
42.9%
(3)
83.3%
(1)
100.0%
(0)- - - -
64.6%
(59)
59.8%
(52)
91.8%
(0)
92.0%
(0)
59.2%
(95)
59.3%
(64)
12.0%
(40)
12.4%
(26)- -
81.2%
(0)
79.1%
(0)
96.4%
(0)
95.7%
(0)
80.8%
(0)
82.6%
(0)
34.6%
(0)
30.3%
(0)
75.6%
(0)
72.6%
(0)
55.5%
(28)
56.7%
(18)
73.4%
(14)
73.6%
(8)
Powderham Medical Centre ACHIEVEMENT 45 12 / 2687.5%
(0)
66.7%
(1)
100.0%
(0)
0.0%
(0)- - - -
74.1%
(0)
72.5%
(0)
84.1%
(96)
82.6%
(26)
36.5%
(73)
28.0%
(31)
8.0%
(23)
4.0%
(11)- -
82.8%
(0)
81.8%
(0)
92.3%
(0)
80.0%
(0)
73.6%
(0)
64.7%
(2)
56.2%
(0)
61.8%
(0)
62.4%
(8)
65.5%
(1)
36.9%
(40)
27.3%
(14)
67.4%
(52)
62.1%
(19)
Regan Street Medical Centre ACHIEVEMENT 45 9 / 2644.4%
(4)
0.0%
(3)
50.0%
(1)
0.0%
(0)- - - -
95.4%
(0)
96.8%
(0)
80.9%
(96)
76.5%
(34)
76.2%
(26)
71.9%
(10)
25.4%
(0)
22.8%
(1)- -
64.2%
(6)
52.0%
(5)
60.0%
(1)
100.0%
(0)
93.5%
(0)
88.0%
(0)
32.7%
(0)
32.0%
(0)
51.0%
(19)
26.1%
(10)
29.4%
(44)
20.0%
(13)
70.8%
(17)
60.5%
(12)
SouthCare ACHIEVEMENT 55 11 / 2697.0%
(0)
100.0%
(0)
93.0%
(0)
92.3%
(0)- - - -
70.2%
(62)
62.5%
(57)
84.1%
(452)
85.2%
(78)
36.4%
(421)
33.9%
(132)
12.0%
(102)
11.0%
(33)- -
77.5%
(0)
75.0%
(0)
93.1%
(0)
100.0%
(0)
70.2%
(0)
74.6%
(0)
32.9%
(0)
26.1%
(5)
65.4%
(19)
66.7%
(4)
38.2%
(186)
37.2%
(54)
38.2%
(1058)
35.8%
(259)
Te Aroha Medcare Ltd ACHIEVEMENT 72 16 / 2693.3%
(0)
100.0%
(0)
91.7%
(0)
100.0%
(0)- - - -
92.8%
(0)
92.5%
(0)
89.8%
(2)
89.4%
(6)
63.4%
(94)
64.9%
(62)
14.5%
(37)
16.1%
(22)- -
73.2%
(0)
72.8%
(0)
72.7%
(0)
80.0%
(0)
81.5%
(0)
82.2%
(0)
48.8%
(0)
50.8%
(0)
74.1%
(0)
73.4%
(0)
43.7%
(37)
42.1%
(32)
64.0%
(56)
63.6%
(41)
Tukapa Medical Centre ACHIEVEMENT 41 9 / 260.0%
(1)
0.0%
(1)
66.7%
(1)
0.0%
(0)- - - -
76.7%
(0)
78.0%
(0)
89.6%
(5)
89.5%
(1)
51.5%
(38)
55.9%
(12)
16.2%
(9)
20.6%
(2)- -
76.9%
(0)
66.7%
(1)
66.7%
(0)
100.0%
(0)
63.6%
(7)
76.5%
(0)
30.9%
(0)
35.3%
(0)
26.3%
(42)
33.3%
(6)
38.5%
(41)
37.5%
(8)
60.9%
(75)
52.0%
(23)
Vogeltown Medical Centre ACHIEVEMENT 49 13 / 2682.4%
(0)
100.0%
(0)
86.4%
(1)
100.0%
(0)- - - -
87.1%
(0)
90.4%
(0)
94.8%
(0)
98.5%
(0)
74.4%
(21)
66.7%
(6)
18.0%
(9)
0.0%
(6)- -
82.2%
(0)
69.2%
(0)
87.5%
(0)
100.0%
(0)
69.1%
(1)
61.5%
(1)
49.1%
(0)
46.2%
(0)
45.4%
(24)
25.0%
(5)
31.4%
(46)
38.5%
(4)
47.7%
(164)
51.2%
(21)
GOAL
ACHIEVEMENT
191 /
36410 / 14 9 / 14 9 / 14 14 / 14 - - - - 12 / 14 12 / 14 8 / 14 8 / 14 2 / 14 2 / 14 3 / 14 2 / 14 - - 12 / 14 11 / 14 11 / 14 13 / 14 7 / 14 7 / 14 13 / 14 12 / 14 4 / 14 4 / 14 0 / 14 0 / 14 3 / 14 3 / 14
ACHIEVEMENT87.9%
(9)
78.8%
(9)
92.4%
(5)
97.8%
(0)- - - -
81.4%
(121)
78.6%
(109)
90.3%
(757)
90.1%
(153)
53.9%
(1255)
53.4%
(488)
17.2%
(365)
15.8%
(151)- -
79.5%
(10)
75.6%
(9)
86.4%
(3)
92.2%
(1)
69.0%
(120)
70.8%
(49)
39.7%
(23)
38.7%
(12)
59.9%
(289)
60.1%
(91)
36.9%
(849)
42.4%
(204)
61.7%
(2010)
61.6%
(503)
Avon Medical Centre ACHIEVEMENT 56 14 / 2688.0%
(0)
92.9%
(0)
92.3%
(0)
100.0%
(0)- - - -
74.0%
(0)
70.6%
(5)
97.2%
(0)
96.6%
(0)
53.7%
(140)
47.9%
(50)
8.0%
(66)
6.7%
(22)- -
0.0%
(0)
0.0%
