Part I: A quick critique of the Whānau Ora performance report

I have now read the Report on the Performance of General Practices in Whānau Ora Collectives as at March 2015 so that you do not have to.

The report is a comparison of two samples of health data available through Med-Tech (that database that your doctor taps away at when you go to visit her) about Māori and Pacific peoples. The first sample is from GPs who work in Whānau Ora Collectives, the second is from GPs in other providers (the latter is the baseline for performance). They are samples comparing performance in March 2014 and March 2015 against particular health measures: cardiovascular (CVD) risk; diabetes review and management; flu vaccination for the elderly; prescriptions for asthma, depression and diabetes and heart disease; fees charged; smoking cessation advice; mammography for high needs; BMI; cervical smears; and mental health.

Why these measures were selected is not clear. All of them are areas in which Māori and Pacific people often have worse outcomes, but they are not a group of measures that I’ve seen put together in this way in other reports. It’s a bit of a potpourri. Some of them relate to the Integrated Performance Incentive Framework, some of them relate to accessibility of health services, some of them relate to strategies the government has recently put in place. As I said, not a natural fit, but in saying that they are all important in Māori and Pacific peoples health.

Overall, Whānau Ora GPs are performing above or as well as the baseline in all measures except for cervical smears, mental health and diabetes management. Where they are not performing as well, Te Puni Kōkiri (the authors) have claimed it is because there are more high needs patients in Whānau Ora Collectives and therefore likely to be more high need patients in the Whānau Ora sample. The former is correct, the latter point is doubtful because the samples from the other providers is of Māori and Pacific patients and Māori and Pacific peoples are by definition regarded as high needs whatever service they are enrolled in.

In any case, the Whānau Ora GPs are providing a pretty reasonable service to Māori and Pacific peoples. However, we have no idea what kind of service. The assumption is that Whānau Ora Collectives’ GPs are operating differently to other providers’ GPs, but this report gives us no evidence that this is the case. It would have been helpful to have some description and examples of the different Whānau Ora models being used by these collectives.

Be very clear on this: the data does not tell us that the reason these group of Whānau Ora Collectives are getting better outcomes in a range of measures is because of the Whānau Ora model these providers are using.

My pick is that some, not all, of the Whānau Ora Collectives do have innovative, even transformative models. Within those collectives, some, not all, GPs are trying to use that model of practice with some, not all, of their patients. Conversely, some of the GPs in Whānau Ora Collectives are doing exactly the same thing as a GP in any other provider. However, this report does not shed any light on that.

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