Western Bay of Plenty Primary Health Organisation Annual Report 2018-2019 by WBOP PHO

Annual Report 2018-2019

Welcome

Thank you for taking the time to read our Annual Report 2018-2019.

Our unique partnership between Iwi and General Practice has proved time and again that together we are better. The EBPHA’s presence now creates a trinity of optimism and expertise so that more ‘new shoots’ can be nurtured. We are excited about the opportunities that this change represents as we stay focussed on using all our resources to protect the taonga of health across our population. Enjoy.

At its heart, the whakataukī challenges us to continually look to new ways of doing things to encourage growth and improvement. We are at a pivotal moment in our organisation’s history as we look to join with Eastern Bay Primary Health Alliance, a partnership that will strengthen and broaden our joint horizons for improving the health and wellbeing of the people we serve.

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Our whakataukī, or proverb – gifted by respected rangatira Dr Morehu Ngatoko Rahipere – has never been more pertinent than now. “Tungia te ururua, kia tupu whakaritorito te tupu o te harakeke”, means “clear the undergrowth so that the new shoots of the flax will grow”.

Contents W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D A N N UA L R E P O R T 2 0 18 -2 0 19 Our History

Co-Chairs’ Report

Chief Executive Officer’s Report

Our Practices

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Our Population

Our Team

Māori Health Planning and our Iwi Partnerships

Our Programmes

Our Performance

Health and Safety

Financials

Our Future Direction

Our History

In 2003, Western Bay of Plenty GPs and Iwi shared a dream of improving the health of their mokopuna (grandchildren). Thanks to working with Māori health advisors such as Colleen Te Arihi over the previous decade, GPs had developed a strong relationship with local Iwi and wanted to go into the new contracting structures called Primary Health Organisations (PHOs) in partnership with them. “Those forming PHOs were advised to have a Māori advisory committee,” says inaugural Western Bay of Plenty Primary Health Organisation chairman Dr John Gemming.

Dr John Gemming, inaugural chairman of the Western Bay of Plenty Primary Health Organisation, and Māori health advisor and Board member, Colleen Whetukioterangi Te Arihi (Ngāi Tamawhariua), were instrumental in the formation of the PHO in 2003. They share their thoughts on how the organisation came to be and how far it has come.

“But that isn’t what we wanted. We said, ‘If we’re going to do this, we need to do it together’. After much discussion and negotiation, we formed the joint venture company Western Bay of Plenty Primary Health Organisation, with equal shares between Western Bay of Plenty Primary Care Providers Incorporated, Ngāti Ranginui and Ngāi Te Rangi. The style was to be one of partnership, with all parties advantaged by means of consensus decision-making.” Colleen organised a hui between the elders of the three Tauranga Iwi – Ngāti Ranginui, Ngāi Te Rangi and Ngāti Pūkenga. “The atmosphere among the Iwi was pretty tense at the time because of the Runanga Iwi Bill. But I can still hear the koroua and kuia saying that health was a good thing to be united on and surely this was a way forward for their mokopuna. They went into this wholeheartedly.” Ngāti Pūkenga chose not to join the PHO, but has always left the door open for a future relationship, says Colleen. John and Colleen say the powers-that-be in Wellington initially looked on the partnership with suspicion. “We took a lot of flak, but our relationship had already been established on honesty and trust. We had opened the doors to our marae and to Te Ao Māori (the Māori world),” says Colleen. The PHO was launched at Hairini Marae on 16 October 2003 and the partnership document signed by Ngaroimata Ngatai-Cavill, Te Taikato Taikato (Ngāi Te Rangi), Rangiwhakaehu Walker, Morehu Ngatoko (Ngāti Ranginui), John Gemming and Tony Farrell (Providers Inc.).

‘Who’s that?’ and I said, ‘John Gemming’s mother’. She told me to go and get her and she brought her up the front with her. I didn’t hear what was said but I like to think it was something like, ‘Now we are partners’.” Values have always played a strong role in the PHO partnership, and to this day Board meetings are opened with members taking turns to share their whakapapa, or a story, poem or song. One of the first programmes introduced by the PHO to try to improve health outcomes for Māori was Mau Rakau, a service focussed on traditional cultural practices to engage rangatahi (youth) and their whānau. The programme is still running today, alongside many other kaupapa Māori programmes. John says while the future of the PHO ultimately lies in the hands of central government and the local DHB, there will always be a need for a body that plans, nurtures and helps coordinate health services for the people in our community. While John and Colleen are pleased with what the PHO has achieved so far, they say there is still a long way to go to achieve equity of health outcomes for Māori. “The challenges remain. What can we do that is different? How do we Dr John Gemming and Colleen Whetukioterangi Te Arihi with the Western Bay of Plenty Primary Health Organisation partnership document signed at Hairini Marae on 16 October 2003.

go forward together?” says John. “The big thing for me is to try and put in place what those koroua and kuia asked of me,” says Colleen. “To improve the health of their mokopuna, and all of our mokopuna. I don’t think that dream has changed.”

the marae when she spotted a white-haired lady at the back. “She said,

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Colleen remembers Ngaroimata getting ready to call everyone on to

Co-Chairs’ Report

He rei ngā niho, he parāoa ngā kauae. We were recently reminded of this whakatauakī. It says if you want to be the teeth of a parāoa (whale) then you must also be part of and understand the inner workings of the whole jaw. In other words, we must first understand that every component of that jaw is designed to work in a particular way and every tooth represents a specific task. All pieces work in unison for the good of the whole. We use that as a metaphor for the workings of primary health. We need to understand the whole to comprehend the individual. When we reflect upon the past 12 months all we can say is ‘wow’, look how much we have had to face, and face head on. Change creates uncertainty which can at times be difficult to navigate, but what we have seen is professionalism at all levels of our organisation. There is CO - C H A I R PAO R A S TA N L E Y

no better example than the professionalism shown by Phil Back and his team as the leadership mantle was passed to Lindsey Webber. The process of finding a CEO was an amazing success in which the Board wholeheartedly participated.

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The primary health environment in which we operate in has been rife with innuendo, gossip and fear, but we kept our resolve and kept our attention where it should be. Most important has been a fundamental desire to address issues equitably and fairly. The creation of Te Haeata brought us closer to Ngā Mataapuna Oranga, EBPHA, and the BOPDHB. Who would have thought we could work together so smoothly? And yet, that potential was always there because we all

“Change creates uncertainty which can at times be difficult to navigate, but what we have seen is professionalism at all levels of our organisation.”

wanted a good collective outcome; we just needed to find a way that would work. Along the way we also moved into a space of reaching out to colleagues at EBPHA and to begin developing a transition phasing for bringing their enrolled population into our 193,000 enrolled population. That has led to some difficult, and at times, close-quarters conversations from all sides, but we were able to subsume the negatives and concentrate on collective visioning. And if all of that wasn’t enough, we had a fire at our Eleventh Avenue site. That involved a tempoary relocation, repairs, make-dos, re-focussing and just plain gritty ‘get on with it’. In fact, we have had to find pathways for ‘getting on with’ a wide array of issues. Our internal relationships within our Board is something others express envy about. Over all of the 15 years our Iwi/GP Board structure has been in place, there have been those who have wondered

if this notion of Iwi and GPs, GPs and Iwi could survive. But we can point to a solid history of getting it done. There is no doubt there has always been an understanding and a commitment by General Practice as well as by Iwi to have synchronised visions. We have done well to work together and challenge each other. At times relationships with the DHB have been strained, but that has to be considered in the context of the years of very positive interactions with the DHB. As a Board we have remained committed to doing the right thing, and there is honour in this thinking. We have seen the advent of the Health Care Home model of care, Whānau Ora, the NUKA model and a series of special projects led by our PHO. We have had representation and participation in the BOP Alliance, the After Hours Committee, our own FARs committee, and a highly active Clinical Committee. The signing off and employment of a Clinical Director, as well as Manager

CO - C H A I R D R LU K E B R A D FO R D

Māori Health gave a clear indication to the sector of where our priorities are. We have experienced change on the Board with the movements of Graham Cameron and Geoff Esterman,

joined by Mel Tata and Lorraine Anderson who bring new experience and wisdom to the table of governance. When we consider the challenges we have faced this year, we should rightly pat ourselves on the back. We have done well; we should all be proud of weathering an often unclear ocean for an outcome that has levels of altruism. We could only have achieved this with a unified Board and a committed staff. When looking into the near future of 2020, there is more of the same ahead. The announcement of the Heather Simpson report findings, the general election, and of course, the announcement of a DHB Board with different makeup, and a new CEO. We face the next round of changes gladly and openly. Finally, as Co-Chairs the thing we both value is the ability to reflect the openess and camaraderie that we as a Primary Health Organisation seek to portray when dealing with others. We are both grateful for the hard work put in by the staff and the leadership of our present CEO and our interim, as well as senior managers. We are ready to meet whatever challenges lay ahead. PAO R A S TA N L E Y ( N G Ā I T E R A N G I ) D R LU K E B R A D FO R D

the notion that we are serving our people. We are now

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both of whom worked tirelessly and with commitment to