(0)
88.2%
(0)
83.3%
(0)
68.4%
(4)
72.7%
(0)
34.6%
(0)
34.8%
(0)
51.4%
(35)
58.2%
(7)
40.2%
(55)
32.7%
(18)
71.6%
(34)
72.1%
(6)
Bellomo Family Health ACHIEVEMENT 49 14 / 2692.9%
(0)
100.0%
(0)
87.5%
(0)
100.0%
(0)- - - -
85.8%
(0)
82.8%
(0)
99.8%
(0)
100.0%
(0)
79.8%
(13)
91.7%
(0)
22.5%
(3)
27.1%
(0)- -
68.6%
(1)
55.0%
(3)
100.0%
(0)
100.0%
(0)
66.7%
(4)
58.3%
(3)
38.7%
(0)
50.0%
(0)
48.4%
(20)
59.1%
(2)
48.8%
(18)
50.0%
(4)
68.7%
(27)
65.9%
(8)
Carefirst Medical Centre ACHIEVEMENT 116 19 / 2693.5%
(0)
100.0%
(0)
93.3%
(0)
91.7%
(0)- - - -
87.5%
(0)
86.1%
(0)
96.0%
(0)
95.1%
(0)
79.7%
(80)
78.8%
(26)
46.9%
(0)
43.6%
(0)- -
82.2%
(0)
80.0%
(0)
85.0%
(0)
78.6%
(0)
67.8%
(16)
69.0%
(2)
52.0%
(0)
45.5%
(0)
70.3%
(0)
67.8%
(3)
49.7%
(119)
53.0%
(20)
79.6%
(0)
80.6%
(0)
Dr Marie Fonseka ACHIEVEMENT 35 13 / 26100.0%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
75.6%
(0)
73.5%
(0)
91.1%
(0)
89.3%
(1)
22.6%
(78)
18.5%
(19)
8.7%
(19)
11.1%
(4)- -
82.6%
(0)
100.0%
(0)
0.0%
(0)
0.0%
(0)
61.6%
(7)
60.0%
(2)
64.0%
(0)
53.3%
(0)
56.9%
(9)
41.7%
(3)
2.9%
(46)
8.3%
(7)
62.5%
(66)
71.2%
(3)
Dr R G Radich ACHIEVEMENT 43 11 / 26100.0%
(0)
0.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
83.2%
(0)
80.9%
(0)
97.1%
(0)
96.8%
(0)
67.6%
(40)
63.0%
(12)
6.1%
(34)
4.3%
(10)- -
67.3%
(3)
59.1%
(2)
100.0%
(0)
100.0%
(0)
58.1%
(20)
51.6%
(6)
24.6%
(9)
12.9%
(5)
42.3%
(41)
37.0%
(9)
34.6%
(37)
36.4%
(7)
77.6%
(0)
71.6%
(4)
Eastside Medical Centre ACHIEVEMENT 134 20 / 2688.2%
(0)
100.0%
(0)
100.0%
(0)
0.0%
(0)- - - -
77.9%
(0)
77.2%
(0)
96.3%
(0)
94.8%
(0)
78.7%
(29)
89.7%
(0)
28.7%
(0)
31.0%
(0)- -
82.4%
(0)
69.0%
(0)
80.0%
(0)
85.7%
(0)
61.9%
(25)
62.3%
(5)
45.5%
(0)
42.0%
(0)
53.4%
(44)
47.6%
(14)
68.9%
(2)
81.0%
(0)
86.6%
(0)
80.0%
(0)
Eltham Health Centre ACHIEVEMENT 64 15 / 26100.0%
(0)
100.0%
(0)
83.3%
(1)
100.0%
(0)- - - -
67.8%
(30)
62.6%
(11)
95.1%
(0)
93.7%
(0)
81.3%
(21)
80.3%
(7)
80.0%
(0)
78.9%
(0)- -
86.7%
(0)
76.5%
(0)
100.0%
(0)
100.0%
(0)
82.4%
(0)
76.5%
(0)
95.9%
(0)
70.6%
(0)
68.9%
(2)
57.6%
(4)
28.3%
(72)
20.6%
(17)
64.8%
(81)
60.8%
(21)
Medicross Taranaki Ltd ACHIEVEMENT 51 14 / 2666.7%
(1)
100.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
75.8%
(0)
74.5%
(0)
93.2%
(0)
94.2%
(0)
32.0%
(131)
33.9%
(35)
10.2%
(33)
11.3%
(9)- -
77.3%
(0)
81.8%
(0)
87.5%
(0)
100.0%
(0)
70.7%
(0)
66.7%
(1)
39.0%
(0)
38.1%
(0)
47.8%
(15)
41.2%
(5)
37.3%
(25)
36.4%
(4)
55.5%
(92)
52.8%
(28)
Moturoa Medical Centre ACHIEVEMENT 105 14 / 2680.0%
(1)
100.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
79.7%
(0)
73.6%
(0)
94.3%
(0)
94.6%
(0)
59.0%
(85)
59.4%
(32)
19.4%
(15)
23.6%
(2)- -
86.0%
(0)
78.0%
(0)
87.5%
(0)
100.0%
(0)
73.5%
(0)
60.8%
(7)
44.2%
(0)
41.9%
(0)
56.1%
(29)
44.3%
(16)
44.2%
(56)
42.0%
(14)
73.4%
(18)
73.7%
(3)
Oakura Medical Centre ACHIEVEMENT 43 14 / 2660.0%
(3)
0.0%
(0)
92.3%
(0)
100.0%
(0)- - - -
81.4%
(0)
79.2%
(0)
99.8%
(0)
100.0%
(0)
45.3%
(57)
45.8%
(11)
18.0%
(9)
25.0%
(0)- -
81.8%
