WBOP PHO Annual Report 2020

Annual Report 2019-2020

Welcome

MÄ tini, mÄ mano, ka rapa te whai.

By many, by thousands, the work will be accomplished. By joining together we will succeed; a great number will accomplish what a few cannot.

Thank you for taking the time to read our Annual Report 2019-2020.

Guiding us is our new Health Strategy, Te Toi Huarewa, which focusses on achieving equity, quality healthcare and sustainability for all. We are well placed to continue our journey to strengthen our unique partnership and work together to improve the health and wellbeing of the people we serve.

Enjoy.

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The long-awaited Health and Disability System Review was also released this year and with it a number of recommendations have been made for transformational change across the whole health system. These include better connecting primary and secondary health and social services, a greater focus on wellness and wellbeing, and local delivery of culturally appropriate care. Working through the recommendations and agreeing actions will take time so we will continue to work collaboratively with our partners in the community as usual.

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Who would have thought 12 months ago that we would be in the grip of a global pandemic? As an organisation central to primary healthcare we had to rally quickly to focus on how we could respond to the crisis, whilst continuing to keep people well in their communities. Our mission was to leave no stone unturned to ensure continuity of care in difficult circumstances. The collaboration and teamwork between General Practice teams, PHOs, Iwi and the DHB was phenomenal and bodes well for the future of healthcare in the Bay of Plenty.

Contents W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D A N N UA L R E P O R T 2 0 19 -2 0 2 0

2020: The Year of COVID-19

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Co-Chairs’ Report

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Chief Executive Officer’s Report

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Our Practices

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Our Population

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Our Team

10

Māori Health Planning and our Iwi Partnerships

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Our Programmes

16

Our Performance

24

Health and Safety

26

Financials

27

Our Whakataukī

46

Our Future Direction

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2020: The year of COVID-19

As a primary healthcare provider, the Western Bay of Plenty Primary Health Organisation has been on the frontline of the pandemic in the region. Only 47 people have contracted COVID-19 locally, all of whom have recovered from the virus. When you look at the international death toll, we have much for which to be grateful.

Testing for COVID-19 began at Chadwick Healthcare and Tara Road Medical Centre in mid-March, closely followed by testing in our Health and Wellness Services clinic car park in First Avenue. At its peak, staff were testing a new patient every 10 minutes over a period of seven days.

As the number of cases in New Zealand ramped up, we worked in partnership with the Bay of Plenty District Health Board and other local PHOs to develop the community-based assessment centres (CBACs).

In January 2020, New Zealand health authorities were cautiously tracking the progress of a mysterious coronavirus that had originated in Wuhan, China in late 2019. By February it had a name – COVID-19 – and New Zealand had what was believed to be its first case; a person in their 60s who had travelled to Iran. In March the World Health Organization declared it a global pandemic. More than one million people have since died worldwide, including 25 New Zealanders.

The first CBAC was at Tauranga Racecourse, which later moved to a larger site at Baypark Stadium. This was followed the next day by a CBAC in Whakatāne. Testing clinics in Ōpōtiki and Kawerau, and mobile clinics to remote communities were established in the following weeks.

More than 3800 people were assessed at the CBACs in the 20 days to 14 April and 1960 people were swabbed.

As well as the logistics of organising venues, equipment, traffic management and security, doctors and nurses had to be pulled in from the community to staff them, and strict clinical processes needed to be in place. The PHO’s IT teams also leapt into action, setting up a database and designing an app to streamline the flow of information.

The PHO also worked with kaupapa Māori providers, Ngāi Te Rangi and Ngāti Ranginui Iwi, The Centre for Health, BOP DHB, and Ngā Mataapuna Oranga to deliver a mobile CBAC service called Pahi Tahi, providing COVID-19 assessment and testing to marae, hapū and vulnerable Māori communities.

On top of COVID-19 testing, more than 1800 people (over 65s,

PHO over five days before the Alert Level 4 lockdown on 26 March. Flu vaccination clinics were also organised for Māori communities on remote Motiti and Matakana Islands.

With no active cases in the Bay of Plenty by the end of May, the Tauranga CBAC closed and testing moved back to our GPs in the community, where it has remained since.

The exception to this was the mass testing of Port of Tauranga staff in August, which the PHO helped to set up at the port alongside BOP DHB. The original directive would have required testing of 6000-7000 workers, but was later brought down to a more manageable 761 high priority workers. These people were successfully tested over four days, with many more tested in General Practice.

While testing kept us on our toes, COVID-19 also forced us to work in a variety of new ways to help keep our communities safe.

GPs were required to offer virtual consults – both phone and video – almost overnight. Many are still offering virtual consults for patients who prefer the convenience of this option.

Virtual Zoom meetings are now commonplace, with the PHO now offering some of its lifestyle wellness and diabetes self-management groups online, as well as its Continuing Medical Education (CME) sessions.

With COVID-19 likely to remain with us for some time to come, we The Port of Tauranga swabbing team led

have found ways to weave it into our ‘business as usual’ and can be rightly

by Ngāti Ranginui Iwi, from left, Margaret,

proud of our innovation and teamwork, as well as the compassion and

Leanne, Lucia, Sue and Katie.

empathy shown to each other during this crisis.

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jabs via drive-through clinics organised by Green Cross Health and the

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pregnant women, and people with chronic health conditions) received flu

Co-Chairs’ Report Working in the healthcare sector is always challenging and unpredictable – there are never two days the same. But COVID-19 was a curveball no one saw coming.

While we started 2020 with the expectation that it would be all about the findings of the Health and Disability System Review and what it was going to mean for primary healthcare and PHOs, it soon became apparent we were in a fight for our community’s lives.

Our heartfelt thanks go to our staff who pulled together and were incredibly adaptable and willing to do the mahi where needed. We acknowledge that this year has been disruptive and stressful at times and we appreciate your efforts.

The PHO was extremely professional in its support of General Practice, and our Iwi partners to deliver all-of-health services to the hardest to reach communities. We have CO - C H A I R M E L A N I E T E A R A I TATA

certainly learned a lot from those activities and can use that learning to further develop our services.

Our General Practice teams have had a challenging year and have adjusted and adapted brilliantly. Over the space of a single weekend they had to move to virtual consultations, and throughout the different Alert Levels had to work with constantly changing information, while still providing a consistent service.

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Our Iwi partners, Ngāti Ranginui and Ngāi Te Rangi, displayed leadership and innovation in mobilising a COVID-19 response. Both Iwi dedicated immediate resource to strengthen resiliency within Māori communities.

When our hospitals had limited access, General Practice and Iwi had to manage people with high health needs who had real medical conditions, and real fears. We

“As a Board, we are more committed than ever to ensure the PHO is empowering community-based providers to deliver services rather than being a service provider ourselves.”

are still seeing the fallout from that. Our community has shown great resilience, however, and the low incidence of COVID-19 in the Western Bay of Plenty is testament to our collective efforts to stay home and save lives.

The impact of COVID-19 on mental health in the community has been substantial, and together with our colleagues at the Eastern Bay Primary Health Alliance (EBPHA) and Ngā Mataapuna Oranga (NMO) we are looking at ways to improve the primary mental health services we offer, taking advantage of new mental health funding announced in the 2019 Wellbeing Budget.

The proposed merger with EBPHA did not go ahead this year, with the Bay of Plenty District Health Board deciding the shifts signalled in the Health and Disability System Review towards locality-based planning and networks made a merger less relevant. We will continue to work alongside our PHO and DHB colleagues, as we did so ably during the COVID-19 crisis, to deliver the best possible health outcomes for our communities.

While the review findings did not signal a clear future for PHOs, it did make clear the need for an empowered, resourced, integrated and collaborative primary healthcare sector, which offers great hope and opportunities in the coming years.

As a Board, we are more committed than ever to ensure the PHO is empowering community-based providers to deliver services rather than being a service provider itself.

Our Health Strategy, Te Toi Huarewa, continues to put energy and resources into doing just that because it is crucial to improve the health and wellbeing of our Māori whānau.

We accept that in order to do that we have to move away from a traditional Western model of primary healthcare delivery to a more holistic approach driven by individuals themselves rather than health professionals.

Where possible, the best people to implement that are Māori themselves so we will be working to empower whānau

CO - C H A I R D R LU K E B R A D FO R D

to manage their own health and design their own health outcomes. The uniqueness of Iwi and its infrastructure continues to be a fundamental element in reducing health inequity for Māori. Iwi partners have consolidated Te Toi Huarewa at a governance level, ensuring measurable outcomes, genuine engagement and culturally competent representation.

Pete Chandler, as well as the new Board chair following the resignation of Sir Michael Cullen earlier this year.

We also welcome the recent appointments of Marama Tauranga, Manakura – Executive Director Toi Ora, and Joanne Baird, Toitaki ki Tauranga – Tauranga Site Leader to the DHB’s Māori Health Gains and Development team. This will strengthen the region’s commitment to improving Māori equity and outcomes.

While we still have to be vigilant about COVID-19 because we’re not out of the woods yet, we certainly aren’t standing still when it comes to progressing our plans for improving the health and wellbeing of our community in general. New programmes continue to be introduced, relationships continue to be developed and enhanced, and quality improvement is always at the forefront.

None of this is possible, of course, without the hard work and dedication of our staff, our Board, our General Practice teams and our Iwi partners. Together, we will clear the undergrowth so that the new shoots of the flax will grow.

Tungia te ururua, kia tupu whakaritorito te tupu o te harakeke.

B OA R D CO - C H A I R S M E L A N I E T E A R A I TATA ( N G ĀT I R A N G I N U I ) D R LU K E B R A D FO R D

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DHB, and look forward to working with the new CEO,

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We continue to have positive interactions with the

Chief Executive Officer’s Report In the midst of a year when we stared down a global pandemic, as an organisation we chose to take time to stop, pause and think about our ‘why?’

We all have a purpose, cause or belief that drives us, and it was pleasing to see that collectively we acknowledge the PHO’s common purpose is to see the improved health and wellbeing of our communities. It’s what brings us together and keeps us going.

Haere mai, welcome to our 2019-2020 Annual Report.

We speak not only about health, but also wellbeing because they go hand-in-hand – there is no health without the things that keep us well, such as safe environments, employment, education, housing and social connectedness.

