REFORM SHORTS: Go-ahead for capitation equity adjuster and comprehensive care teams still awaiting sign-off

Sign-off is still needed for Te Whatu Ora to begin paying targeted capitation equity adjustments in April and start implementing comprehensive care teams before 30 June, a primary care hui heard last night.

Te Whatu Ora hosted the virtual hui on the Primary, Community and Rural Early Actions Programme. Also included were short presentations on developing a kaiawhina workforce and on delivering more planned care and acute care interventions in primary and community care.

The meeting was led by Early Actions co-directors Astuti Balram, Te Whatu Ora national lead – primary and community care early actions, and Cherie Seamark, Te Aka Whai Ora general manager primary and community care. A number of the more than 100 virtual attendees posted questions but the panel ran out of time to answer all of them during the hour-long online meeting. Questions included a number on general practice funding and training support.

Ms Seamark told the hui the equity adjuster fund was a “partial contribution” to a longstanding issue with capitation funding for general practices with high-need populations, particularly Māori and Pacific populations.

The $86 million fund over four years was announced in Budget 2022 and the first $12.76 million tranche is due to be paid out before the end of the financial year on 30 June.

“There is a huge equity lens [for the fund] and it will be targeted for Māori and Pasifika in line with our principles for equity,” says Ms Seamark.

Ms Balram says it was just awaiting final approval from their executive leadership teams and then they looked forward to working with the primary and community sector “to implement it as rapidly as we can”.

The funding of new health professional roles for the Comprehensive Primary and Community Care Teams initiative will be initially targeted at providers with large Māori, Pacific and rural populations, Ms Balram told the hui.

Just over $100 million over three years was announced in Budget 2022 for supporting new roles for teams, with $6 million of that earmarked for this financial year and $61 million for next year.

Ms Balram says through the initiative, Te Whatu Ora will fund additional roles, including kaiawhina, pharmacists, physiotherapists, care coordinators and extended care paramedics, to join existing primary and community care teams to improve patient outcomes.

Rather than building comprehensive teams from scratch, Ms Balram says, it will build on existing teams where they exist, including PHO teams, and introduce new members in other places. “We want to reiterate there is much space in terms of flexibility.”

It is also likely some of these new roles will sit across a range of providers and partners in the community – particularly kaiawhina, who are likely to be employed by Māori or Pacific providers and are best suited to provide cultural support.

Planning is under way on a “few of the core roles that potentially would be introduced” into the teams and what full-time equivalent staff would be needed across the motu, says Ms Balram.

She says discussions are ongoing but it is known that the new roles will be initially targeted at communities with the highest Māori, Pacific and rural populations to prioritise care for people at greatest risk of inequitable health outcomes.

The Early Action team awaits final approval of the implementation process for establishing the teams and hope to start implementing the initiative before 30 June.

Allan Moffitt, Te Whatu Ora clinical director commissioning, also spoke to last night’s virtual hui about extending services available in community care to address inequity and see more consistent care available nationwide.

“In particular, we will be using [community health pathways] as a means to standardise care for the extended care we expect to happen in the community,” Dr Moffitt says.

Some of those pathways are aimed at addressing demand on not only public hospitals but also primary care, the specialist GP says.

Progress to date on the project was a national stocktake of pathways but also on services delivered through Primary Options for Acute or Ambulatory Care (POAC) or planned care (elective or non-acute) models of care.

A detailed proposal has been developed – also awaiting executive sign-off – to implement new extended community care pathway-driven services “this side of the financial year”, says Dr Moffitt.

He says key pathways include early medical abortion (with training and other requirements), abnormal uterine bleeding, musculoskeletal pathways (including physiotherapists), and a range of traditional POAC acute type services.

“What we find is there is quite a lot of variation across the motu in terms of what’s funded in one area may not be funded in another. And we want to move to a situation where things are consistently funded.

“And that is going to take some time – it’s not going to happen in one year.” An example is access to imaging diagnostics.