Chief Executive Officer’s Report

A wise man once said, “The first wealth is health”. He was right, and it is a taonga the Western Bay of Plenty Primary Health Organisation has strived to protect and nurture on behalf of its communities since its founding document was signed in 2003. It is my great pleasure to welcome you to our 2018– 2019 Annual Report. We have come a long way since our inception 16 years ago and much has been achieved. This report is a celebration of our mahi with our General Practice and Iwi partners, and an opportunity to look forward to building on these achievements and setting a bright path for the future. With our beautiful beaches and endless opportunties for an outdoor lifestyle, it is no great surprise that the Bay C H I E F E X E C U T I V E O FFI C E R L I N D S E Y W E B B E R

of Plenty population is growing. Our enrolled and funded population has grown too, with up to almost 193,000 people living in our communities from Waihi Beach in the west to Whakatāne in the east. Sixteen percent of our population identify as being

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Māori and a further 2% as Pasifika. New enrolments at General Practice averaged 510 per month during the past year and we have seen a 5.3% increase in Māori enrolments in that time. This growth in Māori enrolments is important because, together with our Iwi partners, we are committed to achieving equity of health outcomes for Māori, who continue to experience systematic disparities across Aotearoa. I am proud to report that in 2018-2019 we have provided increased support to more communities than ever before. Funding increases have been used to provide services that effectively promote health and wellbeing. Other targeted funding has enabled clinical programmes and interventions to address specific areas of primary healthcare such as diabetes management, smoking cessation and cancer screening. Our patient contacts with General Practice increased again in 2018-2019 to 175,491 GP and nurse visits, and visits by Māori patients to their GP clinic accounted for 23,044 of our patient contacts (13%). Results for 2018-2019 are extremely positive. Advice and support was given to 16,313 smokers in the past 15 months, which contributes to our objective of reducing deaths from the effects of long-term smoking and chronic obstructive pulmonary disease.

Cardio-vascular disease risk assessments were

It will undoubtedly be a challenging time as changes in

completed for 58,585 patients, and improved coverage

health policy being indicated by Government will require all

for Māori males each quarter reflects, in part, the success

PHOs to be ready to respond and adapt to meet the health

of Workplace Wellness programmes and partnership with

challenges we face as a nation.

employers in the community. In a year when New Zealand has faced a serious

Our focus on improving access for high-needs whānau in partnership with our practice and Iwi partners, ensuring

measles outbreak, including 40 cases in the Western Bay

cost-efficient operations, building our clinical leadership,

of Plenty at the time of writing, progress has continued on

and maintaining close DHB and community relationships

timely vaccination of eight-month-olds who are due their

remain the PHO’s strategic kaupapa to ensure we are well-

childhood immunisations. Instances of parents declining

placed to meet these challenges.

immunisations have fallen this year, which translates to greater coverage for infants.

Nāku noa, nā.

Our cancer support screening services team has enjoyed great success in 2018-2019, with breast screening

LINDSEY WEBBER

results for at-risk wahine Māori consistently improving each quarter as a result of a focussed initiative involving better

be expanded to include our Eastern Bay clinics next year. We undertook a range of significant projects with our General Practice partners this year, including changes to the National Enrolment Service in April, the introduction of our new claims management tool Halcyon in September and the roll-out of the web-based reporting platform, Thalamus. The introduction of the Health Care Home model of care was another significant step forward this year and we have a group of innovative practices and committed practice staff who are focussed on ways to improve patient care, as well as improve the working environment for General Practice. This annual report reflects the incredible work undertaken by staff across our clinical and support services teams. I am inspired by the dedication and passion they bring to their mahi and I am truly thankful for their contribution to the achievements for the network. The past year has seen a significant period of change for the organisation. Leading through change is always challenging but it is made less so with a supportive Board and a strong, resilient team. Coming into the CEO role this year I am thankful for the collegiality and support afforded to me by the previous Interim CEO Phil Back, the senior managers and staff. In the coming year I look forward to further developing our relationships with our Eastern Bay colleagues, Iwi partners and networks as we work together for the good of the communities we serve.

“This annual report reflects the incredible work undertaken by staff across our clinical and support services teams. I am inspired by the dedication and passion they bring to their mahi and I am truly thankful for their contribution to the achievements for the network.”

coordinated activity within clinics. This successful model will

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use of patient information, improved clinical processes and

01 Our Practices

Bethlehem Family Doctors

Mount Medical Centre

Bethlehem Medical Centre

Ngati Kahu Hauora

including

Omokoroa Medical Centre

Cameron Medical Clinic Chadwick Healthcare Limited

Papamoa Beach Family Practice Papamoa Pines Medical Centre

including

Chadwick Bethlehem

including

Chadwick Greeton

Papamoa Pines @ Palm Springs

Chadwick Tauriko

Chadwick South City

Pyes Pa Doctors

Dee Street Medical Centre Farm Street Family Health Centre Fifth Avenue Family Practice

including

5th Ave on 10th

Gate Pa Medical Centre Girven Road Medical Centre Hairini Family Health Centre

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Otumoetai Doctors

Cicada Health

Ngā Kākano Foundation Family Health Services

including

Pyes Pa The Lakes Shopping Village

Tara Road Medical Centre Te Puke Medical Centre The Doctors Bayfair

including

The Doctors Papamoa

The Doctors Bureta The Doctors Kopeopeo The Doctors Phoenix The Doctors Tauranga The Doctors Total Health

Healthcare on Fifteenth

The Doctors Welcome Bay

Katikati Medical Centre

Third Age Health (Tauranga)

K AT I K AT I

MT M AU N G A N U I

O M O KO R OA

PĀ PĀ M OA

TAU R A N G A TE PUKE

W H A K ATĀ N E

Funding received for the population enrolled with a General Practice increased by 46% to $39.04m in the year ended 30 June 2019. This funding is used to provide services that promote population wellbeing and management of personal health. Other targeted funding is received to enable clinical programmes and interventions to address specific areas of primary healthcare.

16%

M ĀO R I P O P U L AT I O N E N R O L L E D

30,704

TOTA L P O P U L AT I O N E N R O L L E D

192,964

UP 2.1%

TOTA L PAT I E N T C O N TAC T S

13%

M ĀO R I PAT I E N T C O N TAC T S

W I T H G E N E R A L P R AC T I C E

Our Population Working alongside our General Practices and Iwi, Western Bay of Plenty Primary Health Organisation supports healthy lifestyles and quality healthcare services for a growing number of people in our local communities.

% of Bay of Plenty population enrolled

79.6%

175,491 23,044

Enrolled vs StatsNZ New Zealand Population Projections (2019 estimate)

Western Bay of Plenty Primary Health

Increase in Asian enrolments this year

15.5%

3.5%

Increase in over 65s enrolments this year

2.9%

Organisation currently serves 80% of the estimated population living within the Bay of Plenty. Residents are dispersed from Waihi Beach in the west to Whakatāne in the east. Sixteen percent of the 192,964 enrolled population identify as being Māori and a further 2% as Pasifika. The

30%

increase of enrolled Māori patients this year has exceeded that of the total

21.4%

population growth (+5.3% compared with +3.3%). New enrolments at General Practice averaged 510 per

Increase in Pasifika enrolments this year

7.7%

% of enrolled under 25

% of enrolled over 65

month during the past year.

Our PHO population growth exceeds the 2.27% estimate for Bay of Plenty region and is well above the 2019 national average of 2%. Young people aged under 25 years comprise 30% of our patients,

Increase in Māori enrolments this year

5.3%

while the elderly (aged 65 or more) represent 21.4% of our population. Our annual growth in under 14s (+3.5%) outstripped the elderly (2.9%), however the largest growth of 15.5% can be seen within the Asian population. The demographic profile of our Māori patients is weighted towards children, youth and young adults, which contrasts that of the total population profile skewed towards adults and the elderly.

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3.3%

Increase in under 14s enrolments this year

Total increase in enrolments this year

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Our Team The Western Bay of Plenty Primary Health Organisation team is a dedicated group of professionals with our practices and communities at the centre of everything we do. We aim to provide high quality services and ensure everyone has access to primary healthcare where, and when they need it. This is achieved through strong leadership and everyone working together to keep our communities well.

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M훮ori Health Planning and our Iwi Partnerships Western Bay of Plenty Primary Health Organisation is committed to achieving equity of health outcomes for M훮ori and is working with its Iwi partners, Ng훮i Te Rangi and Ng훮ti Ranginui, to achieve this. This commitment includes creating an organisational culture of equity and quality improvement, informed by best practice.

