Annual Report 2016 Report for the period 1 July June 2016

Transcription

1 Annual Reprt 2016 Reprt fr the perid 1 July June 2016

2 Visin Our visin is t be recgnised by the Ministry f Health, the lcal District Health Bards and the relevant cmmunities as ne f New Zealand s mst innvative and effective primary care netwrks in terms f delivering better, sner, mre cnvenient Primary Health Care t its enrlled ppulatin. Missin Statement Csine Primary Care Netwrk s (Csine) missin is t be an independent, high perfrming and innvative rganisatin prviding high quality primary health care services t ur enrlled ppulatin. Ppulatin Csine has an enrlled ppulatin f 33,780 patients. Of these 6% are Mari, 3% are Pacific and 13% Asian. 13% are identified as High Needs. 1 1 High Need Grups are defined as grups f persns wh are Mari, Pacific and/r persn residing in New Zealand Deprivatin Index deciles 9 &10 areas. (Capital & Cast DHB/ KPHO Cntract Versin 18.0) Page 2 f 21

3 EXECUTIVE SUMMARY During Csine Primary Care Netwrk has imprved n the high perfrmance achieved in the preceding years thrugh the cntinued effrts f bth Karri Medical Centre and Rpata Medical Centre. Tw natinal reviews undertaken in this reprting perid will impact n Primary Health care. In August 2015 the Minister f Health established a sectr-based Primary Care Wrking Grup t prvide him with advice n: ensuring affrdable, equitable access t sustainable general practice general practice wrkfrce sustainability shifting services clser t hme The General Practice Sustainability reprt prduced by the grup was released in February This reprt was infrmed by direct cntact with ver 600 peple invlved in general practice services thrugh 11 cnsultatin frums cnducted between Whangarei and Dunedin in September 2015, as well as an nline survey. The reprt recmmended that the current VLCA funding be reallcated t an enrlled patient level, rather than being allcated at a practice level. The Primary Care Wrking Grup fund the lack f targeted supprt fr peple with high health needs and lw incmes in the existing funding frmula is a majr prblem fr bth patients and general practices. 2 The review f the New Zealand Health Strategy, Future Directin 3, was released in April There are five strategic themes fr change articulated in the reprt. 1. Peple pwered making New Zealanders health smart ; that is, they can get and understand the infrmatin they need t manage their care enabling individuals t make chices abut the care r supprt they receive understanding peple s needs and preferences and partnering with them t design services t meet these cmmunicating well and supprting peple s navigatin f the system, including thrugh the use f accessible technlgy such as mbile phnes and the internet. 2. Clser t hme prviding care clser t where peple live, learn, wrk and play, especially fr managing lng-term cnditins Page 3 f 21

4 integrating health services and making better cnnectins with wider public services prmting wellness and preventing lng-term cnditins thrugh bth ppulatinbased and targeted initiatives investing in health and wellbeing early in life and fcusing n children, yung peple, families and whānau 3. Value and high perfrmance delivering better utcmes relating t peple s experience f care, health status and best-value use f resurces striving fr equitable health utcmes fr all New Zealand ppulatin grups measuring perfrmance well and using infrmatin penly t drive learning and decisin-making that will lead t better perfrmance building a culture f perfrmance and quality imprvement that values the different cntributins the public and health wrkfrce can make t imprving services and systems having an integrated perating mdel that makes respnsibilities clear acrss the system using investment appraches t address cmplex health and scial issues 4. One team perating as a team in a high-trust system that wrks tgether with the persn and their family and whānau at the centre f care using ur health and disability wrkfrce in the mst effective and mst flexible way develping leadership, talent and wrkfrce skills thrughut the system strengthening the rles f peple, families, whānau and cmmunities as carers the Ministry f Health leading the system effectively cllabrating with researchers. 5. Smart system discvering, develping and sharing effective innvatins acrss the system taking advantage f pprtunities ffered by new and emerging technlgies having data and smart infrmatin systems that imprve evidence-based decisins, management reprting and clinical audit having reliable, accurate infrmatin that is available at the pint f care prviding individual nline health recrds that peple are able t access and cntribute t using standardised technlgy that allws us t make changes easily and efficiently. Csine is actively implementing services, and using systems and prcesses, which supprt the actins arising frm the 2016 Health Strategy. Page 4 f 21

