Latest clinical leaders hui notes

• Te Whatu Ora wanted to get into exploring data to help with measures on intersex, transgender and binary people and found that in current state it can’t be done.
• ‘Counting ourselves’ is the first study of its time, given a useful picture of inequities, lack of safety and discrimination – these things can lead to distrust of health providers.
• The health system – from a data perspective – collects inconsistent mix of sex and gender info and it is often mislabelled. Because it isn’t clear it can prevent the health system from offering appropriate care, e.g. cervical screening.
• People are aware and starting to try design new systems, but not necessarily understanding how it may impact on this community, not involving the consumer viewpoint.
• This isn’t a simple matter of collecting data and making it available. All data collection needs to be transparent, respect patient consent and prevent harm.
• Sex assigned at birth information is not sufficient on its own to provide information needed for clinical reasons.
• Without accurate information it is hard to direct resources and skills across the health sector.
• Project underway – covering clinical input, standards, patient centred development, technical/IT and ways of working. Look at international examples (including HL7 who have done a lot in this space). Goal is to develop forward-looking investment case.
• Definitions – have the work from Stats NZ which was well consulted on, but that clearly states health was out of scope due to having more implications.
• Can’t just be a single value for sex – need to have clinical information such as does this person have a cervix.

Feedback to the presenters

• Links with ACC, can’t get too out of step between health and ACC systems.
• Implication to funding structure – how do we recognise that males (who are funded less) may actually need more funding. How to move the gender-based funding forwards in step with this progress.
• Working with PMS vendors is key to enable change at GP clinics.
• Consumer knowledge on sharing of information is incredibly important. Concerns with Hira and the patient summary. Belief we need to do a lot more in terms of information patients where their health data goes – average NZ has limited understanding of what is collected, shared.

• There was an increase in FSA and surgeries in 2023, but there are still people who are waiting long times and not getting care within the target of four months.
• While ‘raw’ rates are up, age standardised rate shows steady decline since 2014. (See slides for data.)
• Have reduced those waiting over a year for operations, but it hasn’t been enough. Barely standing still.
• Outpatient assessment remains under huge pressure.
• Objectives – (1) Achieve a nationally consistent approach to communicating with people waiting longer than four months for FSA or treatment. (2) Contribute data validation of the wait lists. (3) Increase transparency of the wait time for service delivery.
• Pilot in May 2023 had a focus on those waiting more than four months. Pilot delivered some useful learnings.
• Need to contact just under 18K patients for the next cohort, aiming for some consistent wording but there are local nuances and concerns.
• Concern has been noted over the wording wording to contact GPs if they are concerned. In the pilot/May 2023 this wording was used and there was no demand influx noted as a result of the patient comms. However, Te Whatu Ora remains open to potential impact and requires feedback.  
• Once the next cohort work is complete this needs to transition into a BAU mode, keeping patients better informed/expectations set as the norm.
• Making it easier for GPs to access wait time info – will be a new dashboard on healthpathways in July, but want to get it to easy and visible so healthpathways is a starting point.
• Will provide average and 95% (as the average will not be the wait time experience for 50 per cent of people).
• Really interested in understanding on what good engagement looks like with primary care so we can shape future projects better. Are aware it hasn’t gone well to date.
• Other planned care activities including clinical pathways (e.g. FIT for symptomatic, MSK pathway), and clinical prioritisation access criteria.

Feedback to the presenters.

• Ensure comms are not copied to GP clinics unnecessarily.
• GP clinics are already having a lot of additional consults with patients on waiting lists to manage their care while they wait. Goes well beyond the utilisation in funding formulas. Need more recognition from Te Whatu Ora at the impact on workload and capitation funding. It isn’t responding to the phenomenal impact caused by hospital waiting lists.

Planned care patient communication initiative presentation (PowerPoint)

• Winter wellness messaging will start to come out via media etc shortly – standard messages used in previous years, shouldn’t cause any surprises.
• Still some national clinical network co-lead positions being recruited to, close soon. Encourage primary care applicants! Access the job information on the Te Whatu Ora website.
• COVID care in the community – briefing happening on this soon, will come back with a covid update at a future meeting. (Including funding).