Our work has begun with the appointment this year of Manager Māori Health/Kaitaki Oranga Kiri Peita (Ngāi Te Rangi and Ngāti Ranginui) who is leading the development and implementation of Māori health initiatives. Kiri has been actively engaging with practices across the network to support our focus on embedding a culture of equity and a session with Kiri on equity is now part of the induction process for new employees, as well as the whakatau process and learning the PHO’s whakataukī. Information is also available on our website to ensure a focus on equity is embedded in our processes and systems. Together with our Eastern Bay partners, we will be developing a Health Strategy that is informed by evidencebased best practice frameworks and incorporates Māori models of health and wellbeing. One of the ways we can contribute to whānau wellbeing is investment in kaupapa Māori programmes. This approach to service delivery draws upon the values, tikanga and kawa (protocol) unique to the respective Iwi and is recognised as integral to whānau wellbeing. Examples of such programmes funded by the PHO are:

Kiri Peita works with Laina Bolton, Registered Nurse Chadwick Healthcare to help increase her knowledge of Māori health initiatives that seek to reduce inequities.

KO I O R A Koiora is a Ngāi Te Rangi leadership development programme that focuses on enhancement of hauora

basis for encouraging mental and spiritual health, good nutrition, regular physical exercise and enriched cultural connectedness. It is a forum that provides mentoring, sharing of knowledge, networking and goal setting. The rangatahi, aged 11-15 years old, are involved in activities such as mau rakau (Māori weaponry), traditional gathering of kai moana (fish and shellfish), water safety, tree planting, food preparation and free health checks with

Together with our Eastern Bay partners, we will be developing a Health Strategy that is informed by evidence-based best practice frameworks and incorporates Māori models of health and wellbeing.

Rangatahi involved in Koiora paddle out into Waikorire (Pilot Bay) to gather kai moana.

transfer of traditional and cultural knowledge as a

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Māori for rangatahi. The programme provides for the

the Iwi/PHO mobile youth health service, HbU. They also have an overnight stay on a marae at Matakana Island learning traditional Māori customs; climb local mountains and learn about protecting our waterways.

Tamariki had an opportunity to try golf as

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part of Tamariki Ora.

Wahine Ora, Tāne Ora, Tamariki Ora, Rangatahi Ora, Kaumatua and Marae Wānanga are the six fundamental areas that encompass Mauri Ora.

The Tauranga Moana Kohanga Reo Olympics at Queen Elizabeth Youth Centre.

M AU R I O R A Mauri Ora is a Ngāti Ranginui health facilitation and intervention programme to work towards a healthy, thriving Iwi in Tauranga Moana. It is for whānau to leave a legacy of good health for their children and mokopuna and to consider the whakataukī – Kia Tu te Mana o Ranginui – as an affirmation of living a healthconscious lifestyle. The project was launched in 2016 and builds on the previous work of Pae Ora. Wahine Ora, Tāne Ora, Tamariki Ora, Rangatahi Ora, Kaumatua and Marae Wānanga are the six fundamental areas that encompass Mauri Ora. Lifestyle programmes have included Māori fitness programme Patu Aotearoa, marae assistance to establish maara kai (vegetable and herb gardens), and men’s health programmes. Nutritional kaupapa have included looking at traditional kai gathering methods and cooking demonstrations.

M ATAO R A S E RV I C E There are three programmes within this service, including Mental Health and Addiction Co-existing Problems Counselling, Trauma Counselling and Peer Support Advocacy. The first programme uses culturally competent frameworks and approaches such as Whare Tapa Whā to target whānau aged 10 to 65 years plus. Components include screening, brief interventions and risk assessments, as well as more comprehensive assessments leading to diagnosis of substance abuse and Whānau Day cooking demonstration with Tauranga chef Stephen Wilson.

mental health disorders. Trauma Counselling is designed to support people to address and come to terms with and recover from a traumatic event. Trained staff assist individuals and whānau struggling in response to a traumatic event which has resulted in poor life outcomes. Peer Support Advocacy is a non-clinical service grounded in the belief that people are their own greatest resource and that adverse life experiences can be sources of resilience and knowledge. It focuses on what will sustain recovery i.e. employment, reconnection with whānau, and instils hope by being with someone who has been there and ‘through’ it.

Nga Taipakeke o Tauranga Moana

S U P P O R T FO R N G A TA I PA K E K E O TAU R A N G A M OA N A K A PA HAK A ROOPU Western Bay of Plenty Primary Health Organisation supported the Nga Taipakeke o Tauranga Moana kapa haka roopu to take part in the Taikura Kapa Haka 2019 event in Wellington to celebrate Matariki, the Māori New Year. The roopu consisted of Māori elders from the three Iwi of Tauranga Moana – Ngāti Ranginui, Ngāi Te Rangi and Ngāti Pūkenga – ranging in age from their early 60s to their late 80s. Haka and poi were included in their 20-minute performance, and they chose to

“Being involved in this [kapa haka] takes us back to who we are. It is our kori tinana, but not in a prescribed way.”

perform waiata from their era, composed by their own whānau, hapu and Iwi. “Being involved in this [kapa haka] takes us back to who we are. It is our kori tinana (exercise), but not in a prescribed way,” says roopu member Colleen Whetukioterangi Te Arihi (Ngai Tamawhariua). Younger whānau saw how much enjoyment their elders got from being involved and can’t wait for their turn, says Colleen. “Getting older looks positive for them. They can see there is a life after work and children. And our mokopuna get excited because Nan can do kapa haka like them.”

Colleen Whetukioterangi Te Arihi

Kapa Haka event in Wellington.

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practice their waiata-ā-ringa (action songs) for the Taikura

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Our Programmes The Western Bay of Plenty Primary Health Organisation offers a range of healthcare programmes, both DHB and self-funded. We also offer our own Health and Wellness Services to complement and assist the work of our General Practices.

DHB Funded Services AC U T E D E M A N D S E RV I C E (incl. CPO, ASH, ED/St John Redirects) A comprehensive range of targeted services, focusing on reducing Emergency Department presentations and Hospital admissions through enhanced service delivery within a primary care setting. Provision of an acute package of care supports General Practice to manage patients within the primary care setting and ensures people remain connected and cared for by their primary care provider. A F T E R H O U R S S E RV I C E S (incl. Free Access for U14s, GP and 2nd Ave After Hours Services, GP Telephone Nurse Triage, After Hours Support for HN/CSC) This suite of services, providing free access for children under 14 years of age and subsidised access for High Need and Community Service Card holders, includes extended hours offered through General Practice on week days and after hours on weekends, contracted after hours services through Accident and Healthcare and telephone-based access to health advice and triage. AG E D R E S I D E N T I A L C A R E ( A R C ) A specialised team, comprising of Clinical Nurse Specialist/s and a Clinical Pharmacist, actively focussed on enhancing clinical skill development and quality care provision within Aged Residential Care facilities across the Bay of Plenty. CO M M U N I T Y M E D I C I N E M A N AG E M E N T A targeted approach, supporting General Practice teams and referred patients with a comprehensive range of medicine management, adherence

CO M M U N I T Y R A D I O LO G Y S E RV I C E A range of ‘specialist’ radiological services focussed on diagnostic Breast Imaging and DEXA Bone Mineral Density scanning. This service is an excellent example of an integrated partnership. Bay Radiology and Medex are contracted to provide this service. CO O R D I N AT E D P R I M A RY M E N TA L H E A LT H S E RV I C E This service provides for a range of therapeutic services for depression, anxiety and youth mental health. Alcohol/drug and related therapeutic care is also delivered within a ‘Stepped Care’ model, by a range of contracted and internal specialist therapists. This service is one of the PHO’s busiest. GP SHARED CARE A service that provides intensive care to those managing opioid dependency. This service is delivered by an increasing number of GPs in partnership with the BOPDHB’s specialist Bay of Plenty Addiction Services.

Medwise.

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and specialised prescribing support and advice. This is delivered through

Diabetes nurse specialist Brenda Newman and nurse practitioner Caroline Vanstone.

WO R K I N G I N T H E CO M M U N I T Y The Western Bay of Plenty Primary Health Organisation runs several community clinics, including on marae, and provides outreach nursing care for people with long-term conditions. Senior members of the nursing team, nurse

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practitioners Caroline Vanstone and Ruth Haynes, work with other outreach nurses to provide support to our most vulnerable communities. “We support people to recognise changes in their condition early and to take the appropriate intervention,” says Caroline. For example, Caroline arranged home oxygen as well as some home-based supports such as mobility aids and home help for a patient with COPD following her discharge from hospital. These interventions helped to keep the woman well and out of hospital. “Because of these interventions, the woman was no longer as fatigued and her quality of life improved.” Ruth works in two medical centres where she consults with patients as well as their GP. “It really benefits that person because they have all their issues addressed and they benefit from different knowledge streams.” Ruth also visits ‘vulnerable’ patients in places such as Women’s Refuge, the Salvation Army, emergency housing provider Te Tuinga Whānau, and a weekly clinic in a Tauranga pharmacy.

H E A LT H C A R E H O M E Western Bay of Plenty Primary Health Organisation has taken the lead in the roll-out of the nationally recognised Health Care Home Model of Care across participating practices within the BOP. This initiative is supported by a significant two-year investment through BOPDHB and additional investment of both funding and in-kind resource from both EBPHA and the

The Schools Health Service team.