5 Fr example, under the themes Clser t hme and Value and Perfrmance the imperative frm CCDHB t reduce ambulatry sensitive hspital admissin (ASH) rates is being addressed thrugh the prvisin f primary ptins fr acute care (POAC). Launched in 2014, POAC prvides patients with alternative treatment ptins t the Emergency Department. POAC is a service which enables primary care prviders t maximise the management f their acute patients in the cmmunity 4. Patients can nw have an intravenus infusin f antibitics t treat cellulitis r an anticagulant t treat a deep vein thrmbsis administered at the practice. Under the theme Value and High Perfrmance, Csine cntinues t achieve at a high level acrss the MOH targets. Csine participated in the discussins t infrm CCDHB s System Level Measures Plan and in the selectin f the cntributry measures. Cntributry measures have a quality imprvement fcus and are frnt line service level measurements that shw a tangible and meaningful result f the interactin between clinicians and patients. 5 Examples are risk stratificatin f thse at high risk f admissin, increasing the rates f flu vaccinatin and increasing enrlment f children in the dental service, Bee Healthy. Smart systems have been implemented thrugh use f the patient prtal and Health Pathways. Bth practices have champined the use f patient prtals, enabling better access fr patients t health infrmatin and services. Health Pathways have been set up as a resurce fr general practitiners, easily accessed thrugh an icn n the desktp.the nline resurce is designed fr primary health care practitiners t use during cnsultatin, helping them manage and refer their patients t the mst apprpriate specialist, hspital r cmmunity-based services. This nt nly helps patients get the right care, but greatly imprves relatinships between the peple invlved 6. Csine has maintained a high prfile thrugh extensive participatin and representatin at varius frums within the health arena, at lcal, reginal and natinal levels. (See appendix 1) The financial impact n the primary care sectr thrugh a reductin in funding fr cntracted services cntinues. Funding fr Mental Health services in primary care was reduced acrss all the PHO s in Sexual Health services funding was reduced again and will cease in The funding fr cardivascular risk assessments was reduced significantly and ceased at the end f Diabetes and Pharmacy Facilitatin have remained the same. 4 POAC final media release DVT Page 5 f 21

6 Gvernance Csine is a nt-fr-prfit charitable trust gverned by a Bard f Trustees. The Trust Bard cnsists f eight Trustees appinted t represent the cmmunity, prviders and lcal iwi. The Trustees are An independent Chair - Murray Gugh Tw cmmunity/cnsumer representatives - Margaret de Jux (Karri Medical Centre) and Nlaine Cmbes (Rpata Medical Centre) An Iwi representative - Rawiri Evans (Te Ati Awa) Fur prvider representatives - Drs Jeff Lwe and Peter Mdie (Karri Medical Centre) and Drs Chris Masters and Dn Barrett (Rpata Medical Centre) Prgress against the Business Plan t June 2016 The fllwing seven bjectives were the fcus fr the Business Plan The prvider practices f Csine will maintain their status as high-achieving, innvative practices. This will be demnstrated by nging success in relevant clinical perfrmance measures. 2. The prvider practices f Csine are held up as exemplars f Primary Health Care. 3. The sharing f innvative ideas will ccur acrss the Primary Care Netwrk and the health sectr. 4. T engage with the lcal DHBs in the delivery f new prgrammes and mdels f care. 5. T wrk within sustainable funding 6. T achieve targets in rder t receive 100% f the available funding e.g. PPP, CarePlus 7. T attract funding fr innvative pilt prjects Reprting n prgress arund these aims is prvided annually t Capital and Cast DHB. Page 6 f 21

