Unashamedly political: How GPs can lobby with the best

Professor Casswell, director of the social and health out­comes research and evaluation centre at Massey Univer­sity, says she has never lobbied individual MPs, but she expects members of the new Health Coalition Aotearoa will do so.

“It’s only because I don’t have time and it’s not part of my job, but I think it’s really important.

“In a coalition government, no one party can make all the decisions. If they have got some party or some parliamen­tarians against, it’s difficult for them. So I think it probably is a really worthwhile thing to do, to let your local MP know where you stand on key issues.

“I have just been at a meeting of Health Coalition Aotea­roa talking about these sorts of issues we need to get onto the political agenda in order for whatever party is in power next year, for them to look at what the policy needs are.”

A year ago, Dr Clark was at the Health Coalition Aotearoa launch at Parliament. An umbrella organisation for NGOs, the healthcare sector and researchers, the coalition aims to persuade the Government to adopt healthier policies on alcohol, tobacco, and food and drink.

It brings a unified voice to the many organisations that have struggled to make headway on policies such as re­stricting the marketing of unhealthy foods to children and adolescents, mandatory star ratings on packaged food, a 20 per cent sugar levy and tightening controls on alcohol marketing.

The group notes that unhealthy diets, high BMI, tobac­co and alcohol, contribute about a third of the preventable health loss in New Zealand. “As a collective, we strive to pre­vent harm from unhealthy commodities and to strengthen the foundations of public health,” the coalition’s website states. Members include the NZMA, the Stroke Foundation, the Heart Foundation, the Cancer Society, the Royal Aus­tralasian College of Physicians and national Māori public health organisation Hāpai Te Hauora. Key people associated with the coalition include University of Auckland profes­sor of population nutrition Boyd Swinburn, Middlemore Hospital intensive care specialist David Galler and Nelson Marlborough DHB principal dental officer Rob Beaglehole.

“We were an interim organisation,” says Professor Cass­well. “We’ve just become an incorporated society. We’re get­ting out to a range of organisations in New Zealand to ask them to join up.

“I think we will be certainly raising issues about what the evidence says would make a real difference.”

Christchurch GP Dermot Coffey, a board member of Ora Taiao/New Zealand Climate & Health Council, is trying to get the RNZCGP to become more active on climate change.

“I suppose with a subject as big and all-encompassing as climate change, our collective voices as part of the RNZCGP are far more effective and likely to be heard, than individual GPs’ advocacy or submissions,” Dr Coffey says.

He recalls his introduction to civic advocacy was in ap­proaching local councillors, when he lived in Wellington, over cycling infrastructure. He wrote emails and submis­sions, and spoke at workshops and council meetings.

“The only rules I had were to be always civil, to thank councillors and executive staff afterwards regardless of the outcome, to keep all the submissions evidence-based, and to focus primarily on the health impacts of the decisions in question.”

He says GPs are ideally situated to advocate on issues such as cycleways and climate change. As well as being embedded in a community, GPs have a status that allows them “to stick their heads above the parapet to a degree”.

“The health benefits and potential harms are so great that not actively advocating for [climate action] as much as we can is probably unethical.

“As doctors, we do get a certain acknowledgement that’s probably slightly inflated, which to my mind makes it all the more important to use it.”

Lobbyists often find their cause strikes a chord with one or more MPs, particularly opposition members. The sensi­tivity to community views may be even greater with elec­torate MPs, especially in marginal seats.

National MPs Shane Reti (Whangārei) and Hamish Walk­er (Clutha-Southland) have willingly spearheaded cam­paigns that originated with their constituents.

Mr Walker began a petition to Parliament to save the Lumsden Maternity Centre as a primary birthing unit and not downgrade it to a maternal and child hub. More than 5000 people signed the appeal.

Carrie Williams, an advocate for the birthing unit, is a trustee of the Northern Southland Medical Trust, which owns the Lumsden building at the centre of the controversy.

She recalls Mr Walker’s involvement began after South­land DHB released a plan foreshadowing the birthing unit’s closure.

“He called us immediately, and said he was interested in this issue and ‘how can I help?,’” Ms Williams says.

