The document provides an overview of the New Zealand health system and discusses some of its key challenges and drivers for change. It notes that the NZ population is 4.2 million served by a largely devolved system including a central ministry, 20 regional health boards, and private providers. While performance is generally good compared to other OECD countries, challenges include an aging population increasing demands, rising costs, and fragmentation across the system. Key drivers for change include addressing these population trends, workforce needs, financial sustainability, and improving facilities.

1. Ensuring health for the future

2. Overview of the NZ Health system
• 4.2 million population
• 13.8 million GP visits, 65 million prescription items,
24 million lab tests, 1 million E.D. attendances
• Largely devolved system – Central ministry/ACC ,
20 regional Distrist Health Boards, 30 primary care
networks, large number of PPP (pharmacy, labs,
private hospitals, General Practice)
• In comparision to most OECD indicators we are
performing well and delivering value-for-money
• Growth in NZers’ life expectancy is the highest in
the OECD
• 19% of total government spending goes into vote
Health ($14 billion NZD)
• Co-payments in primary care

3. Challenges
• Living within our means: our rate of growth in health spend is
unsustainable – doubled in the previous decade
• Population ageing: increasing demands on health system (44% increase
in demand)
• Increased chronic conditions – 80% of deaths are a result of heart
disease, cancer, diabetes and tobacco related illness
• Increasing expectations from the public on health system performance
• Workforce ageing and changing expectations
• Fragmentation and differences in service performance across a
devolved health and disability system

4. Drivers for Change
Population
Workforce
Sustainability
Facilities

5. Demand increase from existing population
+ change in profile

6. MHN
- NGO, not-for-profit
- GP owned & governed
- 400 GPs
- 500 PNs
- 100 practices
- 500,000 patients
- $135 million
- Covering 4 DHBs
- 100-40% geographical coverage
- Holds the contract with the crown,
sub contracts members
- Regional Alliance contract
- GP, acute A&M, community nursing,
community mental health, PH, chronic
care

7. Ensure the future of high quality general practice….
Be a vehicle to enable the development of new models,
ownership etc to ensure sustainability of high quality GP.
Sustainable & leading edge primary care services
The way to bring together the founding partners to ensure each
partner is successful
Vehicle to enable single contract/plan
Pinnacle
Incorporated
Primary Health
Care Limited
Midlands Health
Network Limited
Midlands Regional
Health Network
Charitable Trust
Role of Members of the Group
Tui Ora
Limited Integrated health service organisation committed to enhancing
health and wellbeing.
General Practice network – sets the strategic framework, priorities, holds
and controls investment resources, monitors performance – Board elected
from members – 350 GP members, 500 PN, 97 PM
Pinnacle provider arm for practice ownership –provides a vehicle to explore
and develop new practice models, supports at risk areas
Management company – employs staff, develops and operates
systems, operates a range of direct to non-GP patient services via provider
arm (the engine room for getting stuff done) – Pinnacle/Independent
Governance
Vehicle for connecting with strategic partners + single point for contracting
with Multi DHBs, MoH – Community/Provider/Independent Governance
MHN Family

