Clear road ahead...sort of: ‘Aspirational drivel’ lacks timelines for the way forward

The Government’s much-anticipated primary care reform plan arrived late last month only to be slated as “aspirational drivel” by GP leader Buzz Burrell.

On 28 August, well over a year after the start of the health reforms, the Ministry of Health released a Cabinet paper on behalf of health minister Ayesha Verrall, describing her vision of primary and community care.

In July at the RNZCGP’s GP23 Conference for general practice, Dr Verrall had spoken of a pending announcement on primary care, saying she would make sure information on plans to address the challenges faced by the sector would be available soon.

“As minister, I have a desire to listen to your experience, understand the significant challenges faced in your work, seek your opinion and act decisively to ensure government is working to tackle the issues that matter most to you,” she said.

Stop producing aspirational strategies and start to fix a completely broken system

Chief medical officer Joe Bourne, in the release, says the primary and community workforce has identified fundamental issues with the sector that need addressing.

“This work programme offers an opportunity to redesign primary and community healthcare to take advantage of the health outcome benefits that it can deliver,” Dr Bourne says.

“We have heard the issues being raised by communities and healthcare workers that impact on access to care.”

The work programme would include work on “how primary and community healthcare providers are funded, including settings for capitation funding, and is likely to indicate the scale of potential future investment that may be required,” he says.

“We will be reviewing the structure of the system, how the knowledge and expertise of the workforce can focus on prevention as well as supporting people with complex chronic conditions, ensuring that investment and funding drive improved outcomes and equity for Māori.”

The paper also outlines the role of localities in primary and community healthcare as part of the reforms, which it says are expected to better connect service providers, iwi and other stakeholders.

But before the dust had settled, GenPro released a survey of its members, saying 90 per cent of general practice owners surveyed were concerned about the future viability of their practices and 84 per cent said their financial position was worse than this time last year.

Thirty-five per cent said they had made a loss in the last quarter of 2022/23.

Dr Bourne says he wasn’t surprised at the backlash from some GPs after release of the Cabinet paper and acknowledges the frustration some doctors feel at the lack of progress made in the reforms.

“People are looking for change and they would like that change to be now,” he says.

Release of the paper was the first step in an 18-month process, says specialist GP Dr Bourne.

If the ministry had released a detailed and prescriptive primary healthcare roadmap, without consulting the sector, it would have rightly been criticised just as strongly, he says.

“If we don’t have a solid base to build a programme of change from, it’s going to make it difficult,” Dr Bourne says.

“But now we can have a conversation to understand what direction we are going in.”

Capitation was first introduced in 2001 and, over 20 years later, it’s time to carry out a fundamental review of the funding model, he says.

“But just because we’re entering into an 18-month work programme doesn’t mean we can’t make changes to the likes of capitation [during that period].”

However, he conceded they would have to be made within the existing funding settings.

Dr Burrell describes the GenPro survey results as “scary” and says while the problems have been in the making for decades, solutions are needed now.

More investment in general practice will not only save primary healthcare, he says, but also the secondary sector from disaster.

“We need the next minister of health to step up and take responsibility instead of hiding behind purchaser–provider models and disregarded reports,” he says.

In an email response to questions, Dr Verrall says GPs and primary healthcare workers are essential for improving the health of New Zealanders.

“We know pressures from workforce shortages are being felt on the front lines of our health system, and these shortages are having an impact on primary care providers,” she says.

“I agree the funding system for GPs is not fit for purpose. But funding alone is a blunt tool. Many changes are required to enable GPs to provide the care they should be able to in communities.”

The next stages of the pae ora reforms will address the issues in collaboration with the sector, Dr Verrall says.