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improving performanceing organisations, and was adapted to suit eachorganisation’s needs. It provided an effectiveframework for leadership, decision-making, communicationand allocation of workforce and otherresources, and a clear sense for all involved thatthis response was not ‘business as usual’.In contrast to some other jurisdictions, wherenational or state response structures had difficultyadapting to challenges such as rapidspread of infection or the generally less severethan expected nature of H1N1 illness, 2,3,9–11the Canterbury response was actively managedat a regional level, and the daily meetings ofall response leaders allowed timely review andconsultation, including involvement of front-linegeneral practitioners.The prompt establishment of the Aranui Clinic(within 48 hours of inception) and rapid con-Pandemic planning in primary care is both a riskmanagement and a pubic health matter whichrequires partnership between general practiceand public health. 12 The ‘keep it out’ and ‘stampit out’ responses, which lasted over six weeks,provided valuable time to prepare other componentsof the response, with early cases effectivelyisolated and contacts treated and quarantined.Laboratory identification of cases and timely provisionof results were vital, with negative resultsas important as positive results for the publichealth response. Existing arrangements withborder agencies and the hotel industry allowedsystems to be established with minimal delay.By the time a cluster of cases was identified inthe Christchurch Samoan community, centredon a recent traveller who had not sought medicalattention for ILI, containment was no longer possible.The Aranui Clinic was a prompt responseto the needs of this community as the overallThe prompt establishment of the Aranui Clinic (within 48 hours ofinception) and rapid conversion of an empty inner-city warehouseinto Christchurch’s first ’Flu Centre were striking examples of whatcould be achieved when agencies worked effectively togetherversion of an empty inner-city warehouse intoChristchurch’s first ’Flu Centre were strikingexamples of what could be achieved when agenciesworked effectively together.The attitudes of lead general practitioners have animportant effect on pandemic responses effectiveness.3 Canterbury had robust existing primarycare organisations and leadership, and the PrimaryCare Co-ordination Room was a centralcomponent of the response. It was supported byCDHB, but led by general practitioners. Sited atthe IPA, based on peer leadership and buildingon existing relationships, it was able to mobiliseand reconfigure primary care in an unprecedentedway, including persuading general practitioners ofthe value of reorganising practice routines so theycould contribute to the staffing of the red streamfunction at the ’Flu Centre.system transitioned to ‘manage it’, and again wasmade possible by existing relationships—in thiscase between local Samoan community leadersand primary care organisations.Reconfiguration of health care services would nothave been effective without significant changesin the way patients approached the system. Effectiveco-ordination of community communicationswas essential for public understanding of howto manage mild illness without medical attention,and how to access services by telephone ifrequired. While this occurred at national level inother countries, 13 Canterbury’s regional responsestructure allowed communications to be matchedto the situation as it evolved locally, with reviewof all communications by CDHB, CPH andprimary care. Overall low rates of workplaceabsenteeism and of primary care consultations328 VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE
improving performancefor other illnesses during the pandemic suggestthat community infection control messagescontributed to reduced rates of not just influenza,but also other winter illnesses, and the CDEMsurvey demonstrated a high level of awarenessamong Canterbury people of what to do if theyor someone in their family developed ILI.A well co-ordinated response also requires wellinformedstaff. The web-based format of theCDHB intelligence report provided ready accessto key information about the pandemic andthe national and local response for all involvedand was the starting point for most planningmeetings and for regular fax and email updatesto primary and secondary care. It was complementedby the primary care pandemic website,providing detailed local advice to all primarycare providers.7. Institute of Environmental Science and Research Limited.Seroprevalence of the 2009 influenza A (H1N1) pandemic inNew Zealand: Wellington; 2010.8. Ministry of Civil Defence and Emergency Management. NZLocal Authority and CDEM Group Pandemic Planning Guide.Information for the CDEM Sector. Wellington; 2006.9. Grayson M, Johnson P. Australia’s influenza containmentplan and the swine flu epidemic in Victoria. Med J Aust.2009;191:150.10. Irving L, Hampson A. Influenza A (H1N1 09): Public healthlessons and questions. Aust Fam Physician. 2009;38:567.11. Eizenberg P. The general practice experience of the swine fluepidemic in Victoria—lessons from the front line. Med J Aust.2009;191:151–153.12. Nori A and Williams M. Pandemic preparedness: risk managementand infection control for all respiratory infectionoutbreaks. Aust Fam Physician. 2009;38:891–895.13. Hine D. The 2009 Influenza Pandemic: An IndependentReview of the UK Response to the 2009 Influenza Pandemic:London; 2010; Cabinet Office. http://www.cabinetoffice.gov.uk/media/416533/the2009influenzapandemic-review.pdf p1 of 19Although there was little demand for co-ordinatedwelfare services during this pandemic wave,a more severe event would require much greaterinvolvement of the welfare sector, including localauthorities, and while current plans do includewelfare, considerably more planning and resourcingcould be required.The most important message from the CanterburyH1N1 09 response has been the importanceof preparing and working together across thesector. The response has further strengthenedexisting relationships, and has enhanced Canterbury’scapacity to provide a co-ordinated responsenot only to future pandemics, but also to otherhealth system challenges.References1. Rowan MS, Hogg W and Huston P. Integrating public healthand primary care. Healthc Policy. 2007;3(1):1–22.2. National Advisory Committee on SARS and Public Health.Learning from SARS: Renewal of Public Health in Canada:Ottawa; 2003; Health Canada. http://www.phac-aspc.gc.ca/publicat/sars-sras/naylor/3. Sweet M. Pandemic lessons from Australia. Br Med J.2009;339:3317.4. Ministry of Health. New Zealand Influenza Pandemic ActionPlan 2006. Wellington; 2006.5. New Zealand Fire Service Commission. The New ZealandCoordinated Incident Management System (CIMS): teamworkin emergency management. Wellington; 1998.6. Jennings LC. Influenza A(H1N1)09: New Zealand’s response tothe pandemic threat. NZ Med J. 2009;122:1298; http://www.nzma.org.nz/journal/122-1298/3700/AcknowledgementsWe thank Peter Mitchelland Chris Ambrose, whoprovided data on serviceutilisation, Nigel Millar,who led the Canterburypandemic response, andthe many dedicated staffwho contributed to theresponse throughoutCanterbury.FundingNo specific funding wasreceived for this paper.Competing interestsNone declared.VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE 329
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