Pegasus Health Annual Report 2020 by PegasusHealth

PEGASUS HEALTH ANNUAL REPORT 2020

Photo: COVID -19 testing station, AAP

CONTENTS REPORTS

EXTENDED INFORMATION

Anniversary of acute community care highlights seamless service

22 23

The Pegasus response to COVID-19 (Continued)

Board Chair Report

CEO Report

Homecare Medical central to supporting our community

Diverse backgrounds but common health study goals

Health care provided in window of opportunity (Continued)

Population Health Advisory Board Report Clinical Quality Advisory Board Report

A strong voice for healthy policy and environments

Supporting change and systems improvement (Continued)

Membership Board Report

Support for getting back to work

Pegasus Health (Charitable) Ltd Financial Statements (Continued)

Canterbury Clinical Network

Health care provided in window of opportunity

PHAB (Continued)

Supporting change and systems improvement

CQAB (Continued)

Fifteen years in response role

Canterbury Clinical Network (Continued)

Homecare Medical (Continued)

STORIES

The Pegasus response to COVID-19

Nursing at the forefront of hard places

Strengthening Family Practice

Increase in referrals for Pastoral Care

Te Tumu Waiora - Ways to Wellbeing

Pharmacy and General Practice closer together

Twenty-Four Hour Surgery response to COVID-19

Strength of Pasifika

In the heart of Ashburton

FINANCIALS AND STATISTICS

System Level Measures

Financial statement commentary

Enrolled population

Facts and figures

Full financial reports are available separately on our website

REPORTS Board Chair Report

CEO Report

Population Health Advisory Board Report

Clinical Quality Advisory Board Report

Membership Board Report

Canterbury Clinical Network

2020 ANNUAL REPORT

REPORTS

BOARD CHAIR REPORT PETER TOWNSEND I must begin this report by

We have an opportunity to demonstrate the exemplar models

congratulating Pegasus member

which Pegasus operates and continues to build.

practices and Pegasus staff for the outstanding and selfless work undertaken during the ongoing COVID-19 pandemic. We are well-served by the role that primary care plays in the Canterbury health system and the quickness of our COVID-19 response demonstrates that primary care remains the foundation on which the health system sits. Recent months have signaled uncertainty for primary health and Primary Health Organisations (PHOs), with the release of the Health and Disability Review and major changes and upheaval in the leadership of Canterbury District Health

These models are a sustainable solution to take the load off secondary care and off DHB finances. They are more

Right now, there is an opportunity to look at the South

Peter Townsend

Island health system as a whole and to ensure that a focus on primary care and public health continues to map the way forward. I would like to thank deputy board chairs Simon Wynn Thomas and Caroline Christie, and our hard working Board members. I would also like to thank Pegasus CEO Vince Barry for his leadership, the Pegasus Team for delivering to our members, and the people of Canterbury at a difficult time.

The programmes that Pegasus runs make a real difference

family.

to the lives of Cantabrians and help ensure people do not

keeping people away from the Emergency Department and hospital admission.

for wellness and for an efficient, patientcentred health system.”

I would also like to acknowledge my appreciation of the support we continue to receive from the wider Pegasus

Our acute care programme and 24 Hour Surgery are vital to

on primary and community care is vital

patient-focused and lead to better outcomes for patients.

Board.

needlessly end up in expensive hospital beds.

“We are well-placed to show that a focus

Peter Townsend

Chair

Photo above: Pegasus Health Charitable Ltd Board. Back row from left: Vanessa Weemink, Simon Wynn Thomas, Peter Townsend, Ben Kepes. Seated from left: Nicky Scott, Ben Hudson, Caroline Christie, Brett Chambers, Sharon Ashmore. Absent: Gayle O’Duffy, Jane Huria. Left: Pegasus Health Board Chair, Peter Townsend

2020 ANNUAL REPORT

REPORTS

CEO REPORT VINCE BARRY

“ It’s at times like this you truly feel the spirit that binds us together as a community.” Vince Barry

The words kia kaha have never

Clinicians have adopted new models of care, as they rapidly

The resilience of our wider community and provider

had more meaning in the lives

put telemedicine in place and adapted to rigorous infection

network has also been demonstrated, as they responded

of Cantabrians, than during the

control procedures to help keep people well.

heroically to the challenges put in front of them. I have

past 10 years. We have proven how resilient and supportive we are as a community, as we have experienced devastating earthquakes, fire in the Port Hills, last year’s tragic mosque massacres and now COVID-19. I am proud of how Pegasus member practices and staff have worked under great pressure to help ensure COVID-19 does not take hold here. Through all this, we need to ensure that we continue to practice good self-care and look after one another. For the Pegasus network COVID-19 has meant working long hours and exposing ourselves to the risk of infection, or worse bringing COVID-19 home to our loved ones. Staff have worked diligently through the lockdown, often from home, while managing household dynamics, child care and the impacts of restricted movement.

Many of our clinicians are in age groups that put them at extra risk of harm or death should they catch COVID-19. I am pleased that our pastoral care programme has worked well during this period, and that everyone has taken a

huge admiration for the team that supported the Muslim community throughout the recent court appearances, following the terror attack in March last year. I hope you can take the time to absorb the richness of the

supportive, ‘can do’ attitude to their roles.

stories contained in this Annual Report.

Our role through the Canterbury Primary Response Group

A special thank you to all the team at Pegasus for the

(CPRG) in setting up and running Community Based

continued dedication to their work, and the leadership team

Assessment Centres (CBACs), has been nothing short of

for their continued support under very trying circumstances.

impressive. We have worked hard to ensure that Pegasus general practices have remained sustainable throughout the COVID lockdown, and now have learnings and experience that we can apply to ensure future practice resilience and sustainability. The team at 24 Hour Surgery adapted quickly to the various messages coming from Wellington about testing and CBAC activity, and again they have worked tirelessly on behalf on our general practice teams.

I am sure that we all look forward to a better, or possibly different, year ahead. Kia Kaha

Vince Barry CEO

2020 ANNUAL REPORT

POPULATION HEALTH ADVISORY BOARD REPORT

STORIES REPORTS

Our purpose is ‘to provide advice to the Pegasus Health Charitable Limited Board on ways that Pegasus can continue to improve health outcomes and reduce health inequities in the Canterbury population and beyond’. In 2018, the Pegasus Population Health Advisory Board (PHAB) reviewed relevant population health data and developed the following priority areas with an overarching priority of improving equity: • Reduce Pacific ambulatory sensitive hospitalisation (ASH) rates for children aged 0-4 years • Improve oral health • Reduce amenable mortality. You can read more about our work later in this report. Ann Richardson Chair, Population Health Advisory Board

2020ANNUAL ANNUALREPORT REPORT 2020

REPORTS

CLINICAL QUALITY ADVISORY BOARD REPORT

The Clinical Quality Advisory Board (CQAB) was established in June 2018. Its mandate is to oversee activities within Pegasus that involve the clinical care of patients, and to provide support to the Pegasus Board to achieve its mission to improve health through high-performing teams and innovative community and primary healthcare. This year, the CQAB agreed on four areas where Pegasus Health and its general practice partners can positively contribute to the System Level Measure Improvement Plan: • Cervical cancer prevention (screening and HPV immunisation) • Equally Well (physical health outcomes for people with severe mental illness and addiction) • Family violence • Oral health. CQAB will be taking a more proactive approach to monitoring and supporting quality improvement across these areas over the coming year. You can read more about our work later in this report. Ben Hudson

Photo: Ben Hudson

Chair, Clinical Quality Advisory Board

2020 ANNUAL REPORT

REPORTS

MEMBERSHIP BOARD REPORT My first report, written this time last year, started with the

I would like to make a special mention of my clinical

sentence, ‘It’s been a difficult year in general practice.’

colleagues who looked after rest home patients who became

Little did I know! But, looking back on last year’s report brings

infected with COVID-19. The first-class clinical care provided

to light a recurring theme – unexpected adversity followed by

and the empathy with which it was dispensed, despite the

a remarkable response from our general practice teams, with

complexities and adversity of wearing PPE or consulting

excellent support from Pegasus Health.

remotely, reminds us of what (and who) we are here for.

As in all times of difficulty, there have been a few bumps along the way. The lessons that we have had to swiftly learn and the processes that we now have in place, (I hope) have made for a stronger unity among our Canterbury / Pegasus community. Amid reports of health professionals contracting

I think Cantabrians would feel incredibly humbled by the massive contribution from our greater health community, whether that contribution to patient care is from the coalface, from Pegasus House or from another part of the Canterbury health system.

COVID-19, my colleagues are telling me that they feel as if

The stoicism and innovation that has served us so well

they have never before put themselves at greater personal

throughout the earthquakes and through a pandemic will be

risk for the benefit of their patients.

needed as much as ever, as we adapt to the challenges that

Thanks to the support and advice from the various parts of the Canterbury health system, to the support from Pegasus Health and the collegiality of colleagues (not to mention the PPE!) I hope that we all feel more supported in our efforts to keep the community safe and well.

the coming year will present. Irrespective of whether these challenges come from the downstream effects of COVID-19, the current difficulties at the CDHB, the Health and Disability Services Review or an unforeseen event, I am grateful to be part of the Pegasus family at such times. Simon Wynn Thomas GP and Chair of Pegasus Membership Board

Photo: Simon Wynn Thomas

2020HEALTH ANNUAL REPORT PEGASUS 2020 ANNUAL REPORT

REPORTS

CANTERBURY CLINICAL NETWORK Canterbury Clinical Network (CCN) is New Zealand’s largest district alliance, with 12 alliance partners working together to improve the health and wellbeing of our communities. Established in 2010, CCN brings people together from across the health system to design and improve health services to ensure our people get the care they need as close to their homes as possible. This service transformation is led by people who live and breathe health – doctors, nurses, pharmacists and health managers – alongside the people who use health services every day. This year CCN has made excellent progress in the key areas outlined in our five-year strategic focus. You can read more later in this report.