“We had requested a meeting with him. But before that, a report was released that alarmed him and he pushed for­ward the meeting to the next day. We had contacted his office, but hadn’t met him or his representatives.”

Ms Williams’ group also contacted southern-based list MPs Liz Craig (Labour) and Mark Patterson (New Zealand First).

“They haven’t been as involved in the issue. They haven’t been as activist in their approach as Hamish Walker. It’s not that we don’t have a good working relationship with Liz Craig and Mark Patterson; they have different constraints to work within than Hamish.

“It doesn’t matter what party Hamish Walker represents. It was that National was in opposition. It would have been the same four years ago [when Labour was in opposition] if we had been working with a Labour MP.

“We got huge attention from Hamish. He spent so much time on this, it’s phenomenal.”

Mr Walker says the community didn’t need to lobby him over the issue. When the DHB plan was revealed, he imme­diately saw a risk to the community because there are more than 100 births in the Lumsden health catchment each year and it is more than an hour away from a secondary hospital. He knew what he had to do.

“Politicians don’t like negative media. I had to get the media involved.”

As well as the petition, he organised a protest march in Lumsden. About 450 people – more than the town’s pop­ulation – took part.

“The petition went to the select committee, and we had the opportunity to recommend to the Government to rein­state services, but the two local list MPs voted that down,” Mr Walker says.

“We had a separate vote on whether to investigate the DHB, and they voted that down too.

“I told the Government there will be babies born on the side of the road, and it would be hard to employ midwives. Both of those have happened.”

Lumsden Medical Centre GP Mathew Stokes, who was part of the community campaign, says Dr Clark wouldn’t talk with the group.

He says the key in getting a backbench MP to help on an issue is to find someone who believes in helping the population.

“Hamish Walker has been fantastic for his community. He met with us early and still continues to have contact with us.”

Despite the local MP’s efforts, Dr Stokes says, there has been “not one positive outcome” from the stressful process, and he remains disheartened.

GP Dr Reti, who notes he is the only practising doctor in the present Parliament, says he handles numerous health matters for constituents, such as people seeking help after being declined ACC cover or after failing to be accepted onto a DHB surgery waiting list.

“What I do is bring my clinical mindset to that. I under­stand the booking process – CPAC [clinical priority assess­ment criteria], what might go onto the list or not.”

He says it’s a form of triage. To some, he will explain they are unlikely to get onto the list; or, if he thinks the North­land DHB has made a bad call, he may take the person’s case through the board secretary.

“If it’s not a DHB issue, I have a range of tools,” Dr Reti says. He reckons the most powerful is the written parlia­mentary question. “Within six days, the minister has to answer, and it’s as if you ask the question in the House.”

Dr Reti says his office is regularly approached by people in primary healthcare, typically on workforce issues (“we are struggling to get locums”). Northland pharmacists and their national representatives have been vocal since the measles outbreak became serious.

He had been working with pharmacists for some time seeking changes to allow them to do on-site vaccinations as per the full National Immunisation Schedule. Then, when the measles outbreak took off in July and August, he began a political campaign for pharmacists to be able to administer the measles, mumps and rubella vaccine.

Asked how much influence an opposition MP can have over government matters, Dr Reti says, “We can still have an impact in opposition. I’m proposing we authorise phar­macists to give the measles vaccine. I have expectations that that will happen.”

His prediction has proved correct. Since he spoke, the Government has changed the pharmaceutical schedule and the classification of MMR vaccines to allow pharma­cists trained as vaccinators to administer the injection for people over 16 at DHB-contracted pharmacies.

Already, pharmacists who have completed vaccina­tor training can administer some vaccines, including state-funded influenza immunisations for pregnant wom­en and the over-65s.

Dr Reti says up to a quarter of Northland pharmacists have completed vaccinator training and, “in times of a se­rious outbreak such as this, we should be making use of that resource”.

With MPs feeling keenly the democratic incentive to be responsive to voters, Ora Taiao’s Dr Coffey has some advice for GPs thinking of trying their hand at influencing that responsiveness.

“Think of the best way you can make a difference with the time you have available, and put your energy into that. Politicians in New Zealand are approachable and friendly.”