The wasted years spent on pause

A complete overhaul of the health system is a year in, with no changes announced for primary care

Apparently nothing gets voters to the polls better than the lure of four-lane motorways, new bridges, and tunnels under Auckland’s Waitematā Harbour.

The spectre of a second harbour crossing seems to rise from the grave of the quietly buried artist’s impression of its predecessor every couple of years. It’s a promise that gets bandied about by politicians of all stripes, and has been talked about for as long as I have lived in New Zealand – 11 years and counting.

The first one I remember was John Key’s 2013 proposal – dubbed “essential and long overdue” by then North Shore National MP Maggie Barry.

In the past eight years, primary care has been scrutinised in detail. Initially it was the review led by specialist GP Peter Moodie (2015); then the Waitangi Tribunal report on primary care Treaty of Waitangi breaches (2019); followed of course by the Health and Disability System Review or Simpson report (2020); and then two Sapere reports – on correcting the underspend on Māori providers (2021) and on capitation funding (2022).

Yet a complete overhaul of the health system is a year in, with no changes announced for primary care.

However, in recent weeks numerous senior government figures have been dropping little breadcrumbs (to borrow an analogy from the boss) about a “roadmap” for primary care. Both health minister Ayesha Verrall and Te Whatu Ora board chair Dame Karen Poutasi name-dropped this roadmap at the recent GP23 conference in Auckland. Both stressed the importance of primary care and general practice feeding back to officials about what is needed.

The Ministry of Health’s chief medical officer Joe Bourne, in an opinion piece for this issue also hints at a process happening behind the scenes, and says there will be “multiple opportunities to engage with efforts to make positive changes to the health system”.

Dr Bourne goes further, in saying there will be a national strategic design focused on four areas, which appear to cover birth to old age, as well as mental health.

However, an attempt to get further information from the ministry on this roadmap has not “borne” fruit and no announcement made as this edition went to press.

I don’t doubt the genuine desire to consult with primary care over what changes need to be made to improve the sector – and that’s a good thing. In my brief time reporting on it, I know there’s no desire for a top-down approach.

Dr Verrall told the conference she had “heard very clearly” from general practice that it wants to be involved in any changes proposed by the Government, and that she was “absolutely committed” to supporting the sector. I think she meant it.

The Government and its health agencies are clearly working on a plan for primary and community care, which will require some level of buy-in from the sector if it’s to be meaningful.

But, with increasing numbers of practices closing their books, long wait times for appointments to see a GP, and ongoing workforce shortages all limiting people’s ability to access primary healthcare, surely these things will be at the front of voters’ minds in the run-up to 14 October, more than roads and tunnels.

Let’s hope this latest attempt at consulting on primary care – whenever it is eventually announced – won’t end up gathering dust in the pile with its predecessors.