Ka mua, ka muri is a Māori proverb that expresses a great truth around a simple image: a person walking backwards into the future. It suggests the past is clearly visible but the future is not, we have imperfect information for the road ahead, but also that this is a natural state of affairs. We can look back for clues to the way forward, but we must understand the future is unwritten.
This time last year we had no idea of the challenges and learning to be gained from the year ahead. Last year while we were taking our summer break, or alternatively working flat out providing primary care to those taking theirs, I imagine some of us were also planning some overseas trips that have not been taken. I should be in London now for Christmas with our kids and family but I'm forever grateful I’ll instead be taking a break in the relative normality of Aotearoa. At least we can see light at the end of a long tunnel with a vaccine on the way, and with it, hope that a national roll-out is well coordinated.
2020 with the pandemic - whilst a very challenging year for primary care - demonstrated in buckets the value of organised general practice, and for me, the privately-owned general practice model. Continuity of care (often quoted, but a woefully undervalued characteristic) and high performing teamwork underpinned the ability for primary care to shift overnight to a virtual, but safe, model of care for patients. These of course are what makes primary care such excellent value all year round. Listening to many of you over the last month or so however, it’s clear that the general practice ‘sponge’ is full and in some cases weeping (in more ways than one!). Our data shows how much complexity has been absorbed within existing capacity, and is at its limits. As you are no doubt feeling, this takes its toll on the workforce but also starts to diminish the potential value. This is a system leadership issue and as I tweeted last week; some parts of the health system have become obese whilst others are severely malnourished.
So as we see system reform play out, 2021 will be the year for protecting what we know works in primary care whilst also being open to addressing the system issues and inequities highlighted by the review. I think we are at a crossroads as a health system where politicians will have to put their Christmas cards on the table as to what they really value.
We can certainly expect some disruption, both actual and perceived. Andrew Little has made it clear he sees the reforms being completed within two years and in my experience this means some system paralysis as the focus moves from service development to structural change. I think our role as a PHO is to keep the noise to a minimum so that primary care can continue to work efficiently but ensure the value and positive change required for effective primary care is heard loud and clear. To this end, I shall be spending more of my time in the next few months, advocating on behalf of general practice and undertaking some specific pieces of work to quantify the increased complexity and workload that has absorbed, particularly from specialist care. We also need a coherent story as to what it could do more of (if funded appropriately of course) to inform future structural, funding and contracting models. As such, I’m pleased to announce that Justin Butcher, whom many of you will know, is stepping into a deputy CEO role so you may see and hear a bit more from him.
But let’s celebrate the positives too! Together we’ve achieved some very positive things this year in spite of the challenges. Ongoing telehealth development, new service models like marae-based services and primary care mental health, a very successful practice nursing conference, leadership programmes for nurses and practice managers, practice strategic business planning to name just a few.
I’ve been having some conversations with practices and GPs around the network about the future team model of general practice, the unique contribution of individual members and GPs acting more as consultants to highly skilled teams. More about this in my next blog.
Lastly, a huge thank you again from the Pinnacle crew for all your hard work this year maintaining high quality primary care services as without that, the system would fail. And a personal thank you from me for your support and engagement over the past year. I’ve worked in primary care for over 25 years and it’s because there are no better people or teams to work alongside. Truly. Here’s to 2021!
Meri Kirihimete to you all and we hope you manage to get some well-earned rest with friends and whānau. I will be first point of contact over the Christmas and New Year period so if you need PHO support please ring me, my details are below.
Helen Parker, Chief Executive
021 925 812