Primary care stakes: I’ll take your detail and raise you two

Where is the patient voice in the changes to smokefree legislation, in the changes to bowel cancer screening?

Primary care has hit the big time. It’s in the news. Following on from prime minister Christopher Luxon’s Christmas epiphany about popular frustration over waiting times to see a GP, the six-weeks-in-the-job health minister Simeon Brown announced a vast tranche of initiatives to rev up general practice and primary care.

A new 24/7 online medical service will launch by mid-year and provide up to a million consultations a year; millions more in funding will be available to reward practices who provide enhanced services – keeping books open, meeting targets, providing minor surgery, and such like. The minister announced financial support to get another 400 newly graduated nurses into primary and community care per year over the next three years and funding support for training for 120 nurse practitioners per year over the next five years. And further support for advanced training for primary care nurses.

Additional workforce capacity is touted by Mr Brown with funding for New Zealand-trained graduate doctors to replace most hospital runs with primary care in their PGY1 and 2 years; and likewise, for overseas-trained doctors to complete pre-registration requirements mostly in primary care.

No mention of a third medical school but another 25 medical school places to be funded from next year – how will that be divided in half? Paper, scissors, rock. Details!

Millions are being poured into primary care – be it over three years, four, five or even 10 years, as for the medical school places.

But, of course, the details are everything, and once you start figuring the figures and what might be involved in putting some of these initiatives in place, not least a national digital health record lickety-split – the figures start to look a little lean. Then there are the twin spectres of pay parity and the annual capitation increase waiting to rain on the parade. But there is a determination that this parade should not be rained on. And a determination to do stuff fast.

In his speech prepared for delivery to a Health Forum hosted by BusinessNZ, Mr Brown says: “There’s often too much focus on what the unions, the colleges, or professional lobby groups say, and not enough focus on what the patient says.”

Which begs the question, where is the patient voice in the changes to smokefree legislation, in the changes to bowel cancer screening? How does the minister decide which patient voice he should focus on?

The lack of reference to specific needs of Māori in any of the primary care announcements might have some believing that existing health inequities have miraculously disappeared – because the Coalition Government ordered it to be so. It makes you wonder how much longer the Pae Ora (Healthy Futures) Act 2022 will be left alone. The Government might be able to handle the hypocrisy of working with legislation that aims to achieve equity in health outcomes, but the members of a new Health New Zealand Te Whatu Ora board might be hard placed to work to the definition of equity currently on the website of Te Whatu Ora:

“In Aotearoa New Zealand people have differences in health that are not only avoidable, but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.”

Our health system should be patient-centred. But it is built on the goodwill of those who work in it. And the colleges and representative groups in primary care are among those raising the red flag when it doesn’t work. That may not be politically appealing, but it is necessary.

If any of these initiatives go west, let’s not be surprised if the blame falls on the sector and not the lack of a genuine collaborative approach to fixing our health system.