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Full steam ahead for PHO strategy


Full steam ahead for PHO strategy

Much has been achieved in implementing New Zealand’s primary health care strategy, according to new research released today by the Health Services Research Centre at Victoria University.

Dr Jackie Cumming, lead investigator in the evaluation of the PHO strategy, and a team of national and international researchers, have completed the first phase of the project by evaluating the results of interviews held with more than 160 informants. The interviews were conducted with policy makers, stakeholders, and participants from both within and outside PHOs. The research is funded by the Health Research Council of New Zealand, the Ministry of Health and ACC.

“Overall, there is considerable goodwill and support for the strategy. More than 90 percent of the population are now registered in one of 77 Primary Health Organisations (PHOs) around the country, which is an uptake considerably faster than originally anticipated”, says Jackie.

”Many informants told us that access to care has improved for some groups under the scheme, and they believe that there is better access to care as a result of reduced costs to the patient. Some practitioners felt that they had been given the opportunity to improve patient care, by supervising patients without having to see them in the office and extending consultation times to those who needed and valued the extra attention.

“Some practitioners have also come to believe the prospects are good for their practices in a financial sense, and expressed a more optimistic view of the Strategy and the changes it is bringing about.

“However, there are still concerns about the implementation of the strategy, with some practitioners concerned that their role in the strategy had been inadequately recognised, and that their participation was unavoidable, given the new funding requirements.

“Some were concerned about the moves towards greater perceived control of general practice by government and about the long-term financial implications for themselves and their practices.

“Concerns were also raised by some informants about the targeting of increased funding, with claims that it had been imprecise and that money had been ‘wasted’ on those who could afford to pay, while affordable care was not as available for some groups who did not meet increased funding criteria. But not everyone agrees with this view.”

The report also covers issues related to PHO governance, management, the effects of the strategy on nurses, and the prospect of new services in the future.

“Many informants stated that new initiatives, such as evening hours, focused clinics and extra-practice services were in the planning stages and would begin to widen and improve care now that the set-up of PHOs was complete. Informants also noted the many opportunities that exist under the Strategy for enhancing the role of nursing in primary health care. With the shift to capitation, many activities can now be undertaken by nurses, and informants believed that increasing nursing input would improve cost-effectiveness. Many PHOs have plans to further expand the role of nurses, particularly in the area of improving services for those with chronic illness.”

The next phase of the research, due for release by early 2006, will focus on the results of a postal survey, which will widen the research to include all PHOs and general practices and allow the researchers to quantify the findings. The next phase will also report on changes in utilisation of services, across population groups, using quantitative data.

Dr Jackie Cumming is Director of the Health Services Research Centre, an established centre supported by the School of Government at Victoria University, with a track record of producing high-quality health services and health policy research. Last week she was awarded project grants from the Health Research Council, totalling more than $1.5M, to conduct further research on improving access to health care through primary health care reform and improving performance in New Zealand healthcare, with a focus on hospital outcomes.

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