7 Activity 1. Success in the relevant clinical perfrmance measures. Csine has maintained the high perfrmance f previus years. A letter frm Jnathan Cleman t Virginia Hpe, Chairman f CCDHB and Hutt Valley DHBs, cmmented n Csine s achievements fr Q4, Cmments frm the target champins are cpied belw. 2. Exemplars f Primary Health Care Csine cnsistently achieves high rates that are abve the natinal average. In additin, the practices are practive in seeking innvative ways f prviding primary care services. An example is the prvisin f a range f POAC services. 3. Sharing f Innvative ideas At a lcal level the practices penly share systems and prcess that aid wrkflw. Examples are the self-check in kisk at Rpata Medial Centre, which frees up receptin staff, and the archived file system at Karri Medical Centre which has been adpted by a number f practices in the regin. Leaders frm bth practices are invlved in discussins with the wider health netwrk which generate and share ideas fr imprvement. 4. Engaging with DHBs in the delivery f new prgrammes The clinical leads cntinue in their established rles within Hutt INC and the ICC and there is increasing participatin frm ther representatives frm bth practices. 5. T wrk within sustainable funding A key bjective fr Csine is that the prvider practices deliver cre services frm n-ging funding in rder t mitigate risk arund staffing and service delivery. The recmmendatins frm the General Practice sustainability reprt will be f interest t all thse wrking in primary care. Cntract funding has been further reduced in this reprting perid. Bth practices meet the shrt fall fr frm practice funds t ensure that service delivery cntinues 6. T achieve targets in rder t receive 100% f the available funding Page 7 f 21

8 Payments were at 100% with the exceptin f Better Help fr Smkers t Quit which was 84%. Hwever a grand parented perfrmance payment cmpnent was applied which ensured that there was n shrtfall. 7. T attract funding fr innvative pilt prjects The Health care Hme mdel f care is being pilted in the CCDHB regin. Karri Medical Centre has been selected as a tranche 1 practice. The practice will receive $14 per enrlled patient when all the initial criteria are met and the cntract signed ff. Hutt Valley DHB is expected t cnsider funding the HCH mdel in 2017 and at that stage Rpata Medical Centre may cnsider adpting the mdel f care. System Level Measures and Health Targets N new measures were added t the IPIF prgramme fr Frm July 2016 the mre heart and diabetes checks results will n lnger be reprted as a health target.eighted RANKING TO 2016 COSINE PERFORMANCE ACROSS THE THREE MOH HEALTH TARGETS 1 Apr 30 Jun 16 1 Jan 31 Mar 16 1 Oct- 31 Dec 15 1 Jul - 30 Sep 15 1 Apr - 30 Jun 15 Health Target Q4 Q3 Q2 Q1 Q4 Increased Immunisatin (95%) 3 99% 1 99% 5 97% 3 98% 1= 98% Better help fr Smkers t Quit (90%) 27 84% 16 87% 26 81% 13 87% 13 93% Mre Heart and Diabetes Checks (90%) 27 90% 25 90% 23 90% 23 90% 18 90% Over the 36 PHOs rates f immunisatin ranged frm 82% t 100% with an average f 94% help fr smkers rates ranged frm 78% - 93% with an average f 88% mre heart and diabetes checks rates ranged frm 85% - 94% with an average f 91% Frm 1 July 2016 the fllwing system level measures will be implemented Ambulatry Sensitive Hspitalisatin (ASH) rates per 100,000 fr 0-4 year lds Acute hspital bed days per capita Patient experience f care Amenable mrtality rates under 75 years. Page 8 f 21

9 ACHIEVEMENTS IN Karri Medical Centre 1. EOI t jin tranche 1 f the Health Care Hme mdel f care apprved. 2. Enrlments in Manage My Health- the patient prtal. Enrlment levels in the patient prtal are amngst the best natinally. As at 1 July % (7692) f the eligible ppulatin were registered t the prtal. 3. Cntinued High Perfrmance in Health Targets. Cntinuus imprvement at this level is achieved thrugh the effrts f the whle practice, with clinical champins taking the lead fr specific areas. 4. Natinal Enrlment Service Karri Medical centre jined tranche 1 in the implementatin f the NES. NES is a system that integrates directly with the practice management system via a secure web link in t the MOH natinal identity and payment system. The practice liaised with Medtech and MOH persnnel t identify glitches in the system. 5. Services t Imprve Access Initiatives KMC has maintained supprt t high health needs patients thrugh a range f SIA initiatives including; Healthy Families Initiative The number f patients enrlled in the initiative has remained steady ver many years and is currently 83 (39 families). Cnsultatins and prescriptins are free fr these families. The lw cst prescriptin initiative is a cllabrative venture with eight Wellingtn Pharmacies which prvides a service fr thse peple wh find cst a barrier t accessing medicatin. The transprt initiative is a service available t high health needs patients attending hspital appintments r Primary Care appintments. It is clsely mnitred by the finance subcmmittee and where pssible patients are linked in with existing transprt ptins e.g. Ttal Mbility. The demand fr this service is unchanged frm the previus reprting perid. Hspital Discharge Initiative Supprts patients wh have had a cnsultatin with their GP (paid fr by the PHO thrugh SIA funding) fllwing an inpatient stay at Wellingtn Public Hspital. This Page 1 f 21