Photo: Canterbury Clinical Network’s Better Breathing Pulmonary Rehabilitation course participant

2020 ANNUAL REPORT

STORIES

Photo: 24 HS CBAC

Diverse backgrounds but common health study goals

A strong voice for healthy policy and environments

Increase in referrals for Pastoral care

Support for getting back to work

Te Tumu Waiora - Ways to wellbeing

Pharmacy and general practice closer together

Health care provided in window of opportunity

24 Hour Surgery COVID-19 response

Supporting change and systems improvement Fifteen years in response role

Strength of Pasifika

In the heart of Ashburton

Anniversary of acute community care highlights seamless service

Homecare Medical central to supporting our community

The Pegasus response to COVID-19

Nursing at the forefront of hard places

Strengthening Family Practice

2020 2020 ANNUAL ANNUAL REPORT REPORT

STORIES

THE PEGASUS RESPONSE TO COVID-19 When COVID-19 emerged as a pandemic, Pegasus staff

CBACs are staffed by doctors, nurses and administration

connected with their colleagues throughout the Canterbury

staff and provide clinical assessment, testing, advice, triage,

health system to respond.

and referrals to other services.

The system worked well as we coordinated through the

Pegasus staff are involved in many aspects of the

Canterbury Primary Response Group (CPRG) with the

CBAC through the CPRG operation including sourcing

Canterbury District Health Board, our fellow PHOs and the

facilities, setting up and supporting technology and patient

Ministry of Health.

management systems, rostering and staffing, communication with referrals, finance and accounts, as well as general

The Community Based Assessment Centres (CBACs)

management and oversight.

Along with general practice, CBACs have become the public face of the response, especially with the Governmentâ€™s focus on testing. At the height of the pandemic, 10 CBACs were operating across urban and rural areas in Canterbury with a mobile unit providing testing facilities for frontline and at-risk workers such as the Police, hotel staff, rest home and supermarket staff.

Photo: Covid -19 testing station, Stuff

Continued

2020 2020ANNUAL ANNUALREPORT REPORT

STORIES

“We are grateful to all our staff, Pegasuswide, who went above and beyond to help control the outbreak and to ensure we had the best possible primary care response in place.” Vince Barry CEO Photo: Covid -19 testing station, Stuff

2020 ANNUAL REPORT

STORIES

CAPTURING THE PEGASUS COVID-19 EXPERIENCE HomeCare Medical central to supporting our community continued

RESPONSE STATISTICS

Over this time we distributed:

From 19 March to 22 July 2020 we received and actioned more than 900 requests for PPE gear from general practices, community pharmacies, urgent care centres and Community Based Assessment Centres (CBACs).

Pairs of gloves

78,000

138,000 Surgical masks

We supported 13 CBACS over this time in Canterbury with 47 ‘pop up’ testing stations at supermarkets, aged care facilities, hospitals and for frontline staff such as Police.

21,500

>1,000

Surgical gowns

Litres of hand sanitiser

90%

1,800

Pegasus general practices

Swabs conducted on

conducted swabbing onsite

people in quarantine / isolation

STORIES 14 STORIES

2020 ANNUAL REPORT

NURSING AT THE FOREFRONT OF HARD PLACES The first nursing advisor was appointed at Pegasus Health in 1997. Over the decades, the appointment has been followed by practice nurse training programmes and strategies to make primary care nursing more effective. In 2011 the Nursing entry to Practice Programme (NetP) was introduced to support graduate nurses into general practice. Pegasus Health Nurse Membership gave practice nurses an individual and collective voice, and influence within Pegasus Health and the Canterbury health system. Director of Nursing, Michael McIlhone says now, during the International Year of the Nurse and the Midwife, is the time to dedicate more financial resources to support the profession. The Nurse Membership structure within Pegasus has been dissolved and in its place is a refocused Nurse Advisory and suite of nursing support services and initiatives for nurses working in general practice, 24 Hour Surgery and Pegasus Health.

“We’ve seen our nurses at the forefront of the Canterbury earthquakes, terror attacks and now the COVID-19 response. They’ve put themselves into the hard places and

A Nurse Director, Nicky Scott, now sits on the Pegasus Health Board and funding will soon become available for professional supervision, counselling sessions, extra scholarships and conference and course attendance for Pegasus nurses. Michael says the Pegasus Nursing Team will also explore additional ways to help develop peer support and mentorship for Pegasus nurses.

we’re backing them up with this new suite of services.” Michael McIlhone Director of Nursing Photo: Pegasus 24HR Surgery

2020 2020ANNUAL ANNUALREPORT REPORT

STORIES

STRENGTHENING FAMILY PRACTICE

The response from Pegasus member general practices to COVID-19 has shown that new ways of working can be beneficial to patients and to practice sustainability. Data collected over the past months has shown that practices that are on the Health Care Home journey are more resilient and able to adapt more quickly to change. This year we have introduced Hikitia, our Strengthening Family Practice programme, which builds on the improvements many practices have already made, and is aligned with the Health Care Home philosophy. The programme is being piloted in several practices. Pegasus team members work through the programme in partnership with practices, making each module easy. Hikitia aims to make practices more resilient, through helping improve business efficiency and sustainability, while focusing on delivering patient care in a variety of new ways that value clinical and patient time, and improve the experience for Photo: Well Child Check in General Practice

both.

2020 ANNUAL REPORT

STORIES

INCREASE IN REFERRALS FOR PASTORAL CARE Pegasus Health’s Pastoral Care Programme has been

Support for the GP may be needed with a range of issues

around since 2009. Designed to detect problems at an early

including depression, bereavement, anxiety or organisational

stage and support doctors on an individual basis through

issues. Once contact is made the care is individualised

times of increased stress, burn out or personal problems,

according to level of impairment, career stage, insight and

the programme has proved its worth through Canterbury’s

motivation. GPs are also offered mentoring by one of five

pattern of crisis, change and progression.

doctors in a pastoral care role. Support may involve a visit

The programme offers a combination of peer support counselling and education, covering such areas as

with a review of file notes. A formal practice review may be done in-house by a peer.

prescribing habits and business sustainability. Referrals often come in from nurses, pharmacists and doctors with concerns for their clinical colleagues. It’s a safe environment to share concerns and a step before the involvement of the Medical Council. Dr Caroline Christie is a General Practitioner, Deputy Chair of the Pegasus Health Board and also oversees the Pastoral Care Programme. She says the programme has expectedly seen an increase in referrals during the COVID-19 response. “We are preparing for a further rise of GPs needing support during this ongoing and likely long term response to COVID-19. All our GPs need to look after themselves and their colleagues, their patients and their businesses as well as adapting to the changing environment in healthcare. It is without question, a very challenging time for healthcare workers and the community,” says Caroline.

“ I feel we are well equipped with the robust and proven processes of the Pastoral Care Programme to assist our colleagues through this period.” Dr Caroline Christie Deputy Chair, Pegasus Health Board

STORIES STORIES

2020 ANNUAL REPORT

TE TUMU WAIORA WAYS TO WELLBEING The Mental Health team at Pegasus has strengthened its relationships with other providers during the COVID-19 response. The team is embracing the opportunity to support the roll-out of a new holistic way of delivering mental health, addiction and wellbeing care through general practice. They are working towards a longer-term solution to provide an integrated model of primary healthcare – Te Tumu Waiora.

“The aim is to make wellbeing and mental health support services more accessible for high priority groups such as Māori, Pasifika, youth, or people with other equity issues.” Shelley McCabe Clinical Implementation Lead

Te Tumu Waiora Canterbury is a joint initiative, led by the Canterbury Clinical Network in partnership with Pegasus Health, Waitaha Primary Health, Christchurch PHO, Canterbury DHB and NGO partners.

Te Tumu Waiora is currently operational in six practices

It puts wellbeing and mental health at the heart of general

practices provide immediate brief intervention to patients,

practice, with the introduction of new focused roles

reducing the need for people to be referred for lengthier

working as part of the general practice team – the Health

interventions.

Improvement Practitioner (HIP) and Health Coaches (HCs). Shelley McCabe is the Clinical Implementation Lead on this programme.

within Canterbury, with more planned for this year. These

2020 ANNUAL REPORT

STORIES

PHARMACY AND GENERAL PRACTICE CLOSER TOGETHER With the swift arrival of COVID-19 in New Zealand, the Canterbury health system benefited from existing relationships between Pegasus general practices and pharmacies, and the response has brought them even closer together. The elements of trust, openness and clear communication mean general practices and pharmacies work well together. Cantabrians are all too familiar with crises, so

Photo: The Eastern Pharmacy team works closely with Eastcare Health from left: Diane, Sarah, Suzanne, Lisa, Jacinta, Simon, Jacqui and Stevie.

our emergency response was well-tested. The COVID-19 experience built on the earlier earthquake response. Problems were ironed out quickly. For example, where a

The instant messaging system between general practice

general practice had an oversupply of Personal Protection

and pharmacists, Jitsi, worked well between Eastcare Health

Equipment (PPE), and their local pharmacies had a low

and Eastern Pharmacy, ensuring positive outcomes for

every pharmacy and find out what the challenges were.”

supply, stock was handed over with ease.

patients, as problems and queries were solved quickly.

This intelligence was then fed to the Canterbury Primary

“We have a strong collegial relationship with Eastern

“It is our goal to make things easier and better for patients,”

Response Group (CPRG).

Pharmacy, Aranui,” says Marie Burke, a doctor at Eastcare

says pharmacist at Eastern Pharmacy Aranui, Simon

At a local level, this meant mapping out a matrix of

Health General Practice. “I have worked with the pharmacy

Church. “We are grateful that Eastcare Health gave us some

for more than seven years, and always have positive

of their hand sanitiser and PPE, and we were able to supply

experiences with them.”

‘flu jabs to the general practice when they had a shortage.”

“We already had the structures and systems in place,” says Canterbury Community Pharmacy Group (CCPG) General Manager, Aarti Patel. “As a result, it was easy for us to ring

vulnerable and high-risk pharmacies and making sure CCPG was communicating with them.

