Compass Health
Annual Report and Quality Accounts 2014

Annual Report

for the year ended 30 June 2014

Facts and Figures

Compass Health and our associated network at a glance for the year ended 30 June 2014

60

General Practice teams supported within the Capital and Coast + Wairarapa districts

289,487

enrolled patients within the Capital and Coast + Wairarapa districts

1,431,918

total General Practice consultations

122

permanent fulltime/part time + fixed term Compass Health staff

44

Compass Health casual staff

95%

of 8-month-olds fully immunised in the Wairarapa District

350

clinical practice development sessions

25,000

funded radiology interventions

6,000

retinal screens

25,000

free sexual and reproductive health consults

1,500

podiatry visits

8,700

funded visits for 2,100 people requiring mental health interventions

16,000

enrolled patients in care plus + guided care to manage their Long Term Conditions

1,600

outreach nurse referrals + consults

1,300

Pacific navigation referrals

General Practice Providers and Patient Ethnicity

An overview of our enrolled population as at 30 June 2014 - click on the markers below to view each Practice's population

Total Population by Ethnicity

24,820

Asian Patients

207,911

European Patients

29,065

Māori Patients

12,610

Other Patients

13,961

Pacific Patients

1,120

Unknown Patients

289,487

Total Enrolled Patients

Capital Locality High Needs Population

Porirua Locality High Needs Population

Kapiti Locality High Needs Population

Wairarapa Locality High Needs Population

Data Source: Compass Health Reporting Services.

A message from the Chair

Dr Richard Tyler reflects on the past 12 months

Dr Richard Tyler

Compass Health Board Chair Dr Richard Tyler

During 2013/14 year our broad strategies have been supporting the integration between primary and secondary care, empowering patients, continuous quality improvement, making Compass a great place to work, improving Pacific outcomes and implementing our Māori strategy Ka Pō, Ka Ao, Ka Awatea.

A lot of effort has gone into our relationship with the DHB and the roll out of the Integrated Care Collaboratives (ICC). Many people in primary care and within the hospital have put a lot of time and effort into this. Relationships have developed well and the first tangible fruits were the roll out of the Cellulitis & DVT packages of care. The DHB purchasing of the Canterbury pathways boosted the clinical pathway development and these are being collaboratively worked through and customised for Capital & Coast needs. We are also working closely with our Hutt Colleagues at Te Awakairangi Health network on cross DHB initiatives.

Following the successful launch of the Shared Care Record in the Wairarapa this has now been rolled out in Capital and Coast and is being used in the hospital and at After Hours. The record is regularly viewed by Emergency Department doctors and nurses and is also used by Outpatient Clinics to check they have the correct information on patients. It is also used by CCDHB pharmacists to assist with medicine reconciliation for inpatients.

Also, we are working with willing Practices to enable patient’s access to parts of their Medical Records.

As part of the continuous quality improvement a number of practices have taken part in the patient satisfaction surveys where they can benchmark themselves against other practices.

Within Compass we have introduced Kaizen improvement training which has been well embraced by the staff and is continuing.

Our Pacific outcomes target has focused on the Pacific Navigation Service which has had an independent evaluation which found that the service was well regarded by the Pacific community. The end of year data found that the Ambulatory Sensitive Hospital admissions for Pacific children aged 0-14 reduced by 12% in the year to June 2014 while the rates for Māori and other ethnicities increased. Admissions for cellulitis dropped from 40 to 25 per year.

Ka Pō, Ka Ao, Ka Awatea is a comprehensive program to improve Māori health. Over the past year the team have focused on developing cultural resources for practices to use – particularly when seeking Cornerstone accreditation. The resources are being trialled in practices now.

This will be my last report as Chair as I am not seeking a further term.

I would like to thank all those Board members who have supported me and contributed to the Compass achievements. I would like to especially thank the wonderful and dedicated staff at Compass who worked so hard for many years and contributed to making Compass Health what it is today.

It has been a pleasure to have been Chair of the organisations in their various forms over a number of years. I am pleased to be leaving the organisation in very good shape and well prepared for even more challenges ahead.

Dr Richard Tyler

Richard Tyler
Compass Health Board Chair

Governance: Compass Health Board

Our Board members and associated sub-committees

Compass Health Board members

Back row: (L-R) Dr Lynn McBain, Simon Watt, Gordon Strachan, Dr Don Simmers, Mano’o Mulitalo, Dale Coles,
Front row: Melissa Simpson, Dr Richard Tyler - Chair, Dr Larry Jordan - Deputy Chair, Elaine Brazendale, Trevor Taylor.

Dr Richard Tyler - Chair

Richard is a Wellington based GP. He has a long history of involvement in organisations supporting GPs and general practice. Richard has expertise in the management and governance of primary health and primary health care organisations.

Dr Larry Jordan - Deputy Chair

Larry has lived and practised as a family GP in Porirua for 30 years. For much of this time he has been involved in the development and governance of primary care services including After Hours medical services. Larry chaired the Tumai mo te Iwi PHO.

Dale Coles

Dale has a degree in Tupunga Hapu from Te Wananga-o-Raukawa. She also has a Masters Degree in Education from Massey University and a background in policy. Dale enjoys applying her knowledge of policy as a problem-solving process when making decisions in her Board work.

Dr Don Simmers

Don has been a Partner GP Newtown Medical Centre for the last six years. Prior to that he was a Partner GP in Queenstown Medical Centre for 20 years. His current interests include meeting the challenge of the increased expectations being placed on primary care.

Elaine Brazendale

Elaine has a variety of roles that give her opportunities to engage with many different people and aspects in the community. Amongst her roles she is currently serving her sixth term as an elected Councillor, now Deputy Mayor for Carterton. Her skills have come from life experiences of growing up in a seven day a week grocery dairy business, working as a bank clerk and dairy farm partner, fostering children for 20 years and long term involvement in many community organisations.

Gordon Strachan

Gordon has many years’ experience as a Chairman, Director and Manager in the commercial sector and has had a continuing interest in health and community activities over many years, being recognised for this in the 1998 New Year Honours with a QSO.

Dr Lynn McBain

Lynn is a GP practising in suburban Wellington for over 24 years and Senior Lecturer in General Practice and Primary Health Care at the University of Otago Wellington. Her role at the medical school involves undergraduate medical student teaching and primary care research. She has extensive experience in clinical governance.

Mano’o Mulitalo

Mano’o has over 30 years of senior management experience in governance and management with national and international organisations including the United Nations Economics Commission for Africa; Local and National Government as an MP and Cabinet Minster; Training institutions; the Business sector; and non-Government organisations sector. Mano’o has been involved in governance and management of primary health care for over 15 years.

Melissa Simpson

Melissa is the Clinical Manager at the Island Bay Medical Centre, with 20 years' experience in primary health care nursing and a Post Graduate Certificate Primary Health Care. Melissa has a supportive teaching role with Otago School of Medicine.

