Health minister stands by call for new business models in primary care

“If being ‘on side’ means I have to accept and encourage the status quo and therefore nobody feels there needs to be change, I’m sorry, I’m not going to do that”

Health minister Andrew Little is standing by his call for new business models in primary care, despite claims that he has insulted the sector.

Mr Little in fact went further in an interview with New Zealand Doctor Rata Aotearoa today, challenging primary care leaders to think about how the sector must change.

“I haven’t heard a lot from the nominal leaders about what a different and better future looks like.

“We need leaders prepared to do the thinking, prepared to challenge their own and say, ‘Yip, we agree it needs to be different and we are prepared to be part of the conversation to understand what that new [system] looks like.’”

The row blew up on Wednesday, when at a media conference Mr Little rejected the view expressed in the rural health sector that rural health needs have been omitted from the health reforms. He retorted they would receive much more attention through the locality planning process.

“Part of the problem with rural health services is that there are old-fashioned business models that don’t work any more,” Mr Little said on Wednesday.

The comment infuriated some in general practice.

Cromwell Family Practice co-owner and specialist GP Greg White said it was an insult to the thousands of rural health workers who had set up trusts, fundraised or run their own healthcare businesses.

RNZCGP medical director and specialist GP Bryan Betty says Mr Little’s comment was unhelpful when the Government needs the whole health sector to support the reforms.

“I thought it was an unfortunate comment as it was directed at the rural sector which is doing it really tough at the moment…It was a little bit of finger-pointing.”

Dr Betty says there is a range of ownership types in general practice including community trusts, corporates and private owners.

“The smaller practices are an integral and very important part of the delivery of community medical services in this country. They deliver a great service to their patients.”

In his opinion, the Government and Ministry of Health understand there is a large amount of money invested in general practice, but they need to acknowledge this publicly.

Mr Little believes primary healthcare is constrained by small, owner-operator general practices and he today again expressed his liking for hubs where patients have access, not only to GP clinics, but also to nurse practitioners and allied health practitioners such as physiotherapists and podiatrists.

He also notes traditional general practice ownership has become less popular among young doctors who commonly don’t want to own a small business, and he comments that this is contributing to the shortage of GPs.

“Given that primary care is reliant heavily on state funding, then I think the state does have an interest in the way they set themselves up to provide care for communities.”

Asked how the state can influence private and trust-owned practices to change, he says it is through locality planning processes, and funding and incentives to drive health to better meet community needs.

“I don’t expect the state to be a big owner of primary care practices. But I think the state, through its funding role, can incentivise and encourage more effective business models to provide better care.”

Asked if he did not resile from his comment on Wednesday that was considered by some to be an insult, Mr Little says, “There are some in the sector who are easily insulted.”

But he wants to focus on things that will expand the availability of health services to those who need them.

He knows that many health practitioners believe it is important to preserve the status quo.

“I’m not that. I’m a status-quo challenger.”

Responding to Dr Betty’s comments, Mr Little says, “If being ‘on side’ means I have to accept and encourage the status quo and therefore nobody feels there needs to be change, I’m sorry, I’m not going to do that.

“If people’s feelings are hurt…people have to grow up a bit here.

“We’ve got some major challenges. This is a government that has poured billions extra into health. We are committed to good-quality health services.”