8. CQI core value
1.1 1.2 1.3 1.4 2.1 2.2 2.3 2.4 3.1 3.2 4.1 4.2 4.3 4.4 4.5 4.6 5.1 6.1 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 DAMR
DAMR
HN
CVRA
CVRA
HN
85.0% 85.0% 93.0% 93.0% 70.0% 70.0% 70.0% 70.0% 72.5% 72.5% 90.0% 90.0% 90.0% 90.0% 25.0% 25.0% 80.0% 80.0% 70.0% 70.0% 70.0% 70.0% 70.0% 70.0% 30.0% 30.0% 70.0% 70.0% 70.0% 70.0% 75.0% 75.0%
Pihanga Health ACHIEVEMENT 40 12 / 26
85.7%
(0)
83.3%
(0)
75.0%
(3)
73.3%
(3)
- - - -
72.5%
(0)
72.5%
(0)
96.6%
(0)
96.3%
(0)
33.9%
(313)
33.1%
(281)
8.6%
(92)
8.7%
(80)
- -
73.6%
(0)
70.2%
(0)
88.9%
(0)
87.1%
(0)
65.2%
(19)
64.4%
(17)
46.5%
(0)
43.8%
(0)
43.0%
(95)
40.7%
(79)
39.0%
(76)
37.9%
(64)
66.9%
(121)
64.0%
(115)
Taupo Health Centre ACHIEVEMENT 40 12 / 26
100.0%
(0)
100.0%
(0)
91.5%
(1)
100.0%
(0)
- - - -
80.1%
(0)
77.0%
(0)
97.6%
(0)
96.7%
(0)
29.7%
(665)
35.8%
(305)
13.1%
(132)
14.1%
(62)
- -
75.4%
(0)
66.0%
(8)
87.5%
(0)
91.3%
(0)
55.7%
(118)
53.6%
(46)
39.4%
(0)
36.4%
(0)
39.0%
(218)
38.6%
(76)
50.0%
(105)
45.0%
(50)
67.1%
(296)
57.7%
(198)
Taupo Medical Centre ACHIEVEMENT 36 12 / 26
98.1%
(0)
95.7%
(0)
93.3%
(0)
100.0%
(0)
- - - -
78.4%
(0)
74.5%
(0)
98.5%
(0)
98.0%
(0)
33.6%
(796)
39.9%
(364)
14.3%
(151)
16.4%
(62)
- -
67.6%
(12)
57.4%
(25)
91.7%
(0)
88.2%
(0)
60.6%
(78)
56.2%
(39)
44.1%
(0)
43.4%
(0)
50.8%
(122)
51.9%
(43)
15.6%
(278)
17.9%
(102)
72.7%
(100)
62.6%
(167)
The Lake Surgery ACHIEVEMENT 70 18 / 26
100.0%
(0)
100.0%
(0)
91.7%
(0)
100.0%
(0)
- - - -
78.3%
(0)
73.4%
(0)
98.0%
(0)
96.4%
(0)
86.0%
(11)
83.2%
(9)
32.2%
(0)
33.6%
(0)
- -
77.6%
(0)
77.2%
(0)
96.6%
(0)
100.0%
(0)
74.4%
(0)
79.7%
(0)
62.1%
(0)
47.3%
(0)
52.4%
(29)
42.2%
(18)
60.3%
(15)
59.6%
(6)
67.8%
(81)
66.2%
(29)
GOAL
ACHIEVEMENT
54 / 104 4 / 4 4 / 4 2 / 4 3 / 4 - - - - 4 / 4 4 / 4 4 / 4 4 / 4 0 / 4 0 / 4 1 / 4 1 / 4 - - 3 / 4 2 / 4 4 / 4 4 / 4 1 / 4 1 / 4 4 / 4 4 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4
ACHIEVEMENT
97.0%
(0)
94.3%
(0)
90.4%
(4)
93.4%
(3)
- - - -
78.3%
(0)
74.6%
(0)
97.9%
(0)
97.1%
(0)
36.5%
(1785)
39.7%
(959)
14.4%
(375)
14.9%
(204)
- -
72.5%
(12)
65.7%
(33)
90.6%
(0)
90.2%
(0)
60.8%
(215)
59.9%
(102)
44.4%
(0)
41.8%
(0)
45.0%
(464)
43.5%
(216)
37.0%
(474)
36.0%
(222)
69.4%
(598)
61.8%
(509)
GOAL
ACHIEVEMENT
54 / 104 4 / 4 4 / 4 2 / 4 3 / 4 - - - - 4 / 4 4 / 4 4 / 4 4 / 4 0 / 4 0 / 4 1 / 4 1 / 4 - - 3 / 4 2 / 4 4 / 4 4 / 4 1 / 4 1 / 4 4 / 4 4 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4 0 / 4
