The first time you make a New Year’s resolution, start at the end and take action

How well does the general practice model of care reach into our Māori communities?

We could be forgiven, as a profession, for feeling under threat in 2022.

Let’s take “general practice” to mean the organisation of community-based, first point of contact, healthcare teams working for an enrolled population. Let’s define the team as one consisting of someone medically qualified, or a nurse practitioner able to perform the same tasks, working alongside other health professionals – usually nurses, but increasingly pharmacists, health improvement practitioners, kaiāwhina, health coaches and others.

This model of care has stood the test of time, but without nurturing and investment, it will stagnate and eventually fade. The health care home movement has provided the most nourishment to the model in the past 10 years, but it needs more.

During the early part of the pandemic response, it was heartening to see the Government put emphasis on maintaining the general practice model by putting in extra funding to cushion the necessary shift from in-person care to “telehealth first” services.

The involvement of GPs in leadership and advisory roles in the Ministry of Health has been a further indication that the general practice model of care is valued by the system. It’s important enough for us to be listened to and for the way we do things to be understood by the centre.

We can see this as a significant vote for the work we all do in our communities. However, we have also witnessed the system look at the model and find us wanting.

How well does the general practice model of care reach into our Māori communities? For Māori who are enrolled, how well does it actually provide service? For the most vulnerable, the people who aren’t enrolled and the people who are enrolled but aren’t engaged, what does the current model of care do to support them? What about the disabled community? How sustainable are our rural services?

The pressing need for rapid, open access to care saw the Government put huge resources into swabbing services, access to vaccination, and care of COVID-19 in the community. General practice has been part of those initiatives, The first time you make a New Year’s resolution, start at the end and take action but certainly not “first cab off the rank”.

We can either bemoan our lot or seek to understand why and do something about it.

The health reforms that will really start to bite this year are our greatest opportunity and threat in 21 years. If we are going to flourish rather than diminish as a result of the reforms, we cannot ignore the need for change.

No one keeps resolutions – if I did, I would be 20kg lighter, fluent in te reo Māori, have robust retirement savings and the liver of a Mormon. But given the potential of 2022, it will be worthwhile sitting with your team and planning for the year ahead.

You need to start at the finish. Look seriously at the outcomes for your enrolled population and compare issues in different groups, including access and engagement for different sectors of your community.

Do you know how long it takes for a Māori family to make a routine appointment compared with a European family? Do you know what level of bad debt you tolerate in different populations? Do you know how many people enrolled in your practice are actually engaged in your service?

Cancer (particularly lung cancer), cardiovascular disease, diabetes, renal disease and respiratory illness are the “big five” domains of physical health where we see the greatest inequities between Māori and European populations. Do you know what the outcomes are for your enrolled population?

Don’t assume you “treat all people the same” until you can prove it. Julian Hart’s inverse care law is the principle that “the availability of good medical care tends to vary inversely with the need for it in the population served”, and believing that you treat everyone the same is a significant barrier to making a difference.

You know there are gaps. Shining a light on them and being able to measure them will provide stimulus to do something about them, and a way to measure whether what you do makes a difference.

What about the unenrolled? They may not seem to be your problem at the moment – after all, you are not paid to care for them, and, by definition, you can’t contact them. However, they are the most vulnerable, the most in need of care and the least likely to be able to access it in our current system. They are in sharp focus in both the pandemic response and the health reforms.

How much do you know about the unenrolled population in the place where you practice? Do you have links into the services that do care for them? How do you support those services?

Overwhelming problems stifle effective resolutions, and a plan to only start measuring things would be a failure – 2022 is the year for action.

What are you going to do for the first time?

For some teams, this will start with the use of simple te reo Māori greetings on the phone, being open to whānau-based consultations via telehealth or in-person, and using te reo Māori terms for body parts during an examination. Other teams may be able to think about tikanga, using the hui process for structuring consultations, offering the option of a karakia or engaging a local kaumatua as a cultural advisor.

Other teams may be able to link with local iwi and other community health providers, or create a community-wide health group.

If there was one 2022 resolution for all general practices, it would be to develop functional relationships with the other teams serving your community. This will be a year of ongoing, seismic pandemic challenges and significant structural reform. If your team is going to thrive, it needs to be a strong part of the foundations of the new health system.

First, you save yourself, then you save the world.

Jo Scott-Jones is medical director for Pinnacle Midlands Health Network, has a GP practice in Ōpōtiki and works as a GP across the Midlands region