March 13 2024 PHO Provider Forum Presentation Slides by WBOP PHO

Provider Forum

March 13, 2024

Whakataka te Hau

Karakia Tīmatanga (opening)

Whakataka te hau ki te uru

Cease the winds from the west

Whakataka te hau ki te ton ga

Kia mākinakina ki uta

Kia mātaratara ki tai

E hī ake ana te atakura

Cease the winds from the south

Let the breeze blow over the land

Let the breeze blow over the ocean

Let the red-tipped dawn come with a sharpened air

He tio, he huka, he hau hū

Tīhei mauri ora!

A touch of frost, a promise of a glorious day

Speaker

Session

Welcome & Karakia Tīmitanga

Lindsey Webber, CEO, WBoP PHO CEO & Board Update

Nadia Du Plessis, Operations Lead, CHIRP

Elizabeth Earles, Community Liaison, CDS

Jo Lambert, CEO, Stroke Foundation of New Zealand

Child Health Integrated Response Pathway (CHIRP) & Child Development Service (CDS)

Take Charge After Stroke

Phil Back, General Manager of Network Services, WBoP PHO

Dr Claire Isham, Clinical Director, WBoP PHO

System Level Measures

PHO Clinical Updates

Closing & Karakia Whakamutunga

PHO Update

Lindsey Webber CEO Western Bay of Plenty Primary Health Organisation

Child Health Integrated Response Pathway

For all Tamariki and their whānau, who have developmental, attentional and/or behavioural concerns of clinical significance to experience timely, responsive and integrated care that matters to them.

The problems we are trying to solve

“Let’s Work Together”

Confused pathways to access support

Long waiting lists

Children falling through gaps or not getting anywhere

Duplication of service

Inequity of access

Fragmented and siloed approaches to service delivery

Not capturing demand/unmet need across the population

Services no longer configured to meet the growing demands of the population Service centered response – criteria driven

Acute/crisis presentations that could have been avoided with earlier proactive intervention

CHIRP CHIRP CHIRP CHIRP CHIRP

Integrating Child Specialist Services

Tauranga CHIRP Triage Team Data Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 0 100 200 300 400 500 600 Clients active within CHIRP May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 0 20 40 60 80 100 120 140 Average days waiting from referral to CHIRP to MDM – Comparing wait-times for Māori and non-Māori Ave. days waiting for all Ave. days waiting for Māori Target waitime

Single point of referral has allowed us to more accurately track demand across all services for neurodevelopmental diagnostic assessment

2021 - 3D recorded an average of 25 Tamariki per month referred for assessment (other referrals into specialist services not captured)

2022 – CHIRP recorded an average of 76 Tamariki per month referred for assessment

2023 – CHIRP recorded an average of 107 Tamariki per month referred for assessment

1/1/2021 1/1/2022 1/1/2023 0 200 400 600 800 1000 1200 1400 297 847 1284 Total Tamariki referred each year

Referrals:

CHIRP is a triage service for neurodiverse children aged 14 years and younger.

Referrals can be made by GP’s, school’s or other community service providers.

Exclusion criteria: CHIRP do not assess for learning difficulties or auditory processing disorder. ADHD is not assessed for children under the age of 6 years.

Referral forms, parent and teacher questionnaires, Vanderbilt Screening for ADHD available online.

Please expect that there will be some waiting time from the point where CHIRP receives the referral, to gathering information, and sending on the appropriate pathway. The website includes Resources which referrers can look at to support families.

BPAC Hauora a Toi Bay of Plenty

Design and Test an ‘Integrated Pathway’ for ADHD/ASD Ko te ahurei o te tamaiti arahia o tatou mahi.

• Let the uniqueness of the child guide our work

• Be needs driven not criteria driven

• Plan the response according to the needs of the child

• Choose the best combination of specialists for the child rather than the service.

• Provide timely, collaborative, meaningful and holistic assessments

CHIRP CHIRP CHIRP CHIRP CHIRP

ADHD assessment support…

New

Qbtech

QbCheck overview

QbCheck is CE marked, TGA registered, and FDA cleared for use as an aid in the assessment and treatment evaluation of ADHD.

QbCheck is the first online ADHD test identifying a patient’s likelihood of having ADHD-like symptoms.

It includes:

> facial recognition technology to measure activity

> tests of sustained attention and impulsivity

> a subjective rating scale aligned with DSM-5

QbCheck adjusts for age/gender (biological sex) and compares results against a group of individuals with and without a clinical diagnosis of ADHD.

