title: Rural health care in New Zealand: the case of Coast to Coast Health Centre, Wellsford, an early Integrated Family Health Centre.
abstract: BACKGROUND
  Primary health care is critical, particularly in rural areas distant from secondary care services.
  
  
  OBJECTIVE
  To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges.
  
  
  METHODS
  Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets.
  
  
  RESULTS
  The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning.
  
  
  CONCLUSIONS
  A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area.
authors.affiliation: Independent Health Care Researcher, Auckland, New Zealand (formerly Senior Research Officer, Waitemata District Health Board, Auckland). antony@raymonts.org.
authors.forename: Antony
authors.initials: A
authors.lastname: Raymont
authors.affiliation: Consultant and independent director, Auckland, New Zealand (formerly Innovation Manager at Waitemata DHB).
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Boyd
authors.affiliation: Coast to Coast Health Centre, Wellsford, Auckland Region, New Zealand.
authors.forename: Timothy
authors.initials: T
authors.lastname: Malloy
authors.affiliation: Coast to Coast Health Centre, Wellsford, Auckland Region, New Zealand.
authors.forename: Nancy
authors.initials: N
authors.lastname: Malloy
mesh_terms: D039602:After-Hours Care; D005192:Family Health; D005249:Fees and Charges; D006297:Health Services Accessibility; D006280:Health Workforce; D006801:Humans; D007400:Interprofessional Relations; D008427:Maternal Health Services / Q000458:organization & administration; D008605:Mental Health Services / Q000458:organization & administration; D009520:New Zealand; D024802:Nurse's Role; D010560:Personnel Selection; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D012959:Socioeconomic Factors