Simon Watt

Simon lives in the Wairarapa and works in Wellington at the commercial law firm Bell Gully, where he has been a partner since 2000. Simon heads Bell Gully’s Government, Health and Climate Change practice groups. Much of his work involves public sector contracting and procurement, including in the areas of ultra-fast broadband, ICT projects and public private partnerships. He also advises Crown entity Boards on public sector governance. During 1997 and 1998 Simon was seconded as Legal Counsel to PHARMAC. He continues to advise PHARMAC as well as DHBNZ and DHBs on their collective procurement activities, individual DHBs and Health Benefits Limited.

Trevor Taylor

Trevor lives in Mahina Bay, and is currently the Chief Executive Officer for Outward Bound Trust of New Zealand a position he has held since December 2001. Prior to Outward Bound Trevor spent 20 years in senior line management position in the energy sector. Trevor is a Member of the Institute of Directors in New Zealand and a Member of New Zealand College of Chartered Accountants (CA). Trevor has held a number of governance positions in the private and public sectors and is currently Chair of the Wellington Free Ambulance Trust, Deputy Chair of Life Flight Trust and a Board Member of Outward Bound International, Surf Life Saving New Zealand and the New Zealand Olympic Committee.

Governance: Compass Health Sub-Committees

Finance and Audit Committee

The Finance and Audit Committee provides Compass Health with an independent interface with the external auditors and an advisory committee to the CEO and the General Manager - Finance; and assists the Compass Health Board in discharging its corporate governance duties to meet the statutory requirements of Directors and Trustees as outlined in the Companies Act (1993), the Financial Reporting Act (1993) and other relevant legislation.

Māori Health Committee

The Māori Health Committee is an advisory committee of the Compass Health Board. The purpose of the Committee is to ensure that Compass Health commits to Iwi, Hapu, and Māori primary health services by providing direction, advice and leadership in response to Māori primary health care at a governance level.

Pacific Health Committee

The Pacific Health Committee is an advisory committee of the Compass Health Board. The purpose of the Committee is to provide advice and recommendations to Compass Health on Pacific health issues; to provide feedback and reports on performance and service delivery effectiveness for the Pacific Community; and to communicate Compass Health's health programs and other relevant information impacting Pacific people to the Pacific Community.

Clinical Quality Board

The purpose of the Clinical Quality Board is to monitor quality in primary health care within Compass Health; provide clinical leadership and oversight to the Compass Health committees and advisory groups; report clinical quality activity and risk to the Compass Health Board; and to act as the conduit of Clinical Quality information between relevant DHB Quality Boards.

Clinical Information Reference Group

The Clinical Information Reference Group has been established as an Information and Communication Technology (ICT) ideas and information sharing group, which is able to make recommendations to Compasss Health ICT and senior management for discussion. The group is able to provide leverage for system change by providing a collective voice.

GP Strategy Group

The General Practice Strategy Group has been established to develop and guide implementation of a short, medium and long term strategy to ensure continuity of care for patients within its geographical region. This strategy promotes models which address clinical excellence and business sustainability issues and may include Compass Health taking an equity stake in General Practice businesses.

Nurses Committee

The Nurses Committee supports the development of Primary Health Care Nursing models and the delivery of nursing services to the highest possible standards; provides a framework for the workforce to be supported; and assists in the development of nursing leadership in primary care.

Radiology Oversight Committee

The purpose of the Radiology Oversight Committee is to act as the Clinical Governance Group of the Community Referred Radiology Scheme. The functions of the Committee include providing oversight to the community radiology services for the greater Wellington region; monitoring and reporting findings on radiology service demand in greater Wellington; suggest and/or make recommendations for changes to the Clinical Guidelines for funding in line with best practice in the context of the programme; audit and report GP use of the Radiology Referral Guidelines as endorsed by the committee; identify, document, and monitor clinical risk and ensure appropriate mitigation strategies are implemented; monitor the income and expenditure under the contract by reviewing full financial reports on a quarterly basis; and ensure that the services are delivered according to the DHB Service Specification.

Mental Health Advisory Group

The purpose of the Mental Health Advisory Committee is to provide leadership and to advocate for primary mental health service delivery; and support, promote and monitor service quality and the development of primary mental health within Compass Health and within the PHO supported by Compass Health management services.

Practice and Provider Management Committee

This committee supports the pursuit of excellence in the practice management, function of practise and supports the development of the Primary Health Care management workforce in the Greater Wellington Region. Management services include those services delivered from general practice/provider sites, as well as other relevant primary care services.

Our Mission, Vision and Values

What we as an organisation and individuals value

Our Mission:

Working together, towards healthy and flourishing communities

Our Vision:

Navigation: Improving the quality, safety and experience of care for our patients

Empowerment: Strengthening general practice capacity and capability

Success: Gaining the best outcomes from the resources available

Wellbeing: Improving the health and equity of our enrolled population

Our Values:

Trust: Maintaining open and honest relationships

Respect: Embracing diversity, uniqueness and ideas

Unity: Valuing strengths and skills

Accountability: Working in a transparent and responsible manner

Courage: Participating with confidence and enjoyment

Annual Plan

Annual objectives and improvement strategies

Compass Health is a primary care network and not-for-profit social enterprise providing quality primary health care services to an enrolled population of 289,487 people across the Wellington, Porirua, Kapiti and Wairarapa areas. We employ 122 people and contract with 60 member practices. We also provide corporate services to Central PHO and a number of general practices.

Every year Compass Health and its associated network:

Provide approximately 1,467,000 consults

Administer approximately 190,000 immunisations

Deliver 350 clinical practice development sessions to 4,000 participants (1,500 individuals)

Provided over 7,000 specialist sexual health visits to approximately 2,600 unique patients

Fund nearly 25,000 radiology interventions

Provide 6,000 retinal screens

Provide over 25,000 free sexual and reproductive health consults

Deliver 1,500 podiatry visits

Arrange 8,700 funded visits for 2,100 people requiring mental health interventions

Enrol 16,000 people in care plus/guided care to manage their Long Term Conditions

Provide 1,600 outreach nurse referrals/consults

Respond to 1,300 Pacific navigation referrals.

Data Source: Compass Health Reporting Services.

Annual objectives and improvement strategies

Strategic Aims Five Year Goals Annual Plan Strategies Improvement Projects Targets /
Indicators

N

avigation:

improve the quality, safety and experience of care for patients
  • 95% of population have shared care record
  • 90% positive patient rating
  • Support health service integration
  • Strengthen patient and community voice
  • Support Pharmacy integration
  • Implement E-Shared Care Record
  • Support ICC workstreams
  • Tihei Wairarapa year 4-6 plan
  • Porirua Social Sector Trial
  • Establish community council
  • Nested patient satisfaction survey
  • Integrated sexual health services
  • Number of Electronic Shared Care Record views
  • Number of pathways available digitally
  • Tihei goal achievement
  • Patient satisfaction rates

S

uccess:

gaining the best outcomes from the resources available
  • Annual management revenue > $1m
  • 90% positive staff rating
  • Environmental sustainablity certification
  • A high performing organisation
  • Shared corporate services
  • ISSP phase 1 implementation
  • Staff climate survey
  • Improvement training
  • E-GP Comms & CPD service
  • Implement sustainability plan year one
  • Radiology - clinical utilisation review
  • Net corp costs < X% of revenue
  • % staff with APR
  • Staff climate index
  • Sick leave days / FTE
  • Actual P&L > Budget
  • Power, paper & fuel consumption reduction
  • Staff turnover