Our health is not just our physical health either – it is also our mental health, our spiritual health and our whānau/family health. This is why we embrace the Whare C H I E F E X E C U T I V E O FFI C E R L I N D S E Y W E B B E R

Tapa Whā model of health and have incorporated its principles into our new Health Strategy Te Toi Huarewa.

We have taken a strong equity approach in this strategy, particularly for Māori, and will seek to understand what matters to whānau and bring them on board to design services that work for them.

Investment in clinical, cultural and health intelligence leadership has strengthened our ability to support

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our network to understand and address inequities, to encourage co-design of services, to be brave and innovative, to challenge outdated ideas and to celebrate new ways of thinking.

Our community’s health and wellbeing has certainly been challenged this year by COVID-19. It has been tough, and a real test of our agility, responsiveness, and resilience.

General Practice met the challenge of changing its service delivery model and embracing telehealth head on.

Thank you to our amazing GP teams for coming together, for stepping up and for making us proud.

Our Iwi partners, Ngāi Te Rangi and Ngāti Ranginui, also had to change their service delivery model and embrace new technologies, showing great flexibility and innovation to keep their communities safe. Our special thanks to them for improving the health and wellbeing experience for Māori, by Māori.

The partnership approach to the mahi to establish the Port of Tauranga surveillance testing programme in particular, led by Ngāti Ranginui and supported by our Clinical, IT and Finance teams, the Bay of Plenty DHB, Pathlab and Port of Tauranga, is a good example of unity across multiple stakeholders and something of which we can all be truly proud.

of-system approach outside of the traditional hospital campus.

And while we rightly had to focus on our COVID-19 response this year, we did not let our key mahi slip and, in fact, had some significant wins.

Our enrolled population continued to grow, with almost 6000 additional people enrolling with one of our General Practices in 2019-2020. Importantly, our number of Māori enrolments continued to grow also and exceeded the growth in our total population.

Brief advice was given to 16,043 smokers in the past 15 months and 14 percent of those were referred to supportto-quit programmes. This bodes well for our objective of reducing patient deaths from the effects of long-term smoking and chronic obstructive pulmonary disease.

We have enjoyed great success with the timely vaccination of eight-month-olds due their childhood immunisations. For the year ending 30 June 2020, we immunised 559 of 657 eligible Māori children.

At the other end of the age spectrum, we gave more than 4600 additional flu vaccinations to our over 65s this year. Of note was an increase in the number of Māori over 65s receiving a vaccination from 55 percent to 71 percent.

We have also come ahead leaps and bounds in our health intelligence space this year – bringing meaning to our reporting capability and knowing where we need to focus our efforts to improve health outcomes through good quality data and analysis.

Our finance capability has also been brought in-house this year, which will give us greater visibility over our financial performance, customer service and business processes.

To summarise our performance as a team this year, there is no doubt we have been adaptive, responsive and innovative in our thinking. We have stepped up and stepped out of our comfort zones and have remained focussed on doing the right thing.

But perhaps the thing that has stood out the most for me this year is our growing sense of whanaungatanga and connectedness as an organisation and network. Thank you all for staying on the waka and taking this journey together.

Nāku noa, nā, LINDSEY WEBBER

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new opportunities for realising the aspirations for a whole-

“Investment in clinical, cultural and health intelligence leadership has strengthened our ability to support our network to understand and address inequities, to encourage codesign of services, to be brave and innovative, to challenge outdated ideas and to celebrate new ways of thinking.”

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These strengthened relationships with our partners, and a new chief executive at the helm of the DHB, bring

01 Our Practices

Bethlehem Family Doctors

Mount Medical Centre

Bethlehem Medical Centre

Ngati Kahu Hauora

including

Omokoroa Medical Centre

Cameron Medical Clinic Chadwick Healthcare Limited

including

Chadwick Bethlehem

Chadwick Greeton

Chadwick Tauriko

Chadwick South City

Cicada Health Dee Street Medical Centre Epic Health Medical Practice Farm Street Family Health Centre

Pāpāmoa Beach Family Practice Pāpāmoa Pines Medical Centre

including

Pāpāmoa Pines @ Palm Springs Pyes Pa Doctors

including

Pyes Pa The Lakes Shopping Village

Tara Road Medical Centre Te Puke Medical Centre The Doctors Bayfair

including

including

5th Ave on 10th

The Doctors Pāpāmoa

Girven Road Medical Centre Hairini Family Health Centre

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Otumoetai Doctors

Fifth Avenue Family Practice

Gate Pa Medical Centre

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Ngā Kākano Foundation Family Health Services

The Doctors Bureta The Doctors Kopeopeo The Doctors Phoenix The Doctors Tauranga The Doctors Total Health

Healthcare on Fifteenth

The Doctors Welcome Bay

Katikati Medical Centre

Third Age Health (Tauranga)

K AT I K AT I

MT M AU N G A N U I

O M O KO R OA

PĀ PĀ M OA

TAU R A N G A TE PUKE

W H A K ATĀ N E

Funding received on behalf of General Practice was $39.69m in the year ended 30 June 2020 for the enrolled population. This funding is used to provide services that promote population wellbeing and management of personal health. Other targeted funding is received to enable clinical programmes and interventions to address specific areas of primary health care.

16%

M ĀO R I P O P U L AT I O N E N R O L L E D

31,987

+5961

TOTA L P O P U L AT I O N E N R O L L E D

198,925

+1148

+4.2%

TOTA L PAT I E N T C O N TAC T S W I T H G E N E R A L P R AC T I C E

M ĀO R I PAT I E N T C O N TAC T S W I T H G E N E R A L P R AC T I C E

661,273 89,486

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Our Population Working alongside our General Practices and Iwi, Western Bay of Plenty Primary Health Organisation supports healthy lifestyles and quality healthcare services for a growing number of people in our local communities.

% of Bay of Plenty population enrolled

76.6% Enrolled vs StatsNZ New Zealand Population Projections (2020 estimate)

Western Bay of Plenty PHO currently

2.0%

Increase in over 65s enrolments this year

3.7%

Increase in Pasifika enrolments this year

7.5%

population living within the Bay of Plenty. Residents are dispersed from Waihi in the west to Whakatāne in the east. 16% of the 198,925 enrolled population identify as being Māori and a further 2% as Pasifika. The increase

Increase in Asian enrolments this year

12.2%

serves 80% of the estimated

in enrolled Māori patients this year exceeded that of the growth in our total population (+4.2% compared with Newborn babies enrolled within 6 months of birth

94.3%

21.6%

+3.1%). Net growth in enrolments at General Practice averaged 496 per month over the past year (510 in 2019).

% of enrolled over 65

Our PHO population growth of 3.1% exceeds the 2.6% estimate for the Bay of Plenty region and is well above the 2020 national average of 1.7%. Young people aged under 25 years comprise 30%

Increase in Māori enrolments this year

4.2%

of our patients, while the elderly (aged 65 or more) represent 21.6% of our population. Our annual growth in under 14s (+2.0%) was lower this year than the elderly (3.7%), however the largest growth of 12.2% can be seen within our Asian enrolled population.

The demographic profile of our Māori patients is weighted towards children, youth and adults, which contrasts that of the total population profile skewed towards adults and the elderly.

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3.1%

Increase in under 14s enrolments this year

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Total increase in enrolments this year

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Our Team Over the past year we have seen a significant growth in activity to ensure our organisation remains up to speed and fit for purpose. This has required investment in infrastructure, data intelligence capability, clinical and cultural leadership, and programme design and implementation resource.

We have also committed to the major

maturity needed to deliver our health

project of bringing our finance capability

strategy and remain agile and responsive.

in-house and have successfully moved into

The end goal remains firmly and squarely

the transition phase of this project. Our

on achieving equity for MÄ ori and

new and improved financial reporting and

improving the health and wellbeing of

analysis tools will provide better visibility

our communities through continued high

of the true cost to deliver our programmes

quality support to our network, up-to-

and services to achieve the desired

date technology and tools, mature health

outcomes.

intelligence and strong clinical leadership.

The investments we are making across

We are very fortunate to have the

all of these functions are necessary to

expertise across all our teams to help us

support the organisational growth and

achieve this goal.

BOARD OF DIREC TORS Board Sub-committees Finance, Audit and Risk Clinical Committee After Hours Committee P R OV I D E R S I N C .

N G ĀT I R A N G I N U I | N G Ā I T E R A N G I

CHIEF E XECUTIVE OFFICER

COMMUNIT Y SERVICES

PR AC TICE SERVICES

Health and Wellness Services

General Practice Liaison

Mental Health Programme

Health Care Home Project

Support to Screening Services

CLINIC AL LE ADERSHIP AND QUALIT Y IMPROVEMENT

N

School-based Health Services

CE

MĀO R I H E A LTH

Programme design development and evalution

Equity Projects

Continuing Medical Education

Iwi-led Programmes

Continuing Nursing Education

Health Promotion

Workforce Development

Cultural Intelligence

Practice Accreditation

CORPOR ATE SERVICES Finance Project Information Management

PEOPLE AND C APABILIT Y Organisational Culture

IT Architecture

Health and Safety

Contracts Management

Training and Development

Performance Reporting

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GE

L PR AC TI ER A

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Acute Demand

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Māori Health Planning and our Iwi Partnerships Whai Mana (equity), particularly for Māori, continues to be a focus of our mahi and is reflected strongly throughout our Health Strategy Te Toi Huarewa. The name of the strategy was gifted by Graham Bidois Cameron.

Often when we are looking for an appropriate name for a specific purpose e.g. the Health Strategy, we will consider a pūrākau (Māori legend) that best reflects that purpose, our values and our vision.

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Te Toi Huarewa – Puhi-whanake was one of the tĹ?hunga (navigation experts) who travelled with Tamatea Ariki Nui (the captain) on the Takitimu waka to Aotearoa.

During the voyage these men passed each night scanning the stars, in order to direct the steersmen and to be able to foretell weather conditions. They travelled all the way to the end of their journey, near the Waiau River in the South Island, and then stayed there as instructed by Tamatea Ariki Nui as ahi kaa (keeping the home fires burning, keeping a place warm through the presence of people) to serve as guardian of his wife who died there. Te Toi Huarewa o Puhi-whanake refers to a journey of striving to attain all knowledge and wellbeing under the guidance of a navigator who sees clearly in the darkness through all challenges. A toi huarewa is the whirlwind path to the highest heavens.