Time to Diagnostic Decision Measures

Time from First Referral for ADHD concern to Diagnostic Decision* Time from Paediatrics Referral to Diagnostic Decision Time from First Paediatric Appointment to Diagnostic Decision 0 100 200 300 400 500 600 700 800 7 0 2 3 3 7 2 2 0 3 7 1 1 9 9 5 3 3 2 5 1 0 5 3

A v e r a g e T i m e t o D i a g n o s t i c D e c i s i o n ( D a y s ) ** *** *** ** *** **

Pre-CHIRP implementation Post-CHIRP implementation Post-QbC implementation Time to Diagnostic Decision Measures

Future plans:

Expand on the new CHIRP Eastern Bay of Plenty Service

Continue development of the Adolescent ADHD Pathway

Investigate new opportunities for ASD Pathway

Te Waka Aorangi – Child Wellness Centre

Child Development Service (CDS)

Who we are and what we do

Who we are

Community based team providing interventions and therapy to children with developmental needs and/or disability

• Visiting Neurodevelopmental Therapists (working with 0 – 2 years)

• Physiotherapists

• Occupational Therapists

• Speech Language Therapists

• Dietitian

• Psychologists (autism and intellectual disability diagnosis)

• Autism Spectrum Disorder (ASD) Coordinator

• Paediatricians

• Therapy Assistant

• Incredible Years Autism

What we do

Areas we might assess

•Gross motor skills

•Fine motor skills

•Feeding (functional and nutritional deficiencies)

•Self-care

•Specialised equipment needed for the home

•Home safety adaptation

•Language and communication (under 2 years)

•Intellectual function

•Autism diagnosis

Following assessment, intervention/therapy is planned with the child and family to meet their identified needs.

What we do

Group therapy, support, education:

CDS Eligibility Criteria

Age: 0-16 yrs

AND

have a physical, sensory or intellectual disability or combination

which is likely to continue for a minimum of six months. OR at risk of developing such a disability OR have developmental delay.

OR Suspected Autism Spectrum Disorder.

Referral examples

• Gross motor delay (eg not sitting at 10/12)

• 15-18/12 with speech concerns and motor delay = ?

ASD

• Delayed head control at 6/12

• Strong hand dominance/preference <12/12

• Autistic traits (for diagnosis)

• Sensory/functional issues (detail ++ in referral form)

refer Referral forms can be found: Bay Navigator https://baynavigator.health.nz/resources/child-health/

for support Child Development Service’

How to

‘Request

Website and available resources Search ‘Child Development” on www.bopdhb.health.nz

WBOP PHO PRESENTATION

STROKE FOUNDATION

MARCH 2024

PRIMARY CARE AND COMMUNITY SERVICES; WORKING TOGETHER TO ACHIEVE

EQUITABLE HEALTH OUTCOMES FOR STROKE SURVIVORS

• Improving integration

• Improving access

MISSION:

PREVENT STROKES, IMPROVE OUTCOMES, SAVE LIVES

THE NUMBERS

• c10,000 strokes per annum

• NZ’s largest cause of adult disability, 2nd highest cause of death

•

•

80% Pakeha >65yrs, 60% Māori <65yrs

4,500 referrals to SFNZ

•

2,800 clients receive support – 70% L1 (telephone)

• $1,100,000,000 per annum - <$1,700,000,000 by 2035

INTEGRATION AND ACCESS CHALLENGES

• Stroke pathway is inconsistent and dominated by hyper acute and acute rehab services

• The continuum of care is disconnected / broken – referrrals are made to primary care, but don’t always get picked up

• Community based rehab is a post code lottery

• Stroke patients “fall off the edge of a cliff” on discharge

• We can achieve more by working together, and supporting primary care to triage the practical and psycho-social needs of stroke patients

• We all want people to live longer and more independently after their stroke, return to work, and reduce the burden of care on whanau

• People are missing out on essential services for their

INTEGRATION AND ACCESS SOLUTIONS

• Champion a consistent pathway between primary and secondary, and remove the rehab postcode lottery

• Each practice might have only 5 new stroke patients each year – this is not an enormous workload

• Summary discharge already flows to primary care

• We can support you to keep your enrolled patients living more independently in their homes after stroke

• We can help you identify whanau at risk, because of strokes –the carers and rangatahi

• Support Take Charge After Stroke implementation – using consistent approach

• Support take up of rehab tools for wider use

OUR LIFE BEFORE STROKE SERVICES

• Community education about stroke risks

• Free BP and AF testing in priority areas

• Industry collaborations to improve employee health

• FAST awareness and online training

• Lived Experience Advisory Panel to inform our mahi

• He Taonga online programme to reduce stroke risk and raise awareness

OUR LIFE AFTER STROKE SERVICES

4 pou:

Navigation Information Support

Person

Advocacy

SERVICE CATEGORIES

SC1

• Telephone support

• Online resources

• Information packs

• SC1, and

• Take Charge After Stroke

SC2

• Individual Support Plans

• Life After Stroke Book

• Introduction to stroke clubs

• SC2 and:

SC3

• Multiple in-home visits

• More connections and support

• Extended engagement

TAKE CHARGE AFTER STROKE

580 TaCAS session in 12 months

339 Follow up sessions

THE FUTURE MEANS

• SFNZ can work alongside your practices to raise awareness of:

• Stroke risk – early identification, BP, AF etc.

• FAST message and access to urgent intervention

• Post stroke information, services and entitlements –e.g. Return to Work support, funding for driving assessments, TaCAS, Total Mobility Cards, Community support groups, peer support

• Being brave through new collaborations and collective impact

• Amplify our voices, to achieve system change

• Working smarter together – we each do what we do best

– we can be your stroke backbone

System Level Measures

Manawa Te Taki regional approach

Ambulatory Sensitive Hospitalisations (ASH) 0-4

Improvement Milestones

• 10% improvement in immunisation rates for tamariki Māori, Pacific tamariki at 24 months by end of June 2024

• 90% of Māori newborns and Pacific newborns fully enrolled with a primary care provider by 12 weeks of age

Activity

• Maintained and enhanced activity focused on improving coverage, particularly for Māori and Pacifica.

• Extend capacity for provision of immunisations across community providers.

Acute Bed Days

Improvement Milestones

• Reduce acute bed days by 4% for Māori and Pacific people by the end of June 2023.

Activity

• Improved seasonal flu vaccination coverage

• Development of local Immunisation collaboratives

• Enhanced range of available services under EPCC (Enhanced Primary and Community care) programme of work.

Whānau Experience of Care

Improvement Milestones

• Whānau voice framework developed and being implemented for Comprehensive Primary and Community Care Teams (CPCT) in Te Manawa Taki.

• All General Practices have accessed their most recent Patient Experience of Care Survey (PES) and identified areas of improvement.

Activity

• PHOs use their learning networks to refresh General Practice understanding of the value and data available in the PES.

• PHOs and General Practices identify themes and have focused improvement activity (could be regional, within PHO or within a Practice).

Amenable Mortality

Improvement Milestones

• CPCT (Comprehensive Primary and Community Care) can be accessed across Te Manawa Taki.

• Increased and equitable uptake of pharmacotherapies for CVD risk reductions and improved diabetes management.

Activity

• PHOs support practices to implement CQI processes on current prescribing inequities with a focus on medications for type 2 Diabetes.

• PHOs support practices to implement CQI processes on current prescribing inequities with a focus on medications for dual and triple therapy for CVD risk.

Youth Access and Utilisation

Improvement Milestones

• Improve knowledge of, and navigation to mental health and wellbeing services for youth.

• Vaccination rates for MMR1, MMR2, and HPV.

Activity

• Strengthen the connection between General Practice and youth mental health and addictions services across Te Manawa Taki.

• Local IPMHA collaboratives/services create focused upskilling opportunity around youth wellbeing with their aligned primary care teams.

Babies Living in Smokefree Homes

Improvement Milestones

• Increase the proportion of babies living in smokefree homes 5% by 30 June 2024.

Activity

• Support increased uptake of the Gen2040 Best Start Pregnancy, and second Trimester kōwae in General Practice settings.

• Increased awareness of hauora Māori pregnancy and parenting classes and Stop Smoking Services across Te Manawa Taki.

Associated SLM Funding

Practice payments based on 1 July 2024 ESUs.

• Payments have now been received from Health NZ, Te Whatu Ora representing 75% of available SLM funding for the 2023-24 financial year.

• Monthly payments based on assumed activity and achievements will be instituted from March, backdated to July 2023, against that 75% funding received.

• Final 25% payment is not due until September 2024 and will be reflective of actual achievement against SLM Milestones and associated Activity.

PHO Clinical Updates

WBoP PHO Clinical Advisory Team

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• PHO Events & Recordings | Western Bay of P lenty PHO (wboppho.org.nz)

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Decypher Interpretation Services

• Decypher provide interpreting and translation services in over 60 languages.

• If the patient/client is with you at the time of the appointment from your mobile phone, please call Decypher at 0800 351 001 and we will transfer the call to the interpreter.