ACHIEVEMENT
97.0%
(0)
94.3%
(0)
90.4%
(4)
93.4%
(3)
- - - -
78.3%
(0)
74.6%
(0)
97.9%
(0)
97.1%
(0)
36.5%
(1785)
39.7%
(959)
14.4%
(375)
14.9%
(204)
- -
72.5%
(12)
65.7%
(33)
90.6%
(0)
90.2%
(0)
60.8%
(215)
59.9%
(102)
44.4%
(0)
41.8%
(0)
45.0%
(464)
43.5%
(216)
37.0%
(474)
36.0%
(222)
69.4%
(598)
61.8%
(509)
City Medical Gisborne Ltd ACHIEVEMENT 77 14 / 26
100.0%
(0)
100.0%
(0)
90.9%
(0)
83.3%
(1)
- - - -
86.6%
(0)
86.3%
(0)
97.6%
(0)
96.2%
(0)
53.0%
(182)
51.6%
(109)
15.1%
(49)
13.1%
(34)
- -
75.6%
(0)
74.3%
(0)
100.0%
(0)
100.0%
(0)
70.3%
(0)
68.2%
(4)
52.1%
(0)
52.0%
(0)
54.4%
(51)
54.6%
(22)
41.8%
(78)
43.1%
(39)
73.0%
(34)
70.1%
(33)
Desmond Road Health ACHIEVEMENT 46 11 / 26
80.0%
(2)
84.6%
(0)
89.5%
(1)
85.0%
(2)
- - - -
77.6%
(0)
74.4%
(0)
94.6%
(0)
93.7%
(0)
25.2%
(509)
25.3%
(297)
6.6%
(145)
6.5%
(85)
- -
78.4%
(0)
75.1%
(0)
96.2%
(0)
93.8%
(0)
69.5%
(3)
67.5%
(6)
45.4%
(0)
40.1%
(0)
44.1%
(132)
44.7%
(55)
14.4%
(216)
16.9%
(100)
56.8%
(521)
55.1%
(215)
The Village Clinic Ltd ACHIEVEMENT 45 12 / 26
87.5%
(0)
100.0%
(0)
91.7%
(0)
100.0%
(0)
- - - -
89.2%
(0)
88.6%
(0)
98.6%
(0)
97.7%
(0)
55.4%
(87)
56.3%
(43)
20.7%
(11)
18.0%
(9)
- -
78.2%
(0)
81.0%
(0)
75.0%
(0)
66.7%
(0)
68.6%
(3)
60.2%
(10)
28.4%
(3)
26.2%
(4)
60.0%
(16)
57.1%
(10)
40.3%
(37)
41.4%
(17)
61.1%
(131)
66.8%
(30)
Three Rivers Medical Centre ACHIEVEMENT 27 7 / 26
80.5%
(4)
81.5%
(2)
92.2%
(1)
97.1%
(0)
- - - -
70.0%
(109)
66.3%
(171)
94.8%
(0)
93.8%
(0)
20.3%
(1262)
19.9%
(964)
6.0%
(345)
5.6%
(267)
- -
60.7%
(63)
57.3%
(62)
81.0%
(0)
80.0%
(0)
60.9%
(111)
59.0%
(91)
34.9%
(0)
33.7%
(0)
52.8%
(180)
52.4%
(126)
25.8%
(301)
27.0%
(210)
64.5%
(492)
60.7%
(406)
Waikohu Health Centre ACHIEVEMENT 58 13 / 26
87.5%
(0)
85.7%
(0)
100.0%
(0)
100.0%
(0)
- - - -
74.7%
(0)
73.3%
(0)
94.0%
(0)
93.7%
(0)
53.6%
(86)
53.2%
(80)
24.3%
(2)
22.9%
(5)
- -
69.4%
(0)
69.2%
(1)
100.0%
(0)
100.0%
(0)
69.4%
(1)
67.0%
(4)
33.1%
(0)
33.9%
(0)
67.6%
(3)
67.3%
(3)
44.4%
(18)
46.2%
(16)
48.6%
(119)
50.0%
(97)
GOAL
ACHIEVEMENT
57 / 130 3 / 5 4 / 5 3 / 5 3 / 5 - - - - 4 / 5 4 / 5 5 / 5 5 / 5 0 / 5 0 / 5 0 / 5 0 / 5 - - 4 / 5 3 / 5 5 / 5 5 / 5 1 / 5 0 / 5 4 / 5 4 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5
ACHIEVEMENT
84.0%
(6)
84.5%
(2)
91.8%
(2)
94.2%
(3)
- - - -
76.4%
(109)
72.2%
(171)
95.5%
(0)
94.3%
(0)
30.5%
(2126)
29.4%
(1493)
9.6%
(552)
8.8%
(400)
- -
69.6%
(63)
65.7%
(63)
88.8%
(0)
88.5%
(0)
65.5%
(118)
62.3%
(115)