E

mpowerment:

strengthening general practice capacity & capability
  • 100% of practices accredited
  • 90% positive rating of Compass by GP staff
  • Implement GP strategy
  • GP Ownership & management services
  • Support GP accreditation
  • GP interest register & satisfaction survey
  • Patient access centre
  • Ownership ROI
  • % practices cornerstone accredited
  • GP satisfaction index

W

ellbeing:

improving the health and equity of our enrolled population
  • In top quintile for all PPP indicators
  • Māori & Pacific PPP performance > mainstream
  • Zero acute hospital growth
  • Achieve PPP targets
  • Improve Pacific outcomes
  • Implement Ka Pō, Ka Ao, Ka Awatea
  • Implement LTC/DCIP programme
  • CVDRA & Smoking Campaign
  • Deliver Whānau Ora Plan
  • Pacific Navigation evaluation
  • ACC Project
  • ACP Project
  • % practices with practice plan
  • Diabetes % hba1c < 64
  • Reduce ASH rates
  • Health target & PPP achievement rates
  • Māori/Pacific PPP, ASH, & DNA rates
  • % use of ACC e-form
  • Number of patients with an ACP

Summary of Achievements

How we ranked against our objectives

N

avigation: improve the quality, safety and experience of care for patients

In 2013/14 we focused on integration and patient and community voice, and we:

  • Achieved an 87% satisfaction rating for services provide by Compass to patients
  • Expanded access to the electronic shared care record by making it available to CCDHB hospitals for the first time, and expanding access in the Wairarapa to pharmacists. Over 80% of our population have the safety of an electronic shared care record to help reduce treatment errors
  • Supported the rollout of consistent clinical pathways to improve decision making and make the interface between primary and secondary care smoother
  • Developed New Zealand's first health oriented Social Sector Trial – integrating health and social care to reduce use of unplanned acute services by Porirua residents
  • Worked with CCDHB to get our sexual health services clinical staff access to CCDHB hospital information and resources, so that they can better treat patients
  • Established a Community Council chaired by Kerry Prendergast to give our communities a stronger voice and connection to Compass Health.

S

uccess: gaining the best outcomes from the resources available

Our goals here included staff engagement, environmental sustainability and financial management. We:

  • Finished the year slightly ahead of budget with a break even financial result
  • Reduced paper consumption from over 60,000 sheets per month to under 30,000
  • Ensured 65% of staff had an up-to-date performance review; fewer than planned, but better than previous years
  • Kept fuel consumption to 20 litres per FTE per month
  • Measured staff satisfaction with our first staff survey; 75% were satisfied overall with their job – lower than we would like.

E

mpowerment: strengthening general practice capacity & capability

General practice development is aimed at improving GP quality and sustainability – so that general practice will be able to support future generations.

  • Two more practices gained Cornerstone accreditation – bringing our total to 53%; all but 8 of the remaining practices are on the route to accreditation
  • We obtained (and passed on to practices) 90% of the possible PHO Performance payment revenue
  • Entered into shared ownership with GPs at two practices: Northland and Kelburn Medical
  • Measured practice team satisfaction with Compass Health for the first time – on average practices gave us a 74% positive rating; our target is a 90% positive rating
  • Received 32,629 webpage views and over 10,000 Provider Portal sessions
  • Supported 47% of our practices to develop a long term conditions plan to improve the health of their practice population, and moved them to flexible funding.

W

ellbeing: improving the health and equity of our enrolled population

The key focus has been in the preventative and proactive care domains – aimed at keeping people well and picking up problems early.

  • Cardiovascular Risk Assessments are aimed at early identification of diabetes, and of risk factors for heart attacks and strokes. The graph shows that Compass Health improved from around 75% cover to nearly 90% coverage of the target groups from 30 June 2013 to 30 June 2014.

    Data Source: Compass Health Reporting Services.

  • Support to quit smoking includes coding smoking status, giving brief advice to quit annually and providing cessation support. The chart shows that practices gave more reliable advice to quit for both the total and the high need population.

    Data Source: Compass Health Reporting Services.

  • Immunisation protects children from infectious disease – our performance is improving at the 8 month period and consistently high for the two year period. We achieved the target of 90% coverage, but results for the high needs group continues to lag.

    Data Source: Compass Health Reporting Services.

Compass Health Audited Annual Report

Audited Report by Deloitte

Total Revenue, per the Statement of Comprehensive Income, of $64.0m is represented in the below chart by Capitation Income, $45.3m (per note 2 in the Financial Statements), Provider and Community Health Services Income of $18.5m (Revenue from Services, less Capitation) and Interest Income of $0.2m.

Total Expenses, per the Statement of Comprehensive Income, of $63.9m is represented by Capitation Expenses, $44.7m (per note 3), Provider and Community Health Services Payments of $12.9m (Project Direct Expenditure, less Capitation) and Operating Expenses of $6.3m.

Total Revenue does not equal Total Expenses by $0.1m, being the operating surplus for the financial year ended 30 June 2014.

For a more detailed breakdown of our Financial Statements, please download from the PDF below the charts.

Revenue


$m

Expenses


$m

Quality Accounts

for the year ended 30 June 2014

Clinical Pharmacy Facilitation

An Audit of Dabigatran across Compass Health PHO

"It was an important achievement by the Pharmacy team that the audit was carried out in all 60 of the Compass Health practices."

Dr Lynn McBain
Clinical Quality Board Chair
Compass Health Board member

In July 2011 a new oral anticoagulant, dabigatran (Pradaxa®), became available throughout New Zealand. Although working in a different way from warfarin, it was approved for use in some of the same conditions.

An advantage of dabigatran is that those prescribed it do not need regular blood tests.

There is, however, no treatment available yet that can reverse the effects of excessive dabigatran anticoagulation. In addition, kidney function must be monitored so the dose can be adjusted accordingly.

Because of dabigatran’s newness, the need to regularly check renal function and reports of it being used for unapproved conditions, the Compass Health Clinical Quality Board (CQB) decided to do a Clinical Quality Improvement audit in all its PHO’s medical practices in 2013.

The purpose of the audit was to check how this medicine was being used against a set of standards. After feedback, if any standards are not met, the medical practice will plan how to achieve them.

It was an important achievement by the Pharmacy team that the audit was carried out in all 60 of the Compass Health practices. At the time of the audit there were 941 patients prescribed dabigatran.

Overall the results were reassuring

Most people were prescribed dabigatran for an appropriate condition and a very high proportion of patients had their kidney function checked as recommended. General practitioners were very good at reducing the dose of dabigatran in patients when needed.

Recommendations of some kind were made in just over 50% of records audited. These included recommendations about other medications the patient was prescribed not just dabigatran. This was an additional benefit of the audit.

Areas requiring attention

Further work is required in some practices to ensure that all patients taking dabigatran have their kidney function checked at least annually, or more often in some cases.

There were a large number of recommendations made, but not all were directly related to dabigatran. Only some of the interactions for example involved dabigatran.

In some instances, dabigatran was being used for unapproved conditions, often initiated by specialists. An education session, with a specialist speaker, was held in September 2014 to clarify some of these issues.