10 service is particularly useful fr patients requiring a medicatin review fllwing changes t their medicatin made while they were in hspital. Rpata Medical Centre 1. Partnership with Kkiri Marae t run smking cessatin clinics 2. Planning twards an Outreach service in partnership with Kkiri Marae Discussins are underway with Kkiri Marae t explre utilising their mbile clinics t carry ut utreach wrk fr cervical smears and immunisatins. 3. Cervical Smear campaign fr the high health needs grup The aim f the campaign is t imprve access t screening services fr thse wh are currently disengaged frm the healthcare. There was a 35% success rate in this campaign and a secnd will be run later in the year. 4. Primary Optins fr Acute Care (POAC) The practice has expanded services frm the treatment f cellulitis t include severe respiratry illness and bwel bstructins. Other services will be ffered as the Health Pathways and POAC services are develped. 5. Wrkplace Immunisatins fr staff at tw schls. 6. Extended Nurse supprt The practice will imprve supprt fr patients and GPs by extending nursing hurs up until 10.00pm n weekdays and all day bth Saturday and Sunday. 7. Manage my Health RMC have significantly increased enrlments in the patient prtal. Page 2 f 21

11 LOOKING FORWARD Karri Medical Centre SIA & HP Plan Karri Medical Centre has 14,418 enrlled patients (1 st January 2016). Of these 11% are identified as High Needs. 7 Patients are residents f Karri, Wellingtn and its envirns. KMC s patient ppulatin cnsists f: 5.0 % Mari 3.0 % Pacific 1.0 % Dep % Asian The percentage f the ppulatin wh identify as Asian has cntinued t increase while the number f high health needs patient has reduced slightly frm the previus year. The graph belw shws the distributin f the enrlled ppulatin by age and ethnicity. Summary This Services t Imprve Access and Health Prmtin plan cvers the perid frm 1 July 2016 t 30 June Karri Medical Centre is cmmitted t prviding quality patient care that is culturally sensitive fr all its patients. KMC strives t review and imprve its services and the access fr all patients t apprpriate medical services which meet their needs. We aim c-rdinate the needs f thse with chrnic disease s that the services patients receive are timely and integrated. The team are frward facing and take pride in being able t respnd quickly t new initiatives and directins in health care. The services prvided are well embedded and are part f business as usual. The Csine Bard have asked the practices t cnsider hw they will respnd t the Childhd Obesity Strategy and there was been discussins n beginning by recrding the weight and height f children in a systematic way. 7 High Need Grups are defined as grups f persns wh are Mari, Pacific and/r persn residing in New Zealand Deprivatin Index deciles 9 &10 areas. Capital & Cast DHB/ KPHO Cntract Versin 18.0

12 Key Achievements Health Care Hme (HCH). KMC was accepted t be ne f the nine practices mving t the HCH mdel f care. 2. Successful TAS audit. 3. Cntinued supprt f families and whanau thrugh initiatives such as Healthy Families, Lw Cst Prescriptins and the Transprt Initiative. 4. Increased access t services fr patients thrugh the patient prtal, Manage My Health. With 4,846 active users we are able t measure the reductin in the number f phne calls in t the practice. Pririties fr Full implementatin f the Health Care Hme mdel f care. Increase enrlment in MMH t ver 85% Increase the number f POAC services Imprve access thrugh extending the hurs f the nurse clinics and the Saturday service (currently mrning nly) The services funded thrugh SIA will cntinue t be prvided in

