Working on it: Angling for best pre-reform position

Many of the country's more than 220,000 health and disability sector employees just had their world turned upside down. Simon Maude talks with doctors' associations about the impacts of the newly announced abolition of DHBs and their replacement with a new agency

On 1 July 2022, all DHBs will be dissolved, and all their 75,000 staff will transfer to Health New Zealand on existing terms and conditions. Before that happens, advisory committees will be in place supporting the design (including the workforce make-up) of Health NZ and its partner organisation, the Māori Health Authority.

Health minister Andrew Little has said not all senior executives will be needed for Health NZ. Mr Little emphasised replacing the DHBs was also about maximising health resources – in part, by eliminating duplication, and that would mean some jobs would go.

In chasing efficiencies, Health NZ will specify which services will be nationally run or contracted, for instance, genetics and transplant services.

In his 21 April announcement, in spotlighting the inefficiencies and obstacles that come with 20 DHB IT departments, Mr Little identified health technology as another area where staff could be shed.

We hold the documents so you don’t have to! Our coverage of the Little reforms references a number of documents which we have gathered together on our website

Medical worker organisations are getting on with their jobs, so to speak.

The Association of Salaried Medical Specialists (ASMS) executive director Sarah Dalton says change is just over the horizon, but the organisation is carrying
on as usual.

ASMS, which represents about 4000 almost entirely DHB hospital-based doctors, has just started negotiating its latest Multi Employer Collective Agreement
(MECA) with the DHBs.

The current MECA ended in March this year but, because of typically protracted to-and-fro negotiations, the expired agreement has a 12-month extension period. “It’s about getting the best agreement [for our members] before things change,” Ms Dalton says.

She told New Zealand Doctor Rata Aotearoa she welcomed Mr Little’s “bold” reforms and hopes the transformational spirit of what’s planned percolates down to rank-and-file workers.

Restructuring the country’s health leadership, especially in hospitals, presents a real opportunity for the association to push for more clinical representation at board level, and at executive level, she says.

Clinicians need to have more say on work conditions such as shift rostering, she says.

In time, in the MECA or equivalent that materialises out of Health NZ, there may still be asymmetries of working conditions between Health NZ-employed specialists and, for example, ACC-employed doctors, that may need to be addressed.

Leading up to the reforms’ implementation in July 2022, the association intends to keep in close touch with Mr Little, and find out more on how it and other health worker representative bodies will be kept informed and given a chance to have their say on implementation.

NZMA chair and Warkworth GP Kate Baddock previously told New Zealand Doctor she did not get any feeling working towards a single public health system
included any plans to nationalise general practice. The NZMA, which has about 5000 members including GPs, enjoys a good working relationship with Transition Unit deputy-director Martin Hefford.

Mr Hefford, who is on secondment to the unit from his role leading Tū Ora Compass Health PHO, has briefed the organisation well on what’s next, Dr Baddock says.

The NZMA will work with the Government on the design and implementation phase, she says. There is only “very vague” and “nebulous” detail about what the next steps are for general practice and workforce matters.

The NZMA is referencing General Practice NZ’s Prepared for Change document, which catalogues the myriad of services PHOs provide, to help it formulate its wish list for changes to be brought to primary care.

“How do you expand the primary care workforce when GP numbers are falling, how do you engage with other workforces [to meet need]?”

Physician associates, nurse practitioners, nurse prescribers and clinical pharmacists could all play a greater role in general practice settings, Dr Baddock says.