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T E TO I H UA R E WA

What is good for Māori is good for all, and what works for everyone does not necessarily work best for Māori.

In developing Te Toi Huarewa we chose not to have a separate Māori Health Plan, but rather a plan that focusses on Māori inequities, based on the analogy above.

We have started our journey in understanding what matters to whānau and meaningfully engaging with them to co-design primary healthcare services. Working initially with Health Care Home practices, we have delivered a consumer engagement and ‘co-design 101’ workshop and then each practice was provided with dedicated co-design expertise to work on a quality improvement project of their choice.

Whai Rangatiratanga is another key priority for us, which confirms our commitment that whānau, hapu and Iwi need to lead, determine and guide pathways that improve Māori health gain, and that we must continue to invest

Students at Te Wharekura a Mauao learn the art of Mau Rakau.

in Iwi-led and locally delivered kaupapa Māori services in partnership with General Practice.

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The Long-Term Conditions Programme – Te Ahunga

M AU R A K AU

Whānau (meaning whānau-directed, whānau-centred and

Mau Rakau is delivered by Te Puna I Rangiriri Trust each school

whānau-focussed) is an exciting pilot programme that has

term to six local kura Māori and aims to train rangatahi Māori in

started with five General Practices (two in the Eastern

the art of Mau Rakau through regular wananga. The traditional

Bay of Plenty and three in the Western Bay of Plenty)

art form draws from a basis of training methods traditionally used

that will be led by Iwi and supported by General Practice.

by tupuna (ancestors). In a contemporary context the programme

The model of care supporting the programme transcends

endorses discipline, culture and the importance of relationships

across traditional health and social sector boundaries

and is underpinned by matauranga Māori (knowledge) and

and incorporates clinical, social and environmental

primarily delivered in te reo Māori. The programme is designed

interventions and navigation support. It is a model of care

for tauira (students) who are at kura Māori. Wananga are held at

that is patient/whānau-centred and will:

different marae in the Mataatua region and rangatahi learn about

• Provide care that is respectful, responsive and

the different marae they stay in and hear from the haukainga (local

meaningful to the individual patient preferences, needs

people of the marae) about the history of their whenua (land) and

and values and that ensures the patient and whānau

significant sites. The programme aims to achieve a future pathway

goals inform clinical decisions.

that will continue the sustainable leadership growth of young

• Encourage high quality and sustainable long-term condition management within the community that empowers individuals and their whānau to take control of their wellness.

• Be accessible, equitable and culturally appropriate.

Director of Māori Health, Kiri Peita (Ngāi Te Rangi and Ngāti Ranginui) has been actively engaging with practices across the network in various ways, including: • An introductory session for General Practice teams on equity and why we focus on Māori health.

• Guidance on implementation of Māori Health Plans developed by a practice’s Māori health working group.

• Providing cultural support to a patient (kaumatua) in General Practice following an Advanced Care Plan kōrerō with him.

Motiti Island resident Richard West learns CPR with first aid trainer Les Maclaren.

people in Tauranga Moana.

KO I O R A Koiora is a Ngāi Te Rangi leadership development programme that focusses on enhancement of hauora Māori for rangatahi. Koiora provides rangatahi with the following opportunities: • Quality of life (rangatahi Māori health and wellbeing).

• Economics and career pathing (rangatahi Māori are assisted in career choices and taught economic literacy).

• Culture and identity (rangatahi Māori build on their cultural identity, increasing their knowledge of cultural heritage, ability to converse in te reo Māori and strengthen their understanding of tikanga).

• Participation and equity (enable rangatahi Māori to build relationships, trust, respect – an expression of manaakitanga,

The Koiora programme in action at Te Rereatukahia

whanaungatanga, pūmautanga, kaitiakitanga and rangatiratanga).

Marae in Katikati.

• Having a conversation with a GP regarding bilingual signage in the practice.

We have engaged with two of our island communities, Matakana and Motiti Islands. They shared with us what was on their wish list and we have ticked off some of their big-ticket items such as a first aid training course for Motiti Island residents and made significant progress in improving health service access via telehealth.

We have advocated at a ministerial level for one of our smaller communities, Ngā Whānau o Whareroa, calling for action regarding health and environmental issues caused by long-term daily exposure to environmental toxins.

During the COVID-19 pandemic the true meaning of mahi tahi (the unity of people working towards a specific

and Development (MHGD), community leaders and other The Mataora Mental Health and Addiction Services

health providers worked together to provide a kaupapa

team, from left, Tony Burne (trauma counsellor), Roy

Māori Community Based Assessment Centre service

Nathan (addiction counsellor) and Kayla Coleman

called Pahi Tahi. The PHO Information Management team

(peer support).

provided hardware and analytical support. Successes included re-engaging some patients who had not received a 2019 influenza vaccination.

M ATAO R A S E RV I C E

Our Iwi-based programmes funded by the PHO

Mataora is delivered by Ngāti Rānginui Iwi

demonstrated how flexible and how innovative Iwi were

to increase access for whānau to culturally

during the COVID-19 lockdown. There were changes to

appropriate mental health and addiction services,

delivery methods across the services to ensure our whānau

encompassing trauma, addiction counselling and

continued to be well-supported, including changing from

peer support advocacy. Since its establishment in

wananga to online learning modules, using digital platforms

July 2020, more than 100 whānau have engaged

to create content (e.g. Kahoot quizzes), utilisation of

and accessed services ranging from complex

Facebook Messenger for virtual counselling and support,

trauma, mild to severe substance use disorders, co-

and motivational posts and resources shared on Facebook

existing disorders and mild to moderate emotional

for whānau to access.

distress.

Treatment ranges from individual, couple, and whānau therapy to implementation of a nineweek group self-care programme that fosters psychoeducation and alternative ways to wellness.

15

kaupapa Māori providers, BOPDHB Māori Health Gains

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goal or the implementation of a task) came to the fore. Iwi,

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05

Our Programmes The Western Bay of Plenty Primary Health Organisation offers a range of healthcare programmes delivered through General Practices and our complementary Health and Wellness Services, as well as Iwi-based services.

DHB Funded Services AC U T E D E M A N D S E RV I C E (incl. CPO, ASH, ED/St John Redirects) A comprehensive range of targeted services, focussing on reducing Emergency Department presentations and hospital admissions through enhanced service delivery within a primary care setting. Provision of an acute package of care supports General Practice to manage patients within the primary care setting and ensures people remain connected and cared for by their primary care provider.

A F T E R H O U R S S E RV I C E S (incl. Free Access for U14s, GP and 2nd Ave After Hours Services, GP Telephone Nurse Triage, After Hours Support for HN/CSC) This suite of services, providing free access for children under 14 years of age and subsidised access for High Need and Community Service Card holders, includes extended hours offered through General Practice on week days and after hours on weekends, contracted after hours services through Accident and Healthcare and telephone-based access to health advice and triage.

AG E D R E S I D E N T I A L C A R E ( A R C ) A specialised team, comprising of Clinical Nurse Specialist/s and a Clinical

TO O L S D E V E LO P E D BY A R C T E A M I M P R OV I N G H E A LT H C A R E FO R O L D E R PEOPLE

Pharmacist, actively focussed on enhancing clinical skill development and

Healthcare assistants and nurses working in aged

quality care provision within Aged Residential Care facilities across the Bay

care have new tools for assessing the health of

of Plenty.

older patients thanks to the work of our Aged Residential Care team.

34 facilities throughout the Bay of Plenty the

patients with a comprehensive range of medicine management and

PHO wanted to find a way to support the aged

adherence, and specialised prescribing support and advice. This is delivered

care workforce to pick up early signs of health

through Medwise.

deterioration.

CO M M U N I T Y R A D I O LO G Y S E RV I C E

to help them identify symptoms for nurses, who

A range of ‘specialist’ radiological services focussed on diagnostic Breast

then carry out a full assessment.

A tool was developed for healthcare assistants

Imaging and DEXA Bone Mineral Density scanning. This service is an

“This helps the nurse to decide on a course of

excellent example of an integrated partnership. Bay Radiology and Medex

action or pass it up to the clinical nurse manager or

are contracted to provide this service.

GP for further consideration. It gives everyone a voice and ensures that concerns are followed up,”

CO O R D I N AT E D P R I M A RY M E N TA L H E A LT H S E RV I C E This service provides for a range of therapeutic services such as a social

says ARC clinical resource nurse Kate O’Dwyer.

There have been fewer ED attendances of

worker, group therapy, GP or nurse extended consults, counselling or

patients from aged care facilities since the tools

psychological support for depression, anxiety and youth mental health.

were introduced, which means potential health

Alcohol/drug and related therapeutic care is also delivered within a

problems are being reversed at an earlier stage.

‘Stepped Care’ model, by a range of contracted and internal specialist therapists. This service is one of the PHO’s busiest.

The registered nurse assessment tool, based on the SBARR framework, has been adapted for use by the Health Quality & Safety Commission of New

GP SHARED CARE

Zealand and is included in the latest Frailty Care

A service that provides intensive care to those managing opioid

Guides for aged residential care.

dependency. This service is delivered by an increasing number of GPs

The project was also named as a finalist in the

in partnership with the BOPDHB’s specialist Bay of Plenty Addiction

Innovation in Service Delivery category in the

Services.

inaugural New Zealand Primary Healthcare Awards.

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With more than 1900 older patients in

A targeted approach, supporting General Practice teams and referred

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CO M M U N I T Y M E D I C I N E M A N AG E M E N T

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H E A LT H C A R E H O M E Western Bay of Plenty Primary Health Organisation has taken the lead in the roll-out of the nationally recognised Health Care Home Model of Care across participating practices within the BOP. This initiative is supported by a significant two-year investment through BOPDHB and additional investment of both funding and in-kind resource from both EBPHA and the PHO to support delivery over the next three years. The Health Care Home Team significantly contributed to the revised national model of care, which now has a stronger focus on health equity, consumer involvement and honouring Te Tiriti o Waitangi.

