Hauora Taiwhenua searching for rural equity in the primary care and rural funding boost announcements

Today, Te Whatu Ora and Te Aka Whai Ora announced how funding, that was made available almost a year ago in last year’s budget, will be allocated.

The funds were set aside to alleviate pressures on our primary care health system and seek increased equity for Māori and Pasifika. Getting any extra support out to stressed general practices is important, and so we welcome these announcements as a way to get the funds distributed.

Hauora Taiwhenua is a strong advocate for equity of health outcomes for Māori. We know that the sums of money committed in Budget 2022 are small and need to be targeted.

Research shows that the population with the worst health outcomes across the whole country are rural Māori. With this equity lens in mind, we are concerned with the current allocation formula.

Rural Māori are in the greatest need, have the highest servicing costs for a provider, and the providers in these rural areas are predominantly smaller practices, not Māori-owned.

Under the announcement, Māori and Pasifika-owned providers will receive an extra $80 per enrolled Māori or Pasifika patient. Non-Māori owned providers will only receive $40 per enrolled Māori or Pasifika patient and would only be eligible for that lower payment if they surpassed a threshold of 50% Māori and Pasifika total enrolment.

“We are concerned that this provider-centric approach to the distribution of equity funding has the potential to actually increase inequities in health outcomes for the huge number of Māori patients serviced by rural general practices,” says Dr Fiona Bolden, Chair of Hauora Taiwhenua.

“At the time of the announcements, Te Whatu Ora were unable to tell us how many rural practices would be eligible for any extra funding for serving their Māori patients, or what percentage of rural Māori will attract this extra funding. We suspect this will be very few but look forward to receiving that analysis from the Agencies”.

Today’s announcements also allocate funding to the provision and training of an increased kaiāwhina workforce across the country.

While we acknowledge the important role of kaiāwhina in supporting whānau engagement with the health system, there is little detail on how this will work in small rural communities.

For kaiāwhina to work effectively, there is the need for ongoing, regular contact and support of the population. When kaiāwhina are allocated on a population basis, this generally means that small rural practices get part-time personnel, shared across a region.

This approach prevents the development of an integrated, trusted primary care team, offering continuity of care to a community.

We acknowledge that extra funding is being made available to provide new skill sets in comprehensive care teams, and that there is a rural priority placed in the distribution of these positions. We look forward to seeing the detail of what that will mean in reality for our rural practices.

As these announcements are made, rural practices continue to deal with the stress of a declining number of doctors and nurses.

They are leaving to seek better pay and conditions in Te Whatu Ora owned hospitals or practices, head overseas, or simply retire due to the unrelenting workload pressures.

The Network Chair, Dr Fiona Bolden, stated that, “While we are delighted to see new funding coming into primary care, today’s announcement is a long way short of what is needed to address the crisis in rural health including the inequitable health outcomes of rural Māori.

"We urge Te Whatu Ora and Te Aka Whai Ora to move quickly on the long-promised review of funding for general practice, ensuring this includes extra loading for delivery in isolated rural communities. In addition, there needs to be urgent action to address the pay disparity for nurses and other clinical professionals in our practices.”

“If there are not enough nurses, nurse practitioners and doctors in rural general practice, it will not matter how many other health care assistants are working to increase access for whānau. We will see further degradation of health outcomes and preventable deaths for rural Māori and others in our rural areas.”