Quality Target Quarter 3 gap to target

14 Mar 2019

CVRA Māori Men 35-44

14 practices are less than 10 patients away from target. We are aware this is a difficult cohort to reach, and are investigating solutions to support practices in this area. As always, ensure recalls have been sent, and take advantage of any opportunistic visits via appointment scanner.

Smoking Brief Advice

Smoking Brief Advice has dropped 3% this quarter compared to last quarter. Don’t forget – ask every patient that arrives through your practice doors, if they have not been asked in the last year. Your Patient Dashboard will remind you

The ABC approach to smoking cessation includes:

  • Ask all people about their smoking status and document their response through Patient Dashboard in Medtech/Evolution
  • Provide Brief advice to stop smoking to all people who smoke regardless whether they have indicated no desire or motivation to quit
  • Offer and/or refer Smoking Cessation through Quitline, Once and for All or in-house smoking cessation providers.

Remember to utilise the TxT2REMIND smoking campaign HPHO have funded through version 4 and utilise Appointment Scanner for opportunistic advice.

For further assistance please contact Robyn Finucane – Smoking Champion for Hauraki PHO robyn.finucane@haurakipho.org.nz or Ph 0275308003

Cervical Screening

As a practice you can help facilitate this process by having a robust recall and screening system, and utilising the support of the PHO Breast & Cervical Team.

Congratulations to those practices who have met or are tracking to meet the target of 80% enrolled women up to date with cervical screening for this quarter.  We can see also that a number of practices are within 10% of achieving the 80% target.

Things you can do to help close the gap to target:

  • Ensure that women overdue for screening have an invitation to attend screening services.
  • Use the Patient Dashboard and appointment scanner to identify women overdue for screening and offer opportunistic screening.
  • Utilise the Karo report received in late January to identify women who may have screened elsewhere, and update the PMS accordingly.
  • If you require support in contacting due/overdue Priority Group Women utilise the referral pathway to the PHO Breast & Cervical Team.
  • If you would like help with the Karo Report, screening histories for women screened elsewhere or help loading screening histories into the practice PMS, contact Nerida (Cervical & Breast Screening Support Services Co-ordinator) on griffiths@haurakipho.org.nz or 027 530 8051.

Diabetes Annual Review

Half a dozen practices are very close to reaching the 90% target, however, a number are some considerable distance away. In terms of prioritising, extra effort should be made to contact the patients that are overdue for a review and at last measure had an HbA1c of 100 above.

Type 2 diabetes is a progressive condition. Once a year the person with diabetes has the opportunity to focus with a health professional on their diabetes. For the patient it is an opportunity to ensure that they are on track and managing well. If this is done, long term complications can be significantly decreased. Blindness, amputations, and renal disease continue to increase in our area. These are costing the person, their whanau and the health system millions of dollars. We cannot afford not to do an annual review.

There are a number of people who can be well managed with an opportunistic annual review, but the majority of people do need longer with a full appointment and the opportunity to add to their knowledge about their condition. Congratulations to those clinics who managed to see more than 90% of their people. Having a system to recall patients, with a person identified to keep track of who needs to be seen and a full team of nurses who are able to complete an annual review help these clinics achieve so well. Ongoing monitoring is needed to check in with patients over the year, supporting them reach their goals.

If you need any assistance with this, please  contact Suzanne, Diabetes Nurse Hauraki PHO on Suzanne.moorhouse@haurakipho.org.nz or 0276086978

Before School Checks

B4School Checks are up on last quarter’s results, with 17 practices reaching target and those who did not getting very close. A reminder that Cay C DHB contract has come to an end, affecting the Before School (B4SC) outreach and the lost to provider service.

What does this mean for you?

  • The B4SC outreach service will be limited to what is provided by the public health nursing team who take referrals for those who are quintile five. You can contact this team through the current referral process. (The B4SC contract remains in place with all its support. For any questions or concerns please contact Michelle Morley, Pinnacle MHN B4SC coordinator.)
  • The lost to provider service will be limited and we will not be able to process referrals at the current speed.


The Manage My Health patient portal target has increased to 30% of patients aged 16+ activated on the portal for Quarter 3. Congratulations to the 6 practices who have reached this target!

Ways to increase your Patients Numbers on ManageMyHealth™

  • Appoint a Practice Champion
  • GP to recommend to patients
  • Implement ManageMyHealth™ Easy Booking
  • Add the ManageMyHealth™ link to your practice website
  • Follow up on your patients registered but not yet activated
  • Send out a text campaign to a target group of patients e.g. run a query builder of patients 16 years and over with diabetes
  • Update your phone message to inform patients that if they are phoning to make an appointment, request lab results and repeat prescriptions or talk to the nurse or the doctors, they are able to do this online via the Patient Portal and to register next time they are in the practice
  • Purchase a stamp/s with the wording – register for ManageMyHealth and have the doctors stamp this on each lab request form
  • Remember to ask each patient that comes into your practice.
  • Remind every patient that phones for an appointment / lab result / repeat RX
  • Add the ManageMyHealth brochure to your mail outs, statements and recalls etc
  • Set patient registration targets for your practice and run a competition to see which staff member registers the most patients.  (A spread sheet and query builder which has been provided to assist you with this

If you require any assistance from our Hauraki PHO Practice Support team or the HPHO Clinical Champions, please email practicesupport@haurakipho.org.nz or phone 0800474648 ( 0800HPHO4U)

Click here for the spreadsheet