Auckland's three DHBs, despite their tightening finances, now all perform well on the four hospital targets and child immunisation. However, in the latest report, in June, they were well short of the required performance on one of the primary care targets - the percentage of smokers offered help to quit when they visited a general practice.
And while Counties Manukau and Auckland DHBs met the other primary care target, Waitemata DHB was 4 percentage points below the required 75 per cent of patients whose heart disease and stroke risk had been assessed in the preceding five years.
Some in the primary care sector believe Waitemata is disengaged with general practice, the front-line of much health care. They point to the messy merging of primary health organisations in 2011, which was to satisfy government demands for less bureaucracy, and the lack of GPs on the board committee concerned with primary care.
GP Dr Jonathan Simon in July resigned in protest from his role as the DHB's clinical director for primary care in West Auckland.
He said that despite the Government's stated commitment to integration of primary and hospital care, there had been no such commitment or support from the DHB for general practice.
Another primary care source said the DHB didn't seek out the experts from the sector who could explain the front-line difficulties of cardiovascular screening. "The structures within the board are not appropriate to harness primary care."
Many practices in rural and poor areas had such heavy loads of sick patients they couldn't keep up with cardiovascular screening, the source said, unless they received extra support like that provided by the Counties Manukau DHB which, like Auckland DHB, had met the target.
Waitemata and Auckland have merged their primary care teams, their community and public health committees and are bringing their planning and funding departments together. They also have the same chairman, Government appointee Lester Levy.
Dr Levy defended Waitemata's primary care performance and said Auckland DHB had made great progress. Referring to the rancour around the 2011 PHO mergers, he said, "We've put that behind us.
"The landscape is looking a lot more positive now although there are people who are not happy with things."
Dr Levy said the Auckland DHB's 81 per cent performance on the cardiovascular risk checks - the highest of all DHBs and up from 48 per cent a year earlier - was a "massive change" and reflected chief executive Ailsa Claire's efforts with the primary care sector.
The centrepiece of Waitemata's progress since the last board elections three years ago is the opening, in July, of its $39 million Elective Surgery Centre beside North Shore Hospital, which is expected to help boost the number of operations and reduce waiting times. That came on the back of a new emergency department in 2011 and new cardiology centre.
Counties Manukau's chief executive, Geraint Martin, said it was coming to the end of a $500 million building programme, particularly at Middlemore Hospital, "and we now have the 21st century hospital South Auckland deserves".
He said the DHB's biggest innovation of the past three years had been the "20,000 days campaign". This had reduced hospital demand by about 5000 patients a year by providing better health services more quickly in the community and more timely and safer care in hospital. It was a key project - which had won international recognition - to reduce the need to build ever-bigger hospitals. Mr Martin said board members could be valuable in helping chief executives know if they were on the right track.
Among those chasing an elected seat at the board table with Mr Martin is Ian Bell, who was the long-serving secretary of the Auckland board.
Counties may be a better bet for a newcomer than the region's other two boards, given the advantage of incumbency. Only four of Counties' sitting members are seeking re-election, whereas at Waitemata and Auckland all seven want another term. At Auckland, a previously elected member, Ian Ward, who lost in 2010 but was later appointed by the minister, is having another crack.
The seven Waitemata seats are the most hotly contested, with 35 candidates, while Auckland has 27 hopefuls and Counties Manukau 19.
DHB profiles
Auckland
2013/14 income: $2 billion.
General hospitals/clinics: Auckland City Hospital, Starship Children's Hospital, Greenlane Clinical Centre.
Population: 469,400.
Ethnicity: 7.7% Maori, 11.1% Pacific, 81.2% Other.
Deprivation: 21% in wealthiest quintile, 19% in poorest quintile.
Waitemata
2013/14 income: $1.46 billion.
General hospitals: North Shore Hospital, Elective Surgery Centre, Waitakere Hospital.
Population: 562,970.
Ethnic mix: 9.7% Maori, 7.4% Pacific, 82.9% Other.
Deprivation: 27% in wealthiest quintile, 8% in poorest quintile.
Counties Manukau
2013/14 income: $1.44 billion.
General hospitals/clinics: Middlemore Hospital, Manukau Super Clinic and Surgery Centre.
Population: 516,050.
Ethnic mix: 16.3% Maori, 23.1% Pacific, 60.5% Other.
Deprivation: 19% in wealthiest quintile, 35% in poorest quintile.
Note: Income includes revenue for own population, plus payments for providing services to patients from other DHBs.
For more on DHB candidates see: aucklandcouncil.govt.nz and health.govt.nz