This was the first time that an audit relating to a particular medicine has been carried out throughout Compass Health PHO. It enabled our organisation to gain an overall picture of how this new medicine is being used and identified some issues that require clarification or improvement.

Achieving National Health Targets

Increased Immunisations, Cardiovascular Risk Assessments and Smoking Brief Advice given

Whaiora Medical Centre immunisations

Whaiora Medical Centre nurse Donna Holmes gives a baby boy his three month immunisations. He was previously immunised on time for his six weeks immunisations.

Immunisations in the Wairarapa

Since August 2007, increased childhood immunisation has been a national health target. The current health target focus is for 90% of 8-month-olds to be fully immunised by July 2014, and 95% by December 2014.

For the 12 month period ending June 2014 the Wairarapa exceeded the national target with 95% of 8-month-olds fully immunised, with an amazing 96% for Māori, 100% for Pacific, and 95% for Deprivation levels 9-10.

The Wairarapa Immunisation working group has adopted a collaborative team approach to achieve high percentage rates throughout the district. The team consists of the District Immunisation Facilitator and National Immunisations Register (NIR) Administrator (Compass Health), Whaiora Outreach Immunisation Service OIS (a local Māori provider), a representative from each of the seven practices, Occupation health, Population Health Unit, and Wairarapa's first and only vaccinating pharmacy.

A change of opinion - example of immunisation in action

The NIR administrator ran a report to determine all children that were not fully immunised by the set dates. From this a child was identified with whom all immunisations had been declined, and for whom we had incorrect details. The NIR administrator contacted the mother to update our records, and asked the mother if she would like to speak to the District Immunisations Facilitator (DIF) regarding immunising her child.

The family consisted of a Māori couple in their mid-20s, and two children aged six months and two years.

The mother had declined immunisation for both of her children due to comments heard from friends and on social media. The DIF discussed all of these concerns with the mother, giving correct immune, disease and vaccine information verbally, as well as sending out some information for the parents to read.

Following this, the mother stated she would really like to have both of her children immunised now, although they only had one car which her partner took to work, and they lived just out of town so transport was an issue for her.

DIF therefore discussed the option of Outreach Immunisation Services (OIS), and offered to refer her to OIS to have the children immunised at home, for which she was thankful for.

DIF made the referral to OIS, who have since vaccinated both children, and have kept them on their service to give all subsequent vaccines until they are up-to-date as per the Immunisation Schedule.

Data Source: NIR BC CI Overview - Milestone Ages PHO/Clinic (Final Dose including PCV).

Cardiovascular Disease Risk Assessments and Smoking Brief Advice given

Compass Health Practices completed 31,413 Cardiovascular Disease Risk Assessments (CVRAs) in the 2013/14 year, 3,607 more than the previous year. High needs CVRA coverage also increased. A total of 21,759 people received brief advice to stop smoking. These activities are likely to make a significant difference to population health in the Capital Coast and Wairarapa areas. In fact, Ministry of Health data shows that myocardial infarcts (heart attacks) declined by 20% in CCDHB and 50% in the Wairarapa over the past three years.

Key results CVRA

  • An increase in CVRA coverage from 82.5% to 86.3% in the Capital Coast DHB area
  • An increase in CVRA coverage from 84.5% to 88.3% in the Wairarapa DHB area
  • An increase in CVRA coverage of high need patients from 78.2% to 81.9% in Capital Coast
  • An increase in CVRA coverage of high need patients from 79.5% to 82.9% in the Wairarapa.

Key results Smoking brief advice

  • Wairarapa DHB increased coverage from 92.7% to 98.4% for all eligible patients and an increase from 97.1% - 99.9% for high need populations.

The highly successful campaign of last year meant large volumes of smoking brief advice codes fell due at the same time resulting in a coverage decrease from 80.1% to 76.9% in the Capital Coast DHB for all eligible patients and a decrease from 81.5% - 76.1% for high need populations.

Key Success Factors to CVRA and Smoking Brief Advice

  • Practice teams building cessation conversations into everyday workflow
  • Dedicated CVRA clinics
  • Dedicated time for smoking brief advice activity
  • Practices were provided with weekly email reports with CVRA and Brief Advice progress information
  • Some Practices trialled appointment scanner software in Practices with high numbers to complete
  • Additional support was provided to practices with high numbers of CVRA and Smoking Brief Advice to complete.

Hataitai Medical Centre gains Cornerstone Accreditation

Practice future proofs its business by gaining highest tick of approval

Janice and Dr Philip Wong

Janice and Dr Philip Wong are proud to be Cornerstone Accredited.

Dr Philip Wong

Dr Philip Wong with his emergency spills bucket.

The time, effort and cost to gain Cornerstone Accreditation have been a focused and concentrated investment in the future for the Hataitai Medical Centre.

Practice owner and GP Philip Wong and practice manager Janice Wong say the Cornerstone status places their practice in a strong position and signals it operates at the highest standard.

"We saw it as another long term investment in the practice."

Janice says the practice met 35 indicators to gain accreditation and the process has benefited it through the development of robust and standardised policies and procedures.

"We have tidied up a lot of areas. I think the doctors and clinicians needed more guidelines on how we do things, so I spent a lot of time discussing with our team members how we wanted to do it, and how we were to standardise it.

"We weren’t doing things wrong, but we now have it written down on pieces of paper for people to go to. Patients will benefit from better procedures around the clinical practices in areas like follow-ups, repeat prescriptions and with consenting forms for things like smoking, cervical screening and immunisations."

She says staff were supportive of the decision to gain accreditation and were active in the process. "We had lots of little micro-meetings during the day and as a result we work better together as a team."

The practice was extensively renovated to assist its accreditation developing a paraplegic toilet, wheelchair access and a wall to enable records to be locked away at night. An electrician tested every power plug and special RCD plugs were installed. Equipment has been upgraded and there are clear labels on all supplies and practice features.

"It’s been a huge effort and we gave it 100% commitment. But we know we can give ourselves and our staff a pat on the back and say we are doing our best at what we do," Janice says.

Island Bay Medical Centre embraces new LTC Programme

LTC funding flexibility puts focus firmly on patients

Melissa Simpson

Island Bay Medical Centre Clinical Director Melissa Simpson enjoys the patient-centered approach to primary care, made possible with the flexibility of the new programme.

The flexibility of funding in the Long Term Conditions (LTC) programme is enabling Island Bay Medical Centre to develop a care plan that is more patient centred and better meets patient needs.

Clinical Manager Melissa Simpson says the flexibility has also had positive benefits for the practice and its staff.

"We are definitely seeing the benefits with funding flexibility. Patient treatment and care is more timely, as we are not restricted to rigid time frames."

As an example Melissa says the practice is doing at least two insulin starts each week for patients that don’t have optimal control of their diabetes. "The longer you leave initiation of insulin therapy the potential for complications is increased, so patients are getting more timely intervention, leading to better control of their diabetes."

To develop its practice plan, Island Bay Medical Centre reviewed its whole population and aligned the service to those that have the greatest need. Melissa expects each practice will do it differently, but Island Bay stratified LTC patients into four groups.