Dr Burke says the strong existing relationship meant it was easy to ask for and offer help.

2020 ANNUAL REPORT

STORIES

24 HOUR SURGERY RESPONSE TO COVID-19 The 24 Hour Surgery team (24HS) is accustomed to treating

GP Clinical Leader and acting Clinical Director Liaison, Dr Alf

whatever comes through the doors of the urgent health care

Scragg says virtual consultations implemented during Alert

facility. The existing emergency response plans have been

Level 4 lockdown will continue to be used.

adapted and upscaled for potential COVID-19 cases.

“These consultations definitely have a place in urgent and

Operations Manager, Claire McQuilken says staff quickly

acute demand care. There are some incredibly exciting

became familiar with the complexities of working in PPE and

opportunities for our patients using this technology. Many

the additional workload of significantly intensified cleaning

patients appreciate they don’t have to worry about travel and

requirements.

it’s a great way to support Aged Residential Care facilities,”

Changing Ministry of Health (MoH) case definitions and

says Dr Scragg.

caring for patients and whānau coping with life in lockdown

The 24 Hour Surgery has appreciated the extra support

means team work has never been more vital.

of the wider Pegasus group during this time. Claire says

Clinical Nurse Leader, Berny Hayes says staff not only ‘stepped up’ initially when media coverage was heavily outlining health risks to frontline health staff and their

working across teams has been really rewarding, receiving help with technology hardware and software, PPE provision and collegiality both virtual and in person.

whānau, they continue to adapt to changing COVID-19 alert

“The atmosphere between different Pegasus teams and

levels and MoH updates.

people has reflected the best of Pegasus, why we work here

“Our team is working hard to ensure smooth handover of patient information and make sure we don’t have any cases of COVID-19 exposure or transmission. This includes adopting paperless systems where we can,” says Berny.

and how we care for our community,” says Claire.

Photo: 24HS nurse with patient

2020 ANNUAL REPORT

STORIES

STRENGTH OF PASIFIKA Post-earthquake processes and strong, genuine

Established email lists, regular use of Zoom meetings

relationships are serving the Pasifika community well during

and translated resources were put into play early on.

the COVID-19 response.

Key messages for radio were produced in nine different

Pegasus Pacific Health Manager, Maria Pasene says connection with Pasifika people in key agencies meant they could mobilize very quickly when COVID-19 arrived.

languages and videos showing people what to do when visiting a Community Based Assessment Centre (CBAC) were produced in a number of languages.

“Our Pacific response to COVID-19 relied on established and genuine relationships with Pacific colleagues and contacts in Education, Ministry for Social Development, Housing and Police. We all worked with the Ministry for Pacific Peoples to

“We’re used to looking after each other.

get information out to our communities and gather feedback

Relationships have been grown over

that would make this easier,” says Maria. Community groups Tangata Atumotu Trust (TAT) and Etu Pasifika were also involved. Maria says the Pasifika community is independent when it comes to caring for its people.

years and mean we are well positioned to make use of collective knowledge. Relationships are our strength.” Maria Pasene Pacific Health Manager

Photo: Suli Tuitaupe is a Mobile Community Nurse for Tangata Atumotu Trust

2020 ANNUAL REPORT

IN THE HEART OF ASHBURTON, HELPING TO SERVE THE WHOLE OF THE DISTRICT

STORIES

Ashburton’s Eastfield Health opened in July this year

“I am delighted that previous ways of working do not

and is already making a difference to its community. The

constrain this general practice,” says Craig. “They have

general practice is in a newly-built, purpose-designed

nurses working at the top of their scope, they are using

facility, providing a warm and welcoming integrated health

telephone and video triage, and the team is always finding

care facility for everyone, from children to the elderly. It has

new and efficient ways of doing things.”

replaced Sealy Street Medical Centre.

Chair of Eastfield Health Ltd, Mary Ross, explains the

Pegasus Rural Health Manager, Craig Watson, is proud of

innovative design of the building, which currently serves

this general practice. He recognises the enormous effort

5,400 patients.

involved by all of the team at Eastfield Health.

“We manage the flow of patients to allow efficient use of

“There have been some huge challenges for Eastfield

everyone’s time and provide more privacy for patients. GPs

Health, as they sought to open their doors at a time of

don’t have their own specific rooms and the consulting

national health crisis,” says Craig.

rooms all mirror each other, so that the layout is familiar and

As with many rural practices, the impacts of local events

supplies can be easily accessed,” says Mary.

are often felt at the medical centre. Whether it’s a change to

Mary is keen to move away from the legacy of GPs being

tourism, a drop in farming prices or a local business closure,

under stress and dealing with a large, often complex,

the medical centre is often the first to manage impacts on its

caseload to an environment where the health team can fully

enrolled population.

enjoy their roles.

“It’s exciting to see a significant investment in a rural practice

Eastfield Health is giving rural residents the chance to

that allows more services to be provided locally,” says Craig.

receive cutting-edge, patient-centred services. For example,

Working to the Health Care Home model, the practice is developing clinical teams of GPs, nurse practitioners, pharmacists and social workers. This collaborative approach Photo: Reception at Eastfield Health

ConnectMed is an online portal where patients can make appointments online, order repeat prescriptions and see test results as they come through.

underpins the desire to provide holistic patient care and

“It’s a journey, not an instant destination,” says Mary, but we

create a sustainable medical centre for the community.

are committed to working towards the Health Care Home model. I am so proud of the team.”

2020 ANNUAL REPORT

STORIES

ANNIVERSARY OF ACUTE COMMUNITY CARE HIGHLIGHTS SEAMLESS SERVICE It’s been 20 years since Pegasus Health set up its Community Care programme, allowing people needing acute health care to safely remain or recover at home. In 2000, general practice doctors and nurses were trained and supported to care for people in their own home, offering all the monitoring and treatment options they would have received in hospital. The programme evolved into the Acute Demand Management Service (ADMS). In 2004, the service was extended across Canterbury, with extra funding received from the Canterbury District Health Board. Today, the ADMS supports around 34,000 people in the community. The concept was at first strange for some. Traditional lines of thought believed a hospital was the best place for a person who was unwell. The outcomes for the patients were clear though. There were more hospital beds available for people needing surgical care. Patients didn’t face repeat general practice visit fees, yet still had access to radiology, ultrasound, ECG and blood tests. They received the results just as fast as if they were in hospital. Additionally, a family-friendly observation unit at the

24 Hour Surgery provides a place for people needing to be closely monitored. There were also significant savings. Community health care costs around $140 per visit, compared to $1,180 for an overnight stay in hospital. When the Canterbury earthquakes damaged hospital buildings in 2010/11, and the number of people needing acute care grew instantly, the ADMS helped fill the gaps. The service has proved particularly helpful for patients with Chronic Obstructive Pulmonary Disorder (COPD). In 2013, people with COPD complication attending the Emergency Department at Christchurch Hospital would automatically be admitted to hospital for care. ADMS nurses were placed inside the department to work with staff on alternative care in the community and by 2016, more than 160 hospital bed days had been saved. Pegasus Health CEO, Vince Barry says the Acute Demand service plays a vital part in the Canterbury health system. “Working with our health system partners to provide patients with convenient, home-based health care for the last 20 years is a real achievement for Pegasus. The continuity of care between the Acute Demand team and the patient’s GP results in a seamless service for the patient,” says Vince.

The benefits soon showed themselves. People were recovering better at home and some were able to avoid admission.

2020 ANNUAL REPORT

STORIES

HOMECARE MEDICAL CENTRAL TO SUPPORTING OUR COMMUNITY Homecare Medical is owned by Pegasus Health and

Eight clinical teams work around the clock to provide people

ProCare. It’s been providing clinical support for general

with the best quality telehealth advice and care, delivered

practices after hours for more than 20 years. Since

by registered nurses, mental health nurses, psychologists,

November 2015, it has also been operating digital telehealth

psychotherapists, psychiatrists, counsellors, doctors,

services, which offer free health, mental health and

paramedics, poisons officers, health advisors, sexual harm

addictions support across digital channels.

professionals, and emergency triage nurses.

Events of the last 18 months have disrupted and reshaped

In the last 12 months (ending 30 June 2020) 825,582

Aotearoa and the health landscape. The work of Homecare

contacts were answered by the National Telehealth Service -

Medical has been central to supporting the response to some

those contacts came from 556,933 people (1 in 10 people in

of those events - from the ongoing effects of the tragic events

Aotearoa New Zealand).

in Christchurch in March 2019, through to the measles epidemic and the Whakaari explosion, and for the last six months, the impacts of COVID-19.

You can read more about the work of Homecare Medical later in this report.

With over 4,000 contacts received each day, Homecare Medical’s role is to ensure that every New Zealander has access to free, high-quality health and social care, 24 hours a day, seven days a week, over seven digital channels. In addition to providing National Telehealth Services, Homecare Medical also independently delivers clinical support through several other services, including Employer Advice Line, Mental Health After Hours, Safe to talk, Puāwaitanga and of course general practice out-ofhours support.

Continued

2020 ANNUAL REPORT

STORIES

DIVERSE BACKGROUNDS BUT COMMON HEALTH STUDY GOALS This year’s Pegasus Workforce Development Scholarship

Nagina Miyahel was born in India and only really found her

recipients have common reasons behind their passion and

independence living in New Zealand. The former refugee

desire for health study.

was in awe of nurses caring for her mother and sister.

This year, 23 students received scholarships. These future doctors, nurses, social workers and midwives are

She wants to nurse babies and young children as part of her career.

dedicated to improving health equity, with many motivated

Josie Nicholas-McAnergney chose a medical career at 15

by experiencing ill health within their whānau. Many have

years of age. She would like to apply a holistic approach to

volunteered in some way within health already and have a

health care and investigate Māori medicine to get the best

holistic viewpoint of treating the whole person – mind, spirit

possible outcomes for her patients.

and physical body.

