Getting the settings right for general practice

There is a lot being said at the moment about the future of primary care. Some of it is useful. Some of it is simply assertion. 

From where I sit, primary care does not need more assertion. It needs sound funding settings, sensible accountability, and decisions that reflect how general practice actually works. 

That is why work such as PSAAP, contingent capitation and data sharing matters so much. These issues may not grab headlines in the same way other topics do, but they go straight to the conditions general practice is working under every day. 

Capitation and funding

PSAAP is underway again this year, and one of the major issues on the table is capitation reweighting. That work has been a long time coming. Capitation is the core funding mechanism for general practice, and the proposed reweighting could take effect from 1 July 2026. While the government has said the aim is to better direct funding to higher-needs populations, it has also made it clear that ethnicity will not be included in the revised formula. 

In my view, that is a mistake. Ethnicity should be included, because we know Māori and Pasifika communities continue to face poorer access, higher unmet need, and worse health outcomes. If funding is meant to reflect need, it has to take those realities seriously. 

For practices, this is not abstract policy. The way funding is set up affects what practices can sustain, where pressure falls, and how well the system supports the people who need care most. 

These conversations need to stay practical. General practice needs a funding model that works for today’s pressures but is also robust enough for the future. It is not enough to announce reform. The detail matters, and so does the practical effect. 

Data sharing and system design

The same is true of contingent capitation and the data sharing agreement that sits alongside it. This has been a substantial piece of work across the sector. It matters because any move towards more contingent funding, more reporting, or more formal data sharing needs to be approached carefully and with a strong general practice voice in the room. 

That is also why it matters that respected clinicians from primary care are contributing to wider advisory work in this space. Good system design depends on practical insight. It depends on people who understand what data is useful, what burdens are reasonable, and what happens when policy looks tidy on paper but is unworkable in practice. 

There is wider work underway too, including around the future of PHOs and the accountability settings expected of the primary care sector. The health minister has asked for a clear strategy on the future of PHOs and clinical alliances, and that discussion is now very much live.  

At the same time, the government is pushing harder on access and performance. In July 2025, it announced consultation on a new primary care target requiring more than 80 per cent of people to be able to see a primary care provider within one week. That target is due to take effect from 1 July 2026. 

Final thoughts

In a climate like this, it is easy for people to overstate simple answers. But primary care is not improved by slogans. It is improved by careful decisions, mature leadership, and a clear understanding of what helps practices do their job well. 

These decisions are not procedural. They affect what general practice can carry, and how well it can care for people. That is why this work needs to be done properly.