Electioneering for general practice

Dr Hayley Scott (owner, Health Te Aroha) and I would have been at a GPNZ session with Michael Woodhouse, National Shadow Health Secretary, on 13 February if morning fog in Hamilton hadn't postponed our flight (yes really, and Hayley was particularly disappointed as Michael had paid a visit to their practice a couple of years ago to see the Health Care Home in action). Those that did make the session reported a very general discussion and not a huge understanding of the current pressures in primary care or policy development that was likely to sort them. Those of you wired in a health policy loving way, can read National's emerging health policy here and add your views. Some policy intentions are welcome, such as retaining the mental health focus but no recognition of the increased funding required to even maintain yet alone develop a strong primary care infrastructure.

I did, however, attend a meeting with four other PHO GPs and CEOs with the current Health Minister, Hon. Dr David Clark, on 11 February. This left the same feeling as the Hamilton summer fog.

We set out our view of the current state of primary care and shared with him all the tangible signs of a 'gathering storm'.  Most areas are now at capacity and running faster to stand still. We reinforced the budget submission we signed late last year setting out the need for an uplift of capitation across age groups, ethnicity and deprivation, and two new capitation groups for over 75s and 85s to reflect increasing demand and complexity for that age group.

Our position to him also included:

• some areas running worryingly short of GPs and the risk of seeing New Zealand primary care fall over (akin to the UK and Ireland) if there wasn't significant increased investment including infrastructure
• the detrimental impact on primary care of the pay award for DHB nurses and need for parity for primary care nursing
• we are seeing real disinvestment in primary care funding
• that Labour's desire to shift elective work from hospitals to primary care was welcome but it would need to come with the proportionate funding and first there would need to be an injection of cash (pun intended) to enable workforce capacity to be increased first
• the particular challenges faced by rural general practice and lack of a national rural health investment strategy
• he risked an electorate becoming increasingly frustrated with lack of access to primary care services and diagnostics.

When lobbying for a larger slice of the health budget pie, it it's understandable that you're making Ministers and the Treasury choose their favourite child as everyone else in the sector is at it too. And with good cause.

The Minister's response was that there would be no new money for health this year so any funding claims from primary care would need to go to DHBs. We did discuss the fallacy of this approach when all DHBs were in significant deficit and statutorily required to break even each year ergo any hospital deficit gets first call on funding. He did acknowledge this policy contradiction and made reference to the recommendations coming out in March from the Health and Disability System review so we'll see what that brings. 

He cited the West Coast model of DHB employed GPs (we reminded him it had the highest turn-over of GPs) and nurse practitioner led models of general practice in a manner that suggested he thought this may be the way forward. He quite rightly stated that models of care needed to change in general practice but didn't seem to understand that a new model of sponge when full cannot expand anymore and some of our Health Care Home practices are at this point.  It didn't fill any of us with confidence that he really understood the evidence base demonstrating the huge value gained from privately owned general practice through much work being done out of goodwill.

What I do know is that meetings with politicians have limited value on their own, it's the continual drip drip approach, objective and factual approach to advocacy that has benefit and Pinnacle will keep shouting loudly in various forums on your behalf. Would be good if you could lobby your Colleges to do the same.