LO N G T E R M CO N D I T I O N S M A N AG E M E N T S E RV I C E S This is the PHO’s most comprehensive integrated service, predominantly delivered through General Practice and community-based contracted providers. It focusses primarily on Cardio-vascular Risk Assessment, and diabetes detection and management, involving the integrated services of

Hapū māmā Bianca McLeod-Ohia and

podiatry, retinal health, nurse specialists and self-management education.

papa Ngāi Te Rangi Toma make a wahakura

COPD support and self-management, and Pulmonary Rehabilitation also

(traditional flax basket) for their pēpi as part

fall within this suite of services.

of the Ūkaipō programme, which has a focus on smoking cessation.

I M M U N I S AT I O N O U T R E AC H S E RV I C E S Under sub-contract to EBPHA, an Outreach Immunisation Service is provided to support General Practice maximise coverage of childhood

The Bay of Plenty is included in statistics for the highest rates of skin cancer in the world. This service enables lesions to be surgically removed by approved specialist credentialed general practitioners. An independent specialist in skin cancer surgery is engaged to triage each referral, ensure clinical standards are maintained and the DHB-assigned resources used well. The PHO is also responsible for credentialing all approved clinicians.

S C H O O L S H E A LT H S E RV I C E Delivering a comprehensive range of primary healthcare services across secondary schools within the Western Bay of Plenty, this service offers both nurse-led services during the school weeks and GP clinics on a contracted basis. These services are underpinned by excellent partnerships between schools and the PHO and has reflected continued increases in access to services by the student population.

S M O K I N G C E S S AT I O N S U P P O R T There are two areas of focus within this service. General Practice teams are enabled to offer support to patients who indicate they want to quit smoking. This is not dependent on a quit date being set and achieved. The other focus is a wananga for pregnant wahine Māori, operating under the gifted name of Ūkaipō. Inclusive of the extended whānau, the service focusses on health lifestyle choices for both māmā and pēpi, including smoking cessation.

19

M I N O R S K I N S U R G E RY S E RV I C E

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immunisations across the rohe.

PHO self-funded services

M AU R Ā K AU ( T E P U N A I R A N G I R I R I T R U S T ) A service focussed on skilled use of traditional weaponry and associated cultural beliefs, knowledge and practices to engage rangatahi and their whānau.

YO U T H H E A LT H S E RV I C E ( N G Ā I T E R A N G I ) A mobile primary healthcare and social work service delivered in the evenings across a number of high-need communities, focussing on the care needs of youth and their whānau. Ngāi Te Rangi Iwi has successfully operated this service for more than 10 years.

CO M M U N I T Y N U R S I N G S E RV I C E A highly regarded registered and specialist nursing service focussed on support to our General Practice network

Water safety is among the activities rangatahi are involved in

and Iwi partners through provision of community-based

as part of the Koiora programme.

outreach nursing care. This comprehensive service operates out of the PHO’s Health and Wellness Services.

S K I N S U R G E RY D I S C R E T I O N A RY S U B S I DY G R E E N P R E S C R I P T I O N S/AC T I V E FA M I L I E S

A limited level of funding provided directly to General

These are a physical activity and health lifestyle-focussed

Practices to subsidise the costs of diagnostic services for

suite of services, supporting individuals and their whānau

patients that do not meet the eligibility criteria for access

who are seeking the benefits of improved levels of activity

to the DHB-funded Minor Skin Surgery Service.

and improved lifestyle choices. Sport Bay of Plenty has been

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contracted to provide these services for more than 10 years.

KO I O R A ( N G Ā I T E R A N G I I W I ) Koiora is a leadership development programme that

PA L L I AT I V E C A R E D I S C R E T I O N A RY F U N D I N G

focusses on enhancement of hauora Māori for rangatahi.

A limited resource intended to enable General Practice to

The programme provides for the transfer of traditional and

provide more intense support during end-stage palliative

cultural knowledge as a basis for encouraging mental and

care to the patient and their family through subsidisation of

spiritual health, good nutrition, regular physical exercise

service costs.

and enriched cultural connectedness. It is a forum that provides mentoring, sharing of knowledge, networking and

P E R FO R M A N C E I N C E N T I V E S

goal setting.

(incl. SLM, CVDRA and national health targets) A range of financial incentives are available to our General Practice network to recognise optimal clinical performance in a number of key areas including CVDRA, 65+ Seasonal Flu coverage, Smoking Brief Advice, and Breast and Cervical Screening coverage for Māori women. System Level Measures funding available through the Ministry of Health is supplemented by the PHO where national financial incentives no longer exist.

H I G H - N E E D D I S C R E T I O N A RY F U N D I N G A dedicated funding line assigned to General Practice to use at their discretion, to assist high-need patients where financial barriers reduce access to health services. This has been particularly welcomed by practices wanting to

The Mauri Ora programme organised an event called 'Brocode'

support vulnerable population groups during and after the

which brought more than 70 tane (men) from throughout

impact of COVID-19.

Tauranga Moana together to discuss health and wellbeing.

M AU R I O R A ( N G ĀT I R A N G I N U I I W I ) The service includes a range of programmes aimed at assisting and empowering whānau to improve and develop their health and wellbeing journeys. The concept of Mauri Ora extends beyond physical healthcare to include factors such as spiritual wellness, mental health, and connectedness to their whānau and community.

M ATAO R A S E RV I C E ( N G ĀT I R A N G I N U I I W I ) There are three programmes within this service: Mental Health and Addiction Co-existing Problems Counselling, Trauma Counselling, and Peer Support Advocacy.

H E KO KO N G A N G Ā K AU W H Ā N AU S U P P O R T S E RV I C E (NGĀI TE R ANGI IWI)

Nurse Margaret Dudley at the Te Puke Community

This service works with tenants of Accessible Properties Limited (APL). The

Health Centre.

service delivery approach is a whānau support model that works alongside that by developing a relationship based on support and trust these issues

N U R S I N G S U P P O R T FO R O U R G E N E R A L P R AC T I C E A N D I W I PA R T N E R S

will be able to be addressed.

Nurse Margaret Dudley (Ngāti Rangiwewehi,

whānau to identify and manage health and wellbeing issues, with the view

Ngāti Raukawa) is a member of our Health and I M PA I R E D G LU CO S E TO L E R A N C E ( I G T )

Wellness Services team providing nursing support

The IGT programme supports GP teams to target patients with pre-

to our General Practice and Iwi partners in the

diabetes who are at risk of developing diabetes and cardiovascular disease.

community.

Avenue, alternate Fridays at Ngā Kākano and Te Puke Medical Centres helping to manage recall lists, home visits, and her own weekly clinic at Te Puke Community Health Centre. She also visits marae

“The patients love that healthcare is more accessible to them in Te Puke and think we provide them a wonderful service.

Many of them like that I am Māori and will come back to see me again. We try to see people in an environment where they feel comfortable.”

Margaret Dudley

and workplaces to conduct health assessments and cervical screening for large groups as required.

Her work involves cervical screening, organising breast screening, and wound care.

“The patients love that healthcare is more accessible to them in Te Puke and think we provide them a wonderful service. Many of them like that I am Māori and will come back to see me again. We try to see people in an environment where they feel comfortable.”

Margaret’s clinics at Te Puke Community Health Centre started off monthly, but have now increased to weekly to meet demand.

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Health and Wellness Services walk-in clinic in First

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She spends her week working between the

Health and Wellness Services

S U P P O R T TO S C R E E N I N G S E RV I C E S A nationally-funded cervical and breast screening service focussed on improving screening coverage rates for priority women. The service supports the BreastScreen Midland breast screening mobile unit when it is visiting our communities and offers cervical screening bookings alongside the unit. The target population is women aged 25-69 years old identifying as Māori, Pacific Island or Asian, and women who have never screened, or not been screened in the past five years.

CALLING TEAM Our calling team is trained in motivational interviewing and contacts patients referred by General Practice who are overdue for breast and/ or cervical screening and other health interventions e.g. heart check, or flu vaccination. Barriers to attending appointments are determined and

Karina Liddicoat follows up a patient with an overdue

solutions to overcome them implemented, including home visits and

medical appointment.

transport assistance if required.

CO P D Providing education and support to General Practice champions in the

C A L L I N G T E A M B R E A K I N G D OW N BARRIERS

effective management of patients diagnosed with COPD as an initiative to

More patients are attending overdue medical

reduce unnecessary ED presentations and admissions related to COPD.

appointments with the help of the PHO Health and Wellness Services’ telephone calling team.

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D I A B E T E S N U R S E E D U C AT I O N

Health and Wellness Services welcome referrals

A highly-regarded service that focusses on the care of acute diabetics and

from General Practices of women overdue for breast

consultative support to clinicians.

and cervical screening, as well as patients who haven’t attended appointments for Cardiovascular

CO M M U N I T Y C L I N I C S

Disease Risk Assessment (CVDRA), or haven’t been

A range of community-based clinics designed to improve accessibility

reached to receive advice on how to quit smoking.

to care and provide a range of services including health assessments, vaccinations and smoking cessation advice.

Members of the calling team then telephone the patients, building a relationship to understand any barriers the patient may express to attending their

S E L F - M A N AG E M E N T G R O U P S ( S M G )

appointment. Transport, fuel vouchers and childcare

These groups are focussed on assisting people to manage their health

are among the types of support offered.

conditions. Groups currently offered include lifestyle wellness and type 2

The team includes five women, two who are

diabetes management. These groups are delivered by a multidisciplinary

fluent in te reo Māori. Two are based in the Eastern

team from the Health and Wellness Services clinic, and are also available

Bay of Plenty and all are trained in motivational

via online video conferencing.

interviewing.

DIETITIAN

two patients contacted going on to attend their

The dietitian provides a range of services for our enrolled population over

appointment.

The initiative has been successful, with one in

18 years old within PHO-delivered services, including having a key role in the provision of self-management groups. One-on-one consults are also available.

ST JOHN AMBUL ANCE Health and Wellness Services supports General Practice in the management of patients redirected by St John or on-referred by Emergency Departments when primary care management is appropriate.

I N S U L I N S TA R T S An education programme developed for practice nurses to optimise the use of insulin for diabetics.

CO N T I N U I N G M E D I C A L E D U C AT I O N (C M E ) The PHO coordinates and delivers a comprehensive medical and nursing continuing education service across our provider network, which is available both face-to-face and via Zoom. It is also part of a collaboration between the Midland region’s five DHBs and eight PHOs to offer the Midland Collaborative Recertification Programme for Registered Nurse Prescribers in Community Health.