13 SERVICES TO IMPROVE ACCESS INITIATIVES Initiative Service Delivery Actins Targets Healthy families Initiative Hspital discharge Initiative Interpreting Services Lw cst prescriptins Transprt Initiative This prgram supprts patients where cst is a barrier t accessing timely medical care. Patients are identified by an utside agency e.g. a pharmacy, well child nurse, church grup. The PHO funds GP cnsultatins. This service is ffered t patients fllwing an inpatient stay in hspital and aims t address medicatin recnciliatin in a timely manner and als ensure that patients have all the services in place that they may need when they return hme. In rder t assist thse wh 1) have English as a secnd language e.g. refugees & migrants and 2) t assist thse with impaired hearing. This service is ffered t patients identified by a Pharmacy, GP, Nurse r utside agency as finding cst a barrier t cllecting medicatin in a timely manner. T assist patients t attend scheduled hspital appintments e.g. renal clinic, cardilgy. This ensures that the patient is assisted t attend rutinely and is therefre less likely t present acutely t the hspital services. Mnthly review t ensure that patients in need are n the prgramme. We have rbust financial reprting Daily review f the discharge list. Patients are cntacted and ffered a free appintment with their GP. T link t the predictive risk mdelling that is underway. The risk mdelling is part f the year f care planning fr the HCH and will give us better understanding f the reasns fr readmissin. The secnd part f the discharge initiative is reviewing emergency department attendances with the aim f treating patient with chrnic cnditins in a planned way, reducing visits t ED. Practively ffer the service. T wrk within budget. Currently there are 90 individuals frm 32 families supprted by the prgramme. Average cnsults are 30 a mnth. Reductin in the readmissin rates. Average cnsults are 55 a mnth. Increase the use f Language Line. Maintain current vlumes within budget; n average 10 a mnth. Maintain current vlumes within budget.

14 HEALTH PROMOTION INITIATIVES Initiative Service Delivery Actins Targets Health campaigns Increasing Activity Prjects dedicated t imprving rates achieved fr cervical screening, flu vaccinatins, childhd vaccinatins, cardivascular risk assessments, Diabetes Get Checked Annual reviews and cntinuus quality imprvement in Clinical Perfrmance Indicatrs. KMC adpts a whle f practice apprach t health campaigns. Subsidised visits t the lcal recreatin centre and pl. Cntinue t develp prgrammes tailred t this grup. T increase the utilisatin rates in the high needs grup t address health disparities. Peple with a leisure card receive up t a 50% discunt. KMC will pay the remaining 50% fr patients wh want t increase their activity levels. Beginning with thse diabetics under active management, we will mnitr the activity fr effectiveness and then rll it ut t patients with ther lng term cnditins. T remve barriers t access in rder t prvide care t all patients. Increase screening rates and imprve utcmes fr thse with lng term cnditins. 30 patients supprted. Liaisn Supprting cllabratin and Initiate discussins n Begin by recrding the

15 Mari Health Training & Educatin Yuth Health netwrking with ther CCDHB PHOs Cllabrate with the Mari health Directrate at CCDHB in their planning T supprt thse delivering the cntractual requirements f Csine PHO (Karri) t undertake apprpriate training. E.g. e learning fr diabetes management Free cnsultatins and prescriptins fr yung peple aged years identified by an utside agency e.g. Karri Yuth Wrker, lcal church yuth grups. childhd besity and family vilence with the CCDHB PHOs. The Csine Bard has cnsidered the annual Mari Health and asked the practices t make dental health f children, diabetes and cardivascular risk assessments a pririty. KMC recgnises the need t supprt n-ging prfessinal develpment t supprt the wrk arund delivery f services t the High Health needs grup and thse wrking t imprve utcmes fr patients with lng term cnditins. Recnnect with the lcal grups t ensure that they are aware f this initiative. weight/height f children at their immunisatin visits. Cmplete mtivatinal interviewing training in regard t family vilence. Prvide 30 free cnsultatins fr this age grup.

