C minus grade for Sapere Report

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It appears to have had no nursing leadership involvement, voice or lens outside of benchmarking practice nurses or nurse practitioners on the now-outdated current DHB MECA.

It's important to note that primary care NPs predominantly belong to the College of Nurses Aotearoa and are members of Nurse Practitioners NZ, and generally are employed on individual employment agreements or contracts, rather than a collectively bargained union contract.

While I certainly agree with primary care registered nurses’ pay parity argument with their DHB counterparts, the scope of the report went nowhere near addressing pay parity consideration for NPs.

There are many experiences of NPs on pay parity with their GP colleagues and many more seeking this. That’s understandable in the current market and given the role NPs play in serving medically underserved populations, ie, aged care and rural and VLCA practices.

There is an argument for paying NPs less, given they are cheaper to educate. On the other side of this argument is that, for the most part, postgraduate and NP education is entirely self-funded, compared to that of their GP colleagues.

The rate suggested in the report for NP annualised salary is actually wrong. The annualised rate on the MECA for DHB employed NPs (Grade 8) step 4 on 3/9/21 was $139,000 (compared with the quoted $116,000. Either figure is not representative of the current marketplace. There is no figure provided for advanced nurses such as nurse prescribers.

The biggest disappointment of Sapere report reviewing capitation, or first access funding, is that the funding model is still predominantly about funding “doctors” to see patients. A service delivery model that has not worked thus far for high-needs populations despite the algorithms.

The report has an astoundingly broad figure of 34 to 234 per cent of underfunding to our most vulnerable and underserved population. It almost seems as if a back of napkin accounting approach would-be more accurate than this pseudo (and undoubtedly expensive) scienced approach.

For the last two years, the underfunded primary care services have been kept afloat by the additional funding provided for COVID care. However, the double edge of this is that the workforce, which was already stretched, is now burnt out.

As the COVID funding and additional community support initiatives dry up, and cases rise on a third wave as a much-needed summer begins, businesses and individuals are facing rapidly rising costs. The burden of unmeet need, especially in high-need communities which find it hard to attract and retain staff, also persists.

It is very positive to see that aged care and Maori and Pasifika health workforces are being targeted early for pay parity by the health minister. However, pay parity is only one part of the solution to reform and aid transformation.

A significant and ongoing issue is that there is no specified funding pathways for primary care nurses to be supported to expand their scope into advanced professional roles to meet the unmeet need in underserved areas.

We also need to look at the traditional task-based approach of primary care nursing and move some of this workload to other workforces such as enrolled nurses or qualified (although currently) unregulated healthcare assistants as we did during the pandemic.

The change in cervical screening programme in 2023 to self-swabbing, is an opportunity to do this and properly plan and develop a workforce strategy. We have recent experience of excellent development and implementation of new workforces with the roll out of health coaches and health improvement practitioners into primary care. We should use this experience to see how further changes can be made.