The first group is those self-managing well. They are funded for an annual visit and can pay if they wish to visit more regularly. The second group receives two free visits each year and the visits aren’t fixed. The third group is similar to the former Care Plus model and receives four visits a year of which two are funded, and again the visits aren’t fixed. The final group is for patients that might need to visit often for a short period of time, such as those discharged from hospital or patients starting on insulin that need to be seen more frequently. For those that can afford to pay a little there can be a co-payment option, or funding could come from the diabetes plan.

"The idea behind it is we can target individual care. It is more patient centred and better meets their needs."

She says the practice plan covers three areas – LTC, diabetes and SIA (services to improve access) – and Island Bay has champions to oversee each area.

"We still offer all our diabetes patients a free annual check, but most of those patients also have another LTC, so we make the visits longer and also incorporate their annual review for their LTC."

The practice plan has brought together the patients, funding, practice and improvement performance targets and associated actions for the whole practice team. "In terms of the whole team approach, it’s been invaluable."

The programme flexibility enables the practice to fund additional services for patients such as prescriptions, vaccines, minor surgery and the removal of co-payments for patients with high needs or financial difficulties.

One year on, after revising its plan, Island Bay will use funding for innovative projects such as nutrition and lifestyle consultations targeting those at risk of developing a LTC.

Melissa says practice nurses are empowered and enthusiastic as the consults are tailored to patient need and are becoming increasingly nurse led. "Island Bay supports a collaborative model that involves patients co-producing care plans with their GP and nurse. Patients feel confident that their care is well co-ordinated and it’s a real strength."

Island Bay is preparing a questionnaire to ask its LTC patients what they think of the programme changes, with the results incorporated into its next care plan as a quality improvement activity.

Learning from Adverse Events

Reportable Events and Key Learnings.

School Clinic

The new layout ensures the fax/printer hides the computer screen.

Managing Patient Confidentiality

A young person's confidentiality was inadvertently breached when their name was viewed on a clinic appointment screen by another young person while waiting to be seen. Information was then circulated on social media. A complaint was lodged with Compass Health that confidentially and privacy of a person's information was breached.

Investigation into the incident prompted two questions:

  1. How did the student get the information that was posted on social media?
  2. What process could prevent this from happening at this clinic or any other clinic?

Actions taken:

  1. Room layouts assessed and rearranged to minimise viewing of computer screen by patients
  2. Swivel monitor bases purchased for computers to allow the purposeful showing of computer information to patients
  3. Staff required to routinely minimise appointment screens between consultations
  4. Limit information visible on appointment screens
  5. Cyber bullying policies implemented.

Use of Complementary and Alternative Medicines

A patient complained to the Health and Disability Commission (HDC) about a staff member promoting the use of complementary and alternative medicines during a consultation. One of the recommendations by the HDC was that Compass Heath needed to have a policy on the Use of Complementary and Alternative Medicines in place.

Investigation on the use of complementary and alternative medicines in New Zealand highlighted that the Medical Council of New Zealand and Nursing Council provide statement documents giving guidance to practitioners and nurses.

Action taken:

The links to the two statement documents were added to the Compass Health Code of Conduct Policy with the documents circulated to staff for signing. Signed copies are held in staff records.

Communicating with Patients

The issue of emailing patient information was raised through an event reported.

Investigations took place as to what guidance can be given on communicating with patients via email or using other electronic methods. We reviewed Statements written by the Medical Council of New Zealand on the Use of the Internet and Electronic Communication and the Use of Telehealth and decided to promulgate these as useful guidance.

Action taken:

The links to the two statement documents were circulated to the Compass Health General Practice Team, internal staff and they were added to the Compass Health Social Media Policy.

Reportable Events and Key Learnings

This section describes the adverse events that were reported to Compass Health during the year. All reported events are summarised and reviewed by the Clinical Quality Board and learnings promulgated to the primary care network.

Reportable Events Key Learnings/Actions
Immunisation administration related incident
Eight immunisation related events were reported:
  • Two related to diluents being given without being mixed with the active ingredient
  • Three related to immunisations repeated because of given elsewhere or record keeping issues
  • One cold chain failure
  • Two patient complaints
  • Reminded practices that full record check should be completed prior to immunisation
  • Fridge failure alerted to supplier
  • Common factor of distraction during administration process noted
  • Practices involved checked and reviewed their processes against best practice
Patient complaints about access/cost
Four access/cost related events were reported:
  • One complaint about being charged casual rate after enrolment until beginning of the next quarter
  • Two complaints about cost of additional unsubsidised treatments such as Aclasta, bone densitometry
  • One complaint about repeat script availability
  • Key issue is that patients should be informed about charges – no surprises
  • Practice has reviewed their letters to patient and added line about possible charges. Radiology provider has put up signs about charges to patient
Privacy related incidents & complaints
Four privacy related events were reported, including:
  • Use of email for prescription requests
  • Person given results intended for ex-spouse
  • Complaint about next of kin being contacted to confirm a mental health appointment time
  • Complaint about a patient at a school clinic seeing another students name on the appointment screen and disclosing via social media
  • Practices have been formally advised not to use unsecure email for patient specific information
  • One incident resulted in HR processes
  • Desk layout at college clinics altered so computers are not visible to patients
Infomation Communication Technology related incidents
Two events were reported, including:
  • Complaint about the Primary Solutions e-referral system not working
  • Practice reported a MedTech issue with importing of inbox documents not occuring when new patient files are received via GP2GP
  • Referral process and e-referral form reviewed and bugs addressed
  • Compass Health working with MedTech to resolve the inbox import issue
Other incidents & complaints
Three miscellaneous events were reported. All three were complaints about staff behaviour. One complaint about advice regarding alternative medicines came via the Health and Disability Commissioner (HDC), but the HDC was satisfied with information received from Compass Health and no further investigation was held. Organisational guidelines updated to include Medical and Nursing Council statements on the Use of Complementary and Alternative Medicines.
Health & Safety related incidents
Three health and safety related incidents were reported:
  • Broken sphygmomanometer mercury spill
  • Patient touched a nurse inappropriately
  • Needle stick injury sustained by clinician
Responses included:
  • Use of non-mercury equipment promoted
  • Flag on patients notes to say needs chaperone for procedures
  • Staff reminded to ensure they have easy access to sharps containers for procedures involving needles and other sharps
Sterilisation/
surgical site infections
Four surgical site infection/sterilisation events were reported:
  • Two were failures in sterilising of instruments process
  • Two patients presented with wound infection post minor surgery
  • Practice review undertaken and new processes implemented to ensure effective checking steps are in place in the equipment sterilisation process
Medication related incidents
Three medication related events were reported:
  • Two related to missing medications or scripts
  • One related to a patient forging prescriptions
  • The Practices involved assessed use of the specific medications and their controlled drugs policies
  • The forger was reported to the Police
Complaints regarding Mental Health Referral delays
Three complaints were received by Compass about delays in accessing primary mental health services. Compass has reviewed processes and is putting in place a new model of care with practitioners based at larger GP practices. We are now monitoring access timeframes weekly.

Māori and Population Health

Whānau Self Assessment.

Compass Health Māori and Population Health logo

Compass Health Māori and Population Health.

Whānau Self Assessment Tool

Whānau Self Assessment Tool.