(0)
75.0%
(0)
100.0%
(0)
100.0%
(0)
60.7%
(14)
61.5%
(1)
42.8%
(0)
38.5%
(0)
46.9%
(30)
41.7%
(3)
33.8%
(28)
25.0%
(4)
58.6%
(102)
36.1%
(24)
Opunake Medical Centre ACHIEVEMENT 50 16 / 26100.0%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
79.6%
(0)
78.7%
(0)
99.7%
(0)
99.5%
(0)
76.5%
(33)
87.3%
(4)
43.3%
(0)
47.3%
(0)- -
75.6%
(0)
78.5%
(0)
95.0%
(0)
93.8%
(0)
62.9%
(16)
60.6%
(12)
47.6%
(0)
46.5%
(0)
46.4%
(49)
43.9%
(30)
31.9%
(61)
32.3%
(35)
68.4%
(57)
70.9%
(17)
Phoenix Urgent Doctors ACHIEVEMENT 34 14 / 260.0%
(1)
0.0%
(0)
100.0%
(0)
100.0%
(0)- - - -
72.6%
(0)
71.8%
(0)
95.5%
(0)
95.8%
(0)
58.9%
(28)
66.7%
(7)
31.1%
(0)
33.3%
(0)- -
82.8%
(0)
50.0%
(2)
100.0%
(0)
0.0%
(0)
61.3%
(5)
64.3%
(1)
53.2%
(0)
42.9%
(0)
46.7%
(14)
28.6%
(6)
40.6%
(19)
62.5%
(1)
66.2%
(24)
65.3%
(7)
Puriri Clinic ACHIEVEMENT 16 8 / 16100.0%
(0)
100.0%
(0)
100.0%
(0)
0.0%
(0)- - - -
90.3%
(0)
94.3%
(0)
97.6%
(0)
96.3%
(0)
20.5%
(58)
30.8%
(8)
6.0%
(16)
7.7%
(2)- - - - - - - - - - - -
40.9%
(26)
50.0%
(2)
57.0%
(108)
57.6%
(10)
Regan Street Health Centre ACHIEVEMENT 84 16 / 26100.0%
(0)
100.0%
(0)
87.5%
(0)
100.0%
(0)- - - -
65.1%
(29)
69.8%
(2)
99.5%
(0)
98.2%
(0)
87.0%
(3)
87.5%
(1)
84.8%
(0)
87.5%
(0)- -
74.5%
(0)
63.2%
(1)
100.0%
(0)
0.0%
(0)
67.3%
(3)
64.0%
(2)
56.1%
(0)
44.0%
(0)
69.8%
(0)
57.1%
(2)
52.9%
(17)
52.6%
(3)
86.4%
(0)
89.2%
(0)
Strandon Health ACHIEVEMENT 95 17 / 2683.3%
(0)
66.7%
(1)
0.0%
(2)
0.0%
(0)- - - -
80.7%
(0)
87.4%
(0)
99.8%
(0)
100.0%
(0)
61.7%
(30)
67.4%
(10)
29.9%
(0)
32.6%
(0)- -
85.0%
(0)
61.1%
(2)
100.0%
(0)
100.0%
(0)
67.8%
(2)
67.6%
(1)
50.6%
(0)
44.1%
(0)
79.7%
(0)
84.0%
(0)
50.0%
(12)
50.0%
(4)
85.6%
(0)
86.3%
(0)
Ta
ra
na
ki
Ba
rb P
urd
ie
PL TOTALS
We
nd
y M
arsh
all
La
ke
s
Jo
an
ne
Min
toft
PL TOTALS
SERVICE DELIVERY TOTALS
Ta
ira
wh
iti
Tia
Mo
ek
e
PL TOTALS
SERVICE DELIVERY TOTALS
GOAL DISTRIBUTION MAP - Q2 SUMMARY GOAL
S.D PL PRACTICEPOINTS
AWARDED
GOALS
ACHIEVED
Let the data sing – Present a Plan
Locality & System Planning
Population
NGO services
Primary Care
Hospital services
Facilities
Future configuration
Locality Planning
MHN – New
Zealand
Locality – Planning Configuration
Helping Practices to understand future
New models of care
• New way of working required to meet new
demands and capacity requirements
• New facilities to support new models of care
• Integrated information systems
• New contracting arrangements to support new
models
• Retraining the workforce
• Resetting the commercial/business model
500,000 lives
5 million + encounters
Hundreds of settings
Life long relationships
60 years of unlearning
A new contracting enabler
• A shift away from traditional funder/provider roles
• Taking experiences from commercial application of risk
sharing contracting arrangements in construction and oil
sectors
• Evidence points to better performance of alliance
governed contracts vs. traditional approaches
• Process and patient focused vs. transactional
• Driven by front line clinicians