PHO to support delivery over the next three years. LO N G T E R M CO N D I T I O N S M A N AG E M E N T S E RV I C E S

P R E V E N TAT I V E C A R E F O R R A N G ATA H I

This is the the PHO’s most comprehensive integrated service,

The Western Bay of Plenty Primary Health

predominantly delivered through General Practice and community-

Organisation offers one of the most extensive

based contracted providers. It focuses primarily on Cardio-vascular Risk

free school health services in the country for 13

Assessment, diabetes detection and management, involving the integrated

to 18-year-olds with health clinics at nine of the

services of podiatry, retinal health, nurse specialists and self-management

region’s secondary schools.

education. COPD support and self-management and Pulmonary Rehabilitation also fall within this suite of services.

Our team of 10 nurses work at each school for up to 30 hours each week and GPs are available for up to two hours.

I M M U N I S AT I O N O U T R E AC H S E RV I C E S

Students use the health service for a range

Under sub-contract to EBPHA, an Outreach Immunisation Service is

of health issues, including wound care, asthma

provided to support General Practice maximise coverage of childhood

management, chest and throat infections, earache,

immunisations.

sexual health and contraception.

M I N O R S K I N S U R G E RY S E RV I C E

service supports student learning by helping

The Bay of Plenty is included in statistics for the highest rates of skin

students to stay well.

Schools health nurse Tricia Tyrrell says the

by approved specialist credentialed general practitioners. An independent

start to develop good relationships with them

specialist in skin cancer surgery is engaged to triage each referral, ensure

and you can help with advice on things like diet,

clinical standards are maintained and the DHB assigned resources used

exercise and smoking cessation.”

well. The PHO is also responsible for credentialing all approved clinicians.

Some students just need someone to talk to, and the School Health Service often refers to other

S C H O O L S H E A LT H S E RV I C E

agencies.

Delivering a comprehensive range of primary healthcare services across secondary schools within the Western Bay of Plenty, this service offers both nurse-led services during the school weeks and GP clinics on a contracted basis. These services are underpinned by excellent partnerships between schools and the PHO and has reflected continued increases in access to services by the student population. S M O K I N G C E S S AT I O N S U P P O R T There are two areas of focus within this service. General Practice teams are enabled to offer support to patients who indicate they want to quit smoking. This is not dependent on a quit date being set and achieved. The other focus is a wananga for pregnant wahine Māori, operating under the gifted name of Ūkaipō. Inclusive of the extended whānau, the service focuses on health lifestyle choices for both mama and pēpi, including smoking cessation.

“We’ve got a good knowledge of the available resources in our area. We offer preventative care, rather than just being the ambulance at the bottom of the cliff.” School health nurse Tricia Tyrrell

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“When you work with students over time you

cancer in the world. This service enables lesions to be surgically removed

PHO self-funded services

M AU R A K AU A service focused on skilled use of traditional weaponry and associated cultural beliefs, knowledge and practices to engage rangatahi and their whānau. YO U T H H E A LT H S E RV I C E ( H b U) A mobile primary healthcare and social work service delivered in the evenings across a number of high-need communities, focussing on the care needs of youth and their whānau. Ngāi Te Rangi Iwi has successfully operated this service for more than 10 years. CO M M U N I T Y N U R S I N G S E RV I C E A highly regarded registered and specialist nursing service focussed on delivering support to our General Practice network and Iwi partners through provision of community-based outreach nursing care. This comprehensive service operates out of the PHO’s Health and Wellness Services. G R E E N P R E S C R I P T I O N S/AC T I V E FA M I L I E S These are a physical activity and health lifestyle-focussed suite of services, supporting individuals and their whanāu who are seeking the benefits of improved levels of activity and improved lifestyle choices. Sport Bay of Plenty has been contracted to provide these services for more than

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10 years. PA L L I AT I V E C A R E D I S C R E T I O N A RY F U N D I N G A limited resource, intended to enable General Practice to provide more intense support during end-stage palliative care to the patient and their family through subsidisation of service costs.

“We support people to recognise changes in their condition early and to take the appropriate intervention.” Nurse practitioner Caroline Vanstone

P E R FO R M A N C E I N C E N T I V E S (incl. SLM, CVDRA and national health targets) A range of financial incentives are available to our General Practice network to recognise optimal clinical performance in a number of key areas including CVDRA, 65+ Seasonal Flu coverage, Smoking Brief Advice, and Breast and Cervical Screening coverage for Māori women. System Level Measures funding available through the Ministry of Health is supplemented by the PHO where national financial incentives no longer exist. H I G H - N E E D D I S C R E T I O N A RY F U N D I N G A dedicated funding line assigned to General Practice to use at their discretion, to assist high-need patients where financial barriers reduce access to health services. S K I N S U R G E RY D I S C R E T I O N A RY S U B S I DY A limited level of funding provided directly to General Practices to subsidise the costs of diagnostic services for patients that do not meet the eligibility criteria for access to the DHB-funded Minor Skin Surgery Service. KO I O R A ( N G Ā I T E R A N G I I W I ) Ūkaipō facilitators Tiana Bennett from the Western

the transfer of traditional and cultural knowledge as a basis for encouraging

Bay of Plenty Primary Health Organisation and

mental and spiritual health, good nutrition, regular physical exercise and

Natasha Rawiri, BOPDHB midwife, safe infant sleep

enriched cultural connectedness. It is a forum that provides mentoring,

and smoke cessation coordinator at Huria Marae.

sharing of knowledge, networking and goal setting. M AU R I O R A The service includes a range of programmes aimed at assisting and

H A P Ū M Ā M Ā L E A R N I N G TO B E S M O K E FR E E

empowering whānau to improve and develop their health and wellbeing

Ūkaipō is the PHO free four-day wānanga

journeys. The concept of Maui Ora extends beyond physical healthcare to

supporting hapū māmā (pregnant women) towards

include factors such as spiritual wellness, mental health and connectedness

a smokefree future. They also learn how to weave

to their whānau and community.

a wahakura (traditional flax baskets) that provide a safe sleeping space for their pēpi (babies).

M ATAO R A S E RV I C E

Māori women have the highest smoking rate in

There are three programmes within this service: Mental Health and

the country at 37 per cent, and are more likely to

Addiction Co-existing Problems Counselling, Trauma Counselling and Peer

smoke during pregnancy (35 per cent).

Support Advocacy.

Ūkaipō alternates between different marae in Tauranga Moana and gives hapū māmā the

H E KO KO N G A N G Ā K AU W H Ā N AU S U P P O R T S E RV I C E

knowledge, skills and confidence to make lasting

This service works with tenants of Accessible Properties Limited (APL).

changes, says Ūkaipō Lead/Health Promotion

The service delivery approach is a whanau support model that works

Coordinator Tiana Bennett.

alongside whānau to identify and manage health and wellbeing issues,

“It’s ‘kai’ for their souls, their minds and their

with the view that by developing a relationship based on support and

bodies. It’s also a great opportunity for māmā

trust these issues will be able to be addressed.

to support each other on a smokefree journey towards a healthy future for their whānau.” Women who attend the programme learn about the effects of first, second and third-hand smoking, and sudden unexpected death in infancy (SUDI), of which smoking is a contributing factor.

enhancement of hauora Māori for rangatahi. The programme provides for

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Koiora is a leadership development programme that focusses on

Health and Wellness Services

S U P P O R T TO S C R E E N I N G S E RV I C E S A nationally-funded cervical and breast screening service focussed on improving screening coverage rates for priority women. CO P D A service focussed on providing education and support to General Practice Champions in the effective management of patients diagnosed with COPD as an initiative to reduce unnecessary ED presentations and admissions related to COPD.

The Support to Screening team: Sharmila Pathak, Joanne Tuhakaraina and Donna Moon.

D I A B E T E S N U R S E E D U C AT I O N A highly-regarded service that focusses on the care of acute diabetics and consultative support to clinicians.

S U P P O R T FO R B R E A S T A N D C E RV I C A L SCREENING The Western Bay of Plenty Primary Health

CO M M U N I T Y C L I N I C S

Organisation has exceeded its Ministry of Health

A range of community-based clinics designed to improve accessibility

targets for breast and cervical screening for wāhine

to care and provide a range of services including health assessments,

Māori, largely thanks to the efforts of our Support

vaccinations and smoking cessation advice.

to Screening team.

S E L F - M A N AG E M E N T G R O U P S ( S M G )

extended to cover the Eastern Bay of Plenty.

These groups are focussed on assisting people manage their health

Services Leader, Philippa Jones, is hoping to mirror

conditions. Groups currently offered include lifestyle wellness, CVD,

the success achieved in the Western Bay of Plenty

diabetes and mindful eating.

by working with Eastern Bay businesses and the Iwi

The success has resulted in the contract being

alliance.