39.7%
(3)
36.7%
(4)
52.2%
(382)
52.8%
(216)
27.8%
(650)
29.6%
(382)
62.8%
(1297)
60.4%
(781)
GOAL
ACHIEVEMENT
57 / 130 3 / 5 4 / 5 3 / 5 3 / 5 - - - - 4 / 5 4 / 5 5 / 5 5 / 5 0 / 5 0 / 5 0 / 5 0 / 5 - - 4 / 5 3 / 5 5 / 5 5 / 5 1 / 5 0 / 5 4 / 5 4 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5 0 / 5
ACHIEVEMENT
84.0%
(6)
84.5%
(2)
91.8%
(2)
94.2%
(3)
- - - -
76.4%
(109)
72.2%
(171)
95.5%
(0)
94.3%
(0)
30.5%
(2126)
29.4%
(1493)
9.6%
(552)
8.8%
(400)
- -
69.6%
(63)
65.7%
(63)
88.8%
(0)
88.5%
(0)
65.5%
(118)
62.3%
(115)
39.7%
(3)
36.7%
(4)
52.2%
(382)
52.8%
(216)
27.8%
(650)
29.6%
(382)
62.8%
(1297)
60.4%
(781)
Central Medical Centre ACHIEVEMENT 31 10 / 26
100.0%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)
- - - -
82.3%
(0)
78.1%
(0)
83.5%
(106)
86.4%
(8)
57.7%
(36)
60.0%
(8)
16.2%
(10)
16.0%
(2)
- -
73.8%
(0)
66.7%
(0)
77.8%
(0)
100.0%
(0)
67.9%
(3)
58.1%
(4)
15.7%
(23)
6.5%
(7)
52.8%
(21)
40.0%
(8)
26.3%
(35)
33.3%
(4)
65.2%
(77)
63.6%
(11)
City West Medical Centre ACHIEVEMENT 135 24 / 26
100.0%
(0)
100.0%
(0)
100.0%
(0)
0.0%
(0)
- - - -
88.3%
(0)
83.3%
(0)
99.8%
(0)
100.0%
(0)
95.7%
(0)
100.0%
(0)
70.0%
(0)
90.0%
(0)
- -
87.7%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)
75.7%
(0)
72.2%
(0)
41.7%
(0)
55.6%
(0)
81.1%
(0)
90.9%
(0)
34.9%
(37)
63.6%
(1)
87.2%
(0)
87.1%
(0)
Devon Medical Centre ACHIEVEMENT 138 24 / 26
96.2%
(0)
100.0%
(0)
95.5%
(0)
100.0%
(0)
- - - -
91.4%
(0)
91.2%
(0)
92.8%
(0)
92.2%
(0)
91.8%
(0)
95.3%
(0)
46.2%
(0)
51.8%
(0)
- -
87.9%
(0)
82.5%
(0)
89.3%
(0)
100.0%
(0)
71.5%
(0)
76.2%
(0)
32.3%
(0)
38.6%
(0)
74.3%
(0)
76.7%
(0)
39.9%
(97)
50.9%
(11)
76.7%
(0)
85.5%
(0)
Family Health Centre ACHIEVEMENT 93 14 / 26
66.7%
(1)
0.0%
(1)
100.0%
(0)
0.0%
(0)
- - - -
81.9%
(0)
80.8%
(0)
99.2%
(0)
98.4%
(0)
73.0%
(37)
82.5%
(4)
20.0%
(11)
22.8%
(1)
- -
87.4%
(0)
85.3%
(0)
90.0%
(0)
100.0%
(0)
65.5%
(14)
60.6%
(7)
38.1%
(0)
39.4%
(0)
46.6%
(54)
44.4%
(14)
32.6%
(71)
50.0%
(7)
87.1%
(0)
89.2%
(0)
Inglewood Medical Centre - Dr
Finnigan
ACHIEVEMENT 21 9 / 26
88.9%
(0)
100.0%
(0)
66.7%
(1)
0.0%
(0)
- - - -
79.6%
(0)
72.5%
(0)
93.6%
(0)
92.8%
(0)
13.7%
(162)
17.0%
(34)
4.2%
(44)
4.3%
(10)
- -
65.6%
(4)
52.9%
(3)
50.0%
(1)
0.0%
(1)
54.0%
(18)
45.0%
(5)
68.1%
(0)
65.0%
(0)
46.0%
(24)
26.3%
(8)
36.7%
(30)
41.2%
(5)
41.7%
(245)
35.9%
(40)
Inglewood Medical Centre - Dr
Jones
ACHIEVEMENT 29 13 / 26
100.0%
(0)
0.0%
(0)
100.0%
(0)
0.0%
(0)
- - - -
80.5%