Maca Raleque has chosen a nursing career after 18 years as

Fifth-year medical student Danni Ryan has particularly

a Bank Officer and 10 years as a health care assistant and

enjoyed her placement within Women’s Health.

support worker. Maca believes every second of every day is

“I attended a woman and her partner during the birth of their

about health.

baby… the moment when the baby was delivered and placed

Pegasus Health CEO, Vince Barry, says the annual

in the mother’s arms was emotional, and brought a tear to

scholarships are a great way to demonstrate Pegasus’

my eye,” says Danni.

commitment to bringing equity to the centre of its work.

Hineari Kahu has wanted to become a doctor since she was

“We are proud to offer these scholarships to health students.

eight years old. Her tīipuna tāne (great grandfather) was

There is no doubt recipients will contribute significantly

unwell and aware of the limited health care available to him

to their respective fields and patients will benefit. There

in his rural location, Hineari wanted to care for him, herself.

are longstanding inequities in health for Māori, Pasifika

Now, Hineari is keen to work in a rural town once qualified.

and people from Culturally and Linguistically Diverse communities. These scholarships are just one way we can

Photo:Josie Nicholas-McAnergney, Scholarship Recipent

help support these communities,” says Vince.

2020 ANNUAL REPORT 2020 ANNUAL REPORT

STORIES

MĀORI SCHOLARSHIPS

PASIFIKA SCHOLARSHIPS

CULTURALLY AND LINGUISTICALLY DIVERSE (CALD) SCHOLARSHIPS

Toriana Murray, Ngāti Apa / Te Āti Awa/Te Whānau ā Apanui,

Danni Ryan, Medical

Divya Gopalakrishnan Nair, 4th year nursing

Jordan Meddings, Medical

Irene Ng, 3rd year counselling

Ezra Taulamana, Nursing

Mariapaola Mastroviti , 2nd year nursing

Marita Naoupu, Nursing

Nagina Miyakhel, 2nd year nursing

Raina Tekii, Nursing

Wondyrad Asres, 3rd year social work

Maca Vuniwaqa, Social work

Yuko Neiman, 3rd year nursing

5th year medical Josie Nicholas-McAnergney, Waitaha, 5th year medical Hineari Kahu, Ngāi Tahu, 4th year medical Shahana Truscott, Ngāti Porou / Ngāti Kahungunu/ Rongomaiwahine, 3rd year nursing Tara Tobola, Ngāi Tahu, 3rd year nursing Grace Tamatea, Ngapuhi / Ngāti Porou, 2nd year nursing Kaimana Gallop, Te Rarawa / Ngapuhi, 2nd year nursing Maddren Green, Kati Mamoe, 2nd year medical imaging Te Koha Russo-Greig, Ngapuhi, 3rd year midwifery Elizabeth Harpur, Ngāti Waewae, 3rd year

Fa’aeteete Mary Ann (Keke) Avia, Social work

2020 ANNUAL REPORT

STORIES

A STRONG VOICE FOR HEALTHY POLICY AND ENVIRONMENTS Pegasus Health is a strong advocate for public policy

This year, Pegasus has taken a strong stand on tobacco

Katie says being a member of HCA will increase Pegasus’

and environments that make the healthy choice the easy

control both regionally and nationally. Our work in this

influence through joint advocacy opportunities, support

choice. Pegasus supports a ‘Health in All Policies’ approach

area includes:

our advocacy activity at regional and national levels, and

- an approach that integrates health considerations into policymaking to improve health, whether it be at a local or national policy level. Population Health Programme Specialist, Katie Brown says Pegasus holds position statements on a variety of health topics, including: Equity of Health Care for Māori, Equally Well (addressing physical health inequity for people experiencing serious mental illness and addiction), Tobacco Control, Healthy Weight, Alcohol and Drinking Water Fluoridation. “Our positions align with those taken by the Canterbury

• Member (Chair) of Smokefree Canterbury

demonstrate our commitment to working collaboratively.

• Partner of Te Hā – Waitaha Stop Smoking Canterbury

“We are developing a Pegasus position on Equity to underpin

service • Member of the National Tobacco Supply Reduction Steering Group • Lead and contributing submitter on two significant pieces of tobacco control legislation: • Smoke-free Environments and Regulated Products (Vaping) Amendment Act • Smoke-free Environments Prohibiting Smoking in Motor Vehicles Carry Children Amendment Act.

District Health Board (DHB), Royal New Zealand College of

Pegasus also made submissions on the Regulations for

General Practitioners, and other local and national health

the Medicinal Cannabis Scheme and the Climate Change

organisations,” says Katie.

Response (Zero Carbon) Amendment Bill.

Positions are reviewed annually by our two advisory boards and endorsed by the Pegasus Health Charitable Limited Board. New positions are developed and adopted to respond to changes in priorities.

In late June, Pegasus became a member of the national Health Coalition Aotearoa (HCA). HCA’s vision is ‘for greater health and equity for all New Zealanders through reduced consumption of harmful products (tobacco, alcohol, unhealthy foods and beverages) and improved determinants of health’ – a vision aligned with many of Pegasus’ positions on health and wellbeing.

and strengthen our commitment to equity through all our advocacy efforts. Pegasus will also be developing and adopting positions on Family Harm and Gender Affirming Care,” says Katie. With strong support from our Population Health Advisory Board, Pegasus will continue to advocate for the fluoridation of water, and our belief that the authority to fluoridate the drinking water supply belongs centrally (at national level), rather than regionally with individual DHBs. The timeframes for the impact of the ‘Health and All Policies’ work can be long, but when policy is changed, the effort is truly worth it. For example, Pegasus’ tobacco control advocacy, alongside Smokefree Canterbury partners and the Cancer Society, has contributed to new vaping regulation that supports people choosing to ‘vape to quit’, while at the same time protects young people from exposure to the marketing and availability of vape products.

2020 ANNUAL REPORT

STORIES

SUPPORT FOR GETTING BACK TO WORK Here Toitū is a national programme launched in 2019 and

volunteering, and their families say it’s great to see them

designed to support people living with a health condition or

doing something they wouldn’t have thought possible

disability, helping them to set their own goals and aspirations,

in the past”, says Melissa.

and where they can, return to earning, learning, caring or volunteering in a workplace.

A team of health navigators work individually with people to meet the specific health needs affecting their wellbeing

The programme is jointly run by the Ministry for Social

and ability to work. Melissa says there is collaboration

Development (MSD) and Primary Health Organisations

between general practice, Ministry of Social Development

across New Zealand.

and the health navigators.

Pegasus Health’s Community Liaison Access Manager,

A participant who has re-entered the workforce through

Melissa McCreanor, has been working with the programme’s

the Step Up Programme says the health navigator helped

predecessor, Step Up, since 2017. This has now evolved into

her with interview confidence and pointers on how to

Here Toitū after a successful pilot and trials.

approach and talk about her illness with future employers.

The new programme has taken the best aspects of Step Up, combined them with elements from similar programmes Mana Taimahi (Auckland and Whanganui based programme) and Well Plan (Auckland-based) - and scaled up the service to more general practices in their regions, making it available to more people. “We’ve already seen through our work with Step Up that it’s about more than just returning to work. We’ve heard great stories from our general practices about patients with complex mental health needs feeling really satisfied through

2020 ANNUAL REPORT

STORIES

HEALTH CARE PROVIDED IN WINDOW OF OPPORTUNITY Most of the youth offenders at Te Puna Wai ō Tuhinapo need

“More of our residents are arriving with complex mental

some form of mental health support.

health needs. They are more likely to be withdrawing from

The Youth Justice Residential Facility located just outside Rolleston is operated by the Ministry for Vulnerable Children,

substance abuse and some have been affected by foetal alcohol syndrome,” says Moyra.

Oranga Tamariki. It can house up to 40 residents. Their

Sarah Hadley says the time residents spend at Te Puna

length of stay varies from one week to several months and

Wai is often the only time they have a positive relationship

lasts while they are on remand, until sentenced by the court.

or connection with health care.

Pegasus Health provides primary health care services to

“There are some really sad stories here. We have young

Oranga Tamariki. This includes services at Te Puna Wai

people who have had to look after their siblings, trying to

Youth Justice Facility and Te Oranga – Care and Protection

keep them fed and safe from violence in the home. They

Facility in Burwood.

see their mother being ‘bashed’ or a parent lashing out.

Residence Youth Health Nursing team leader Moyra Docherty, and nurses Sarah Hadley and Kym Delahunty,

They live in poverty and many have seen an awful lot of violence,” says Sarah.

work primarily at the Rolleston facility, while nurse Rebekah

On arrival, the residents are assessed for heath needs and

Coapman is based at Burwood. Moyra says their care

wrapped in layers of care. Each young person is assigned

provides a window of opportunity for long-neglected health

a case leader and connected with the youth forensic team,

problems to be checked and as much health care ‘infused’

sexual health clinic and dental services.

into the young person as possible. The nursing team at Te Puna Wai sees and assesses all new

“All the agencies really try and help. We have some big challenges,” says Moyra.

residents within two days of their arrival. They work hard to make sure the connection with health professionals is a positive experience. Continued

Photo: Nurses at Te Puna Wai From left: Kym Delahunty, Sarah Hadley and Moyra Docherty work hard to infuse as much health care as they can into young people in their care.

2020 ANNUAL REPORT

STORIES

Improved access to cervical cancer screening

In-hospital Patient Experience Survey engagement

Primary Care Patient Experience Survey implementation

Understand ethnic variation in Ambulatory Sensitive Hospitalisation (ASH) rates

Improved physical health for people with mental illness

Health promoting lifestyle to support reduced regular smokers.