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Referrals come from a variety of sources including BreastScreen Midland, General Practice and self-referrals. Team members come from backgrounds and ethnicities that reflect the demographic of the women they are phoning,

“Sometimes the women have told their General Practice they don’t want it done so we make a last-ditch effort with more information and encouragement and sometimes that works.” Clinical coordinator Donna Moon on support for breast and cervical screening.

which helps develop a rapport. And they are persistent. “We’re like the squeaky wheel,” says clinical coordinator Donna Moon. “Sometimes the women have told their General Practice they don’t want it done so we make a last-ditch effort with more information and encouragement and sometimes that works.” Appointments can be made for a cervical smear at a community clinic (including marae), at Health and Wellness Services’ walk-in clinic or within a woman’s home. On average the team has around 300 referrals each month for breast and cervical screening. The team has several initiatives to promote screening, including attending the Tauranga Moana Tangata Tauranga Festival, and tapping into the PHO’s Workplace Wellness programme to identify women for screening.

DIETITIANS Two dietitians provide a range of services within PHO-delivered services, General Practice and community-based organisations including taking a key part in the provisions of self-management groups. M AU R I O R A Health and Wellness Services partner with Ngati Ranginui Iwi in the provision of a range of nurse-led healthcare and marae-based services. ST JOHN AMBUL ANCE Health and Wellness Services support General Practice in the management of patients redirected by St John or on-referred by Emergency Departments when primary care management is appropriate. I N S U L I N S TA R T S An education programme developed for practice nurses to optimise the use of insulin for diabetics. CO N T I N U I N G M E D I C A L E D U C AT I O N (C M E ) Health and Wellness Services coordinates and delivers a comprehensive medical and nursing continuing education service across our provider network. R O U T I N E WO U N D M A N AG E M E N T Health and Wellness Services provides a back-up arrangement for patients

Jones with St John territory manager Ross Clarke outside Health and Wellness Servicesâ&#x20AC;&#x2122; walk-in clinic.

Western Bay of Plenty Primary Health Organisaton Services Leader Philippa

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referred to their General Practice for management of wounds.

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Our Performance In 2018-2019 the Western Bay of Plenty Primary Health Organisation provided increased support to more communities than ever before, with funding increases used to provide services that effectively promote health and wellbeing. Services provided by the Western Bay of Plenty Primary

part, the success of Workplace Wellness programmes and

Health Organisation reached more patients in the year

partnership with employers in the community.

ended 30 June 2019 than in previous years and clinical

Progress continued on timely vaccination of eight-

staff had greater success in reaching greater numbers of

month-olds who are due their childhood immunisations,

at-risk patient groups.

with sustained success in reaching MÄ ori children.

Brief advice was given to 16,313 smokers in the past 15 months and clinical staff made positive gains during the year. This activity, along with the referrals for 16% of

Instances of parents declining immunisations have fallen this year, which translates to greater coverage for infants. Our cancer support screening services team contacted

smokers to support-to-quit programmes, reflects progress

12% more women than in 2018 for their cervical smears.

towards the PHO objective of reducing patient deaths from

Contacts with at-risk MÄ ori women (50-69 years) have

the effects of long-term smoking and chronic obstructive

consistently improved quarterly breast screening results

pulmonary disease.

for the Western Bay of Plenty as a result of a focussed

Cardio-vascular disease risk assessments were

PHO initiative involving better use of patient information,

completed for 58,585 patients, which reflects sustained

improved clinical processes and coordinated activity within

clinical intervention for at-risk patients. Improved coverage

clinics. This successful model will be expanded to include

for MÄ ori males (35-44 years) each quarter reflects, in

our Eastern Bay clinics next year.

Smokers provided with support to quit

89.5% WO M E N S C R E E N E D F O R C A N C E R

Māori women screened for breast cancer

79.3% 92.4%

Capitation funding increase

46.2% *per MOH Capitation Schedules

72%

7,600 Student contacts with Schools Health Service *number of student visits to a nurse Comprehensive health assessments for Year 9s

“Targeted funding has enabled clinical programmes and interventions to address specific areas of primary healthcare such as diabetes management, smoking cessation and cancer screening.” CEO Lindsey Webber

651

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5.8%

Māori women screened for cervical cancer

Cancer support screening services teams contacted 12% more Māori women than in 2018.

eligible patients received heart and diabetes checks

Patients 15+ with diabetes

38,783

2 5

Advice and support was given to 16,313 smokers in the past 15 months, which contributes to our objective of reducing deaths from the effects of long-term smoking and chronic obstructive pulmonary disease.

07 Health and Safety The Western Bay of Plenty Primary Health Organisation is committed to protecting and nurturing the physical and mental wellbeing of all people in its workplace by providing a healthy, safe and positive place to work. Our Health and Safety Committee includes staff and

As part of a positive and collegial working environment PHO staff have

management who work together to improve conditions and

taken part in some fun team-building activities, including a games day

interactions in our workplace.

and Gnoming Competition.

A highlight this year came during Mental Health Awareness Week 2019. Staff were involved in daily activities to explore the awareness week themes of whenua (connection to land and roots), taha hinengaro (mental and emotional wellbeing) taha tinana (physical wellbeing), taha whānau (family and social wellbeing) and taha wairua (spiritual wellbeing). This included a lunchtime picnic in Yatton Park where

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Manager Māori Health Kiri Peita provided a history of the area and Primary Mental Health Coordinator Sylvia Donaldson took staff though some mindfulness exercises. In another nod to maintaining a positive and collegial work environment we have taken part in some fun team-building activities, including a games day at Queen Elizabeth Youth Centre and a Gnoming Competition where staff came together to dress, name and create a whakapapa for their team gnome. All staff were involved in the national ShakeOut 2019, which reminds people of the action to take during an earthquake – Drop, Cover and Hold – and to practice a Tsunami Hīkoi (evacuation) in a coastal area. As part of our health and safety responsibilities we have health and safety representatives, including fire and floor wardens, at all three of our sites – Head Office in Eleventh Avenue, Health and Wellness Services in First Avenue West, and our Eastern Bay base in Whakatāne. All new team members receive a health and safety induction, including a workstation assessment, and we are members of the Vitae Employee Assistance Programme, New Zealand Institute of Safety, and the Employers and Manufacturers Association.

O U R H E A LT H A N D S A FE T Y T R A I N I N G I N C LU D E S : • an overview of health and safety responsibilities, including proactive reporting • an online defensive driving course • emergency planning training • IT security • fire safety for our fire and floor wardens • a de-escalation course • dog safety training for staff working in the field.

08 Financials FO R T H E Y E A R E N D E D 3 0 J U N E 2 0 19

Directorsâ&#x20AC;&#x2122; Annual Report

Statement of Comprehensive Revenue and Expense

Statement of Changes in Net Assets

Statement of Financial Position

Statement of Cash Flows

Notes to the Financial Statements

Auditorâ&#x20AC;&#x2122;s Report

Directory

W E S T E R N B AY O F P L E N T Y P R I M A RY C A R E P R OV I D E R S I N C R E P R E S E N TAT I V E S

Dr Luke Bradford Dr Todd Hulbert Lorraine Anderson (appointed 4 September 2019) Dr Symon Roberton (appointed 20 September 2018) Dr Geoff Esterman (resigned 4 September 2019) Marion Guy (resigned 20 September 2018) N G Ā I T E R A N G I R E P R E S E N TAT I V E S

Charlie Tawhiao Paora Stanley N G ĀT I R A N G I N U I R E P R E S E N TAT I V E S

Graeme Elvin Melanie Te Arai Tata (appointed 26 March 2019) Graham Cameron (resigned 26 March 2019) ACCO U N TA N T S

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Baker Tilly Staples Rodway Tauranga Limited AU D I TO R S BDO Tauranga BANKERS ASB Bank S O L I C I TO R S Cooney Lees Morgan 247 Cameron Road Tauranga R E G I S T E R E D O FFI C E C/- Cooney Lees Morgan 247 Cameron Road Tauranga

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Directorsâ&#x20AC;&#x2122; Annual Report For The Year Ended 30 June 2019

The Board of Directors present their Annual Report for the year ended 30 June 2019. The Shareholders of the Company have exercised their rights under S.211(3) of the Companies Act 1993, and unanimously agreed that this Annual Report need not comply with any paragraph and (e) - (j) of S.211 (1) of this act. T R A N S AC T I O N S W I T H D I R E C TO R S The Board received no notices during the year from directors that they had an interest in any transactions, or proposed transactions, with the Company. D O N AT I O N S

Dr Luke Bradford

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

Paora Stanley

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Donations totalling $6,670 were made during the year (Last Year: $50)

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Comprehensive Revenue and Expense For The Year Ended 30 June 2019

Note

2019

2018

Revenue received

16,396,675

14,688,985

Project expenditure

(12,841,636)

(11,659,552)

GROSS SURPLUS

3,555,039

3,029,433

Other income

–

(2,614,386)

(2,283,771)

OPERATING SURPLUS/(DEFICIT)

940,653

745,662

Adminstrative expenses

Investment income

373,185

331,070

NET FINANCE INCOME

373,185

331,070

3 0

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NET SURPLUS/(DEFICIT)