Our Population Health approach aligns with Whānau Ora and focuses on a broad range of factors both inside and outside of the health care system that can influence health. These factors include early childhood development, health promoting communities and healthy lifestyles, education, income, housing, and accessto healthcare. We seek to involve individuals, communities, schools, workplaces, local and central government.

We have specific responsibilities for ensuring Compass Health delivers on our commitment that Māori enjoy the same health status and access to primary health care services as non-Māori. To achieve this, we need to work both within Compass Health, with Practices and all health providers, Iwi, Hapu and Whānau and across sectors. The team brings tikanga me ona kaupapa skills and knowledge to the organisation through strategic thinking, application of policy, and development of sustainable relationships with iwi and Māori.

Whānau Self Assessment

During 2013, the Māori and Population Health team designed a WWhānau Self-Assessment in using Whānau Ora approaches, Te Pae Mahutonga and Population Health principles.

This was developed in response to our observation that there was not a simple way for Whānau to signal their wider health and social needs and to be able to access support through a straight forward process.

Our resulting assessment is a visual interactive tool. Supporting the assessment is a one-page flow diagram with referral contacts for each item on the self-assessment form.

Masterton Medical Fire

Getting back to business following adverse event.

Masterton Medical Fire Damage

Surviving an adverse event - Masterton Medical's Key Points:

  1. Do your best to try and identify another location so that you are prepared. Identify some location options and establish a memorandum of understanding
  2. Make sure you have appropriate back-ups for all IT
  3. Make sure insurance policies are robust, including rental income protection for property company and yourself, and appropriate length of time for insurance policies
  4. Get CIMS training and understanding.
Masterton Medical Fire Damage

Masterton Medical Centre; 6:40pm Tuesday 25th February 2014.

Within 16 hours of suffering a devastating fire, Masterton Medical was operating out of temporary premises seeing patients.

"We are the largest practice in the country. We have 23,000 patients, just over 50% of the Wairarapa population and we were seeing about 500 patients a day. No one could pick up that workload so we had to get up and running quickly," General Manager Paul Cocks says.

There were two critical factors to the response. There was another facility with capacity to operate consultation rooms and the centre’s computer servers with patient records had been saved by the fire service. "So we had the site and access to MedTech."

Other matters around phones, clinical suppliers and messages to stakeholders were resolved with support from the DHB, Compass Health and the local community. The centre’s business interruption and other insurances were also up-to-date.

"One of the key messages we needed to get to our 72 staff on day one was that you were going to get paid and no one was going to lose their job. Many thought that if they weren’t working they wouldn’t be paid. We were running half the staff at any given time as we didn’t have the room for all of them, but we paid them as normal."

Paul says managing and supporting the team has been the hardest challenge in the wake of the fire. "The adrenalin lasts for so long when you have change upon change. It does get weary and tiring."

He says they were also concerned for their patients’ welfare. "We knew there would be patients trying to do the right thing by not coming to see us and when they did present they could be quite complex, so we needed to get our general appointments going. By day four we were up to 70% of normal capacity, although patients were not necessarily being seen through our GPs."

Other GP practices in Masterton helped by taking on some of the centre’s patients, a situation made easier with access to the shared care records.

Now operating out of more permanent yet temporary facilities, Paul says the experience has taught them to accept what they have and to make the most of it. The fire has presented Masterton Medical with an opportunity to redesign its model of care and plans for a new purpose-built centre will follow within two years.

The fire highlighted the centre’s business continuity plan was "rubbish and too generic". Masterton Medical is now establishing a more realistic Co-ordinated Incident Management System (CIMS) and Paul - who was the only member of the practice with any CIMS training - recommends CIMS to all practices.

CIMS is a command co-ordinated process, about an initial response, then management and then recovery. It is used by emergency services.

"If you just have a power outage you can follow your business continuity plan, but when you have no power, no security, no water, no clinical suppliers and you don’t have a building your plan quickly becomes very difficult to implement."

There have been other learnings from the fire. Masterton Medical now carries more clinical supplies and stationery, and its business interruption insurance policy has been extended from six months to two years. Changes have also been made to its rent protection insurance to increase its level of cover.

Pacific Navigation Service

Consolidating our processes and systems.

The Pacific Navigation Service in Action

A middle-aged Pacific patient was referred to the Navigation Service as the patient had both respiratory and social issues, and also suffered from a number of Long Term Conditions resulting in numerous hospital admissions.

The Pacific Navigation Service (PNS) met with the patient's family, and together assessed a reason for the patient's poor health was having been prescribed many different medications. The patient did not understand what they were for or when to take them, and also had language, social and financial issues.

The assigned Pacific Navigator and patient met with their GP to discuss their findings. As a result, supportive letters were sent to WINZ and HNZ forms were given to the patient. Medication education was given to improve self-management of their conditions, and the patient's son was given support to apply for a WINZ caregiver's allowance.

The patient now has improved mobility, is taking medication correctly and following evaluations of the patient's housing maintenance and moisture, improvements have been agreed to make the patient's home safe.

As a result of the service the patient is happier and in better health. They are managing their medication better have avoided further hospital admissions. Working with their GP was a positive experience for all parties.

The Pacific Navigation Service includes three Registered Nurses and six community health workers.

Professional development has been a focus in the last 12 months. One staff member is completing a PG Certificate in Pacific health, and two staff have completed the Weltec National Certificate in Health, Disability, and Aged Support.

Our recruitment of a new graduate will be supported by the NetP programme at Capital Coast DHB. In this programme she will complete a PG Certificate and enter the PDRP programme at competent level. Another member is commencing the Weltec - National Certificate in Health, Disability, and Aged Support this semester.

Alongside this work we are developing an education programme on Long Term Conditions to upskill staff on how to respond to issues raised by families.

Pacific Navigation Service Evaluation

An external evaluation of the service was completed in January in consultation with staff, providers and users of the service. The findings highlighted key and consistent issues presented by participants and substantiated by the documents reviewed. The findings were:

  • Pacific Navigation Service is a necessary service to support Pacific patients - referring practices acknowledged that PNS had potential to facilitate a cohesive wrap around service for Pacific patients
  • Aspects of clinical, cultural and Pacific leadership need to be managed and carefully integrated in any ongoing developments of PNS
  • Effective work relationships need support:
    • There needs to be effective relationships with priority practices and the Pacific Health Unit as navigators with each other - professional development addressing workplace confidence and knowledge
    • The referral process can be improved
    • A space for Pacific practices and the ability to explore, critique and share as colleagues requires space for effective team work and for relationships to develop.

Future recommendations include:

  • A cohesive wrap-around service
  • The need for clearer understandings of PNS roles and responsibilities
  • Distinct leadership functions and the options to respond
  • By Pacific for Pacific - consider amalgamating the two sub-teams to a single service space
  • Give consideration to Pacific governance.

The response to these recommendations has been to introduce one Clinical Leader working across the teams. The team meet more regularly to support planning and develop a work and education programme to support all learning and growth. The team is developing ways of ensuring we use the strengths, skills and knowledge when triaging referrals, and there is potential for members of the team to work across localities.

Activities over the last year have included self-management programme held late last year, monthly PIPC group work, radio presentations.