R O U T I N E WO U N D M A N AG E M E N T Caitlin Milne runs a self-management session online.

Health and Wellness Services provides a back-up arrangement for patients referred to their General Practice for the management of wounds. Access is supported by offering home visits and drop-in clinics at Health and Wellness Services. The service also delivers wound care for patients with

S E L F - M A N AG E M E N T G R O U P S GO ONLINE

an injury covered by ACC.

The PHO’s lifestyle wellness and type 2 diabetes

WO R K P L AC E W E L L N E S S

self-management groups were unable to go ahead

Workplace Wellness works with General Practice to bring free health

during the COVID-19 lockdown so Level 3 saw a

services into qualifying workplaces. It includes heart checks, diabetes

move to offering the sessions online via Zoom.

checks, women’s health checks, immunisations, help for smokers to quit, Employees are assisted to enrol with a General Practice if they are not

such a hit with patients that they are continuing as

enrolled already.

an online option, as well as in person.

“Providing the courses online removes the

WO R K I N G W I T H V U L N E R A B L E P O P U L AT I O N S

barrier of needing transport to get to the courses,

Two primary care nurse practitioners work with our most vulnerable

reduces the time the individual has to take out of

populations, including the homeless and abused women, and provide

their day to attend, and is less confronting than

clinics for non-government organisations who also work with vulnerable

being in person for some,” says clinical exercise

populations in Tauranga such as Salvation Army, Awhina House, Te Tuinga

physiologist Caitlin Milne.

Whānau, and Street Retreat.

The lifestyle wellness course covers exercise, stress and sleep, mindful eating, and nutrition for people with pre-diabetes or diagnosed/at risk of cardiovascular disease and/or metabolic syndrome.

The type 2 diabetes course covers exercise, nutrition, and medications for people with the condition and is led by a pharmacist from Medwise, a podiatrist from Foot Mechanics and a diabetes nurse specialist.

Patients can self-refer to the groups or be referred by their GP (via BPAC), or organisations such as the Tauranga Sleep Clinic, Tauranga Eye Specialists, Tauranga Hospital, and the Green Prescription programme via Sport Bay of Plenty.

“Providing the courses online removes the barrier of needing transport to get to the courses, reduces the time the individual has to take out of their day to attend, and is less confronting than being in person for some.”

Caitlin Milne

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and self-management courses for heart disease, diabetes and weight loss.

sessions over four to five weeks and have been

23

The courses were compressed into 90-minute

06

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Our Performance In 2019-2020 the Western Bay of Plenty Primary Health Organisation provided increased support to more communities than ever before, with funding increases used to provide services that effectively promote health and wellbeing.

Services provided by the Western Bay of Plenty Primary

Progress continued on timely vaccination of eight-

Health Organisation reached more patients in the year

month-olds who are due their childhood immunisations,

ended 30 June 2020 than in previous years and clinical

with sustained success in reaching 559 (81 percent) M훮ori

staff had greater success in reaching greater numbers of

children. Messaging about the benefits of immunisation

at-risk patient groups.

following the COVID-19 response this year has contributed

Brief advice was given to 16,043 smokers in the past 15 months and clinical staff made positive gains during the

to greater coverage for infants.

Our Support to Screening Services team ensured that

year. This activity, along with the referrals for 14 percent of

37,642 eligible women had their cervical smears by 30 June

smokers to support-to-quit programmes, reflects progress

2020. Contacts with at-risk M훮ori women (50-69 years)

towards the PHO objective of reducing patient deaths from

have consistently improved quarterly breast screening

the effects of long-term smoking and chronic obstructive

results for the Western Bay of Plenty as a result of a

pulmonary disease.

focussed PHO initiative involving better use of patient

Cardio-vascular disease risk assessments were

information, improved clinical processes and coordinated

completed for 59,491 patients, which reflects sustained

activity within clinics. This successful model was expanded

clinical intervention for at-risk patients. Improved coverage

in September this year to include our Eastern Bay clinics.

for M훮ori males (35-44 years) each quarter reflects, in

By 30 June 2020 the PHO had reached 4996 eligible M훮ori

part, the success of Workplace Wellness programmes and

women.

partnership with employers in the community.

Cardio-vascular disease risk assessments were completed for 59,491 patients, including improved coverage for Māori males (35-44 years) each quarter. This reflects sustained clinical intervention for at-risk patients.

Smokers provided with support to quit

88.7% Māori children received 8 month immunisations

81%

Māori women screened for cervical cancer

67%

By 30 June 2020 the PHO had reached 4996 eligible Māori women for breast screening

91.6%

8344 *number of student visits to a nurse

Patients 15+ with diabetes

5.5% 30,696 influenza vaccinations in total to over 65s

Comprehensive health assessments for Year 9s

A F T E R H O U R S V I S I T S BY U N D E R 14 s

658

11,651 Nurse Vannessa Dunn, left, and Dr Clare Duffett,

Māori over 65 who received influenza vaccinations

71%

administer influenza vaccinations to patients via drive-through clinics organised by Green Cross Health and the PHO prior to the COVID-19 lockdown in March.

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Student contacts with Schools Health Service

2 5

eligible patients received heart and diabetes checks

07 Health and Safety

Physical and Mental Wellness FI T N E S S C H A L L E N G E In February, staff were issued a fitness challenge where, for one month, staff recorded their biking, running, active walking or swimming in kilometres. As well as spot prizes and a gift voucher for one lucky

The Western Bay of Plenty Primary Health Organisation is committed to protecting and nurturing the physical and mental wellbeing of all people in its workplace by providing a healthy, safe and positive place to work.

winner, the CEO added an additional challenge of purchasing an electric bike for the workplace if our combined distances reached 4000km. This total was achieved, and we now have an electric bike as an additional resource for commuting between local venues.

W E I G H T LO S S C H A L L E N G E Several staff from Health and Wellness Services worked together and

Our Health and Safety Committee includes staff and

issued a 12-week weight loss challenge in February, which provided

management who work together to share responsibility for

support, healthy eating education and weekly weigh-ins for those who

instigating, developing and actioning measures designed to

wished to participate. Unfortunately, the initiative had to be cancelled

safeguard the health and safety of our employees.

due to the COVID-19 pandemic.

As part of our health and safety responsibilities we have health and safety representatives who attend monthly

GNOME MORE

Health and Safety Committee meetings, fire wardens who

Our Gnome Competition, which commenced last year, continued to

carry out bi-annual fire drills, and first aid officers at all

provide entertainment and a collegial work environment as teams

three of our sites – Head Office in Eleventh Avenue, Health

were challenged to photograph their gnomes in the most unique

and Wellness Services in First Avenue West, and our

locations while trying to kidnap and photograph other team’s gnomes

Eastern Bay base in Whakatāne.

for additional points. It turned out to be highly competitive, with most

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All new employees receive a health and safety

joining in the spirit of the light-hearted competition, while others were

induction and a workstation assessment. We are

worthy of a Charles Dickens protagonist with cries of ‘bah humbug’ and

members of the Vitae Employee Assistance Programme,

plots to destroy the delicate gnomes.

New Zealand Institute of Safety, and the Employers and Manufacturers Association.

R U G BY WO R L D C U P 2 0 19 The staff at Head Office in Eleventh Avenue took part in a Rugby World Cup Challenge in September 2019 where teams decorated their work pods in their allocated team’s colours and shared kai in the form of their team’s national dishes.

GAMES EVENINGS Two games evenings were held to celebrate the end of lockdown and to celebrate the end of winter. Participation was encouragingly high, with fun and laughter being shared by all.

GL ASSES REIMBURSEMENT POLICY A little-known historic Glasses Reimbursement policy was resurrected, formalised, and communicated to all staff. The policy allows for a biennial reimbursement of eye tests and 50 percent reimbursement of glasses up to the value of $250. The policy was maintained as it was recognised that consistent computer work can place strain on an employee’s eyes.

All staff were again involved in the national ShakeOut 2020, which reminds people of the action to take during an earthquake – Drop, Cover and Hold.

08 Financials FO R T H E Y E A R E N D E D 3 0 J U N E 2 0 2 0

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Directors’ Annual Report

29

Statement of Comprehensive Revenue and Expense

30

Statement of Changes in Net Assets

31

Statement of Financial Position

32

Statement of Cash Flows

33

Notes to the Financial Statements

34

Auditor’s Report

45

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Directory

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W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Directory

W E S T E R N B AY O F P L E N T Y P R I M A RY C A R E P R OV I D E R S I N C R E P R E S E N TAT I V E S

Dr Luke Bradford Dr Todd Hulbert Lorraine Anderson Dr Symon Roberton N G Ā I T E R A N G I R E P R E S E N TAT I V E S

Charlie Tawhiao Paora Stanley N G ĀT I R A N G I N U I R E P R E S E N TAT I V E S

Graeme Elvin Melanie Te Arai Tata ACCO U N TA N T S Baker Tilly Staples Rodway Tauranga Limited AU D I TO R S

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BDO Tauranga BANKERS ASB Bank S O L I C I TO R S Cooney Lees Morgan 247 Cameron Road Tauranga R E G I S T E R E D O FFI C E C/- Cooney Lees Morgan 247 Cameron Road Tauranga

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Directors’ Annual Report For The Year Ended 30 June 2020

The Board of Directors present their Annual Report for the year ended 30 June 2020.

The Shareholders of the Company have exercised their rights under S.211(3) of the Companies Act 1993, and unanimously agreed that this Annual Report need not comply with any paragraph and (e) – (j) of S.211 (1) of this act.

T R A N S AC T I O N S W I T H D I R E C TO R S The Board received no notices during the year from directors that they had an interest in any transactions, or proposed transactions, with the Company.

