The arc of the fall: Primary care left to teeter for longer

The election campaign is rattling along and health is hot – promises and pledges flying

I was walking through a large pedestrian area to a venue at the recent Edinburgh Fringe Festival when I caught a movement out of the corner of my eye.

It was a man slowly toppling to the ground in the midst of a group of people. At first, I thought he was a street performer and some sort of magic was going to stop his fall. But nothing, and no one, did; he hit the concrete with a crack.

In a matter of minutes, a fluoro-clad first-aider arrives on a pushbike. I move away from the scene and later, as I sit eating lunch in another corner of the courtyard, I hear the sound of the siren. Soon after, a paramedic loaded with kit dashes past where I sit, rushing in the wrong direction.

I take off in pursuit, yelling as I catch up with him, “Are you luking for the unconchush min?”

Judging by his bewildered look I’m guessing this is how my words sound. Nevertheless, after only the briefest hesitation, he heads in the direction I am pointing. It seems like quite a while later that the siren sounds again. I’m not sure if that is a good or a bad sign. There is still a faint stain of blood on the concrete when I walk by the following day. Maybe those standing with the man thought it was a performance, that at the last minute his hands would reach out or his knees would buckle and he would save himself. After all, it is a festival – context is everything.

My return from a wonderful six weeks’ leave spent mostly in Greece has been abrupt. The shock of day one – “what exactly is it that I do?” as I stare at my desk, the niggly sore throat a few days later that combines with the final onslaught of jet lag to see me bedridden by day four and, the biggest challenge, the demon that is two-factor authentication added to all office devices.

And then there is the news.

Monday morning’s editorial meeting proceeded with a blur as the reporters recounted the previous six weeks in primary care. I felt a sort of mania take hold as one story seemed to top another. Financial calamity for practices, PSAAP denied, localities trucking on, pay parity fallout, health worker strikes, urgent-care hours cut and then, the pièce de résistance – the primary care roadmap – another plan for a plan with a destination 10 years down the track.

Six weeks away and Winston Peters is back in the polls. The election campaign is rattling along and health is hot – promises and pledges flying as if all the funding problems besetting the sector can be solved just by saying the magic words “if we are government…”

On jet lag D-Day, I take a short break from bed to attend a political panel discussion. All the health spokespeople talk of the importance of primary care. Later, I watch a Te Whatu Ora video extolling the new health charter and the single system – the imagery is all hospital based. Not even a token street scene to suggest the community.

But my mind keeps going back to those 10 years and opportunities wasting away as the hospital system – aka Te Whatu Ora – continues to feed itself off the back of a narrative of broken general practice, while primary care is left to wait again, putting the entire system at threat.

Is this how a patient-centred system is built? It feels like a farce, like some sort of parody of how a reform might take place.

I wonder where in the arc of the fall the primary care system sits; what hands will reach out to catch it.