Mihi nui ki a koe

Dedication to improving access to healthcare and quality care, particularly for the large high-needs communities we serve, is Total Healthcare Healthcare Charitable Trust's top priority.

Our aim as a PHO is to assist healthcare planners and funders to support the Government in enhancing access to high quality healthcare – where and when people need it.

Many of our patients require extra help to access healthcare due to financial constraints and health needs. In fact, more than 60 percent of our patient population is deemed high needs by the Ministry of Health. At several of our largest practices in high needs areas, 85 percent of patients are high needs; at the Bairds Road Clinic that equates to about 26,000 patients.

So that’s why initiatives that improve access for high-needs patients are so important to us.

Best Start to Life

One of our new plans is providing more support to vulnerable mothers as soon as they test positive for pregnancy.

This project, called Best Start to Life, will ensure those vulnerable mums and their children are healthy and nurtured by giving support at the earliest opportunity to address healthcare and wellbeing needs.

The package of support will include: maternity care, Well Child checks, smoking cessation help, addiction assistance, parenting skills and screening for mental health issues pre and postnatally. It will tap into existing services and offer new support including coffee group meetings providing new mothers with peer support.

Fighting for a fair deal

A key focus for me in recent months has also been travelling to Wellington to help with Primary Service Agreement Amendment Protocol working group negotiations and advocate for practices like ours across New Zealand with large numbers of high-needs patients.

The group gave advice about how health funding should be allocated, including to allow Community Service Card (CSC) holders access to the same doctors’ fees as Very Low Cost Access (VLCA) patients in areas with large numbers of high-needs patients.

The original funding formula suggested to the group would have been unfair on VLCA practices.

Advocacy from myself, along with Dr Rawiri Jansen of National Hauora Coalition and Susan Iverson from Healthcare Aotearoa, is helping a more equitable formula to be developed.

New funding negotiated 

What this new initiative is going to do is provide non-VLCA practices with a significant additional funding pool for their CSC holders. However this highlighted the financial struggles VLCA practices have in maintaining low cost fees that will soon be available to all CSC holders.

Therefore, we successfully negotiated for an increase in the funding pool nationally for VLCA practices to provide some compensation for the extra costs involved in providing for CSC card holders and other high needs patients.

The extra funding doesn’t fully cover our costs, or resolve other inequities for us, but it is a step in the right direction.

Mark Vella
Chief Executive Officer
Total Healthcare Charitable Trust

Support for domestic violence prevention 

The visionary work of Gandhi Nivas in helping to reduce family violence is gaining praise and recognition as it expands its services.

Men are referred to the service by police or self-refer and quickly get access to help, including free emergency accommodation and counselling, which keeps their families safe.

Total Healthcare, New Zealand Police, Sahaayta Counselling and Support Services and Serenity Foundation partnered to establish the first Gandhi Nivas house in Otatuhu in 2014.

ACC provides funding to Gandhi Nivas as part of its violence prevention strategy to reduce harm caused by violence at home.

In July, ACC Minister Iain Lees-Galloway opened the Te Atatu Gandhi Nivas house  (pictured above) saying it was bold and courageous to recognise that perpetrators needed support to change and that help had a positive impact on families too.

Prime Minister Jacinda Ardern also mentioned Gandhi Nivas in her speech to the Government’s Criminal Justice Summit when talking about the importance of early intervention.

The positive role of health coaches

The breakthroughs diabetics are making in the management of their condition after health coaching at Total Healthcare clinics were shared at the RNZCGP 2018 conference.

Health psychologists Nicholas Cao and Leona Didsbury and (pictured above) spoke at the conference about the trial of health coaching in South Auckland where there are more than 40,000 patients with type 2 diabetes.

The use of health coaching at some Total Healthcare clinics started in 2016 and the positive results for patients has resulted in it now being used in four of its South Auckland clinics

Health coaches are offering support to people who are struggling to manage their diabetes condition by providing self-management support and bridging communication gaps between patients and GPs.

A trial at the Otara Mall clinic of health coaching with more than 100 diabetics, from June 2016 to early 2018, saw their HbA1c levels drop on average by 9.8 percent.

Support for nurse prescribing training

Total Healthcare plans to support up to 10 registered nurses a year from Nirvana Health or White Cross Healthcare to take part in the Nursing Council of New Zealand prescribing training.

This training will enhance the role practice nurses have in health promotion, disease prevention and the assessment and treatment of minor ailments and illnesses.

It will also help improve access to healthcare for our vulnerable communities by making it easier for patients to get basic medicines they need by alleviating the acute demand in waiting rooms, particularly in winter.

Pictured above are Nirvana Health Mana Kidz nurses (with nurse development manager Reshmi Lata Chand, left) who started this year being able to prescribe a limited list of prescription and other medicines to treat common conditions.

The trio of registered nurses completed six months' training, developed by Counties Manukau DHB in conjunction with the Nursing Council of New Zealand, that included supervison and mentoring by doctors.

Medical study – a labour of love 

The proud moment of walking on stage to receive an RNZCGP GP fellowship this year was the reward of years of hard work juggling study, work and family for four Total Healthcare doctors.

Among them was Dr Moana Taylor (pictured above with her family) whose surprise early arrival of her second child meant she was lucky to get through her fellowship final assessment – she gave birth to Oliver the day after her assessment.

Studying for a fellowship has always been on the cards for Moana: "Being vocationally registered is important not only because of the continued learning and discipline, but also belonging to the college helps bolster that credibility that our patients expect."

Working together to improve health outcomes

Total Healthcare contracts Nirvana Health Group as its management support organisation to provide medical and management services required in the PHO/DHB contracts across Auckland. Nirvana Health providers include East Tamaki Healthcare, West Auckland Healthcare, Mt Roskill Healthcare and White Cross.

Did you know?

Total Healthcare has the largest number of enrolled Pacific Island patients in the Counties Manukau DHB area.
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