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17 Rpata Medical Centre SIA & HP Plan Intrductin Rpata Medical Centre has a current enrlled patient ppulatin f 19, 259 with patient numbers increasing steadily year n year. RMC s patient ppulatin cnsists f: 6.1% Mari 2.5% Pacific 9.7% Quintile 5 Nn Mari r Pacific 11.6% Asian Prprtin fr Mari and Pacific peples have remained stable fr a number f years, irrespective f register grwth. Hwever, we have seen a steady increase in ur Asian ppulatin with an apprximate increase f 305 new patients in the last 12 mnths. Bringing new and fresh challenges t the practice arund language barriers, understanding f culture and practice and medical terminlgy are just part f the grwing list. RMC s distributin by age and ethnicity is shwn in the graph belw. Summary This Services t Imprve Access and Health Prmtin Business Plan cvers the perid frm 1 July 2016 t 30 th June Rpata Medical Centre s visin statement is t Prvide high quality primary care services, recgnising the need fr integratin, resulting in a practice which staff want t wrk at, patients want t jin, and as a result cntinue t be a leader in General Practice. We have a new team at Rpata with a Practice Manager wh cmmenced n the 4 th April 2016, a Nurse Manager wh cmmenced n 11 th April 2016 and an RN that cmmenced n 4 th April We als have three RN s that have been part f the team fr less than twelve mnths and we are in the middle f recruiting three new RN s. The new team is cmmitted t the delivery f patient fcused primary care.

18 Fcus fr T priritise services t thse patient grups mst in need 2. T prvide high quality services within the PHO funding prvided 3. T maximise use f health prmtin funding t reduce future lng term health cnditins f RMC s patients. 4. T ensure we imprve r cntinue t meet the Ministry f Health targets relating t Primary Care. 5. T imprve n better utilising SIA funding fr thse patients mst in need. 6. T cntinue t reach ut t ur Mari and Pacific patients using experience gained while wrking in areas with a high health needs ppulatin. 7. Engage with ur increasing Asian ppulatin by cming up with strategies fcused arund understanding individual cultures and practices. 8. We wish t explre ways f breaking dwn the language barriers fr ur diverse ppulatin. 9. There are many pprtunities t wrk with and influence cmmunities arund educatin t health and in particular besity. Pririties fr 2016/17

19 1. T wrk in alliance with the DHB and ther lcal health prviders t identify and target thse patient mst in need thrugh best utilisatin f PHO funds 2. Strive fr quality services which are sner and clser t hme. 3. T cllabrate and cntribute t the lcal lng term cnditins plan 4. Make Rpata Medical part f the cmmunity thrugh integratin and invlvement. 5. Increase availability t health practitiners thrugh extra clinics fr nurses. Services t Imprve Access SIA Initiatives Outreach Nurse Admin supprt Easier Access fr staff fr utilising SIA funding Service Delivery 1 FTE senir nurse t fcus n imprving access fr high needs patients in the delivery f clinic appintments and utreach visits. Part funding fr admin supprt t fcus n recalling high needs patients fr participatin in key screening activities and health targets. An SIA accunt hlder accunt set up in MEDTECH t allw staff easier access t be able t invice services if staff feels these are apprpriate. Services ffered are: GP appintments Nurse appintments Tests such as ECGs, spirmetry, etc. Transprt paid t appintments t RMC r hspital Prescriptins Outreach vehicle Use f SIA funds t cver maintenance and fuel csts f vehicle t use in utreach visits Health Prmtin Initiatives Health Prmtin Initiatives Smking Cessatin Advisr Pre-Diabetes Screening Service Delivery RMC s Healthcare Assistant dedicates 5 hurs per week targeting current smkers fr smking cessatin advice by text messaging, telephne and face t face cntact. This is t supprt achieving ur IPIF target. Utilise Health prmtin funding t target pre-diabetic patients. Patients will be identified thrugh virtual screening f HBA1C results, sent a letter and resurce pack and ffered a free prediabetic Nurse appintment.