D O N AT I O N S

Dr Luke Bradford

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

29

Melanie Te Arai Tata

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Donations totalling $5,880 were made during the year (Last Year: $6,670)

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Comprehensive Revenue and Expense For The Year Ended 30 June 2020

Note

2020 2019 $

$

3

21,871,430

16,396,675

Project expenditure

Revenue received

(20,366,645)

(12,841,636)

GROSS SURPLUS

1,504,785

3,555,039

Other income

0

–

4

(3,885,877)

(2,614,386)

OPERATING SURPLUS/DEFICIT

(2,381,092)

940,653

Adminstrative expenses

Investment income

332,814

373,185

NET FINANCE INCOME

332,814

373,185

3 0

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NET SURPLUS/(DEFICIT)

(2,048,278)

1,313,838

Other comprehensive income

–

–

TOTAL COMPREHENSIVE REVENUE AND EXPENSE FOR THE YEAR

(2,048,278)

1,313,838

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Changes in Net Assets For The Year Ended 30 June 2020

Contributed

General

Clinical Services

Retained

capital

reserve

reserve

earnings

Total

$

$

$

$

$

Balance at 1 July 2018

–

1,000,000

6,410,477

2,096,514

9,506,991

Total comprehensive revenue and expense Surplus/(deficit) for the period

–

–

–

1,313,838

Transfers

–

Total comprehensive revenue and expense

–

1,313,838

–

1,188,388

(1,188,388)

–

–

1,188,388

125,450

1,313,838

Balance at 30 June 2019

–

1,000,000

7,598,865

2,221,964

10,820,829

–

–

–

(2,048,278)

(2,048,278)

Transfers

–

–

(925,006)

925,006

–

Total comprehensive revenue and expense

–

(925,006)

(1,123,273)

(2,048,278)

Balance at 30 June 2020

–

1,000,000

6,673,859

1,098,692

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

8,772,551

31

Surplus/(deficit) for the period

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Total comprehensive revenue and expense

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Financial Position For The Year Ended 30 June 2020

Note

2020 2019

$

$

CURRENT ASSETS Cash and cash equivalents

6

994,617

609,628

Short term deposits

7

8,395,675

11,548,092

Trade and other exchange receivables

8

3,103,984

1,412,756

TOTAL CURRENT ASSETS

12,494,276

13,570,476

NON-CURRENT ASSETS Plant and equipment

9

331,845

333,858

10

102,561

46,760

TOTAL NON-CURRENT ASSETS

434,406

380,618

Intangible assets

TOTAL ASSETS

12,928,682

13,951,094

32

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CURRENT LIABILITIES Trade and other payables

11

2,738,845

1,543,650

Deferred income/revenue

3

1,035,098

1,367,731

Provisions

5

382,188

218,884

TOTAL CURRENT LIABILITIES

4,156,131

3,130,265

TOTAL LIABILITIES

4,156,131

3,130,265

NET ASSETS

8,772,551

10,820,829

EQUITY Contributed capital

18

Reserves

-

-

16

7,673,859

8,598,865

Retained earnings

1,098,692

2,221,964

TOTAL EQUITY

8,772,551

10,820,829

For and on behalf of the board of directors

Melanie Te Arai Tata. Date: 10/11/20

Dr Luke Bradford. Date: 10/11/20

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Statement of Cash Flows For The Year Ended 30 June 2020

Note

2020 2019 $

$

Cash flows from operating activities Cash receipts from customers

19,766,725

17,047,317

Cash paid to suppliers

(18,134,829)

(11,927,038)

Cash paid to employees

(4,559,101)

(3,436,551)

Net cash from operating activities

(2,927,205)

1,683,728

16

Cash flows from investing activities Interest received

370,994

322,087

Acquisition of intangible assets

(89,752)

(38,120)

Acquisition of property, plant and equipment

(121,467)

(262,135)

Acquisition of short term deposits

3,152,419

(1,331,445)

Net cash flow from investing activities

3,312,194

(1,309,613)

–

–

Net cash flows excluding cash and cash equivalents

384,989

374,115

Cash and cash equivalents at 1 July

609,628

235,513

Cash and cash equivalents at 30 June

994,617

609,628

THE ACCOMPANYING NOTES FORM PART OF THESE FINANCIAL STATEMENTS

3 3

Cash flows from financing activities

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W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements For The Year Ended 30 June 2020

1 R E P O R T I N G E N T I T Y Western Bay of Plenty Primary Health Organisation (‘the Company’) is a company incorporated in New Zealand and registered under the Companies Act 1993 and is a reporting entity for the purposes of the Financial Reporting Act 2013.

The Company is a charity registered with Charity Services (Charity Registration CC30518). It provides primary health care services to 197,000 people residing in the Western Bay of Plenty. It is a Joint Venture between two Western Bay of Plenty Iwi, Ngāi Te Rangi and Ngāti Ranginui; and the Western Bay of Plenty Primary Care Providers Inc.

Since becoming operational on 1 October 2003, the organisation has developed and delivered a wide range of nursing, general practitioner and other health disciplines. This is undertaken in close association with the District Health Board and other health-focussed community-based organisations.

The Company is considered a public benefit entity for the purposes of financial reporting in accordance with the Financial Reporting Act 2013.

2 B A S I S O F P R E PA R AT I O N The financial statements have been prepared on a going concern basis, and the accounting policies have been consistently applied throughout the period. Western Bay of Plenty Primary Health Organisation management have considered the ability to continue to trade during the COVID 19 pandemic. It is management’s opinion that Western

3 4

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Bay of Plenty Primary Health Organisation will not face going concern issues due to servicing the health sector.

Accounting policies are selected and applied in a manner which ensures that the resulting financial information satisfies the concepts of relevance and reliability, thereby ensuring that the substance of the underlying transactions or other events is reported. (a) Statement of Compliance The financial statements have been prepared in accordance with New Zealand Generally Accepted Accounting Principles (“NZ GAAP”). They comply with Public Benefit Entity International Public Sector Accounting Standards (“PBE IPSAS”) and other applicable Financial Reporting Standards, as appropriate for Tier 2 not-for-profit public benefit entities. The entity has elected to report in accordance with the Tier 2 standards, taking advantage of all disclosure concessions as it is not publicly accountable and has expenses less than $30 million. (b) Measurement Basis The financial statements have been prepared on the basis of historical cost. (c) Functional Currency The financial statements are presented in New Zealand dollars and all values are rounded to the nearest dollar ($). (d) Goods and Services Tax All balances are presented net of goods and services tax (GST), except for trade receivables and trade payables which are presented inclusive of GST. (e) Income Tax The Company is exempt from taxation as a result of being registered as a charitable entity under the Charities Act 2005 from 30 June 2009.

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

(f) Accounting Policies There have been no changes in accounting policies. Policies have been applied on a consistent basis with those of the previous reporting period.

3 R E V E N U E Revenue Accounting Policy Revenue is recognised to the extent that it is probable that the economic benefit will flow to the Company and revenue can be reliably measured. Revenue is measured at the fair value of consideration received.

The Company assesses its revenue arrangement against specific criteria to determine if it is acting as the principal or agent in a revenue transaction. In an agency relationship only the portion of revenue earned on the Company’s own account is recognised as gross revenue in the Statement of Comprehensive Revenue and Expense.

The following specific recognition criteria must be met before revenue is recognised. (i) Revenue from Exchange Transactions $

$

Contract income

14,791,283

9,741,776

14,791,283

9,741,776

Policy The Company is involved in providing essential primary healthcare services, as well as performing related services.

Exchange revenue is revenue received in exchange for goods or services of approximate equal value.

Exchange revenue from Provision of Healthcare Services rendered is recognised in proportion to the stage of completion of the transaction at the reporting date and performance against other ongoing obligations under the contracts. The stage of completion is assessed by reference to work performed and milestones achieved in project and contract-based funding. (ii) Revenue from Non–exchange Transactions

2020 2019 $

$

First level services funding

7,080,147

6,654,899

7,080,147

6,654,899

Policy Non–exchange revenue Non–exchange transactions are those where the Company receives value from another entity (e.g. cash or other assets) without giving approximately equal value in exchange. When non–exchange revenue is received with restrictions attached, but there is no requirement to return the asset if not deployed as specified, the revenue is recognised on receipt. (iii) Interest Income Interest revenue is recognised as it accrues, using the effective interest method.

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2020 2019

35

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Notes to the Financial Statements

For The Year Ended 30 June 2020

(iv) Donated Services The Company sometimes provides placements for student nurses within its nursing services. The Company has elected not to recognise these services as they are difficult to measure reliably and are immaterial in the context of the activities of the company. (v) Agency Basis The Company considers it is acting as an agent in respect of capitation funding received from the Ministry of Health. During the year $39,694,063 was received and paid out to member practices (2019:$34,896,617).

Deferred Income/revenue

Contract income in advance Other income in advance

2020 2019 $

$

922,098

1,252,231

113,000 1,035,098

115,500 1,367,731

Policy The above revenue is deferred to reflect either the contractual obligations associated with the contracts or the constructive obligations arising from commitments by the Board to spend these funds on specific projects. They have been classified as current depending on the terms of the contracts or if no time frame exists on management's estimate of when the funds will be spent. The funds associated

36

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with this income are restricted for use in accordance with the obligations.

4 A D M I N I S T R AT I O N E X P E N S E S

2020 2019 $

$

included within administration expenses are the following: Audit fees Depreciation of property plant and equipment Loss on disposal of property, plant and equipment Depreciation recovered Rent and operating lease payments Amortisation of intangible assets Accountancy

11,567

10,763

108,340

73,158

19,708

4,705

–

–

263,818

284,390

29,385

54,542

220,429

185,591

5 E M P LOY E E B E N E FI T S

2020 2019 $

$

Wages and salaries

4,777,781

3,503,554

4,777,781

3,503,554

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

Employee Benefits continued

2020 2019 $

$

Short term provision for holiday pay Opening balance

218,884

174,304

Movement for the year

145,780

44,580

Closing balance

364,664

218,884

2020 2019 $

$

Short term provision for long service leave Opening balance

–

–

Movement for the year

17,524

–

Closing balance

17,524

–

POLICIES Short Term Employee Benefits Short term employee benefits are expensed as the related service is provided. A liability is recognised for the amount expected to be

Provisions Provision is made for benefits accruing to employees in respect of wages and salaries and annual leave when it is probable that settlement will be required and they are capable of being measured reliably.

6 C A S H A N D C A S H E Q U I VA L E N T S

Cash and bank balance Call deposits (≤ 3 months maturity) ASB Visa

2020 2019 $

$

994,617

609,628

–

–

– 994,617

– 609,628

Cash and cash equivalents are cash balances that are short term in nature for the purposes of the Statement of Cash Flows, and are classified as a Loans and Receivables financial asset. Call deposits have maturities under 90 days.