• If the patient is not with you at the appointment, here is how to make a threeway conference call:

1.Call Decypher at 0800 351 001

2.While being on hold waiting for Decypher to connect with the interpreter press Add call and call the patient.

3.Then press Merge, and you can do the conference call.

• The WBOP PHO funds the Decypher video and phone interpretation services for it’s WBOP PHO members, however face to face interpreting (on site) and written translation services will need to be self funded by the requesting General Practice.

Workforce Pressures Reporting

Background

• During winter 2022 Te Whatu Ora requested regular workforce reporting to identify pressures within primary care.

• A weekly workforce capacity tool was developed which has seen good uptake across the network.

• Results have been consistently reported up to Hauora a Toi Bay of Plenty's Integrated Operations Centre.

• Average Response rate has been 60% over the 17 month period Aug 2022- Dec 2023.

• 25 practices participated to some degree, 16 practices have provided regular updates.

• The WBOP PHO accumulated workforce capacity data for a 17 months period (August 2022 to December 2023).

VRM Overview

What is it?

• The system used in Secondary & Tertiary care nationally to evaluate service capacity and workforce pressures.

How is it calculated?

• In order to calculate a VRM score we ask a question/s across dimensions. These responses are then given a score and weighted against each other. The aggregation of these scores is your overall VRM score

Limitations

• It can only consider when information is completed and obscures any pressure that isn’t updated regularly as change occurs in the practice

Outline of Status definitions

• VRM Status Scores

• Green 0-19

• Capacity is able to meet demand

• Yellow 20-48

• Early variance - Practice is stretched to capacity. There is more stress on services than usual.

• Amber 49-77

• Significant capacity deficit - Practice is working past its maximum capacity. Non-acute care is probably being deferred.

• Red 78-100

• Critical capacity deficit - Practice capacity is critically degraded. Acute and non-acute care is being deferred or redirected.

PHO Overview

Average VRM score by week – All Results 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 3 4 5 6 7 8 9 10 11 12 13 14 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 2022 2023 0 10 20 30 40 50 60

Total Reported Staff Absences

32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 2022 2023 0 10 20 30 40 50 60 70 80 90 100 Allied Health Staff Nurses Nurse Practitioners Administrators General Practitioners

Reported Wait Time for next routine appointment

3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 5 0 2022 2023 0 50 100 150 200 250 300 1-2 Busines Days 6-10 Business Days 3-5 Business Days <1 Business Day 10+ Business Days 12 monthly weighted average Wait time by practice 0 2 4 6 8 10 12 14 16 18 20 32% 19% 40% 9% Your Practice 1-2 Business Days 6-10 Business Days 3-5 Business Days 10+ Business Days

Service Delivery

• Care was deferred 322 times in the WBOPPHO network during the sample period

• Average number of deferred care instances was 11.9 per participating practice

• The highest number of reported instances of deferred care was 60 across the 71 weeks we have data

What is the Primary Care Resilience Tool?

For each Practice/Clinic/Pharmacy/Service:

Open or closed

(incl. partially closed or virtual only)

Workforce pressures (clinical and non-clinical staffing levels)

Resource pressures (critical supplies, IT, infrastructure)

Overall status (red, amber, green)

Approximate wait times (GP and UCC only) (third next available appointment for routine and urgent + virtual and walk in)

Free text

(direct comments and feedback)

Key Messages

• This reporting provides Te Whatu Ora with visibility regarding primary care workforce pressures.

• Ensures primary care data is being considered in TWO IOC (Integrated Operations Planning) alongside the sophisticated hospital capacity reporting.

• Preparation for emergency planning – becomes BAU, so when it’s no longer BAU these systems are already well embedded.

• Creates excellent baseline data in order to develop powerful workforce planning reporting to inform: Demand, Supply and Equity.

• Once familiar with the new PCRT system it will take a staff member 2 minutes per week to complete.

New HPV Dashboard - Thalamus

• Thalamus_Report-HPV_Population_March2024.pdf (wboppho.org.nz)

• Resources | Western Bay of Plenty PHO (wboppho.org.nz)

CME/CNE Sessions

Community Based Attachment

(CBA) Funding

• To address current and forecast workforce shortage GPs, funding is being provided to general practices to host CBAs.

• Provides a fee of $3,600 to general practices for each 3month CBA placement they host.

• These placements provide PGY 1 and 2 doctors with valuable experience working in primary care. This experience can also lead to registrars choosing general practice as their vocation.

• How can you get involved? Reach out to your local District Resident Medical Officer (RMO) unit.

• More info here