The service has seen 754 people in the past year. Staff have also worked with practices to achieve PPP targets.

Over the past year Ambulatory Sensitive Hospitalisations of Pacific children in CCDHB have reduced by 4.4 per 1000. This is net decrease of 25 admissions (12%). The number of admissions has decreased or remained stable for all top conditions except Dental Conditions where there has been an increase.

Compass Health would like to acknowledge the loss of Lesieli (Rachel) O'Brien Registered Nurse who passed away in early 2014. She was a well-respected senior member of the team. Her loss was felt keenly by the team and the community we serve.

Patient Satisfaction Survey

Putting our patients first

"The Patient Satisfaction Survey was easy to implement at a practice level, with the NZGPAQ questionnaire offering detailed evaluation questions.

"The analysis report was comprehensive, and is a useful practice development tool. We look forward to running the survey again in 2015 to compare our results."

The team at Tawa Medical Centre

For the first time Compass Health has offered all Practices the standardised and validated New Zealand General Practice Assessment Questionnaire (NZGPAQ) Patient Satisfaction Survey this year. The NZGPAQ offers the benefit of being able to compare Practice results with the National Benchmark as well as the PHO network sample. It is widely used across New Zealand in General Practice and has been determined to be a reliable patient survey tool. It is delivered in New Zealand by Health Services Consumer Research (HSCR) in Auckland.

The NZGPAQ is a useful practice development tool as it is repeatable and will show changes over time. It helps to identify areas for improvement and also fulfils some requirements for Cornerstone Accreditation. Compass Health has also offered an online version of the NZGPAQ questionnaire, a popular option for many patients who can choose to easily complete the questionnaire on their mobile device.

The first PHO network level report was completed by HSCR in June 2014, based on 1,421 responses from 16 practices, the following were highlighted:

  • 87% of patients were satisfied or very satisfied with their practice
  • 91% were satisfied with the doctors caring and concern
  • 66% saw a nurse during the visit
  • 97% rated the quality of nursing care good to excellent
  • Only 62% were satisfied with waiting times at the practice
  • Only 63% were satisfied with phoning through to their GP
  • Only 18% of patients said they usually can get to see their particular doctor on the same day, versus the benchmark of 40%.

A further 12 practices have now implemented the NZGPAQ Patient Survey since the initial PHO report. HSCR will deliver a final 2014 PHO report in November this year.

Porirua Social Sector Trial

Reducing Ambulatory Sensitive Hospitalisations and Emergency Department Attendances in Porirua

Social Sector Trial launch

Ranei Wineera-Parai, Project Manager; Hon Tony Ryall, Minister of Health; Carl Crafar, National Social Sector Director at the launch of Tumai Hauora ki Porirua Action Plan.

Creekfest 2014

Congratulations to Dub Moki who was one of several winners of the health messages competition run during Creekfest 2014.

The aim of the Porirua Social Sector Trial (SST) is to have agencies collaborate to change the way that social services are delivered in Porirua. The SST is focused on improving health outcomes for people in Porirua aged between 0 and 74 years, and specifically aims to:

  • reduce the number of people being admitted to hospital for Ambulatory Sensitive Hospitalisations (ASH) that could be better prevented or managed in the community; and
  • reduce the number of people attending the Wellington Regional Hospital Emergency Department (ED).

Activities to trial innovative approaches to impacting these outcomes, between July 2013 and June 2015, are set out in the Tumai Hauora ki Porirua Action Plan (the Action Plan). The Action Plan was developed in consultation with the community as a planning and accountability mechanism.

There is commitment and support for the SST from the Ministries of Health, Social Development, Education and Justice, the New Zealand Police, Te Puni Kokiri, Regional Public Health, Ngati Toa, Porirua City Council and non-government organisations to ensure that we work together towards these outcomes.

The SST is responsible to joint Ministers, is guided by an Advisory Group and has clinical oversight from the Porirua Kids Project.

Our key challenge is determining the correlation between our activities and our high level outcomes of reducing ASH and ED presentations. Due to the multiple and complex determinants of health, this is not always feasible. However, we are confident that every action we have taken has contributed to improving the health outcomes in our community, either at an individual or at a population health level.

Our progress against the Action Plan

The Action Plan began with 86 activities. During the past year eight new activities have been added, making 94 activities in total. As at June 2014, 52 of these were complete and 31 were in full implementation phase. The SST is on track for delivering the remaining activities by June 2015. There is an increasing level of co-ordination and synthesis within and between the activities.

Achievements during 2013 - 2014 under Five Focus Areas

Improved self-management, resilience and wellbeing for communities in Porirua

  • Developed key health message packs to primary care, schools and early childhood centres
  • Encouraged health awareness and healthy eating options at eight community events, including Porirua Youth Expos, Youth Week school events, Porirua Men United, Kapo Kapo 2014 where 3,000 bottles of water were sponsored, Relay for Life and Creekfest 2014
  • Increased the percentage of people given brief alcohol intervention advice
  • Contributed to the Capital Coast DHB youth needs assessment and support the implementation of recommendations.

A 'Well' Start to Life for Children in Porirua

  • Commenced joint DHB initiative for increasing the percentage of the population aged two years enrolled in dental services, primary care and Well Child services
  • Increased the number of under five-year-olds enrolled in dental services through shared enrolment data with primary care
  • Supported key health messages and behaviour changes in young children by providing 4,000 bottles of liquid soap and 436 boxes of tissues to all 30 primary schools in Porirua
  • Contributed to managing skin disorders in children being admitted to hospital by distributing 1,000 healthy skin packs to medical centres, pharmacies and Work and Income offices. Provided Bepanthen antiseptic cream to 30 primary schools and 60 early childhood centres
  • Support school referrals from Porirua East and Titahi Bay for children with absenteeism due to health by developing a referral options resource.

Improved Access to Appropriate primary care in Porirua East and Titahi Bay

  • Improved access to affordable health care, through joint initiatives with Work and Income, by promoting access to the Disability Allowance, re-direction of benefits to primary care and pharmacies and a direct email for health and social support professionals
  • Increased respiratory services in Porirua though additional Chronic Obstructive Pulmonary Disease (COPD) clinics being offered
  • Facilitated consistent nurse triage training and other training needs across Porirua by supporting training needs analysis research for primary care by Whitireia New Zealand
  • Improved availability of primary care by supporting more nurse-led clinics, and funds in pharmacies to support families who are not collecting their prescription medications due to financial barriers
  • Increased cardiovascular risk assessments being completed
  • Contributed to the CCDHB oversight group that supports people who do not attend their outpatient clinic appointments.

An Aligned Inter-Agency Response to Support Collaboration, Co-ordination and Communication to Targeted Communities

  • Reviewed culturally appropriate service training for primary care and community workers. Plans are in place to deliver bi-cultural training and training in working with refugee communities
  • Contributed to shared wellness promotion for families in need with young children by providing fruit and vegetable packs while being taught to plant and grow their own gardens
  • Facilitated networking of social workers in Porirua through a community forum with a second forum planned
  • Facilitated cross-sharing of strategic knowledge by Advisory Group member as a step towards reducing fragmentation and aligning service provision for Porirua
  • Shared skills and knowledge through regular SST newsletters.