37

estimated reliably.

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paid if the Company has an obligation to pay this amount as a result of past service provided by the employee and the obligation can be

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

7 S H O R T T E R M D E P O S I T S

2020 2019 $

$

ANZ term deposits

1,862,332

2,907,144

ASB term deposits

2,606,288

4,944,446

BNZ term deposits

2,388,616

2,644,900

Kiwibank term deposits

1,538,440

1,051,602

8,395,675

11,548,092

Short term deposits are made for varying periods of between three months and nine months depending on the immediate cash requirements of the Company and earn interest at the respective short-term deposit rates. Of those held at year end, $5,116,941 have matured at 31 October 2020.

Policy Short term deposits compromise of bank term deposits with maturities of less than 12 months at acquisition but greater than three months. Term deposits are recognised at cost, being the fair value of the consideration given. After initial recognition, term deposits are measured at amortised cost using the effective interest method.

8 T R A D E A N D OT H E R R E C E I VA B L E S

38

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Trade receivable (exchange transactions)

2020 2019 $

$

2,702,318

818,105

Income accrued

253,259

403,581

Prepayments

148,406

191,070

–

–

GST receivable

3,103,984

1,412,756

Trade receivables are shown net of allowances for bad and doubtful debts of $nil (2019: nil) Policy Trade receivables are initially measured at fair value, then adjusted for any impairment. Trade receivables are classified as a Loan and Receivables financial asset.

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

9 P R O P E R T Y, P L A N T A N D E Q U I P M E N T

Office

Leasehold

Equipment

Improvements

Wellness Assets

Health and

Total

$

$

$

$

Balance at 1 July 2018

430,745

19,622

200,169

650,534

Additions

185,653

56,788

19,695

262,136

Disposals

(9,316)

–

–

(9,316)

607,082

76,410

219,864

903,354

Cost

Balance at 30 June 2019

Balance at 1 July 2019

607,082

76,410

219,864

903,354

Additions

100,476

6,794

14,199

121,469

Disposals

(32,141)

(1,428.00)

(11,809)

(45,378)

Balance at 30 June 2020

675,417

81,776

222,254

979,445

Depreciation Disposals Balance at 30 June 2019

(382,563)

(7,218)

(111,169)

(500,949)

(30,700)

(2,372)

(40,086)

(73,158)

4,611

0

–

4,612

(408,651)

(9,590)

(151,256)

(569,495)

Balance at 1 July 2019

(408,651)

(9,590)

(151,256)

(569,495)

(67,561)

(7,991)

(32,788)

(108,340)

20,379

1,032

8,825

30,236

(455,833)

(16,549)

(175,219)

(647,599)

48,182

12,403

89,000

149,586

Balance at 30 June 2019

198,430

66,820

68,608

333,858

Balance at 30 June 2020

219,583

65,227

47,035

331,845

Depreciation Disposals Balance at 30 June 2020 Balance at 1 July 2018

POLICIES Measurement All property, plant and equipment are stated at cost less accumulated depreciation.

Depreciation is allocated over the estimated useful life of the asset. The following methods are used in the calculation of depreciation: Office equipment

0–67%

Straight line

Leasehold improvements

7–21%

Straight line

Health and Wellness assets

7–40%

Straight line

Any gain or loss on disposal of an item of property, plant and equipment is recognised in surplus or deficit.

39

Balance at 1 July 2018

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Accumulated depreciation

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

10 I N TA N G I B L E A S S E T S

Intangible Assets

Cost Balance at 1 July 2018 Additions Disposals Balance at 30 June 2019

145,254 38,121 – 183,375

Balance at 1 July 2019

183,375

Additions

89,752

Disposals

(7,150)

Balance at 30 June 2020

265,977

Accumulated Depreciation Balance at 1 July 2018

(82,073)

Amortisation

(54,542)

Disposals Balance at 30 June 2019

– (136,615)

4 0

W E S T E R N B AY O F P L E N T Y P R I M A R Y H E A LT H O R G A N I S AT I O N A N N U A L R E P O R T 2 0 19 -2 0 2 0

Balance at 1 July 2019 Amortisation Disposals Balance at 30 June 2020

(136,615) (29,385) 2,584 (163,416)

Balance at 1 July 2018

63,182

Balance at 30 June 2019

46,760

Balance at 30 June 2020

102,561

POLICIES Measurement Acquired computer software licenses are capitalised on the basis of the costs incurred to acquire and bring to use the specific software.

Costs that are directly associated with the development of software for internal use are recognised as an intangible asset.

Direct costs include the costs of materials and services, employee costs, and any directly attributable overheads.

Costs of software updates or upgrades are capitalised only when they increase the usefulness or value of the asset. All other costs are expensed when incurred.

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

Intangible Assets continued Amortisation The carrying value of an intangible asset is amortised on a straight-line basis over its useful life. Amortisation begins when the asset is available for use and ceases at the date that the asset is derecognised. The amortisation charge for each financial year is recognised in the surplus or deficit.

The amortisation rates of major classes of intangible assets have been estimated as follows: Computer software and development

10-40% Straight Line

11 T R A D E A N D OT H E R PAYA B L E S 2020 2019

Other trade payables

570,241

177,737

1,808,200

945,999

GST payable ASB Visa Accrued expenses Trade payables

$

36,374

3,130

1,880

4,282

322,150

412,502

2,738,845

1,543,650

Trade payables are recognised at cost when the Company becomes obliged to make future payments resulting from the purchases of goods and services. Trade payables are classed as an 'other amortised cost financial liability'.

1 2 CO M M I T M E N T S (a) Operating Commitments 1. The Company leases three office premises under operating leases. The head office lease for the Eleventh Ave building, due to expire on 30 September 2020, was extended after balance date, with a new expiry date of 31 March 2021. The First Ave lease for the Health & Wellness Centre was renewed on 1 July 2019 and has a final expiry date of 30 June 2021. A small office is leased on The Strand in Whakatāne. The current lease, signed on 8 July 2020, expires on 30 June 2021.

2. The Company also leases office equipment under operating leases. The leases typically run for a period of three years. The equipment is replaced at the end of the period and a new lease is negotiated.

Operating Lease Commitments

No later than one year Between 1-5 years More than 5 years

2020 2019 $

$

129,570

239,651

99,975

96,582

–

–

229,544

336,233

Subsequent to balance date the Company leased six additional vehicles. The amount committed is $128,629. (2019: $68,658.)

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Trade payables due to related parties

$

41

W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Notes to the Financial Statements

For The Year Ended 30 June 2020

13 CO N T I N G E N T L I A B I L I T I E S There were no contingent liabilities as at 30 June 2020. (2019: nil) 14 S U B S E Q U E N T E V E N T S (a) COVID-19 The COVID-19 pandemic has developed rapidly in 2020, with a significant number of cases appearing. Measures taken by the Government to contain the virus have affected economic activity. We have taken a number of health and safety measures to monitor and mitigate the effects of COVID-19 for our people, including limiting numbers of staff across our offices, social distancing, hygiene measures and working from home, and ensuring ongoing supply of materials that are essential for our service delivery.

At this stage, the impact on our business and results has not been significant and based on our experience to date we expect this to remain the case. As we operate in the health sector, we have found increased demand for our services and expect this to continue. We will continue to follow the various Government policies and advice and, in parallel, we will do our utmost to continue our operations in the best and safest way possible without jeopardising the health of our people.

Please refer to refer to notes 2 and 19 in relation to potential going concern and liquidity risk issues arising from the COVID 19 pandemic.

(b) Health and Disability Review A Government-initiated Health and Disability System Review report was released in June 2020. The report makes a series of recommendations into the health and disability sector. The Government has indicated that full consideration of, and any subsequent

42

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action on the recommendations will not commence prior to the 2020 Government election.

It is expected that some change will impact the Western Bay of Plenty Primary Health Organisation. It is unknown what priority or time scale the Government might take to implement the changes.

The Western Bay of Plenty Primary Health Organisation, together with the BOP DHB has initiated discussions to ensure that any structural change to the health and disability sector will take a collaborative approach.

The Western Bay of Plenty Primary Health Organisation board has agreed to investigate establishing a Western Bay of Plenty Māori Hauora Commissioning Agency (MHCA) in response to one of the recommendations contained within the Health and Disability System Review. The MHCA would be responsible for improving the health outcomes for the Western Bay of Plenty population through identifying and enabling hauora approaches that benefit all.

1 5 R E L AT E D PA R T Y T R A N S AC T I O N S

(i) Key Management and Governance Personnel Remuneration Key management personnel compensation The Company classifies its key management personnel into the following categories: ‒ Directors (of the governing body) ‒ Executive Officers Directors of the governing body receive an annual fee of $12,500 each. Co-chairs receive a further $15,500 each per annum in recognition of their additional duties and responsibilities. Executive Officers are employees of the company and are on standard employment contracts.

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Notes to the Financial Statements

For The Year Ended 30 June 2020

The table below depicts the aggregate remuneration of key management personnel and the number of individuals determined on a full–time equivalent basis, receiving remuneration with the category.

2020 Remuneration

Number

2019

Remuneration

Number

Directors

183,165

8

167,608

9

Executive officers

1,034,685

6.6

550,681

3.5

(ii) Transactions with Other Related Parties The Company transacts with other related parties in the normal course of business. Such entities include those related by virtue of common governance and management personnel.

During the year, the Company made the following purchases from related parties for the provision of health services and at year end, the following balances remained owing:

Payable

Purchases

2020 2020

Payable

2019 2019

$

$

$

$

Ngāti Ranginui Iwi Incorporated

1,104,451

166,558

233,501

57,500

Te Runanga O Ngāi Te Rangi Iwi Trust

1,432,662

190,598

761,621

71,875

Fifth Avenue Family Practice

4,042,378

108,854

3,270,893

30,877

Pāpāmoa Pines Health Centre

3,070,314

104,232

2,522,976

12,905

WBOP Primary Care Providers Inc

–

–

955

–

Gate Pa Medical Centre Limited

–

–

776,001

7,274

Graham Cameron

–

–

2,940

–

Moana Communications

–

–

900

–

Te Manu Toroa Trust

(1,303)

(2,694)

–

–

9,649,805

570,241

7,568,484

177,737

Ngāti Ranginui Iwi Incorporated is a shareholder and provider to the Company. Melanie Te Arai Tata and Graeme Elvin are their appointed directors.

