Hauraki PHO and Practice Partner Advance Care Planning update – “local changes ahead”

6 Aug 2019

      • I wish to acknowledge the tremendous support received from Hauraki PHO and our Practice Partners whilst implementing Advanced Care Planning (ACP) over the past 2 ½ years. Due to this support we are leading New Zealand in ACP implementation according to the latest National HQSC stakeholder review (May 2019).


      • Last quarter has seen a great surge in ACP completions loaded into MMH-117, *240 plans in total, noting that not all loaded into MMH as ‘go live’ as DHB connectivity didn’t happen until recently) with a further 36 Advance Directives (AD) loaded since July 2019. ACP Completed by Ethnicity: Māori and Pacific are still significantly under represented in the ACP figures. Age: As to be somewhat expected, the bulk of the completed ACPs are for those aged 65+, but not exclusively. Quintile: Approximately 40% of the completed ACPs are for patients living in high quintile (low socio-economic) areas.


      • Workforce development has seen 148 staff trained within our Roopu over the past three years in level 1, 1a and 2, plus 48 participants in our shorter ‘How 2’ workshops.  We have reached 2,858 people in our ACP awareness raising presentations.


      • We are currently in year three of our collaborative five year implementation plan and gathering great momentum with Aged Care facility (ARC) engagement and others to include Primary Care, Waikato DHB, NGO, St John, Hospice and Pharmacy. ACP requires time, collaboration to implement in a sustainable way as it is a paradigm shift for consumers and some practitioners.


      • Hauraki PHO and Midland Health Network were asked to submit a joint proposal to the DHB Planning and Strategy in October 2018. Both PHO current contracts were extended until 30th September 2019, whilst the DHB considered our proposal. Both PHO’s were notified in July 2019 that the proposal was declined and that the DHB are changing the model of ACP implementation from the 30th September 2019, to an ‘in house’ approach, which will include a volunteer workforce and 1.5 FTE ACP facilitator. It does not include primary care partnership, nor a ‘fee for service’ for ACP. It is important for me that you know I continue to ask the DHB to reconsider their positon and at least pay the practices “fee for service” for ACP directly.


      • The Hauraki PHO ‘fee for service’ read code completed plan continues until 30th September 2019 and Hauraki PHO and the support for ACP continues beyond that as the Hauraki PHO staff and Practice Support Team are well versed in ACP.


      • All practices will receive resources before 30th September 2019. Which includes a USB (files too big to send electronically), 6 videos for waiting room and or teaching purposes. ACP/AD guide, ACP Summary document, training and resource ordering instructions, Guidelines for engaging Maori, Pacifica and Asian patients and their whanau.


      • Michelle Rohleder and I are level 1A accredited trainers so if there are any staff between now and 30th September 2019 who would like to update their training or practice their ACP conversations, please do not hesitate to ask. If you have plans that need up loading into MMH and need support with this, do not hesitate to contact your practice support team or myself. We continue to engage with ARC and are available to load AD’s for our Practice Partners enrolled patients in these facilities and have data by NHI/practice if you would like us to support this process.  This includes $100 per read coded completed AD/ACP with a 6 month recall until 30th September 2019.


      • Please find attached the completed ACP and AD guide. This has been through rigorous clinical and legal review within WDHB and is one of the deliverables in my work plan.


* for ease reference there is a flow chart on page 8, which is hyperlinked to guide you.  


Click here for ACP and AD Guide


“Me haere tahi tātou mō te hauora me te oranga o ngā iwi katoa o Aotearoa”

“Let us journey together for the health and wellbeing of the people of Aotearoa”

(Rev Leo Te Kira 15 December 2005)