It’s a jungle out there: Why is Te Whatu Ora not taking my calls?

The lure of invisibility is woven throughout popular culture. HG Wells’ Invisible Man succumbed to it when a chemistry experiment went wrong; the hobbit Bilbo Baggins found invisibility when he put on the ring of Tolkien sagas; the Romulans outwitted the Federation with their invisibility inducing spaceship cloaking device in Star Trek and, more recently, Harry Potter outwitted his professors and tormentors with his more literal invisibility cloak.

I’ve been thinking that one of the problems faced by primary care for many years has been invisibility.

And it turns out this is nowhere near as exciting, or as handy in a tight spot, as popular culture would have us believe.

At the RNZCGP’s recent Conference for General Practice, health minister Ayesha Verrall heard from Taranaki GP Thaya Ashman about her experience attending a Te Whatu Ora clinical webinar where general practice was invisible.

Dr Verrall acknowledges the new central agency created by merging the former DHBs has inherited the biases of those organisations. But she expects this will change through the implementation of the recently released pae ora strategies. Time will tell how easily the prejudice towards the work of the vast primary care sector, largely a prejudice against private providers, is sloughed off.

If there can be any positives arising from the COVID pandemic, it is that primary care shook off some of the invisibility. But, despite the minister’s reassurances, there remains a sense that State health sector managers would really rather see the sector back in its box.

At heart, it’s a relationship problem.

First up, ghosting. This is used to describe a situation where one party suddenly stops communicating and completely vanishes from the relationship

To get a feel for what might be going on, I found myself searching for clues in online dating etiquette, given that health sector protagonists are often no longer in the same room, rather, they’re conducting their relationship via Zoom and Teams.

Needless to say, online dating is a complicated paradigm.

First up, ghosting. This is used to describe a situation where one party suddenly stops communicating and completely vanishes from the relationship.

Gaslighting, on the other hand, sees one party manipulating the other, so the latter begins to question their own reality to the point where they no longer trust themselves, leaving the “gaslighter” absolved of any responsibility for problems in the relationship.

Put them together and you get a newcomer to this hall of relationship horrors, ghostlighting – where one party ghosts the other and then denies it.

But, wait, there’s more. Fizzling is another relationship landmine – it’s sort of ghosting lite – where a potential date puts less and less effort into the conversation rather than ending the relationship. The replies are slower and less frequent, and shorter, and eventually the fizzler stops and the fizzlee is ghosted.

But forget ghosting, gaslighting, ghostlighting, fizzling – I suspect the relationship between Te Whatu Ora and primary care is subject to the innocently termed “breadcrumbing” described by Psychology Today as “the act of sending out flirtatious, but non-committal social signals (‘breadcrumbs’) in order to lure a romantic partner in without expending much effort”.

Te Whatu Ora’s breadcrumbs include the promise of localities and talk of a road map.

Recently appointed Te Whatu Ora board chair Dame Karen Poutasi also spoke at the conference.

Specialist GP and part-timer with Te Whatu Ora, Justine Lancaster took up where Dr Ashman left off the previous day, challenging Dame Karen on language that placed primary care outside the public health system.

The “one system” theme was central to the reform-focused Simpson report, was endorsed by former health minister Andrew Little and written into the Pae Ora (Healthy Futures) Act 2022 via the health charter – a set of values to be followed by health entities and organisations and workers involved in delivering publicly funded services.

I think it is important that primary care, or the “funded” sector, is covered by the charter. It’s mostly a statement of good intent but, if primary care is not covered, then it will continue to be ghosted by government agencies.