Supportive Environments for Wellbeing in Porirua

  • Contributed to improving access to warm housing by being part of a joint working group. Community feedback has been sought on the impacts of overcrowding
  • Helped to reduce the misuse of alcohol in Porirua by making a submission to the draft Local Alcohol Policy
  • Contributed to better understanding of domestic violence determinants to reduce its impacts by supporting the Porirua Strategic Family Violence Prevention Group.

Data Source: Ministry of Health, National Non-Admitted Patient Collection.

Shared Care Record Success

Shared Care Record gives timely information

"The Shared Care Record is great as it allows us to find information when patients are too sick to explain for themselves."

Peter Hicks
Intensive Care Specialist
Capital and Coast District Health Board

As someone who has worked in both the emergency department and in general practice, Tony Becker appreciates the benefits of the Shared Care Record (SCR).

As Masterton Medical’s Clinical Director and the Wairarapa GP Clinical Leader, Tony was a member of the team instrumental in establishing the SCR in the region.

"There was a big impetus all around to get the SCR, including from the secondary care side to get the information so the emergency department (ED) could use it."

Working half time in the ED and as a GP at the time, he saw the benefits first hand.

"I remember one night an older lady coming in to ED and we asked if she had an allergy to anything and she said she was allergic to every white pill. I can image it restricts what you can do if it’s after hours and someone is allergic to every white pill."

Tony says the SCR enables ED to access information to identify what people have been prescribed and any allergies they have. It quickly tells ED what classifications, medications and allergies a patient may have.

He says privacy issues are taken care of by an "opt-off" system, but issues around gaining patient permission in ED to access the information have restricted its use.

"The argument is that we do need to get an approval and ask the patient before you look at it, but as long as you can show that anything you do is for the benefit of the patient then there is tacit approval to do that."

While the SCR is working well, Tony says there are improvements that could be made. "Right now it’s one way and stuff that happens in the DHB is not visible to the GP. As a GP it’s a pain if someone in the DHB modifies a medication as we have to scan that prescription, shred the paper and then manually change it in our system.

"It makes far more sense that if someone at the DHB changes medication they change it on a database that is common to everybody. Ultimately we have to head in that direction."

Tony says the patient portal, supported by Compass Health, is also proving valuable in accessing patient information. Masterton Medical is giving patients the login to their own notes, informing them of medications they are on or conditions they have. "I have just given it to a young fella who is going to the United States. If anything goes wrong he will be able to login from anywhere and provide health professionals with useful information."

Data Source: MedTech Global.

Shared Care Records Improve Patient Safety - Implementation in Capital and Coast

Patient safety has been improved in Capital & Coast DHB’s Emergency Department (ED), wards and outpatients through the availability of summary electronic patient healthcare records from primary care.

Chief Medical Officer Geoff Robinson says the hospital has found it helpful to have the information, with 482 out of 678 doctors (about 70%) having accessed patient information using the Shared Care Records (SCR) since they went online in April this year.

"From the hospital point of view we have found having online access to the records really helpful. It adds to patient safety through this newly available information. It’s also in the patient’s interest for the hospital to have as much information about them available as possible."

Dr Robinson says the records are a useful tool and enhance the clinical information available about patients. The records will identify any patient allergies; assist in reconciling medication and in checking test results.

"We can see the GP ordered blood tests, which if recent may not need to be repeated in the hospital so it avoids duplication and unnecessary tests. There’s also a cost saving."

He says it is becoming routine practice for ED doctors to view the records as part of their overall care plan for a patient.

Dr Robinson is working hard to encourage all hospital doctors to access the records, and also encourages those general practices hesitant to sign-up to reconsider.

Timeline

Compass Health annual key points and events.

  • July 2013

    Long Term Conditions flexible practices funding commences

    Post Earthquake Emergency Response

    Following the 6.5 magnitude earthquake that rocked the city at 5.09 pm Sunday 21 July, Compass Health continued to operate with minimal disruption while a structural engineer's report was completed on the Willis Street site.

  • September 2013

    Electronic shared care record functionality expanded to include pharmacies in the Wairarapa

    Wairarapa leads the nation in all three of the primary care targets for the quarter

    Increased Immunisation 97%, Better Help for Smokers to Quit 98% and More Heart and Diabetes Checks 98%.

  • October 2013

    Annual Australian and New Zealand Association for the Treatment of Sexual Abuse (ANZTSA) held

    Kim Lund, Compass Health Clinical Nurse Specialist and Clinical Manager, presents the process behind the "Who Are You?" collaborative project at the ANZTSA Conference in Hobart, Tasmania.

  • November 2013

    Compass Health purchases 50% of Northland Village Surgery

    Continuing Professional Development (CPD) Online Booking System goes live to Practice Staff

    Accessible via the Compass Health Provider Portal for Compass practices, and via the Compass Health website for non-Compass practices.

    Standardised patient satisfaction survey offered to Compass Health practices

    New Zealand General Practice Assessment Questionnaire (NZGPAQ), provides a comparative view of patient experience across practices.

  • December 2013

    Launch of Tumai Hauora ki Porirua, Porirua Social Sector Trial Action Plan

    Dr Logan McLennan is awarded the Queen's Service Medal (QSM)

  • March 2014

    Wairarapa again ranks top in the country in three areas of health targets

    More diabetes and heart checks, immunising 8-month-old babies, and helping smokers to quit.

    First Compass Health survey of GP team satisfaction with Compass Health services

    Totals 132 responses: Overall satisfaction rate 7.5/10 with a goal of 9/10.

    Porirua Social Sector Trial

    Distributes 1,000 healthy skin packs to Porirua medical practices, pharmacies and the Work and Income Community Link to support people to clean and cover cuts and care for their skin, and 4,000 bottles of liquid soap to 30 primary schools in Porirua

    Register of GP and Practice nurse interests developed

  • April 2014

    Compass Health purchases 50% of Kelburn Medical Centre

    Shared Care Record goes live at Capital and Coast ED

    An official launch of the Shared Care Record was held in the Wellington Hospital Emergency Department on April 7 2014, attended by Minister Ryall. Ministry data shows a 20% reduction in MIs in Capital and Coast and 50% in the Wairarapa.

  • May 2014

    Compass Health Wairarapa and Stopping Violence Services are successful applicants to pilot a healthy relationships programme at Makoura College

    Compass Health, along with the Porirua City Council, YAG, Mai FM, Opportunities Centre organise Porirua Youth Expo. Providers’ stalls at the event were well resourced and effectively directed youth to services available to them when they have left school.

  • June 2014

    Implementation of Primary Options for Acute Care (POAC)

    POAC is a stream of funding for services provided to the patient in the community where the service is intended to avoid the need for an ED attendance, outpatient visit or hospital admission. Currently there is POAC funding for IV antibiotics for the management of adult cellulitis where there has been high dose antibiotic failure and Clexane administration for the management of lower limb DVT.

    Community Council formed

    Sexual health staff have logins to DHB systems approved

    New model of care primary mental health in general practise launched in two trial practices

    65% of practices have developed a practice plan to manage their practice population

  • End of
    Financial
    Year