Amenable mortality rates under 75 years

ASH rates for 0–4 year olds

Improved oral health

Increased newborn enrolments

SUPPORTING CHANGE AND SYSTEMS IMPROVEMENT

Reduced length of stay and monitor readmissions

Reduced acute admissions following a fall

Patient experience of care

Acute hospital bed days Babies in smokefree households at 6 weeks post birth

Access & utilisation of youth-appropriate health services

Reduced inappropriate polypharmacy

Increased number of pregnant women are smokefree

Referrals of pregnant women to stop smoking services

Pegasus Chair of the System Outcome Steering Group, Lynley Cook, says “Unless we work together, we can’t make improvements.” Lynley is working collaboratively across Pegasus and with other partners in the Canterbury health system, to bring about significant improvements for the health of all Cantabrians through her work with System Level Measures (SLMs). SLMs focus on how health systems improve outcomes at a population level, increasing access to health services and reducing inequity in the health outcomes of our communities.

Accessible and youth-friendly oral health services

Continued

2020 ANNUAL REPORT

STORIES

FIFTEEN YEARS IN RESPONSE ROLE As Chair of the Canterbury Primary Response Group

were nextdoor to Southern Cross so had their facilities and

“The rest of New Zealand and the world have been

(CPRG), Dr Phil Schroeder has helped lead his primary

specialists keen to help for fracture diagnosis and treatment.”

interested in what we have done here. We are often called to

colleagues through some of the most eventful decades in Canterbury’s recent history. The list includes swine flu, earthquakes, floods, major snow storms, fires on the Port Hills and now COVID-19.

When the CPRG began in 2005 in response to Avian ‘flu, it was solely focused on pandemics and later, ‘flu. The group lobbied the Canterbury District Health Board to provide a broader response to any emergency involving a

Dr Schroeder has stepped down from his role with the

primary care response and was given the go-ahead just five

CPRG, after 15 years with the group, including 12 years as

days before the February 2011 earthquake.

Chair. The Christchurch earthquake stands out the most in his experiences, and he is grateful that the CPRG was in place with systems and processes to assist primary care, pharmacy and district nursing at a critical time. Dr Schroeder was in Rotorua when the earthquake struck and got himself to Auckland and on a flight to Christchurch in the morning.

A key role of the CPRG has been helping primary care to manage seasonal ‘flu, he said. “We have been able to help forecast when the season will

Departing Chair, CPRG

outbreak, which was hampered by inconsistent and at times incorrect communications from national organisations us something.”

in the car park dealing with things as best they could. They

Dr Phil Schroeder

A low point for Dr Schroeder was the 2019 measles

to the 24 Hour Surgery from Christchurch airport. “It was

“On the day of the earthquake, Afterhours were operating

“It has been a real privilege to be involved with the CPRG team and the care of the people of Canterbury. The CPRG is something unique and will carry on serving our community.”

to manage,” he said.

and vaccine suppliers. “But, each response has taught

imagined.”

and the UK,” he said.

peak and help rest homes, primary practice and pharmacies

He recalls being shocked at the devastation as he drove really quite emotional. Reality struck, it was worse than I had

offer advice to other parts of the country, Australia, Canada

The combined experience of the past 15 years has meant Canterbury was “well placed” to tackle the challenges of COVID-19, he said. Photo: Dr Phil Schroeder

FINANCIALS STATISTICS AND

System Level Measures

Financial statement commentary

Enrolled population

Facts and figures

2020 ANNUAL REPORT

FINANCIALS AND STATISTICS

SYSTEM LEVEL MEASURES

Pegasus Health, along with other Primary Health Organisations (PHOs), receives a portion of Canterbury’s health funding to build capacity and achieve quality improvements across the Canterbury health system. The pie chart (right), similar to last year, shows that Pegasus uses most of its funding to support quality improvement at practitioner and practice level, through education and training, and innovative new ways of working. Specific examples include the support and development of practice nursing and administration workforce, Foundation Standard programme and assessment, GPVu and the Summer Students that are hosted by Pegasus every year. The framework has measures that look at integration across the system, rather than individual activity at general practice level.

System Levels Administering Programme Workforce Development Scholarships Clinical Service Development Practice Support, Liason and Coordination IT Developments Developing Models of Care

Number 224,462 251,377 947,307 514,183 492,500 347,00

2020 ANNUAL REPORT

FINANCIALS AND STATISTICS

PEGASUS HEALTH (CHARITABLE) LTD FINANCIAL STATEMENTS COMMENTARY YEAR ENDED 30 JUNE 2020 We present consolidated “Group” financial statements. The Company consists of Pegasus Health (Charitable) Ltd and its associates. The Group consists of the Company and its subsidiaries, most notably Pegasus Health (LP) Ltd, which holds our 50% investment in Homecare Medical (NZ) Limited

• Canterbury Primary Response Group (CPRG) took

$3.1M COVID-19 expenses commented on above, expense

Community Based Assessment Centres (CBACs) to

movements are consistent with activity levels. The most

support the COVID-19 pandemic response resulting in

significant component of expenses, after wages and salaries,

increased revenue of $3.1M, offset by $3.1M cost.

continued to be the data-related support of General Practice

Partnership (Homecare Medical), and After Hours Properties

Comprehensive Revenue and Expenses (aka Profit and

Ltd which has been wound up during the year.

Loss account)

The financial statements for the year ending 30 June 2020

The Company’s operating result, a deficit of $153k, was

illustrate what has been overall a positive year financially. The significant financial transactions this year were: • Revaluation of land and buildings being 401 Madras Street at year-end. This resulted in a $1M gain to other comprehensive income. • Dividend received of $0.5M during the year from Pegasus Health (LP) Ltd, as well as $0.6M subsidiary loan received. • Continued strong performance including significant

information systems. Furthermore, the useful life of intangible assets was reviewed resulting in accelerated amortisation of $0.3M. All other expenses have moved in line with either their respective revenue stream or prior year.

$654k better than budget, and the Group’s operating result was a surplus of $1,672k.

Net finance costs were stable

Revenue, primarily from the delivery of health services,

The Limited Partnership, dividend and revaluation entries are

increased by $6.8M. The largest contribution to the increase in revenue was from the COVID-19 CPRG contract held with the DHB which had a cost recovery basis. The remaining increase arose across the business, including incremental increases for HealthOne and ERMS, and increased activity

covered in the bullet points above and not repeated here. All of the above come together to give a Group total comprehensive income of $2.7M (2019: $0.6M) demonstrating a positive year overall.

in services supporting General Practice.

COVID response activity from Homecare Medical,

After a successful trial in the prior year, a contract was

resulting in $2.3M (2019: $1.3M) income to the Group.

agreed with MSD to provide a health navigator service, now

• Repayment of a further $1M (2019: $1M) of partnership

Operating expenses increased by $5.4M. Excluding the

a leading role in the coordination and delivery of

offered within general practice that helps Cantabrians who

capital related to the initial telehealth capital injection.

are on a benefit and have a medical deferral to find and stay

This capital injection has now been repaid in full to

in work. There has also been an extension of the ACC High

Pegasus.

Tech Imaging initiative where Pegasus expanded this offering to other PHOs.

Continued

2020 ANNUAL REPORT

ENROLLED POPULATION STATISTICS

ENROLLED POPULATION BY AGE 2020

FINANCIALS AND STATISTICS

2020 ANNUAL REPORT

ENROLLED POPULATION STATISTICS

ENROLLED POPULATION BY ETHNICITY 2020

FINANCIALS AND STATISTICS

2020 ANNUAL REPORT

FINANCIALS AND STATISTICS

FACTS AND FIGURES

7 7 ,7 6

BETTER HELP FOR SMOKERS TO QUIT

MORE HEART AND DIABETES CHECKS

CERVICAL SCREENING

29,390 smokers received smoking cessation advice and

77,766 people have been assessed for cardiovascular risk,

66.7% of women aged 25 to 69 have received a cervical

support from their general practice team in the 2019/20 year; that’s aproximately 70% of all smokers in Pegasus PHO.

as at 30 June 2020. This means 55% of eligible population

smear in the last three years, as at 30 June 2020. This

having had a risk assessment by their general practice

shows a small reduction of 1.2%.

Overall, coverage was lower than previous years due to the residual impact of external factors from 2019 (measles / terror attacks) and the very significant impact of COVID-19 from early 2020 which saw coverage drop to 70% by end

team. During COVID-19 lockdown and the unpredictable six months for general practice this has fallen by 11% from last year’s figures.

of Quarter 4, 2019/20. The Stop Smoking Support team, based at Pegasus, contacted 8,500 patients on behalf of their general practice team to offer brief advice and cessation support. Of those contacted, 846 accepted a referral to a cessation support service.

Continued

2020 ANNUAL REPORT

FINANCIALS AND STATISTICS

Facts and Figures Continued

83% 95

B4 SCHOOL CHECKS

INCREASED IMMUNISATION

A total of 4,641 Pegasus enrolled children had a B4 School

By the end of the 2019/20 year, Pegasus general practices

Check in the 2019/20 year which equates to 83% coverage,

had vaccinated 91% of Māori children, 96% of Pasifika

and 216 of these checks were completed in the child’s own

children, and 95% of children across all ethnicities at the

home by the Pegasus B4SC Mobile Outreach team. Overall,

eight months of age milestone.

83% of Māori children and 84% of Pasifika received their B4 School Check. A total of 317 dental referrals; 401 vision referrals; and 284 hearing referrals were made as an outcome of the checks. There were 314 children referred to a health professional due to concerns about growth/weight, while 174 declined a referral. Note: during COVID-19 lockdown levels 3 & 4 no B4SCs were allowed

At the two-year-old milestone, Pegasus general practices vaccinated 92% of all Māori, 98% of all Pasifika and 95% of all two-year-olds. These results are outstanding, taking into account the considerable drop in vaccination rates during the lockdown period earlier this year.

