BLOG: Future-proofing healthcare delivery though prevention
Dominoes

By Mark Vella
CEO, Total Healthcare PHO


It has been hugely rewarding to see how the network of PHOs around the country kicked into action in 2020, capitalising on their agility and capacity to support their frontline general practice troops in the battle against COVID-19.

This has been particularly evident among our own team of 1000 who have been stellar in their fast and efficient response to the pandemic. Because of their expertise and support, we found ourselves well placed to set up a strong community testing response. But our strategic forward planning as a PHO also ensured we were well prepared.

Our provider group, Tāmaki Health, already had plans in train to introduce virtual health consults and this was really put to the test in the COVID-19 lockdown. Our region’s high needs patient population responded in kind with over 20,000 virtual consults delivered in one annual quarter, with 45% of those Pacific Island and 17% Māori. We are now looking at how to invest FFP funding to support virtual consults beyond the pandemic as it has the potential to enhance capacity and reduce waiting times at clinics, as well as further reducing barriers to access for high needs patient populations.

Prevention remains key focus
At the same time, despite COVID-19, we have been able to maintain a future-proofing focus on preventative health through screening and support for long term conditions, while remaining agile enough to respond to other acute needs that may arise.

While we are a purchasing group for community health services, we go much further than that in healthcare procurement. To ensure our communities stay well we proactively identify needs and develop health programmes to both anticipate and meet those needs. In this, we are guided by a strong community voice through a board of trustees that guides our spending towards where it is most needed.

This has led to our identification, development and support of services that reduce the strain on the hospital system and other secondary healthcare agencies by providing care in the community.

Groundbreaking services
We have developed New Zealand’s cutting edge mental wellbeing service that has transformed wellness support through phone consults to young people to increase access, mindfulness training, personal health coaching and the establishment of men’s groups, among other initiatives. 

Over the past eighteen months we have helped give the best start to life to over 500 young pregnant Māori and Pasifika mothers and their babies with our Maternity Coordination Services programme. This was put in place to address inequities in the care of our high needs population; it helps women under 22 years in South Auckland to secure not only health support but also helps them navigate social services support throughout their pregnancies and for the first six weeks of motherhood.

We have been a seed funder of the Gandhi Nivas early intervention family harm programme that operates throughout our region. Instead of removing victims after a family harm incident, the Gandhi Nivas programme removes men from the family home, provides them with temporary housing, 24/7 specialist counselling and support to begin behavioural change, while a wraparound support service is offered to whānau.  The results of a study by Massey University released at Parliament in June this year showed a nearly 60 % reduction in family harm among Gandhi Nivas clients over a five-year period.

Innovative funding required 
Health practices within our network are seeing more than 3000 patients a day, or 1 million patients a year. We are just as innovative with how we fund our day to day health services to achieve best practice. Currently, community health providers in GP centres get just a little over 5 per cent of a multi billion dollar health spend and yet the majority of need is in the community.

We are embracing the concept of “networks” outlined in the Health and Disability Review and look forward to working with Government’s implementation team to explore how these might look in the future. They are to address primary care, vulnerable young mums, family harm and mental health. Having worked with multi agencies to achieve the innovative programmes outlined above, “networks” present a huge opportunity to commission services closer to those who need them most.

Agility and capacity are the hallmarks of our PHO model, and it’s working.

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