(0)
80.5%
(0)
92.2%
(0)
91.6%
(0)
72.2%
(26)
71.9%
(6)
16.0%
(13)
15.6%
(3)
- -
81.9%
(0)
75.0%
(0)
60.0%
(1)
0.0%
(0)
58.9%
(14)
27.3%
(5)
54.3%
(0)
81.8%
(0)
45.9%
(26)
40.0%
(3)
24.1%
(53)
25.0%
(4)
48.5%
(178)
53.6%
(15)
Parklands Medical Centre ACHIEVEMENT 41 14 / 26
94.7%
(0)
91.7%
(0)
100.0%
(0)
100.0%
(0)
- - - -
91.6%
(0)
91.5%
(0)
93.3%
(0)
93.2%
(0)
31.9%
(226)
32.4%
(119)
7.7%
(67)
8.7%
(34)
- -
77.6%
(0)
77.0%
(0)
66.7%
(0)
77.8%
(0)
52.5%
(63)
52.1%
(25)
51.7%
(0)
44.3%
(0)
52.7%
(52)
44.4%
(32)
31.3%
(104)
36.8%
(29)
69.1%
(74)
63.8%
(54)
Patea & District Community
Medical Trust
ACHIEVEMENT 109 13 / 26
66.7%
(3)
42.9%
(3)
83.3%
(1)
100.0%
(0)
- - - -
64.6%
(59)
59.8%
(52)
91.8%
(0)
92.0%
(0)
59.2%
(95)
59.3%
(64)
12.0%
(40)
12.4%
(26)
- -
81.2%
(0)
79.1%
(0)
96.4%
(0)
95.7%
(0)
80.8%
(0)
82.6%
(0)
34.6%
(0)
30.3%
(0)
75.6%
(0)
72.6%
(0)
55.5%
(28)
56.7%
(18)
73.4%
(14)
73.6%
(8)
Powderham Medical Centre ACHIEVEMENT 45 12 / 26
87.5%
(0)
66.7%
(1)
100.0%
(0)
0.0%
(0)
- - - -
74.1%
(0)
72.5%
(0)
84.1%
(96)
82.6%
(26)
36.5%
(73)
28.0%
(31)
8.0%
(23)
4.0%
(11)
- -
82.8%
(0)
81.8%
(0)
92.3%
(0)
80.0%
(0)
73.6%
(0)
64.7%
(2)
56.2%
(0)
61.8%
(0)
62.4%
(8)
65.5%
(1)
36.9%
(40)
27.3%
(14)
67.4%
(52)
62.1%
(19)
Regan Street Medical Centre ACHIEVEMENT 45 9 / 26
44.4%
(4)
0.0%
(3)
50.0%
(1)
0.0%
(0)
- - - -
95.4%
(0)
96.8%
(0)
80.9%
(96)
76.5%
(34)
76.2%
(26)
71.9%
(10)
25.4%
(0)
22.8%
(1)
- -
64.2%
(6)
52.0%
(5)
60.0%
(1)
100.0%
(0)
93.5%
(0)
88.0%
(0)
32.7%
(0)
32.0%
(0)
51.0%
(19)
26.1%
(10)
29.4%
(44)
20.0%
(13)
70.8%
(17)
60.5%
(12)
SouthCare ACHIEVEMENT 55 11 / 26
97.0%
(0)
100.0%
(0)
93.0%
(0)
92.3%
(0)
- - - -
70.2%
(62)
62.5%
(57)
84.1%
(452)
85.2%
(78)
36.4%
(421)
33.9%
(132)
12.0%
(102)
11.0%
(33)
- -
77.5%
(0)
75.0%
(0)
93.1%
(0)
100.0%
(0)
70.2%
(0)
74.6%
(0)
32.9%
(0)
26.1%
(5)
65.4%
(19)
66.7%
(4)
38.2%
(186)
37.2%
(54)
38.2%
(1058)
35.8%
(259)
Te Aroha Medcare Ltd ACHIEVEMENT 72 16 / 26
93.3%
(0)
100.0%
(0)
91.7%
(0)
100.0%
(0)
- - - -
92.8%
(0)
92.5%
(0)
89.8%
(2)
89.4%
(6)
63.4%
(94)
64.9%
(62)
14.5%
(37)
16.1%
(22)
- -
73.2%
(0)
72.8%
(0)
72.7%
(0)
80.0%
(0)
81.5%
(0)
82.2%
(0)
48.8%
(0)
50.8%
(0)
74.1%
(0)
73.4%
(0)
43.7%
(37)
42.1%
(32)
64.0%
(56)
63.6%
(41)
Tukapa Medical Centre ACHIEVEMENT 41 9 / 26
0.0%
(1)
0.0%
(1)
66.7%
(1)
0.0%
(0)
- - - -
76.7%
(0)
78.0%
(0)
89.6%
(5)
89.5%
(1)
51.5%
(38)
55.9%
(12)
16.2%
(9)
20.6%
(2)
- -
76.9%
(0)
66.7%
(1)
66.7%