EXTENDED INFORMATION The Pegasus response to COVID-19 (Continued)

Health care provided in window of opportunity (Continued)

Supporting change and systems improvement (Continued)

Pegasus Health (Charitable) Ltd Financial Statements (Continued)

PHAB (Continued)

CQAB (Continued)

Canterbury Clinical Network (Continued)

Homecare Medical (Continued)

2020 ANNUAL REPORT

EXTENDED INFORMATION STORIES

The Pegasus response to COVID-19 Continued

Surveillance Testing

Supporting General Practices

On April 17 the first COVID-19 surveillance testing was

Pegasus staff, across a range of teams, supported general

conducted at Moorhouse Pak’nSave where more than 400

practices to overcome the challenges and changes faced in

people were tested. The directive from the Ministry of Health

delivering care for their patients. An essential initiative was

to set up this ‘pop-up Community Based Assessment Centre’

the provision of technology and guidance to provide virtual

was given on the previous day and many staff were involved

consults for patients.

in a short and intense burst of activity to get this CBAC operational for Friday morning. A CBAC was set up in the east of Christchurch at Ngā Hau e Whā Marae where Pegasus worked in partnership with He Waka Tapu, Whanau Ora Community Clinic and Te Rūnanga o Ngā Maata Waka.

Advocating for general practice with the Ministry of Health through GPNZ was also a key focus throughout the pandemic, helping ensure practices remained sustainable. When demand at general practices decreased and patients hesitated to seek usual care, the Pegasus communications team organised a media campaign to encourage people

This CBAC did a fantastic job, reaching out to vulnerable

to continue to contact their practice in the usual way. This

communities to remove barriers to accessing tests, while

campaign ran in The Press, online and social channels as

providing advice to the community about COVID-19 and

well as radio advertisements translated into a number of

access to financial and other support services.

languages.

Primary Mental Health Service The Primary Mental Health service had to change its face-toface consultation model and move to phone consultations. During the course of lockdown, the service saw some real benefits of moving to this model with ‘Did Not Attend’ rates dropping and high engagement with the service. With referral rates from general practice initially dropping during the response, the service was also able to dramatically decrease wait times.

Regular and routine support services for general practices were also required during this time, often adjusting to new ways of doing things such as organising new claims and payments, technology support, and support for clinicians, including pastoral care. With the pandemic arriving at the start of the ‘flu season, Pegasus has worked behind the scenes to help ensure there is a supply of ‘flu vaccines so that frontline staff and vulnerable people can be vaccinated.

Photo: COVID -19 testing station, Stuff

2020 ANNUAL REPORT

EXTENDED INFORMATION STORIES

Health care provided in window of opportunity Continued

One young male arrived wearing $5 glasses. “These were completely useless as reading glasses, he was virtually blind. We got him an appointment with an

ADMISSIONS AT TE PUNA WAI Ō TUHINAPO

optometrist and new prescriptive glasses. This was life-

The Youth Justice Residential Facility located just

changing for him and he can now do school work,” says

outside Rolleston in Canterbury is operated by the

Sarah.

Ministry for Vunerable Children, Oranga Tamariki.

The list of health concerns can be long. Sexually transmitted

Pegasus Health provides primary health care to its

diseases, vision and hearing problems, substance abuse,

residents.

declining mental health, skin infections and fungal feet are common.

220 Of young people

Young people enter

admitted are

TPW on average

Måori / Pasifika

per year

Preventative care, such as personal hygiene education and immunisation is also provided.

500 - 600 Scheduled appointments are provided by the primary health team per quarter.

2020 2020ANNUAL ANNUALREPORT REPORT

EXTENDED INFORMATION

Supporting change and systems improvement Continued

There are six key areas of focus that are recognised

At the centre of addressing the System Level Measures is

nationally. Canterbury has a set of locally-selected

our primary care workforce. As part of strengthening this, a

contributory measures (circling the SLMs on the chart). Of

locally-designed skills development course on motivational

particular significance to Pegasus are four areas:

interviewing was started in 2017, called “Motivating

• Improved cervical cancer prevention with increased access to cervical cancer screening • Improved physical health for people with mental illness – also known as ‘equally well’ • Improved oral health • Though not identified as a contributory measure, addressing ‘family harm’ has been identified as an area where primary care can have a significant impact. “We recognise that general practice and primary care can make a big impact in these areas. In a sense, this is where we believe we can make some of the biggest differences in people’s lives, in particular, to reduce disparities in outcomes,” says Lynley Cook.

Conversations.” This supports health professionals to bring about positive behavioural change through their interactions with patients. More than 720 GPs, practice nurses, pharmacists and other primary health care professionals have been trained in conducting motivational conversations. Feedback on the course has been positive, particularly with the easy transferability of the skills to their practice. Participants say they are listening more, avoiding jumping to conclusions and checking what the patient wants to achieve. The groundwork done by Lynley and colleagues, across Pegasus and other health system partners, helps to ensure Pegasus is well placed to collarborate when times get tough. The aim is always to deliver high-quality health services to the community.

2020 ANNUAL REPORT

EXTENDED INFORMATION

Pegasus Health (Charitable) Ltd Financial Statements Continued

Financial Position (aka Balance Sheet)

Cash Flows

Due to the result set out above, Company equity has

Cash was well managed to ensure Pegasus remained

increased to $18.7M (2019: $17.8M), whereas Group equity

comfortably within its banking covenants throughout the

has increased to $21M (2019: $18.3M).

year. At year-end, cash balances had increased by $1.3M to

Significant asset movements are: • Cash has increased, as commented on in cash flows section below; • Property, plant and equipment has increased, due to the revaluation of land and buildings • Receivables have increased due to timing of reimbursement of claims paid out to practices for COVID swabbing costs • Group investments have increased due to this year’s share of limited partnership profit while Company investments have decreased due to the wind-up of After Hours Properties Ltd in the current year • Significant liability movements in the Company are due to an advance from subsidiary of $623k and an increase in employee benefit liability due to a decrease in leave taken during lockdown. The Group liabilities have further increased due to funding received in advance increasing as a result of technical accounting standards adjustments related to Homecare Medical.

$5.5M.

Our PHO Function had a stable twelve months of operations. This culminated in an operating deficit of $16k for the year. The cash position increased slightly to $2.5M at year end, with over $100M of funds distributed to service providers, the most significant being Capitation payments to General Practices.

Net cash generated from operating activities totalled $983k for Group and $1,444k for Company with the main difference being the dividend received of $454k. Cash generated from investing activities totalled $337k for Group whilst the Company had an investing cash outflow of $693k. This is due to capex spend being offset at a Group level by the $1M capital repayment from Homecare Medical. Financing activities reflect the $623k subsidiary loan in the

Summary Pegasus remains in a sound financial position. Prudent and deliberate governance and management practices continue to be demonstrated, and a measured approach maintained. Cash position and Reserves remain strong. This financial year’s initiatives continue to position Pegasus well to support General Practice through the challenges and opportunities

Company.

ahead, enabling Canterbury people to be well and healthy in

Primary Health Organisation (PHO) Function Special

We hope this commentary assists your understanding when

Purpose Financial Statements These separate special purpose financial statements are produced to meet PHO reporting requirements. They are an extract from the full financials commented on above. The significant financial transactions bullet- pointed in the first section of this commentary do not involve PHO Function funds.

their own homes and communities.

reading both sets of financial statements which are available separately on our website.

2020 ANNUAL REPORT

EXTENDED INFORMATION

PHAB Continued

During 2019-2020, PHAB continued to focus on its priority

(SDG), to identify areas where Pegasus and the Oral

areas, and provided the following information and advice

Health SDG could work together. PHAB recommended

to Pegasus:

that Pegasus continue to advocate for fluoridation of

• Pegasus working with the Culturally and Linguistically

drinking water, and that oral health be included as a

Diverse (CALD) Communities Health Advisory Group,

topic in the Pegasus primary care education programme.

and migrant health professionals, to help them find

Members of the Oral Health SDG also gave a

relevant work experience

• A letter to Pegasus to endorse the Pegasus Equity Stocktake and congratulate Pegasus on the activities undertaken to improve equity. It was agreed that the stocktake will be updated, and that PHAB will review it every six months. • Agreed to review the Pegasus Position Statement on Health and Wellbeing every six months. • Regularly reviewed population health data for the Pegasus enrolled population and wider Canterbury population. Congratulated Pegasus on immunisation coverage in 2019 for children aged eight months, and children aged two years, which met the 90% target in all ethnic groups. High immunisation coverage is likely to contribute to lower ASH rates and to lower amenable mortality in future. In the meantime, however, we

presentation to PHAB members, and discussions about accessing recent oral health data are underway. • PHAB provided feedback to the Ministry of Health on their Healthy Food and Drink Guidance draft documents.

PHAB endorsed the following: • The Pegasus Equity Stocktake • The Pegasus Health Quality Plan • Pegasus contribution to the Canterbury Health System Level Measures Improvement Plan • The updated Pegasus Smokefree/Auahi Kore position statement

identified that there are persistent inequities in ASH

• The Equally Well Action Plan to improve the physical

rates for children aged up to four years. PHAB also

health of people with serious mental illness and/or

identified a lack of recent oral health data for children

addiction

aged five years, which makes it impossible to assess progress towards improving children’s oral health. • PHAB met with members of the Canterbury Clinical Network’s Oral Health Service Development Group

• Pegasus continuing to provide support to improve access to, and quality of, Gender Affirming Care

• Pegasus becoming a member of the Health Coalition Aotearoa. I wish to thank all the PHAB members for their expertise and commitment to improving the health of the Canterbury population, especially during the COVID-19 pandemic, and the Pegasus Health staff who have provided PHAB with information, advice and support.

PHAB Priorities and Possible Recommendations March 2019 The Pegasus Population Health Advisory Board (PHAB) was established in March 2018, and first met on 18 April 2018. The Terms of Reference state that the purpose of PHAB is “to provide advice to the PHCL Board on ways that Pegasus can continue to improve health outcomes and

• A pilot project to integrate Kaupapa Māori and Pacific

reduce health inequities in the Canterbury population, and

NGO nurses into the Pegasus small group education

on occasion, beyond.” Since the establishment of PHAB,

programme

we have reviewed relevant reports and other information, and identified the following priorities.

2020 ANNUAL REPORT

PHAB Priorities The overarching PHAB priority is to improve equity, and our initial priorities to help achieve this are:

Reduce Pacific ASH rates for children aged 0-4 years • Pacific ambulatory sensitive hospitalisation (ASH) rates for children aged 0-4 years in Canterbury are approximately twice those for Māori and other ethnic groups. • The most common conditions are URTIs, asthma, cellulitis, dental conditions, gastroenteritis/dehydration (Halim 2018).