20 Health campaigns Mre heart and diabetic checks RMC participate in varius natinal health prmtin campaigns such as Stptber and Natinal Cancer week. The use f the predict tl is used fr the delivery f mre heart and diabetic checks t standardise reprting. Services t Imprve Access Funding 2016/17 Revenue in INCOME advance Jul Aug Sep Oct Nv Dec Jan Feb Mar Apr May Jun Prjected Services t Imprve Access ,204 Ttal Incme 0 9,267 9,267 9,267 9,267 9,267 9,267 9,267 9,267 9,267 9,267 9,267 9, ,204 EXPENDITURE Wage nurses Wage admin 1,164 1,164 1,164 1,164 1,164 1,164 1,164 1,164 1,164 1,164 1,164 1,164 13,968 Mtr vehicle ,031 Other csts Ttal Expenditure 10,336 10,336 10,519 10,987 10,519 10,519 10,519 11,082 10,519 10,519 10,519 10, ,893 Mnthly Prfit/Lss -1,069-1,069-1,252-1,720-1,252-1,252-1,252-1,815-1,252-1,252-1,252-1,252 Year t Date Prfit/Lss -1,069-2,138-3,390-5,110-6,362-7,614-8,866-10,681-11,933-13,185-14,437-15,689-15,689 Health Prmtin Funding Revenue in INCOME advance Jul Aug Sep Oct Nv Dec Jan Feb Mar Apr May Jun Prjected Health Prmtin ,019 Other incme Ttal Incme 0 3,665 3,665 3,665 3,667 3,667 3,667 3,678 3,678 3,678 3,663 3,663 3,663 44,019 EXPENDITURE Wages nurse Wages (Smking Cessatin Admin) 1,008 1,008 1,008 1,008 1,008 1,008 1,008 1,008 1,008 1,008 1,008 1,008 12,096 Warfarin Educatin Pre-diabetes ,283 Other csts ,596 Ttal Expenditure 2,658 2,577 2,537 2,685 2,550 2,577 2,523 2,604 2,523 2,658 2,577 2,577 30,587 Mnthly Prfit/Lss 1,007 1,088 1, ,117 1,090 1,155 1,074 1,155 1,005 1,086 1,086 Year t Date Prfit/Lss 1,007 2,095 3,223 4,205 5,322 6,412 7,567 8,641 9,796 10,801 11,887 12,973 13,432 Under Spend 2016/17 The under spend in the Health Prmtin budget will be used and accunted fr with the new initiatives as utlined earlier. A lt f what we d and achieve is rutine practice and t make significant changes and imprvements t an already successful enterprise takes sme time t adjust and understand. The verspend in the SIA budget that will be absrbed by the business.

21 Leadership Rpata Medical Centre Dr Chris Masters Member f Hutt INC, Alliance Leadership Team Clinical Lead fr Hutt INC Enablers wrk stream Clinical Lead Health Pathways, 3DHB Member f HV Cmmunity Radilgy Advisry Grup Bard Member f Patients First Ltd Dr Paul Rwan Member f Hutt INC, Lng Term Cnditins Clinical Netwrk Dr Sarah Painter Member f Hutt INC, Acute Care Clinical Netwrk Dr Gillian Yardley Member f Hutt INC, Child Health Clinical Netwrk Dr Stewart Reid Chair f Natinal Immunisatin Technical Frum Member f HVDHB CPHAC Adrian Tucker Primary Acute Care in the Hutt Valley. A wrking grup examining acute care, particularly after hurs services. The grup includes Hutt Hspital Emergency department, the After Hurs Medical centre and the general practices. Karri Medical Centre Dr Jeff Lwe Clinical Champin fr the CCDHB ICC Lng Term Cnditins Grup Member f the DHBs Leaders Grup Member f the Patients First steering grup Deputy chair f GPNZ Member f the ICC Alliance Leadership Team Dr Peter Mdie Chair f the Primary Care Wrking Grup prviding advice t the Minister f Health Chair f the ICC Medicines Management Grup Dr Rs Wall Member f the Diabetes Clinical Netwrk Dr Myrt Kenny Cmmunity Radilgy Advisry Grup Lyn Allen Member f the 3DHB Integrated Labratry Clinical Reference Grup (CRG)