The ‘astonishing’ work of PHOs: Has GPNZ made a strong case for retaining them?

A lot of decision-makers... have an impression about PHOs, which we think is erroneous and perhaps even unhelpful

Population health expert Tim Ten­bensel says a new report from General Practice New Zealand looks backward at PHOs, rather than forward at what they could do in future.

GPNZ needs to convince deci­sion-makers about what it and PHOs could do, says Dr Tenbensel, associate professor of health policy at the School of Population Health, University of Auckland.

However, GPNZ deputy chair Larry Jordan says the report, Pre­pared for Change, “speaks for itself” in terms of demonstrating PHOs’ ability to evolve with the times.

The 23-page report, released by GPNZ on 8 April, outlines what PHOs have accomplished, and argues for their retention.

The paper covers PHOs’ leadership, governance and community engage­ment, population health and clinical programmes, workforce development, general practice support, data and dig­ital, and COVID-19 contributions.

GPNZ chair and Wellington GP Jeff Lowe says in a media release: “This snapshot of the work our member PHOs are involved in is astonishing. We know that primary care is where most people access the health support they need, but our stocktake highlights not just how much goes on in primary care every day, but how much of it is unrecognised.”

Dr Tenbensel calls the document a good conversation-starter with government and health decision-makers, especially those in the Transition Unit working on reforms to be based on the Health and Disability System Review. The country’s 30 PHOs are in the firing line and face an uncertain future, because the review panel recommended DHBs no longer be required to channel primary care funding through PHOs. The review’s recommendations were broadly accepted by the Government.

Dr Tenbensel says PHOs were created with the aim of strengthening primary care, by promoting integration between providers and facilitating seamless services for patients.

“But their role as implementers of government primary care policy is certainly downplayed,” he says.

“[Highlighting this achievement] makes sense in the context of making a pitch to ‘add value’ to the sector.”

Dr Jordan, a GP in Whitby, Porirua, agrees PHOs as policy implementers “could have been emphasised more”, but he says that, by detailing the breadth and depth of PHO work, the report implies that track record.

It demonstrates PHOs’ ability to evolve with the times, he says.

“With one or two exceptions, like Transition Unit head Stephen McKernan, a lot of decision-makers are either unaware of what PHOs do, or have an attitude or an impression about PHOs, which we think is both erroneous and perhaps even unhelpful.”

Dr Jordan says the Health and Disability System Review was short on detail about Tier 1 (primary and community) services and PHOs’ role, and the GPNZ paper fills the vacuum. There’s deep scepticism across the primary care sector that DHBs could fill any void left by PHOs, he says.

Without PHOs, many worry the comprehensive services they have been tasked with delivering, or have created through their own initiative, will fall by the wayside and leave communities worse off.

Dr Jordan says there’s still time and “wiggle room” for interpreting the review’s somewhat broad-brush recommendations, and to lobby to find a place for PHOs.

“GPNZ’s view is that building on cur-rent PHO capacity would be the obvious way to go, because you don’t want to throw the baby out with the bathwater.”

He understands a range of decision-makers and stakeholders in the Department of the Prime Minister and Cabinet, director-general of health Ashley Bloomfield, and senior Cabinet ministers have been sent the GPNZ document.