1,313,838

1,076,732

Other comprehensive income

–

TOTAL COMPREHENSIVE REVENUE AND EXPENSE FOR THE YEAR

1,313,838

1,076,732

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Changes in Net Assets For The Year Ended 30 June 2019

Contributed

General

Clinical Services

Retained

capital

reserve

earnings

Total

Balance at 1 July 2017

–

1,000,000

5,359,142

2,071,117

8,430,259

Total comprehensive revenue and expense Surplus/(deficit) for the period

–

1,076,732

Transfers

–

Total comprehensive revenue and expense

–

1,076,732

–

1,051,335

(1,051,335)

–

1,051,335

25,397

1,076,732

Balance at 30 June 2018

–

1,000,000

6,410,477

2,096,514

9,506,991

Surplus/(deficit) for the period

–

1,313,838

Transfers

–

1,188,387

(1,188,387)

–

Total comprehensive revenue and expense

–

1,188,387

125,450

1,313,838

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Total comprehensive revenue and expense

Balance at 30 June 2019

–

1,000,000

7,598,864

2,221,965

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

10,820,829

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Financial Position For The Year Ended 30 June 2019

Note

2019

2018

CURRENT ASSETS

Cash and cash equivalents

609,628

235,513

Short term deposits

11,548,092

10,216,649

Trade and other exchange receivables

1,412,756

1,308,984

TOTAL CURRENT ASSETS

13,570,476

11,761,146

NON–CURRENT ASSETS Plant and equipment

333,858

149,585

46,760

63,183

TOTAL NON–CURRENT ASSETS

380,618

212,768

TOTAL ASSETS

13,951,094

11,973,914

1,543,650

1,638,936

Deferred income/revenue

1,367,731

653,683

Provisions

218,884

174,304

TOTAL CURRENT LIABILITIES

3,130,265

2,466,923

TOTAL LIABILITIES

3,130,265

2,466,923

NET ASSETS

10,820,829

9,506,991

–

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Intangible assets

CURRENT LIABILITIES Trade and other payables

EQUITY Contributed capital

–

Reserves

8,598,864

7,410,477

Retained earnings

2,221,965

2,096,514

TOTAL EQUITY

10,820,829

9,506,991

For and on behalf of the board of directors

Paora Stanley. Date: 30/10/2019

Dr Luke Bradford. Date: 30/10/2019

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Cash Flows For The Year Ended 30 June 2019

Note

2019

2018

Cash flows from operating activities

Cash receipts from customers

17,047,317

14,708,660

Cash paid to suppliers

(11,927,038)

(10,475,526)

Cash paid to employees

(3,436,551)

(3,154,518)

1,683,728

1,078,617

Interest received

322,087

337,924

Acquisition of intangible assets

(38,120)

(23,891)

Net cash from operating activities Cash flows from investing activities

Acquisition of property, plant and equipment

(262,135)

(94,502)

Acquisition of short term deposits

(1,331,445)

(2,362,775)

Net cash flow from investing activities

(1,309,613)

(2,143,243)

Cash flows from financing activities

–

Net cash flows excluding cash and cash equivalents

374,115

(1,064,627)

Cash and cash equivalents at 1 July

235,513

1,300,140

Cash and cash equivalents at 30 June

609,628

235,513

3 3

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

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W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements For The Year Ended 30 June 2019

1 R E P O R T I N G E N T I T Y Western Bay of Plenty Primary Health Organisation (‘the Company’) is a company incorporated in New Zealand and registered under the Companies Act 1993 and is a reporting entity for the purposes of the Financial Reporting Act 2013. The Company is a charity registered with Charity Services (Charity Registration CC30518). It provides primary healthcare services to 190,000 people residing in the Western Bay of Plenty. It is a Joint Venture between two Western Bay of Plenty Iwi, Ngāi Te Rangi and Ngāti Ranginui; and the Western Bay of Plenty Care Providers Inc. Since becoming operational on 1 October 2003, the organisation has developed and delivered a wide range of nursing, general practitioner and other health disciplines. This is undertaken in close association with the District Health Board and other health-focussed community-based organisations. The Company is considered a public benefit entity for the purposes of financial reporting in accordance with the Financial Reporting Act 2013.

2 B A S I S O F P R E PA R AT I O N The financial statements have been prepared on a going concern basis, and the accounting policies have been

3 4

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consistently applied throughout the period. Accounting policies are selected and applied in a manner which ensures that the resulting financial information satisfies the concepts of relevance and reliability, thereby ensuring that the substance of the underlying transactions or other events is reported. (a) Statement of Compliance The financial statements have been prepared in accordance with New Zealand Generally Accepted Accounting Principles (“NZ GAAP”). They comply with Public Benefit Entity International Public Sector Accounting Standards (“PBE IPSAS”) and other applicable Financial Reporting Standards, as appropriate for Tier 2 not–for–profit public benefit entities. The entity has elected to report in accordance with the Tier 2 standards, taking advantage of all disclosure concessions as it is not publicly accountable and has expenses less than $30 million. (b) Measurement Basis The financial statements have been prepared on the basis of historical cost. (c) Functional Currency The financial statements are presented in New Zealand dollars and all values are rounded to the nearest dollar ($). (d) Goods and Services Tax All balances are presented net of goods and services tax (GST), except for trade receivables and trade payables which are presented inclusive of GST. (e) Income Tax The Company is exempt from taxation as a result of being registered as a charitable entity under the Charities Act 2005 from 30 June 2009.

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

(f) Accounting Policies There have been no changes in accounting policies. Policies have been applied on a consistent basis with those of the previous reporting period.

3 R E V E N U E Revenue Accounting Policy Revenue is recognised to the extent that it is probable that the economic benefit will flow to the Company and revenue can be reliably measured. Revenue is measured at the fair value of consideration received. The Company assesses its revenue arrangement against specific criteria to determine if it is acting as the principal or agent in a revenue transaction. In an agency relationship only the portion of revenue earned on the Company’s own account is recognised as gross revenue in the Statement of Comprehensive Revenue and Expense. The following specific recognition criteria must be met before revenue is recognised. (i) Revenue from Exchange Transactions

2018

Contract income

9,741,776

9,249,896

9,741,776

9,249,896

Policy The Company is involved in providing essential primary healthcare services, as well as performing related services. Exchange revenue is revenue received in exchange for goods or services of approximate equal value. Exchange revenue from Provision of Healthcare Services rendered is recognised in proportion to the stage of completion of the transaction at the reporting date and performance against other ongoing obligations under the contracts. The stage of completion is assessed by reference to work performed and milestones achieved in project and contract-based funding. (ii) Revenue from Non–exchange Transactions

2019

2018

First level services funding

6,654,899

5,439,089

6,654,899

5,439,089

Policy Non–exchange revenue Non–exchange transactions are those where the Company receives value from another entity (e.g. cash or other assets) without giving approximately equal value in exchange. When non–exchange revenue is received with restrictions attached, but there is no requirement to return the asset if not deployed as specified, the revenue is recognised on receipt. (iii) Interest Income Interest revenue is recognised as it accrues, using the effective interest method.

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2019

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

(iv) Donated Services The Company sometimes provides placements for student nurses within its nursing services. The Company has elected not to recognise these services as they are difficult to measure reliably and are immaterial in the context of the activities of the company. (v) Agency Basis The Company considers it is acting as an agent in respect of capitation funding received from the Ministry of Health. During the year $34,896,617 was received and paid out to member practices (2018:$26,701,021). Deferred Income/revenue

2019

Contract income in advance

1,252,231

578,433

Other income in advance

2018

115,500 1,367,731

75,250 653,683

Policy The above revenue is deferred to reflect either the contractual obligations associated with the contracts or the constructive obligations arising from commitments by the Board to spend these funds on specific projects. They have been classified as current depending on the terms of the contracts or if no time frame exists on managementâ&#x20AC;&#x2122;s estimate of when the funds will be spent . The funds associated

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with this income are restricted for use in accordance with the obligations. 4 A D M I N I S T R AT I O N E X P E N S E S

2019

2018

included within administration expenses are the following: Audit fees Depreciation of property, plant and equipment Loss on disposal of property, plant and equipment Depreciation recovered Rent and operating lease payments Amortisation of intangible assets Accountancy

10,763

16,783

(25,796)

67,239

4,705

609

â&#x20AC;&#x201C;

(2,392)

284,390

232,575

54,542

39,744

185,591

169,632

5 E M P LOY E E B E N E FI T S

2019

2018

Wages and salaries

3,503,554

3,180,462

3,503,554

3,180,462

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

Employee Benefits continued

2019

2018

Short Term Provision for Holiday Pay Opening Balance Movement for the year Closing Balance

174,304

152,554

44,580

21,750

218,884

174,304

POLICIES Short Term Employee Benefits Short term employee benefits are expensed as the related service is provided. A liability is recognised for the amount expected to be paid if the Company has an obligation to pay this amount as a result of past service provided by the employee and the obligation can be estimated reliably. Provisions Provision is made for benefits accruing to employees in respect of wages and salaries and annual leave when it is probable that settlement will be required and they are capable of being measured reliably.