• Clinical commissioning in another language
The Alliance Agreement
• A nationally determined agreement that is a relationship and
decision making agreement rather than a service delivery
agreement.
• The agreement establishes a structure to enable clinicians, alongside managers and others, to make decisions about how
to apply resources to specific services to achieve the best
outcomes. Commissioning & decommissioning
• Decisions involve less specification and an emphasis on quality processes and transparency of information to assure
accountability and best value for money.
• The scope of the agreement has been broadly developed
collectively around agreed key health areas.
• It places the risk and rewards of success on all parties.
Alliance in action
• The Alliance Leadership Team is the body for managing
change, not for managing business as usual.
• Supported by
– The Alliance Agreement
– The Alliance Charter
– Underlying agreement with Government
• Each party to the Alliance retains their role and own
goverance.
• Resources around agreed areas are pooled by
agreement to support Alliance recommendations
• Requires strong senior clinical and management leadership and committment
Alliance contracting
Alliance
MHN
GP Network
GP
Other providers (pharmacy, Allied etc)
DHB
Hospital
The road so far
• Long term conditions management – The LTCM is a suite of resources and support designed to
enable the general practice team to proactively provide
targeted care to patients diagnosed with a LTC
• Getting resources upfront – Traditional post hospitalization resources being shifted to
preventative roles
• Medical Home – Primary care taking broader responsibility for coordinating
care
Co-designed – co-funded
Key components
• Planned care: comprehensive assessment and a planned
approach with a longer term view towards staying well in
the presence of an incurable disease (rather than acute
care for an episode of ill health)
• Patient led care with the health care team as the patients
agent
• Co-ordinated complete care for people with complex needs
• Commissioning resources to those in greater need
• Wider scope of services being available in the patients' Health Care Home (primary care)
• Integrated services that are "seamless" from the patient's
point of view.
Elements and enablers
The effect to date
• Haven't had time to measure full impact
• Noted increase in clinical leadership
• Appears to be a reduction in acute ED
presentations – 11- 7%
• Patient satisfaction higher
• Workforce satisfaction higher
• Improvement in related quality program
performance
National performance data
Healthy Communities
Fit for purpose General Practice
Models of Care
MDTs
Integration
Right sizing Hospitals
Sustainability
Hospital performance
BSMC Services MDT
performance Proactive care
General Practice performance
Self care
Whole of system thinking
& commissioning
The risk of
doing
nothing….
The
challenge of
change…