Improve oral health • Socioeconomic gradients in dental caries are evident by age 4 years. • Evidence of any caries experience at age 4 years: European 6.8% (6.8 - 6.9), MELAA (Middle Eastern, Latin American and African) 15.0% (14.6 - 15.4), Asian 17.9% (17.7 - 18.0), Māori 22.3% (22.2 - 22.4) and Pacific 30.6% (30.4 - 30.9) (Shackleton et al 2017).

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Reduce amenable mortality • Between 2000 and 2014 the age-standardised

Evidence-informed strategies to address PHAB priorities

amenable mortality rate has seen a relative decrease of

The following evidence-informed strategies have been

39.2% for Māori, 33.6 % for Pacific and 39.2% for non-

identified:

Māori, non-Pacific populations. • The amenable mortality rate was substantially higher for Māori (196.8 per 100,000) and Pacific peoples (186.4 per 100,000) compared with non-Māori, non-Pacific (75.6 per 100,000) in 2014. • The top 10 causes are Coronary heart disease, Chronic obstructive pulmonary disease (COPD), suicide, Cardiovascular disease (CVD), breast cancer, diabetes, accidents, rectal cancer, melanoma, prostate cancer. • CHD, COPD, CVD, and diabetes accounted for 49% of amenable mortality (Ministry of Health 2017). • People with serious mental health problems and/or addiction have higher risks of many chronic health conditions, which contribute to a considerably shorter life expectancy compared with the general population (Cunningham et al 2014, Te Pou o te Whakaaro Nui 2017).

Primary prevention • Fluoridation of drinking water (PHCL has already acted on PHAB’s recommendation to write to the Minister of Health, Ministry of Health, CDHB, and CCC endorsing fluoridation of drinking water). • Decrease risk factors for poor oral health and amenable mortality (decrease tobacco and alcohol use, obesity and poor nutrition - decrease sugar and salt intake, decrease red/processed meat intake). • Increase protective factors (increase physical activity, promote breast feeding, promote increased intake of plant-based foods).

2020 ANNUAL REPORT

Improve access to primary care • Barriers to access are cost (14.3% of adults, 3.0% of

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Proposed Recommendation That Pegasus Health develops a Plan to Improve Equity.

children), appointment not available at usual medical

The plan would include a definition of equity, and would

centre within 24 hours in past 12 months (18.4% of

use an evidence-informed approach to improving equity by

adults, 15.8% of children), lack of transport (3.2% of

addressing priorities, including those identified by PHAB, as

adults, 2.6% of children). (Ministry of Health NZ Health

described on previous pages. Evidence-informed strategies

Survey 2016/17)

would be included in the Plan, with each strategy to be

• Prioritise access for Māori and Pacific to improve equity

implemented within a specified timeframe. Measurable

(for example 9.1% of Māori women and 9.7% of Pacific

outcomes from these strategies would also be included in the

women reported lack of transport, and 25% of Māori

Plan.

women reported appointment not available at usual medical centre). (Ministry of Health NZ Health Survey 2016/17) • Reviews show consistent findings that community

Evidence-informed examples could include: • Enhancing existing partnerships with other providers to promote primary prevention strategies. This would

health workers (CHWs) can improve access to primary

require funding, communication, a mandate for

care for disadvantaged/ under-served groups (Jack et

collaboration, and targeted advocacy, professional

al 2016, Kim et al 2016). Most randomised controlled

education (Wong et al 2017) and collaboration between

trials have been carried out in the US, but there have

oral health services, public health, and primary care

been observational studies and evaluations in New

(Beckett and Meldrum 2018)

Zealand (Bidwell 2013). Shared culture/experience and

• Appointing new Partnership Community Workers

strong links with the communities they serve, and strong

(PCWs); one from the Maori community, one from the

partnerships with providers, are important, and CHWs

Pacific community, and one from the CALD community.

must be supported by appropriate, accessible services

Ensuring appropriate pathways are in place to support

(Gibson et al 2015, Bidwell 2013, Barwick 2000).

these appointments. These pathways will include:

• Awareness (consult with community groups about suitable links for example, Churches? Clubs? Other organisations?) • Accessibility (ways to help people without access to transport, ways to help with costs of healthcare) • Acceptability (ensuring practices have capacity to accept new patients, and cultural training for practice staff (Neuwelt et al 2015) such as the proposed MIHI pilot project).

2020 ANNUAL REPORT

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REFERENCES Barwick H.

Gibson O, Lisy K, Davy C, et al.

Ministry of Health.

Improving access to primary care for Māori and Pacific

Enablers and barriers to the implementation of primary

New Zealand Health Survey 2016/17 https://www.health.

peoples: a literature review commissioned by the Health

health care interventions for Indigenous people with chronic

govt.nz/nz-health-statistics/national-collections-and-surveys/

Funding Authority. Wellington: HFA, 2000.

diseases: a systematic review. Implementation Science

surveys/new-zealand-health-survey#2016-17

Beckett DM, Meldrum AM.

2015; 10: DOI 10.1186/s13012-015-0261-x.

Neuwelt PM, Kearns RA, Browne AJ.

Factors that influence inequity of oral health in New Zealand

Halim AA.

The place of receptionists in access to primary care:

and what we can do about them. In: Health and wellbeing of

Ambulatory sensitive hospitalisation (ASH) in 0-4 year olds.

challenges in the space between community and

under-five year olds in the South Island 2017. Dunedin: NZ

Christchurch: Pegasus Health Limited, 2018.

consultation.Soc Sci Med 2015; 133: 287-295.

2018.

Jack HE, Arabadjis SD, Sun L, et al.

Shackelton N, Broadbent JM, Thornley S, et al.

Impact of community health workers on use of healthcare

Inequalities in dental caries experience among 4-year-old

Bidwell S.

services in the United States: a systematic review.J Gen

New Zealand children.Community Dent Oral Epidemiol 2018;

Improving access to primary health care for children and

Intern Med 2016; 32: 325-44.

46: 288-296.

Kim K, Choi JS, Nieman CL, et al.

Te Pou o te Whakaaro Nui.

Effects of community-based health worker interventions

The Physical Health of People with Mental Health Conditions

to improve chronic disease management and care among

and/or Addiction: Evidence update December 2017.

Cunningham R, Paterson D, Sarfati D, Stanley J,

vulnerable populations: a systematic review. Am J Public

Auckland: Te Pou o te Whakaaro Nui, 2017.

Collings S.

Health 2016 doi:10.2105/AJPH.2015.302987.

Child and Youth Epidemiology Service; University of Otago,

youth: a review of the literature for the Canterbury Clinical Network Child and Youth Workstream.Christchurch: Community and Public Health, 2013.

Premature mortality in adults using New Zealand psychiatric services. NZ Med J 2014; 127: 31-41.

Wong ST, MacDonald M, Martin-Misener R, et al.

Ministry of Health.

What systemic factors contribute to collaboration between

Health and Independence Report 2017. The Director-

primary care and public health sectors?. An interpretive

General of Health’s Annual Report on the State of Public

descriptive study. BMC Health Services Research 2017; 17:

Health. Wellington: Ministry of Health, 2018.

DOI 10.1186/s12913-017-2730-1.

2020 ANNUAL REPORT

EXTENDED INFORMATION

CQAB continued

The CQAB continued to meet digitally during the COVID-19

cardiovascular risk management, and in many of the areas

lockdown. During this period we dealt with a number of

relating to the way primary care communicates with the wider

matters relating to the primary care response. These

health system. This joint approach to discussion has been

included recommendation on the use of PPE by healthcare

successful and we plan to make it a more regular feature of

workers and patients, infection prevention and control

our meetings.

measures, and the approach to community assessment and testing of potential COVID-19 cases. We are also alert to the potential longer-term impacts of the pandemic, in particular in relation to mental health and the capacity of primary care to respond to the likely increased need. Communication between healthcare providers has been a regular feature on our agendas this year. We have responded to enquiries and prepared advice on the imminent demise of the fax machine and its potential replacements, changes to the way the Emergency Department communicates with primary care, and challenges and opportunities in the way laboratory tests are ordered by primary care clinicians. On several occasions this year we have invited clinical leaders from Waitaha and Christchurch PHOs to join our discussion on matters affecting the entire local primary care system, for example in discussions about the roll-out of population screening for bowel cancer, the Ministry of Healthâ€™s proposed changes to performance measurement in

2020 ANNUAL REPORT

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Canterbury Clinical Network Continued

health professionals to easily read, write and edit plans as

Working Towards Achieving Equity

Mana Ake – Stronger for Tomorrow

In 2019 CCN created a Te Tiriti and Equity group with Māori

The Mana Ake Service Level Alliance was established in

leaders from across the system, including members from

March 2018 to promote and support wellbeing and positive

The suite of shared care plans includes the Advance Care

Te Kāhui O Papaki Kā Tai, the CCN Māori Caucus and the

mental health for children in Years 1 to 8 across Canterbury

Plan, the Acute Plan and the Personalised Care Plan (PCP),

Canterbury DHB alongside the Alliance Leadership Team

schools.

all hosted in Health Connect South.