(0)
100.0%
(0)
63.6%
(7)
76.5%
(0)
30.9%
(0)
35.3%
(0)
26.3%
(42)
33.3%
(6)
38.5%
(41)
37.5%
(8)
60.9%
(75)
52.0%
(23)
Vogeltown Medical Centre ACHIEVEMENT 49 13 / 26
82.4%
(0)
100.0%
(0)
86.4%
(1)
100.0%
(0)
- - - -
87.1%
(0)
90.4%
(0)
94.8%
(0)
98.5%
(0)
74.4%
(21)
66.7%
(6)
18.0%
(9)
0.0%
(6)
- -
82.2%
(0)
69.2%
(0)
87.5%
(0)
100.0%
(0)
69.1%
(1)
61.5%
(1)
49.1%
(0)
46.2%
(0)
45.4%
(24)
25.0%
(5)
31.4%
(46)
38.5%
(4)
47.7%
(164)
51.2%
(21)
GOAL
ACHIEVEMENT
191 /
364
10 / 14 9 / 14 9 / 14 14 / 14 - - - - 12 / 14 12 / 14 8 / 14 8 / 14 2 / 14 2 / 14 3 / 14 2 / 14 - - 12 / 14 11 / 14 11 / 14 13 / 14 7 / 14 7 / 14 13 / 14 12 / 14 4 / 14 4 / 14 0 / 14 0 / 14 3 / 14 3 / 14
ACHIEVEMENT
87.9%
(9)
78.8%
(9)
92.4%
(5)
97.8%
(0)
- - - -
81.4%
(121)
78.6%
(109)
90.3%
(757)
90.1%
(153)
53.9%
(1255)
53.4%
(488)
17.2%
(365)
15.8%
(151)
- -
79.5%
(10)
75.6%
(9)
86.4%
(3)
92.2%
(1)
69.0%
(120)
70.8%
(49)
39.7%
(23)
38.7%
(12)
59.9%
(289)
60.1%
(91)
36.9%
(849)
42.4%
(204)
61.7%
(2010)
61.6%
(503)
Avon Medical Centre ACHIEVEMENT 56 14 / 26
88.0%
(0)
92.9%
(0)
92.3%
(0)
100.0%
(0)
- - - -
74.0%
(0)
70.6%
(5)
97.2%
(0)
96.6%
(0)
53.7%
(140)
47.9%
(50)
8.0%
(66)
6.7%
(22)
- -
0.0%
(0)
0.0%
(0)
88.2%
(0)
83.3%
(0)
68.4%
(4)
72.7%
(0)
34.6%
(0)
34.8%
(0)
51.4%
(35)
58.2%
(7)
40.2%
(55)
32.7%
(18)
71.6%
(34)
72.1%
(6)
Bellomo Family Health ACHIEVEMENT 49 14 / 26
92.9%
(0)
100.0%
(0)
87.5%
(0)
100.0%
(0)
- - - -
85.8%
(0)
82.8%
(0)
99.8%
(0)
100.0%
(0)
79.8%
(13)
91.7%
(0)
22.5%
(3)
27.1%
(0)
- -
68.6%
(1)
55.0%
(3)
100.0%
(0)
100.0%
(0)
66.7%
(4)
58.3%
(3)
38.7%
(0)
50.0%
(0)
48.4%
(20)
59.1%
(2)
48.8%
(18)
50.0%
(4)
68.7%
(27)
65.9%
(8)
Carefirst Medical Centre ACHIEVEMENT 116 19 / 26
93.5%
(0)
100.0%
(0)
93.3%
(0)
91.7%
(0)
- - - -
87.5%
(0)
86.1%
(0)
96.0%
(0)
95.1%
(0)
79.7%
(80)
78.8%
(26)
46.9%
(0)
43.6%
(0)
- -
82.2%
(0)
80.0%
(0)
85.0%
(0)
78.6%
(0)
67.8%
(16)
69.0%
(2)
52.0%
(0)
45.5%
(0)
70.3%
(0)
67.8%
(3)
49.7%
(119)
53.0%
(20)
79.6%
(0)
80.6%
(0)
Dr Marie Fonseka ACHIEVEMENT 35 13 / 26
100.0%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)
- - - -
75.6%
(0)
73.5%
(0)
91.1%
(0)
89.3%
(1)
22.6%
(78)
18.5%
(19)
8.7%
(19)
11.1%
(4)
- -
82.6%
(0)
100.0%
(0)
0.0%
(0)
0.0%
(0)
61.6%
(7)
60.0%
(2)
64.0%
(0)
53.3%
(0)
56.9%
(9)
41.7%
(3)
2.9%
(46)
8.3%
(7)
62.5%
(66)
71.2%
(3)
Dr R G Radich ACHIEVEMENT 43 11 / 26
100.0%
(0)
0.0%
(0)
100.0%
(0)
100.0%
(0)
- - - -
83.2%
(0)
80.9%
(0)
97.1%