2019

2018

609,628

235,338

–

Cash and bank balances Call deposits (≤ 3 months maturity) ASB Visa

– 609,628

175 235,513

Cash and cash equivalents are cash balances that are short term in nature for the purposes of the Statement of Cash Flows, and are classified as a Loans and Receivables financial asset. Call deposits have maturities under 90 days.

7 S H O R T T E R M D E P O S I T S ANZ term deposits

2019

2018

2,907,144

3,109,508

ASB term deposits

4,944,446

4,227,987

BNZ term deposits

2,644,900

1,862,387

Kiwibank term deposits

1,051,602

1,016,767

11,548,092

10,216,649

Short term deposits are made for varying periods of between three months and nine months depending on the immediate cash requirements of the Company and earn interest at the respective short term deposit rates. Of those held at year end, $6,979,929 have matured at 31 October 2019.

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6 C A S H A N D C A S H E Q U I VA L E N T S

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

Short Term Deposits continued Policy Short term deposits compromise of bank term deposits with maturities of less than 12 months at acquisition but greater than three months. Term deposits are recognised at cost, being the fair value of the consideration given. After initial recognition, term deposits are measured at amortised cost using the effective interest method.

8 T R A D E A N D OT H E R R E C E I VA B L E S

2019

2018

Trade receivable (exchange transactions)

818,105

784,691

Income accrued

403,581

322,487

Prepayments

191,070

173,472

GST receivable

â&#x20AC;&#x201C; 1,412,756

28,334 1,308,984

Trade receivables are shown net of allowances for bad and doubtful debts of $nil (2018: nil) Policy

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Trade receivables are initially measured at fair value, then adjusted for any impairment. Trade receivables are classified as a Loan and Receivables financial asset.

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

9 P R O P E R T Y, P L A N T A N D E Q U I P M E N T

Office

Leasehold

Equipment

Improvements

Wellness Assets

Health and

Total

558,301

15,560

158,188

732,049

Additions

34,243

4,062

50,662

88,967

Disposals

(161,800)

–

(8,682)

(170,482)

430,745

19,622

200,169

650,534

Cost Balance at 1 July 2017

Balance at 30 June 2018 Balance at 1 July 2018

430,745

19,622

200,169

650,534

Additions

185,653

56,788

19,695

262,136

Disposals Balance at 30 June 2019

(9,316)

–

607,082

76,409

–

(9,316)

219,864

903,354

Depreciation Disposals

(508,367)

(6,110)

(89,107)

(603,584)

(35,568)

(1,108)

(30,563)

(67,238)

161,373

–

8,501

169,874

Balance at 30 June 2018

(382,563)

(7,218)

(111,169)

(500,949)

Balance at 1 July 2018

(382,563)

(7,218)

(111,169)

(500,949)

(30,700)

(2,372)

(40,086)

(73,158)

4,611

–

4,612

(408,651)

(9,590)

(151,256)

(569,495)

49,934

9,451

69,081

128,466

Balance at 30 June 2018

48,182

12,403

88,999

149,584

Balance at 30 June 2019

198,431

66,820

68,608

333,858

Depreciation Disposals Balance at 30 June 2019 Balance at 1 July 2017

POLICIES Measurement All property, plant and equipment are stated at cost less accumlated depreciation. Depreciation is allocated over the estimated useful life of the asset. The following methods are used in the calculation of depreciation: Office equipment

0–67%

Straight line

Leasehold improvements

7–21%

Straight line

Health and Wellness assets

7–40%

Straight line

Any gain or loss on disposal of an item of property, plant and equipment is recognised in surplus or deficit.

Balance at 1 July 2017

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Accumulated depreciation

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

10 I N TA N G I B L E A S S E T S

Intangible Assets

Cost Balance at 1 July 2017 Additions Disposals

113,437 31,817 –

Balance at 30 June 2018

145,254

Balance at 1 July 2018

145,254

Additions

38,121

Disposals

–

Balance at 30 June 2019

183,375

Accumulated Depreciation Balance at 1 July 2017

(42,328)

Amortisation

(39,744)

Disposals

4 0

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Balance at 30 June 2018

– (82,072)

Balance at 1 July 2018

(82,072)

Amortisation

(54,542)

Disposals Balance at 30 June 2019

– (136,614)

Balance at 1 July 2017

71,109

Balance at 30 June 2018

63,182

Balance at 30 June 2019

46,760

POLICIES Measurement Acquired computer software licenses are capitalised on the basis of the costs incurred to acquire and bring to use the specific software. Costs that are directly associated with the development of software for internal use are recognised as an intangible asset. Direct costs include the costs of materials and services, employee costs, and any directly attributable overheads. Costs of software updates or upgrades are capitalised only when they increase the usefulness or value of the asset. All other costs are expensed when incurred.

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

Intangible Assets continued Amortisation The carrying value of an intangible asset is amortised on a straight line basis over its useful life. Amortisation begins when the asset is available for use and ceases at the date that the asset is derecognised. The amortisation charge for each financial year is recognised in the surplus or deficit. The amortisation rates of major classes of intangible assets have been estimated as follows: Computer software and development

33–40% Straight line

2019

2018

Trade payables due to related parties

177,737

220,904

Other trade payables

945,999

1,056,747

GST payable

3,130

–

ASB Visa

4,282

–

Accrued expenses Trade payables

412,502

361,285

1,543,650

1,638,936

Trade payables are recognised at cost when the Company becomes obliged to make future payments resulting from the purchases of goods and services. Trade payables are classed as an ‘other amortised cost financial liability’.

1 2 CO M M I T M E N T S (a) Operating Commitments 1. The Company leases two office premises under operating leases. The head office lease for the Eleventh Ave building, due for renewal and rent review on 30 September 2018, and the First Ave lease for the Health and Wellness Centre which has a renewal date of 1 July 2019 and a final expiry date of 30 June 2021. 2. The Company also leases office equipment under operating leases. The leases typically run for a period of three years. The equipment is replaced at the end of the period and a new lease is negotiated. Operating Lease Commitments

2019

2018

239,651

138,900

96,582

31,135

No later than one year Between 1–5 years More than 5 years

–

336,233

170,035

Subsequent to balance date the Company entered into three additional vehicle leases. The amount committed is $68,658. (2018: nil.)

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11 T R A D E A N D OT H E R PAYA B L E S

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

13 CO N T I N G E N T L I A B I L I T I E S

There were no contingent liabilities as at 30 June 2019. (2018: nil)

14 S U B S E Q U E N T E V E N T S The governing boards of the Company and Eastern Bay Primary Health Alliance have entered into a Memorandum of Understanding with the intention to combine the two organisations. Combination discussions are at a very early broad stage and the legal form of the combination has not been identified or confirmed. A combined organisation is not likely to occur any earlier than 1 December 2019. It is hoped that operational efficiencies will be achieved upon combining, to allow a greater emphasis on positive health outcomes of enrolled service users of all populations within the combined geographic area. 1 5 R E L AT E D PA R T Y T R A N S AC T I O N S (i) Key Management and Governance Personnel Remuneration Key management personnel compensation The Company classifies its key management personnel into the following categories: ‒ Directors (of the governing body)

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‒ Executive Officers Directors of the governing body receive an annual fee of $12,000 each. Co–chairs receive a futher $15,000 each per annum in recognition of their additional duties and responsibilities. Executive Officers are employees of the company and are on standard employment contracts. The table below depicts the aggregate remuneration of key management personnel and the number of individuals determined on a full–time equivalent basis, receiving remuneration with the category.

2019 Remuneration

Number

2018 Remuneration

Number

Directors

167,608

186,616

Executive officers

550,681

3.5

606,674

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

(ii) Transactions with Other Related Parties The Company transacts with other related parties in the normal course of their business. Such entities include those related by virtue of common governance and management personnel. During the year, the Company made the following purchases from related parties for the provision of health services and at year end, the following balances remained owing: Purchases

Payable

Purchases

Payable

2019

2018

Ngāti Ranginui Iwi Incorporated

233,501

57,500

391,000

80,500

Te Runanga O Ngāi Te Rangi Iwi Trust

761,621

71,875

416,612

92,766

Fifth Avenue Family Practice

3,270,893

30,877

2,866,562

38,354

Papamoa Pines Health Centre

2,522,976

12,905

–

3,570

691,032

4,352

WBOP Primary Care Providers Inc Gate Pa Medical Centre Limited Graham Cameron Moana Communications Te Manu Toroa Trust

955 776,001

– 7,274

2,940

–

4,780

–

900

–

1,700

–

(1,303)

(2,694)

(9,623)

1,362

7,568,484

177,737

4,365,633

220,904

Ngāti Ranginui Iwi Incorporated is a shareholder and provider to the Company. Graham Cameron and Graeme Elvin are their appointed directors. Paora Stanley and Charlie Tawhiao are Trustees of Te Runanga O Ngāi Te Rangi Iwi Trust which is a shareholder and provider to the Company. Dr Luke Bradford is a Partner in Fifth Avenue Family Practice which is a provider to the Company. Dr Geoff Esterman is a Director in Gate Pa Medical Centre Limited which is a provider to the Company. Dr Symon Roberton is a Director in Papamoa Pines Health Centre limited which is a provider to the Company. Charlie Tawhiao is a Trustee for Moana Communications. Graham Cameron is a Trustee of Te Manu Toroa Trust All related party transactions were on normal commerical terms. No related party tranactions were written off or forgiven during the period.