Paora Stanley and Charlie Tawhiao are Trustees of Te Runanga O Ngāi Te Rangi Iwi Trust which is a shareholder and provider to the Company.

Dr Luke Bradford is a Partner in Fifth Avenue Family Practice which is a provider to the Company.

Dr Symon Roberton is a Director in Pāpāmoa Pines Health Centre limited which is a provider to the Company.

Charlie Tawhiao is a Trustee for Moana Communications.

All related party transactions were on normal commercial terms. No related party transactions were written off or forgiven during the period.

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Purchases

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Notes to the Financial Statements

For The Year Ended 30 June 2020

16 R E S E RV E S

General Reserve The general reserve was established in 2010 to provide for future possibilities in respect of member practices and lease obligations.

Clinical Services Reserve The clinical services reserve was established in 2011 to provide funds for clinical projects not funded by the Bay of Plenty District Health Board. Normal policy is to transfer surpluses from completed contracts into the clinical services reserve.

17 R E CO N C I L I AT I O N O F S U R P LU S W I T H N E T C A S H FR O M O P E R AT I N G AC T I V I T I E S

2020

2019

$

$

(2,048,278)

1,313,838

Cash flows from operating activities Net surplus

Adjustments for: ‒ Depreciation/amortisation

137,722

127,700

Net finance costs

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‒ (Gain)/loss on sale of property, plant and equipment

19,708

4,705

Changes in: ‒ Trade and other receivables ‒ Prepayments ‒ Trade and other payables ‒ Provisions and employee benefits ‒ Deferred income/revenue ‒ GST

(1,733,891)

(114,507)

42,663

(17,597)

1,161,951

(98,416)

163,304

44,579

(332,634)

714,049

33,244

31,464

Less items classified as investing activities ‒ Interest received Net cash from operating activities

(370,994) (2,927,205)

(322,087) 1,683,729

18 S H A R E C A P I TA L The number of authorised ordinary shares total 120 (2019:120). The authorised shares are fully issued but unpaid.

All shares have equal rights to vote. In terms of the Constitution, the Directors have no authority to declare dividends.

19 L I Q U I D I T Y R I S K Western Bay of Plenty Primary Health Organisation management has considered the ability to remain liquid throughout the COVID-19 pandemic and immediate future as key to its core business. Steps have been taken to ensure that the organisation’s liquidity is not jeopardised.

I N D E P E N D E N T AU D I TO R ’ S R E P O R T TO T H E S H A R E H O L D E R S O F W E S T E R N B AY O F P L E N T Y P R I M A RY H E A LT H O R G A N I S AT I O N L I M I T E D

Report on the Audit of the Financial Statements

OPINION

In preparing the financial statements, the directors are

We have audited the financial statements of Western

responsible on behalf of the Company for assessing

Bay of Plenty Primary Health Organisation Limited (“the

the Company’s ability to continue as a going concern,

Company”), which comprise the statement of financial

disclosing, as applicable, matters related to going concern

position as at 30 June 2019, and the statement of

and using the going concern basis of accounting unless the

comprehensive revenue and expense, statement of changes

directors either intend to liquidate the Company or to cease

in net assets/equity and cash flow statement for the year

operations, or have no realistic alternative but to do so.

then ended, and notes to the financial statements, including a summary of significant accounting policies.

AU D I TO R ’ S R E S P O N S I B I L I T I E S FO R T H E AU D I T O F T H E FI N A N C I A L S TAT E M E N T S

In our opinion, the accompanying financial statements

Our objectives are to obtain reasonable assurance about

present fairly, in all material respects, the financial position

whether the financial statements as a whole are free from

of the Company as at 30 June 2020, and its financial

material misstatement, whether due to fraud or error,

performance and its cash flows for the year then ended in

and to issue an auditor’s report that includes our opinion.

accordance with Public Benefit Entity Standards Reduced

Reasonable assurance is a high level of assurance, but is

Disclosure Regime (“PBE Standards RDR”) issued by the

not a guarantee that an audit conducted in accordance

New Zealand Accounting Standards Board.

with ISAs (NZ) will always detect a material misstatement

aggregate, they could reasonably be expected to influence

Standards on Auditing (New Zealand) (“ISAs (NZ)”).

the decisions of users taken on the basis of these financial

Our responsibilities under those standards are further

statements.

described in the Auditor’s Responsibilities for the Audit of the Financial Statements section of our report. We

A further description of our responsibilities for the audit

are independent of the Company in accordance with

of the financial statements is located at the External

Professional and Ethical Standard 1 International Code of

Reporting Board’s website at: https://www.xrb.govt.

Ethics for Assurance Practitioners (including International

nz/assurance-standards/auditors-responsibilities/audit-

Independence Standards) (New Zealand) issued by the

report-8/.

New Zealand Auditing and Assurance Standards Board, and we have fulfilled our other ethical responsibilities in

This description forms part of our auditor’s report.

accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and

W H O W E R E P O R T TO

appropriate to provide a basis for our opinion.

This report is made solely to the Company’s Shareholders, as a body. Our audit work has been undertaken so that we

Other than in our capacity as auditor we have no

might state those matters which we are required to state to

relationship with, or interests in, the Company.

them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume

D I R E C TO R S ’ R E S P O N S I B I L I T I E S FO R T H E FI N A N C I A L S TAT E M E N T S

responsibility to anyone other than the Company and the

The directors are responsible on behalf of the Company

this report or for the opinions we have formed.

Company’s Shareholders, as a body, for our audit work, for

for the preparation and fair presentation of the financial statements in accordance with PBE Standards RDR, and for such internal control as the directors determine is necessary to enable the preparation of financial statements

BDO Tauranga

that are free from material misstatement, whether due to

Tauranga, New Zealand

fraud or error.

10 November 2020

45

error and are considered material if, individually or in the

We conducted our audit in accordance with International

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when it exists. Misstatements can arise from fraud or B A S I S FO R O P I N I O N

09

O U R W H A K ATAU K Ī

Tungia te Ururua, kia tupu Whakaritorito te tupu O te harakeke

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Clear the undergrowth so that the new shoots of the flax will grow.

Our whakataukī was gifted to the Western Bay of Plenty Primary Health Organisation by respected rangatira Dr Morehu Ngatoko Rahipere, wellknown for his strong and wise leadership.

The whakataukī is a poetic expression and gentle reminder to consider new ways of thinking when embarking on new journeys, making bold, courageous decisions, and striving to attain knowledge to achieve optimum health and wellbeing for our hapori (community).

Significance of harakeke (flax): Harakeke is cherished by Māori and cultivated in special plantations called pā harakeke, nature’s hapori. There are four strands which symbolise the interconnection, roles, and responsibilities of each whānau member to protect the wellbeing of the hapori: • The rito, or inner shoot, is the child and is never removed as they are valued, a taonga. A whānau must protect and nurture its tamariki (children) to maturity if it is to survive. The young are protected by their mātua (parents) and kaumātua (elders).

• The awhi rito, or protectors of the rito, stand on each side. They are mātua. Like the rito they are retained to produce further ‘generations’ of growth • Only the outer leaves, likened to extended whānau members, are harvested. The whānau share common roots and derive strength and stability from forming part of a larger whole.

maximising the contributions for the collective good of all.

To thrive it is important to prune and keep the ururua (waste) maintained in order to keep disease at bay and clear of dead leaves, weeds and debris otherwise it attracts and provides a home for insects that chew and damage the harakeke leaves. It is a wise reminder when striving for quality, and to enhance a continuously improving and meaningful journey, we may need to leave behind ways of doing things which no longer contribute to the wellbeing of our hapori, and adopt new methodologies in order to provide better health outcomes for whānau and actively protect their health with genuine engagement.

The whakataukī is a source of inspiration which aligns and strengthens the core values the PHO has committed to: • Whai mana – equity • Whai ora – quality healthcare • Whai rangatiratanga – sustainability.

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all. Everybody has something to offer; it is a shared role,

47

The whole hapori/team collaborate to enable success, to flourish, and contribute to equitable outcomes for

10 Our Future Direction

The Health and Disability System Review signalled a potential end to primary health organisations as we know them, but that does not mean we are going away.

The review proposes working towards a much more networked primary healthcare environment where the full range of primary and community services are planned with the community, not planned for them. It also proposes enhanced services designed to work for the population they are serving, for example, Māori communities having access to a wider range of kaupapa Māori services.

We have started a journey to move away from direct provision of services and grow our role as facilitator to support strengthening of the partnership between Iwi and General Practice teams.

An example of this is our new Long Term Conditions Programme – Te Ahunga Whānau – an outreach programme led by Iwi, centred in General Practice, with kaiāwhina (health navigators) working in equal partnership with nurses, individuals and whānau to address health and social needs.

The programme is in keeping with our new Health Strategy – Te Toi Huarewa – and our priorities of:

WHAI MANA – EQUIT Y • Achieving equity in health outcomes for Māori through investment in Iwi-led and locally delivered kaupapa Māori programmes in partnership with General Practice teams • Not being afraid to try new and innovative models of care, acknowledging that one size doesn’t fit all. Models such as Health Care Home and primary care services that reach out to people will be forefront in our thinking • Enabling people and whānau through a focus on self-management and

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shared care programmes to achieve independence and live healthy lives.

W H A I O R A – Q UA L I T Y H E A LT H C A R E • Working with our General Practice and Iwi partners, DHB and community providers to ensure a positive care experience for individuals and whānau throughout their health journey • Ensuring we have a strong and fit-for-purpose workforce. We will invest in and support the development of existing and new roles to promote a holistic approach to improving health and social wellbeing • Customer focus – maximising opportunities for engaging local communities in service design and evaluation.

W H A I R A N G AT I R ATA N G A – S U S TA I N A B I L I T Y • Building our capacity and capability and that of our Iwi partner organisations to proactively support people to achieve and maintain wellness • Improving access to quality health services for our rural communities • Promoting the value and contribution of our General Practice teams to the health and wellbeing of whānau.

While not something we would have wished for, the COVID-19 pandemic has given us an opportunity to explicitly demonstrate the value of General Practice as central to the community’s health and wellbeing. The family doctor has never been so important.

W B O P P H O.O R G . N Z