It’s a heartache

This year has exhausted us all.

We thought the prior two years, with lockdowns and “traffic lights” and vaccine drives and boosters and video consults and Teams and Zoom, were a struggle. But something about attempts to return to normality when normality is still beyond our grasp, made 2022 tougher than the first two years of pandemic.

The year started with Omicron on the rise and is ending with Omicron on the rise.

In between times, workplace and health services have been dogged by COVID-19 and influenza, and the resulting workforce shortages have been exacerbated by the long-anticipated, slow-breaking wave of GP retirement.

Sigh! We told them so. Would they listen? No. Are they listening now? Not really, it seems.

The past few weeks have seen the usual year-end flurry of reports and news.

The Sapere capitation review finally saw the light of day, only to be talked down as a mere trifle in the larger scheme of another primary care funding rethink. Who knew?

Meanwhile, the pay gap between general practice nurses and Te Whatu Ora nurses has been talked away by health minister Andrew Little. Seems everyone is just a little confused come the end of the year – there is no pay gap, after all, Mr Little says.

He has opted to give more funding to Māori and Pacific providers outside general practice and to aged-residential care, and that’s great news. But ignoring general practice nurses (for now) is a problem, not only because it prejudices the general practices run by Māori and Pacific providers. Rather, because, after years of being told to collaborate, innovate and generally circulate, the primary care sector is far more intertwined than Wellington agencies and politicians appear to understand.

Silo-based funding goes against the collaboration and innovation called for by the minister as he launched the reforms. It leads to unintended consequences, as we saw with the Very Low Cost Acess funding rules – that is, high-needs practices overflowing and unable to fund their services.

As they proceed, the health reforms risk embedding the sector cultural norms that were to be squeezed out of the system.

By the time localities truly arrive, Te Whatu Ora districts will be well settled in, and primary care will be deemed a latecomer to the party, with all the prejudices that attracts.

True, work is under way with localities and iwi Māori partnership boards, but that covers just a fraction of the country.

And, until primary care funding is sorted, the key driver of change will be a wing and a prayer.

The pay parity outcome feels like a harbinger of things to come.

It’s exhausting just thinking about how everything fits together – or not.

I was sad to receive, out of the blue, Wellingtonian Emma Dunning’s contribution telling me of her decision to leave general practice. A few years back, Emma was a regular, witty and insightful columnist for the paper. She was enthusiastic about the changes happening in her practice. Now she is not.

I don’t want to finish the year on a glum note because I know that, despite the grind, our readers’ work means a lot to them. But at times it can be hard to love.

Another GP said to me recently: “Once I had my 15 minutes to diagnose and treat. Now I have to be holistic and the patients arrive with their own diagnosis, demanding a treatment and I’m left to say ‘no’, and sort out all the other problems in their life. It’s exhausting.”

It must be very difficult when the future of your profession is uncertain and the conspiracy theorists drive constant criticism of your work. And that’s just from working in the health media. On the front line, you have it much tougher.

So, to you all – GPs, nurses, nurse practitioners, managers, assistants, hospital specialists, health officials and even you politicians, I say I’m sorry for the shite you have to put up with. I wish you the best over the Christmas break and a warm summer ahead. See you in 2023.

Sadly, this issue we farewell deputy editor Ruth Brown. Ruth has been with New Zealand Doctor Rata Aotearoa for eight years. And, in what rates as an incredible feat of fine-line walking, she has also been editor of sister publication Pharmacy Today for the past four years. To both roles she has brought a great commitment to quality journalism and an eye keenly focused on what is of interest and value to her readers. We wish Ruth all the best in her new role at The Listener. Also on the move is our visiting journalist Amanda Cameron. Amanda is returning to the UK after a long visit with family.

Happy travels – Barbara