(0)
96.8%
(0)
67.6%
(40)
63.0%
(12)
6.1%
(34)
4.3%
(10)
- -
67.3%
(3)
59.1%
(2)
100.0%
(0)
100.0%
(0)
58.1%
(20)
51.6%
(6)
24.6%
(9)
12.9%
(5)
42.3%
(41)
37.0%
(9)
34.6%
(37)
36.4%
(7)
77.6%
(0)
71.6%
(4)
Eastside Medical Centre ACHIEVEMENT 134 20 / 26
88.2%
(0)
100.0%
(0)
100.0%
(0)
0.0%
(0)
- - - -
77.9%
(0)
77.2%
(0)
96.3%
(0)
94.8%
(0)
78.7%
(29)
89.7%
(0)
28.7%
(0)
31.0%
(0)
- -
82.4%
(0)
69.0%
(0)
80.0%
(0)
85.7%
(0)
61.9%
(25)
62.3%
(5)
45.5%
(0)
42.0%
(0)
53.4%
(44)
47.6%
(14)
68.9%
(2)
81.0%
(0)
86.6%
(0)
80.0%
(0)
Eltham Health Centre ACHIEVEMENT 64 15 / 26
100.0%
(0)
100.0%
(0)
83.3%
(1)
100.0%
(0)
- - - -
67.8%
(30)
62.6%
(11)
95.1%
(0)
93.7%
(0)
81.3%
(21)
80.3%
(7)
80.0%
(0)
78.9%
(0)
- -
86.7%
(0)
76.5%
(0)
100.0%
(0)
100.0%
(0)
82.4%
(0)
76.5%
(0)
95.9%
(0)
70.6%
(0)
68.9%
(2)
57.6%
(4)
28.3%
(72)
20.6%
(17)
64.8%
(81)
60.8%
(21)
Medicross Taranaki Ltd ACHIEVEMENT 51 14 / 26
66.7%
(1)
100.0%
(0)
100.0%
(0)
100.0%
(0)
- - - -
75.8%
(0)
74.5%
(0)
93.2%
(0)
94.2%
(0)
32.0%
(131)
33.9%
(35)
10.2%
(33)
11.3%
(9)
- -
77.3%
(0)
81.8%
(0)
87.5%
(0)
100.0%
(0)
70.7%
(0)
66.7%
(1)
39.0%
(0)
38.1%
(0)
47.8%
(15)
41.2%
(5)
37.3%
(25)
36.4%
(4)
55.5%
(92)
52.8%
(28)
Moturoa Medical Centre ACHIEVEMENT 105 14 / 26
80.0%
(1)
100.0%
(0)
100.0%
(0)
100.0%
(0)
- - - -
79.7%
(0)
73.6%
(0)
94.3%
(0)
94.6%
(0)
59.0%
(85)
59.4%
(32)
19.4%
(15)
23.6%
(2)
- -
86.0%
(0)
78.0%
(0)
87.5%
(0)
100.0%
(0)
73.5%
(0)
60.8%
(7)
44.2%
(0)
41.9%
(0)
56.1%
(29)
44.3%
(16)
44.2%
(56)
42.0%
(14)
73.4%
(18)
73.7%
(3)
Oakura Medical Centre ACHIEVEMENT 43 14 / 26
60.0%
(3)
0.0%
(0)
92.3%
(0)
100.0%
(0)
- - - -
81.4%
(0)
79.2%
(0)
99.8%
(0)
100.0%
(0)
45.3%
(57)
45.8%
(11)
18.0%
(9)
25.0%
(0)
- -
81.8%
(0)
75.0%
(0)
100.0%
(0)
100.0%
(0)
60.7%
(14)
61.5%
(1)
42.8%
(0)
38.5%
(0)
46.9%
(30)
41.7%
(3)
33.8%
(28)
25.0%
(4)
58.6%
(102)
36.1%
(24)
Opunake Medical Centre ACHIEVEMENT 50 16 / 26
100.0%
(0)
100.0%
(0)
100.0%
(0)
100.0%
(0)
- - - -
79.6%
(0)
78.7%
(0)
99.7%
(0)
99.5%
(0)
76.5%
(33)
87.3%
(4)
43.3%
(0)
47.3%
(0)
- -
75.6%
(0)
78.5%
(0)
95.0%
(0)
93.8%
(0)
62.9%
(16)
60.6%
(12)
47.6%
(0)
46.5%
(0)
46.4%
(49)
43.9%
(30)
31.9%
(61)
32.3%
(35)
68.4%
(57)
70.9%
(17)
Taranaki
BarbPurdie
PL TOTALS
WendyMarshall
Lakes
JoanneMintoft
PL TOTALS
SERVICE DELIVERY TOTALS
Tairawhiti
TiaMoeke
PL TOTALS
SERVICE DELIVERY TOTALS
GOAL DISTRIBUTION MAP - Q2 SUMMARY GOAL
S.D PL PRACTICE
POINTS
AWARDED
GOALS
ACHIEVED

