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Launch Of Primary Health Care Strategy

HEALTH Minister Annette King said today the Primary Health Care Strategy looks forward to a time when doctors, nurses and other in the front line of health services are working closely together with their communities to improve health, avoid illness and make sure everyone gets care when they need it.

Mrs King launched the strategy at Tapu te Ranga Marae in Wellington.

"New Zealand has limited resources to spend on all social services. The key to securing better health for people, therefore, is to spend our health dollars where they can do the most good. If we can keep people out of the expensive hospital system, then that makes huge sense."

Mrs King said a stronger population-based approach to primary health care was needed. "This means looking at the needs of groups of people and keeping them healthy as well as just caring for individuals when they get sick. Obviously this change can not happen overnight. But the benefits will start to become apparent in the next year as District Health Boards fund organisations to work with communities and respond to their individual needs and priorities.

"The strategy sets the framework for more preventative care services, better access to services, comprehensive care, and improved coordination between primary health care providers and secondary providers of services.

"The strategy encourages the establishment of Primary Health Organisations and Maori Development Organisations made up of a wide of range of health providers including doctors, nurses, and other health professionals working together. They will be not for profit organisations, funded by DHBs according to the needs of their enrolled populations, rather than just on an individual fee for service approach."

Mrs King said there was international evidence that user charges for health services impacted more on those who were poorer or sicker. "The Government will reduce cost barriers over time, with priority for those with greatest need. As funds become available (either by transfer from other parts of the health budget or through new funds) more support will be given to a wider range of people.

"The strategy also promotes sharing of information. When successful initiatives are put in place in one area, these ideas will be shared with other regions too.

"This document is a high-level document. It doesn't prescribe minute detail about how the strategy will work in each community, because there must be flexibility to meet individual community needs.

"The document takes the wide view. We want our communities to be well, and we'll give them all the encouragement we can within our means."

For more information, contact John Harvey (04) 471 9305. Background questions and answers, and other contacts for information, attached.

Questions and Answers

What is Primary Health Care?

Primary health care means essential healthcare based on practical, scientifically sound, culturally appropriate and socially acceptable methods; that is universally accessible to people in their communities; involves community participation; is integral to, and a central function of, New Zealand's health system; and is the first level of contact with our health system.

What is the New Zealand Primary Health Care Strategy?

The Primary Health Care Strategy sets a clear direction for the future development of primary health care. It is the first time a New Zealand Government has announced such a clear and comprehensive vision of how primary health care should be organised and delivered. It sets the framework for implementing a population-focused health and disability sector at the primary health care level. This means more preventative care to avoid unnecessary hospitalisation, better access to services, comprehensive care and more coordination between primary health care providers and secondary providers of services. It also means good quality care which meets agreed national standards.

What is the New Zealand Health Strategy?

The NZHS provides an overall framework for the health sector, with the aim of directing health services at those areas that will ensure the greatest benefits for our population, focusing in particular on tackling inequalities in health. Primary healthcare is one of the five service priority areas in the NZHS.

What is the New Zealand Disability Strategy?

The NZDS, once developed, will aim to identify how to remove the barriers faced by people with disability to enable their full participation in society. The strategy will identify barriers, goals, action areas and targets across all relevant sectors in order to guide policy and service development.

How is the Primary Health Care Strategy linked to the NZHS and NZDS?

Primary health care services need to be organised and delivered in a way that ensures the best health and independence for populations. The strategy provides direction for District Health Boards. DHBs will work through Primary Health Organisations to achieve local health goals.

How is the Primary Health Care Strategy intended to work?

The Strategy outlines a move to a system where services are organised around the needs of a defined group of people. Primary Health Organisations and Maori Development Organisations will be the local structures to achieve this. They will be funded by DHBs, and comprise primary health care practitioners, health clinics, Maori and Pacific providers. People will join a Primary Health Organisation by enrolling with a general practice or local health clinic that is part of the organisation. Membership of the Primary Health Organisations will be voluntary.

These organisations will work with communities, respond to the needs and priorities of each community and improve and maintain the health of the population, as well as provide first line services to restore people's health when they are unwell. They are expected to involve their communities in the governing process and must be able to show they are responsive to community priorities and needs. Primary Health Organisations will be not-for-profit bodies and will be fully and openly accountable for all public funds. They will be able to contract for services from private, for-profit providers such as general practices or to directly employ doctors, nurses and other health workers.

Will the strategy have any impact on promoting free visits to GPs?