In September 2019, the initiative was one of only 19 (out of

During COVID-19, Acute Plans, which contain information

84 entries) shortlisted as a finalist for the Spirit of Service

about a person’s health condition and the recommended

awards in the Better Outcomes Award / Te Tohu mō ngā Hua

treatment if their health suddenly gets worse, were promoted

E Pai Ake Ana.

as a solution to record decision-making, investigations, and

Chair, members from the Population Health and Access Service Level Alliance and the CCN Programme Office. The group meets bi-monthly to progress specific, equity-focused actions. One of the actions that has been prioritised is enhancing the health system’s approach to co-design – a regularly applied approach to improve health services by bringing together

In March 2020, Prime Minister Jacinda Ardern visited Northcote School in Christchurch to see first-hand the way

appropriate, even if they are not the original author.

goals of care that needed to be communicated to clinicians not familiar with the patient.

the initiative is enhancing the wellbeing and the mental

This targeted work with general practice teams and hospital

health of our tamariki. The PM took the opportunity to talk to

specialists saw the use of Acute Plans increase significantly,

children, whānau and teachers to hear more about how the

with a total of 670 created in April 2020 (more than the

In 2019, the Te Tiriti and Equity group carried out a

initiative works and see some of the group activities that are

combined total of the previous six months) and 368 created

comprehensive review of CCN’s co-design with the aim

available through Mana Ake in action.

in May 2020.

consumers, service providers from across the health system, and other government and community organisations.

of developing an approach that ensured the voices of Māori, Pacific, Culturally and Linguistically Diverse (CALD)

Improving the patient experience through Shared Care

communities and other minority groups were heard and

Planning

influenced the changes needed in accessing health care.

Electronic shared care plans enable secure information-

This will be put in place over the next few months, with a plan to review and make changes to the process as needed.

sharing between hospital, primary and some communitybased clinicians across the South Island. They allow

2020 ANNUAL REPORT

Interpreter Services Best Practice Guidelines The Population Health & Access Service Level Alliance created a new set of best practice guidelines around interpreter services. The guidelines are designed for Canterbury health system clinicians, non-clinical staff and health organisations to use, when they provide health and disability services to people for whom New Zealand Sign Language (NZSL) is a first or preferred language and people for whom English is not their first language, who have limited English proficiency. Download the guidelines. Te Tumu Waiora Canterbury Te Tumu Waiora is a new way of delivering mental health, addictions and wellbeing care through general practice. It has been designed as a holistic model which supports and addresses the physical, emotional and social needs of the person, rather than focusing on traditional mental health or addiction needs.

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It puts mental health and wellbeing at the heart of general

Te Tumu Waiora is for anyone, of any age, with any issue

practice with the introduction of new focused roles, working

affecting their mental wellbeing. The focus is on supporting

as part of the general practice team. The new roles are:

individuals to develop skills to better manage existing issues.

• Health Improvement Practitioner (HIP): experienced

It is free of charge to patients.

and registered mental health clinician with experience in

Canterbury Clinical Network is leading the implementation

talking therapies. They hve additional training to work as

of Te Tumu Waiora across Canterbury, with a number of

part of the general practice team to address a patient’s

practices already using the model and reporting excellent

feelings, thoughts and behaviours that underlie poor

results.

health, both physical and mental health. • Health Coaches (HC): trained in self-management techniques to support goals made by patient alongside the HIP. This model allows for a ‘warm handover’ which means that a GP or nurse in the general practice can offer someone who is experiencing mental distress or addiction issues the option of seeing the HIP in the same location quickly – often immediately.

Frequently Asked Questions

2020 ANNUAL REPORT

Homecare Medical Continued

In the last 12 months (ending 30 June 2020) over 825,582 contacts were made to the National Telehealth Service - those contacts came from 556,933 people (1 in 10 people in NZ). A further 207,325 COVID-19 contacts were answered in the four months between 1 February and 30 June 2020, taking the total contacts answered through NTS services during FY20 to over 1million contacts.*

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Key services

The 1737 need to talk?

The Alcohol and Other

The Emergency Triage

More than 100,000

service answered over

Drugs team answered

nurses triaged nearly

people accessed and

123,000 contacts and

19,394 contacts supporting

45,000 incidents, redirecting

interacted with The Journal

supported more than

16,250 people with

51% of contacts to non-

website tools

59,000 people in distress

addiction within their family

emergency services, which helps keep our hospitals and ambulances available for emergencies

*Figures have been rounded to nearest 100; these are ‘answered’ contacts.

The Quitline team answered

The Poisons team helped

The Gambling team

The Emergency Mental

more than 50,000 contacts

24,000 people, with 76% of

received nearly 4,300

Health Response team

supporting more than

contacts requiring no further

contacts supporting 3,300

medical treatment or self-

people dealing with the

triaged over 11,000

11,600 people start their quit journey, with 29%

care information

effects of problem gambling

contacts from Police and Ambulance to support more

remaining smoke free after

than 8,000 people in social

4 weeks

and psychological distress.

2020 ANNUAL REPORT

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Supporting New Zealand’s COVID-19 Health Response

COVID-19 Clinical Advice Line

The National Telehealth Service COVID-19 response began

In early April, on behalf of the Ministry of Health, the National

on 7 February, with the establishment of a dedicated phone service available 24/7. The team provided to a central front door for COVID-19 related health advice and information to the public. It was launched at a time when many general practices were overloaded. Over time, this service has extended to supporting people in self isolation, support with contact tracing as required, provision of mental health support, and a clinical advice line

Telehealth Service established a COVID-19 clinical advice line – on 0800 177 622 – for general practice, pharmacy, nurses, midwives and aged residential care providers. The line operates 8am - 7pm, from Monday to Saturday. The helpline offers general advice about the management of COVID-19 and is staffed by primary care nurses, pharmacists and GPs, with at least one GP on every shift. Most calls are initially managed by a nurse, with a GP

to support community-based practitioners.

available at all times to provide specialist advice as well as

At its peak 207,325 COVID-19 contacts were answered. In

number ensures that community clinical staff can access

the four months between 1 February and 30 June 2020 the team answered 14,000 contacts in one day. During COVID-19, more than 770 extra people were

access to additional clinical support. Having a dedicated advice directly from peers.

Supporting General Practice

engaged and trained, five new contact centres (eight in

Homecare Medical offers general practices an after-hours,

total) were set up to enable physical distancing while

nurse-led triage service.

we responded, and a five-month technology project was delivered in just seven days, increasing infrastructure by six times, to accommodate increased demand.

Over the last 12 months, Homecare Medical handled more than 100,000 clinical calls from patients calling their medical home; and of those they managed 85% with primary care

Critical to achieving this were the strong relationships and

and/or selfcare advice; 8% required urgent care; and 6%

support from our health partners, including Homecare

required emergency services (111 and ED). The services

Medical’s owners, Pegasus and ProCare.

help to reduce unnecessary presentations to emergency departments and strengthen general practice as the front door to primary care.

Virtual GP Kits Homecare Medical worked with ProCare and Pegasus clinicians and practices to design and road-test protypes for an innovative ‘Virtual GP Kit’. In mid-March the Virtual GP Kits - including webcams - were made available to Canterbury and Auckland general practices to provide everything a practice needs to begin delivering virtual consults. Homecare Medical fast-forwarded the roll-out to meet the pressures of COVID-19. GPNZ has made the Virtual GP Kit model available country-wide.

Mental Health After-Hours In August 2019, Homecare Medical commenced a Mental Health After-Hours contract with the Canterbury District Health Board (CDHB). Registered mental health nurses provide tele-triage cover afterhours: between 4:30pm and 12:00am from Monday to Friday, and between 10:30am and 12:00am on weekends and public holidays. The contract provides acute triage service and associated pathways. Non-acute pathways continue

2020 ANNUAL REPORT

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to be managed by the Canterbury DHB Mental Health

It achieved an 87% Māori conversion rate from referral to

and Addictions team.

engagement in the last year. Māori make up 25% of its client

The service received 11,001 calls between its establishment to 30 June 2020. Service users increased each quarter. Of the calls answered, 4.3% required Category A (Police or

base. Other service users comprise: New Zealand European (54 percent); Pasifika Peoples (6%); Asian (7%) and other European (5%); and other (5%).

ambulance) attention; 26% of answered calls required very

Pegasus patients comprised 21% of all Puāwaitanga

urgent, urgent, and semi-urgent mental health responses

registrations.

(categories B, C, and D); 33% were category E, non-urgent calls; and referral to non-mental health services and advice/ information responses (categories F and G) were required for 37% of calls.

Puāwaitanga Homecare Medical’s telephone and digital counselling service – Puāwaitanga (meaning to bloom or grow) - was established almost two years ago and is based on a pilot study called eTalk initiated by the Canterbury District Health Board. Puāwaitanga enhances general practice mental health service capacity and offers counselling outside normal office hours, including weekends. The service offers referred clients a package of care for up to 12 months. Users select their preferred counsellor and session time via an online portal.

Puāwaitanga services are increasing to meet demand. There are currently 20 registered psychotherapists, psychologists, occupational therapists, counsellors, mental health nurses, social workers, addiction practitioners and ACC registered therapists, offering services in over 15 different languages. Outcomes for all clients are positive with the average DUKE Score increasing by 31 percent for Māori clients and by 26 percent for all other clients in the last year. Current referring organisations include Canterbury District Health Board, Ministry of Social Development, Central PHO, ProCare, Auckland University of Technology and the University of Auckland.

2020 2020ANNUAL ANNUALREPORT REPORT

Service User Feedback • “I was … at ease immediately and felt I was listened to and given expert advice”Healthline • “She gave me the confidence to make the next decision.” Healthline • “Fantastic. She took care of me holistically, thinking about my mental wellbeing.” COVID Healthline

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National Telehealth Service 2019/20 A total of 825,582 contacts were answered - more than 36,800 contacts above forecast in the annual plan and 12% increase on FY19 contacts. Those contacts came from 556,933 people (1 in 10 people in New Zealand).

• “Wonderful service.” – COVID Healthline

In addition to the answered contacts, more than 215,000

• “I am very thankful for the help. I am now on the road to

outbound contacts were also made across the NTS services

recovery.” 1737 • “It helped me immensely. Thank you.” 1737 • “You helped save my life.” 1737 • “Just a big thank you. I haven’t had a smoke since my quit day and I don’t know I could have done it without your help.” Quitline • “It was great getting your encouraging texts and support. I am one-year smoke free. Thanks.” Quitline

in the year ending 30 June 2020. A further 207,325 COVID-19 contacts were answered in the four months between 1 February and 30 June 2020, taking the total contacts answered in FY20 to over 1 million.