4 3

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W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2019

16 R E S E RV E S General Reserve The general reserve was established in 2010 to provide for future possibilities in respect of member practices and lease obligations. Clinical Services Reserve The clinical services reserve was established in 2011 to provide funds for clinical projects not funded by the Bay of Plenty District Health Board. Normal policy is to transfer surpluses from completed contracts into the clinical services reserve.

17 R E CO N C I L I AT I O N O F S U R P LU S W I T H N E T C A S H FR O M O P E R AT I N G AC T I V I T I E S

2019

2018

1,313,838

1,076,732

127,700

106,981

4,705

(1,783)

(114,507)

(86,240)

Cash flows from operating activities Adjustments for:

‒ Depreciation/amortisation

4 4

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Net finance costs

‒ (Gain)/loss on sale of property,

plant and equipment

Changes in:

‒ Trade and other receivables ‒ Prepayments

(17,597)

(36,446)

‒ Trade and other payables

(98,416)

238,587

‒ Provisions and employee benefits

‒ Deferred income/revenue

‒ GST

44,579

21,751

714,049

112,770

31,464

(15,811)

(322,087)

(337,924)

1,683,729

1,078,617

Less items classified as investing activities

‒ Interest received

Net cash from operating activities

18 S H A R E C A P I TA L The number of authorised ordinary shares total 120 (2018:120). The authorised shares are fully issued but unpaid. All shares have equal rights to vote. In terms of the Constitution, the Directors have no authority to declare dividends.

I N D E P E N D E N T AU D I TO R ’ S R E P O R T TO T H E S H A R E H O L D E R S O F W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Report on the Audit of the Financial Statements

OPINION

necessary to enable the preparation of financial statements

We have audited the financial statements of Western

that are free from material misstatement, whether due to

Bay of Plenty Primary Health Organisation Limited (“the

fraud or error.

Company”), which comprise the statement of financial position as at 30 June 2019, and the statement of

In preparing the financial statements, the directors are

comprehensive revenue and expense, statement of changes

responsible on behalf of the Company for assessing

in net assets/equity and cash flow statement for the year

the Company’s ability to continue as a going concern,

then ended, and notes to the financial statements, including

disclosing, as applicable, matters related to going concern

a summary of significant accounting policies.

and using the going concern basis of accounting unless the directors either intend to liquidate the Company or to cease

In our opinion, the accompanying financial statements

operations, or have no realistic alternative but to do so.

present fairly, in all material respects, the financial position of the Company as at 30 June 2019, and its financial

AU D I TO R ’ S R E S P O N S I B I L I T I E S FO R T H E AU D I T

performance and its cash flows for the year then ended in

O F T H E FI N A N C I A L S TAT E M E N T S

accordance with Public Benefit Entity Standards Reduced

Our objectives are to obtain reasonable assurance about

Disclosure Regime (“PBE Standards RDR”) issued by the

whether the financial statements as a whole are free from

New Zealand Accounting Standards Board.

material misstatement, whether due to fraud or error,

not a guarantee that an audit conducted in accordance

Standards on Auditing (New Zealand) (“ISAs (NZ)”).

with ISAs (NZ) will always detect a material misstatement

Our responsibilities under those standards are further

when it exists. Misstatements can arise from fraud or

described in the Auditor’s Responsibilities for the Audit

error and are considered material if, individually or in the

of the Financial Statements section of our report. We

aggregate, they could reasonably be expected to influence

are independent of the Company in accordance with

the decisions of users taken on the basis of these financial

Professional and Ethical Standard 1 (Revised) Code of

statements.

Ethics for Assurance Practitioners issued by the New Zealand Auditing and Assurance Standards Board, and

As part of an audit in accordance with ISAs (NZ), we

we have fulfilled our other ethical responsibilities in

exercise professional judgement and maintain professional

accordance with these requirements. We believe that

scepticism throughout the audit. We also:

the audit evidence we have obtained is sufficient and

• Identify and assess the risks of material misstatement

appropriate to provide a basis for our opinion.

of the financial statements, whether due to fraud or error, design and perform audit procedures

Other than, in our capacity as auditor we have no

responsive to those risks, and obtain audit evidence

relationship with, or interests in, the Company.

that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material

D I R E C TO R S ’ R E S P O N S I B I L I T I E S FO R T H E

misstatement resulting from fraud is higher than for

FI N A N C I A L S TAT E M E N T S

one resulting from error, as fraud may involve collusion,

The directors are responsible on behalf of the Company

forgery, intentional omissions, misrepresentations, or

for the preparation and fair presentation of the financial statements in accordance with PBE Standards RDR, and for such internal control as the directors determine is

the override of internal control. • Obtain an understanding of internal control relevant to the audit in order to design audit procedures that

continues overleaf

Reasonable assurance is a high level of assurance, but is

We conducted our audit in accordance with International

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and to issue an auditor’s report that includes our opinion. B A S I S FO R O P I N I O N

Independent Auditor’s Report to the Shareholders of Western Bay Of Plenty Primary Health Organisation Limited continued

are appropriate in the circumstances, but not for the

We communicate with the directors regarding, among

purpose of expressing an opinion on the effectiveness

other matters, the planned scope and timing of the audit

of the Company’s internal control.

and significant audit findings, including any significant

• Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates

deficiencies in internal control that we identify during our audit.

and related disclosures made by management. • Conclude on the appropriateness of the use of the

W H O W E R E P O R T TO

going concern basis of accounting by the directors

This report is made solely to the Company’s Shareholders,

and, based on the audit evidence obtained, whether

as a body. Our audit work has been undertaken so that we

a material uncertainty exists related to events or

might state those matters which we are required to state to

conditions that may cast significant doubt on the

them in an auditor’s report and for no other purpose. To the

Company’s ability to continue as a going concern. If

fullest extent permitted by law, we do not accept or assume

we conclude that a material uncertainty exists, we are

responsibility to anyone other than the Company and the

required to draw attention in our auditor’s report to the

Company’s Shareholders, as a body, for our audit work, for

related disclosures in the financial statements or, if such

this report or for the opinions we have formed.

disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the Company to cease to continue as a going concern.

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• Evaluate the overall presentation, structure and content of the financial statements, including the

BDO Tauranga

disclosures, and whether the financial statements

Tauranga

represent the underlying transactions and events in a

New Zealand

manner that achieves fair presentation.

13 November 2019

Tungia te ururua, kia tupu whakaritorito te tupu o te harakeke.

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Clear the undergrowth so that the new shoots of the flax will grow.

08 Our Future Direction

Primary healthcare is usually the first port of call for people who are sick. But it is not just our job to treat the sick – first and foremost it is our job to keep people well. We can’t do it alone. Health and wellness is a team effort, achieved only when we collaborate and work together. The Western Bay of Plenty Primary Health Organisation was founded on a strong partnership between General Practice and Iwi. It is a partnership that will now be further strengthened with our Eastern Bay colleagues and community. We know that current health outcomes for Māori are unacceptable. Our overriding focus for the year ahead will be to achieve equity in health outcomes for Māori, provide quality healthcare for all our communities, and ensure we are bringing everyone on the journey together. Over the coming year these areas of focus will stand us in good stead for the future: WHAI MANA – EQUIT Y • Achieving equity in health outcomes for Māori through investment in Iwi-led and locally-delivered kaupapa Māori programmes in partnership with General Practice teams. • Not being afraid to try new and innovative models of care, acknowledging that one size doesn’t fit all. Models such as Health Care Home and primary care services that reach out to people will be forefront in our thinking. • Empowering people and whānau through a focus on self-management and shared care programmes to achieve independence and live healthy lives. W H A I O R A – Q UA L I T Y H E A LT H C A R E • Working with our General Practice and Iwi partners, DHB and

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community providers to ensure a positive care experience for individuals and whānau throughout their health journey. • Ensuring we have a strong and fit-for-purpose workforce. We will invest in and support the development of existing and new roles to promote a holistic approach to improving health and social wellbeing. • Customer focus – maximising opportunities for engaging local communities in service design and evaluation. W H A I R A N G AT I R ATA N G A – S U S TA I N A B I L I T Y • Building our capacity and capability and that of our Iwi partner organisations to proactively support people to achieve and maintain wellness. • Improving access to quality health services for our rural communities. • Promoting the value and contribution of our general practice teams to the health and wellbeing of whānau. Primary care has a critical part to play in the future of an effective and sustainable New Zealand health system. We have an exciting opportunity to demonstrate how locally-designed and delivered models of care, services and programmes can work in true partnership to empower individuals, whānau and communities to achieve their goals.

W B O P P H O.O R G . N Z