One principle in the NZHS is to ensure timely and equitable access for all New Zealanders to a comprehensive range of services, regardless of their ability to pay. The fees charged for first level care in general practice are a barrier for many people. Reducing or removing fees will help people get the care and advice they need earlier, and keep them well and out of hospital. Under the Primary Health Care Strategy the Government will reduce cost barriers over time. Priority will be given to those with the greatest needs. As funds become available (either by transfer from other parts of the health budget or by preferentially using new funds), more support will be given to a wider range of people.

When will we see benefits of the Primary Health Care Strategy?

The first benefits will start to be seen in 2001. The agreements with DHBs will spell out more clearly than before what primary health care services people can expect in towns of different sizes. Primary Health Organisations will be formed and will build up links with their local communities as well as with the DHB. People will start to enrol with a general practice or health clinic and in that way will join up with a Primary Health Organisation to get the benefit of more coordinated care, with more attention paid to how to keep healthy and avoid disease. Doctors, nurses and other practitioners who provide services will start to work in new ways, eg, ensuring continuity of care for the elderly and those with ongoing conditions, being paid to look after the health of those who have enrolled, and improving referrals to specialists and diagnostic services. Other early initiatives are likely to include projects around rural services and exploring ways to address cost barriers for places where there is the greatest need. As funds become available in future years the Strategy will be able to be widened.

How will funding be allocated to meet the needs of local communities?

Primary health care is a high priority for additional funding within Vote Health as it is central to removing inequalities and improving health. However, more funding for primary health care will need to be considered against other health priorities as well as funding for other areas of Government and DHB expenditure. The first priority for any extra funding will be groups within the greatest health need. Primary Health Organisations will be funded according to the needs of their enrolled populations, rather than on the number of services providers have given in the past. The implementation will be developed and communicated through funding agreements and other accountability documents for DHB performance.

What impact will the Strategy have on the primary health care workforce?

The Strategy will have significant implications for the number, mix, distribution and education of the primary health care workforce. The current mix and distribution of the primary health care workforce has been largely an unplanned response to demand and various initiatives and incentives. The future mix, distribution and education will be managed by a Health Workforce Advisory Committee to ensure a better balance to meet wider needs of New Zealanders.

What impact will the Strategy have on rural communities?

DHBs are expected to achieve minimum standards for first-contact service coverage levels according to the size and geographical nature of the district and its communities. It is accepted that the needs of rural communities require special consideration. The Ministry is facilitating development of a coherent approach to rural health service provision, including the issues of attracting and retaining the appropriate workforce. The HWAC will consider national workforce implications.

Does the Strategy allow for specific services to meet the need of Maori and Pacific people?

It promotes development of Maori and Pacific provider services, as well as improving the delivery of mainstream services for these groups. In recent years Maori have begun to develop specific culturally competent health services for their own people which are usually delivered by Maori health practitioners. Work has also been undertaken regarding Maori co-purchasing and Maori Development Organisations which work to improve the funding and delivery of services to Maori. These achievements will be built on with DHBs continuing to contract with Maori providers. Similarly with Pacific services, new initiatives are emerging which involve a wide range of practitioners and services. DHBs will fund and support further development of Pacific providers and organisations.

What are the benefits of having Primary Health Organisations?

Primary Health Organisations will be required to identify and address those groups in their populations who have poor health or are missing out on services. In addition, primary health care organisations will act as advocates for and involve their communities in finding ways to improve health for the most disadvantaged. Their funding will be based on the population they serve so those with greater need (especially older populations, those from deprived areas, Mäori and Pacific people) will have more funds to address poor health.

How will Primary Health Organisations deal with multiple enrolments by individuals?

Enrolments will be checked against the unique patient identifier - the National Health Index - to determine if a person is already enrolled with a Primary Health Organisation and to ensure there is no duplication.

Will Primary Health Organisations be able to refuse enrolments?

They will not be allowed to refuse people because of their need for health services. However, they may seek to limit enrolments to people within their geographical DHB, though this would need to be approved by the DHB.

Will there continue to be variation in the cost of primary health care?

The Government will reduce cost barriers over time. Priority will be given for those with the greatest needs. As funds become available (either by transfer from other parts of the health budget or by preferentially using new funds) more support will be given to a wider range of people.

What gains have already been made in terms of improving Primary Health Care in New Zealand?

Health gains have already been made in terms of Maori and Pacific Island provider development; various rural initiatives such as the coordinated approach in Dargaville; better use of prescriptions, laboratory tests and other referrals; increased rates of coverage for preventive care; improved collaboration between community and hospital providers; and improved coordination of care, eg, for people with diabetes or in care of the elderly. Some gains have been quite widespread, others are so far limited to certain pilot initiatives.

How will the Strategy develop to meet the needs of future generations?

The Strategy is a 'living document' which will evolve over time as populations, technology and other factors change.

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