You may soon read in the press that Taranaki DHB is enrolling patients into its new practice in Hawera hospital. This episode raises significant issues not only for maintaining the integrity of comprehensive primary care, but also how the integrity of collaborative system leadership, partnership and informed service development with communities must be maintained and fought for.
We have, with our South Taranaki practice teams, been working with the DHB over the last year or so to develop a community health hub model of rural care, integrating rural hospital teams with primary care and other service providers.
The DHB decided, without consultation, that it would establish its own enrolling practice (using rural hospital specialists who are vocationally trained and a nurse practitioner). The DHB applied to Pinnacle in late September 2020 for a PHO contract, stating local primary care had failed in the locality. We declined the application on the basis of no consultation, no data or other evidence provided the locality had worse outcomes or challenges compared to other rural communities, or how adding another practice in the locality would improve care that investing in existing services wouldn’t achieve.
Underpinning all this of course is the firm principle that DHBs are not experienced in providing high quality primary care, and have only taken on practices in other areas of the country as a last resort and with a PHO contract. (Taranaki DHB applied for a Section 88 contract which was also declined.)
In early January 2021 our South Taranaki practices began to receive note transfer forms from patients ‘enrolling’ with the new practice. There has been no communication from the DHB to the practices, or us, about this despite our numerous requests. Furthermore, the DHB are not able to charge a co-payment, so are funding a free general practice service in a way they don’t fund existing primary care.
The Pinnacle Board felt a line had been crossed where we had no choice but to raise our significant concerns directly with Minister Little.
Notwithstanding the lack of policy framework for a DHB setting up an enrolling, free practice without an aligned contract to do so, why would the Ministry support the establishment of a new primary care commissioning contracting model three months out from the release of the system reform plan... this is the thin end of a precarious wedge for ensuring we maintain and invest in strong primary care as a country.
Yet again it shows the degree to which some DHBs have a complete lack of understanding about delivering comprehensive primary care. We are all aware of increasing access issues to specialist services and diagnostics - and the impact this has on patient care. Yet as primary care providers we wouldn’t set up our own specialist services as the preferred response would we?
As yet, we have had no response from the Minister, although we understand he is gathering information from the DHB and primary care teams within the Ministry and will take a position very soon.
We have also raised our concerns with Dr Shane Reti, Shadow Health Minister - and the College who wrote to Ashley Bloomfield echoing our concerns.
Whilst we are of course still committed to developing primary care and community services for the Taranaki population in collaboration with the DHB, this is probably one of the most important stands we are, and should be, making on behalf of all general practices and their communities - especially in the context of a pending system reform.
I also want to acknowledge the patience and professionalism of the South Taranaki practices who have been caught in the middle of this political storm, have seen the continuity of care for transferring patients disrupted and continue to work with us, and together, to improve services and models of care.
Helen Parker, Chief Executive
021 925 812