9. Let the data sing – Present a Plan

10. Locality & System Planning
Population
NGO services
Primary Care
Hospital services
Facilities
Future configuration

11. Locality Planning
MHN – New
Zealand

12. Locality – Planning Configuration

13. Helping Practices to understand future

14. New models of care
• New way of working required to meet new
demands and capacity requirements
• New facilities to support new models of care
• Integrated information systems
• New contracting arrangements to support new
models
• Retraining the workforce
• Resetting the commercial/business model

15. 500,000 lives
5 million + encounters
Hundreds of settings
Life long relationships
60 years of unlearning

16. A new contracting enabler
• A shift away from traditional funder/provider roles
• Taking experiences from commercial application of risk
sharing contracting arrangements in construction and oil
sectors
• Evidence points to better performance of alliance
governed contracts vs. traditional approaches
• Process and patient focused vs. transactional
• Driven by front line clinicians
• Clinical commissioning in another language

17. The Alliance Agreement
• A nationally determined agreement that is a relationship and
decision making agreement rather than a service delivery
agreement.
• The agreement establishes a structure to enable clinicians,
alongside managers and others, to make decisions about how
to apply resources to specific services to achieve the best
outcomes. Commissioning & decommissioning
• Decisions involve less specification and an emphasis on quality
processes and transparency of information to assure
accountability and best value for money.
• The scope of the agreement has been broadly developed
collectively around agreed key health areas.
• It places the risk and rewards of success on all parties.

18. Alliance in action
• The Alliance Leadership Team is the body for managing
change, not for managing business as usual.
• Supported by
– The Alliance Agreement
– The Alliance Charter
– Underlying agreement with Government
• Each party to the Alliance retains their role and own
goverance.
• Resources around agreed areas are pooled by
agreement to support Alliance recommendations
• Requires strong senior clinical and management
leadership and committment

19. Alliance contracting
Alliance
MHN
GP Network
GP
Other
providers
(pharmacy,
Allied etc)
DHB
Hospital

20. The road so far
• Long term conditions management
– The LTCM is a suite of resources and support designed to
enable the general practice team to proactively provide
targeted care to patients diagnosed with a LTC
• Getting resources upfront
– Traditional post hospitalization resources being shifted to
preventative roles
• Medical Home
– Primary care taking broader responsibility for coordinating
care
Co-designed – co-funded

21. Key components
• Planned care: comprehensive assessment and a planned
approach with a longer term view towards staying well in
the presence of an incurable disease (rather than acute
care for an episode of ill health)
• Patient led care with the health care team as the patients
agent
• Co-ordinated complete care for people with complex
needs
• Commissioning resources to those in greater need
• Wider scope of services being available in the patients'
Health Care Home (primary care)
• Integrated services that are "seamless" from the patient's
point of view.

22. Elements and enablers

23. The effect to date
• Haven't had time to measure full impact
• Noted increase in clinical leadership
• Appears to be a reduction in acute ED
presentations – 11- 7%
• Patient satisfaction higher
• Workforce satisfaction higher
• Improvement in related quality program
performance

24. National performance data

25. Healthy
Communities
Fit for purpose
General Practice
Models of Care
MDTs
Integration
Right sizing
Hospitals
Sustainability
Hospital
performance
BSMC Services
MDT
performance
Proactive
care
General Practice
performance
Self care
Whole of system thinking
& commissioning

26. The risk of
doing
nothing….
The
challenge of
change…