Significant Extra Funding For Rural Health
30 May 2002
GPs, Nurses and other health workers serving rural communities will receive extra funding of more than $32 million over the next three years as the Government extends its primary health care funding package in rural New Zealand.
Health Minister Annette King today announced she had accepted the recommendation of the Rural Expert Advisory Group that a primary health care premium be paid to help rural areas retain a skilled health workforce.
Ms King said the actual additional funding allocated over the next three years was $6.5 million in 2002/03 and $12.9 million in each of the two subsequent years.
The total of over $32 million is in addition to $4 million allocated to the rural bonus scheme and $1 million in each of the next two years for the rural locum scheme. It is also in addition to funding for primary health care to be delivered through Primary Health Organisations, many of which are likely to be established first in low-income, high health need rural areas.
"This package is important not only to reassure rural communities and to recognise doctors, nurses and other health workers who serve them, but also to underline our commitment to primary health care as the way forward for all New Zealanders," Ms King said.
The rural primary health care premium will be in two parts, the first is to enable extra payments to support primary health care workers to stay in rural areas, and the second to enable those practising in such areas to maintain reasonable on-call rosters.
The amount of the premium will depend on how isolated an area is. In Matamata, for example, a practice population of 1200 people would be paid a premium of $8900 this year while at the other end of the scale a similar practice population in Reefton would get $22,500. Rural areas will be graded on the basis of an already-existing rural ranking score.
"Our intention is to make this money available through Primary Health Organisations, and I know that in many rural areas there is a lot of interest in setting these up. However we are well aware that some rural communities need it now. I am currently looking at how best to make the money work straight away."
Ms King said the reasonable roster allowance would be allocated on a case-by-case basis - targeted at practitioners who were on call every second or third night or even every night.
"Establishing reasonable on-call rosters is important for several reasons. We need to maintain access for rural people to urgent primary health care out of normal business hours as well as aiding practitioner recruitment and retention. While rural New Zealand has a lot to offer a doctor and his or her family as a place to work and live, it is important that they have adequate time to enjoy it."
Ms King said the measures were the first elements in a more comprehensive rural health package still being developed.
"In the next financial year we will be working on two national initiatives to strengthen the viability of the rural workforce.
“The first will be a national recruitment service that will enable the current locum service to continue, and extend to long-term placements and permanent recruits. I will also be investigating incentives for new graduates to take up rural practice."
Today's announcements of rural support are one component of the primary health care funding package. Other components of the package may also benefit rural populations, such as, for example, funding to set up Primary Health Organisations in areas of high need and low income.
The Rural Expert Advisory Group is a group of people from the rural sector, including doctors, nurses, Maori groups, Health Care Aoteroa and DHBs, set up by the Ministry of Health.
CURRENT RURAL INITIATIVES
The new funding to support the rural primary health care workforce builds on a range of support already in place.
The rural bonus payable to rural GPs according to a rural ranking scale, which takes account of:
- travelling time from the practice surgery to a hospital
- on-call duty
- on-call for major trauma
- travelling time to the nearest general practitioner at place of work
- travelling time to most distant practice boundary
- regular peripheral clinics.
GPs are ranked according to a 100 point scale from the minimum amount of $3000 to those scoring 35 points up to a maximum of $21,000 for the highest score. The Government spends a total of $4 million each year for rural bonuses.
The Rural locum support scheme commenced earlier this year with funding of $1 million each year for two years. The locum services to be provided under the Rural Locum Support Scheme (when sufficient locums have been recruited) and already provided by the Northern Rural General Practice Consortium provide around two weeks of subsidised locum service to rural GPs to enable them to take breaks for both continuing education and relief.
The Government has also provided $11 million in total for the bridging programme to train 250 Overseas Trained Doctors and get them up to NZ Recs exam standards so they can practice in New Zealand.
PRIME (Primary Response in Medical Emergencies) services have been established in rural localities. This service is co-ordinated by Order of St John and is funded by ACC and Health. GPs and primary health care nurses in designated rural localities receive specific training and equipment for emergency care and work with the ambulance services to improve outcomes from rural emergencies.
Training support for rural general practitioners, including:
- Certificate/Diploma in Rural Primary Health Care
- Diploma in Rural & Provincial Hospital Practice
- Rural rotations for doctors in the second year after they graduate
- Additional bursaries for doctors placed in a rural practice for the General Practice Vocational Training Programme
- Support for attendees to the General Practice Vocational Training Programme in a specific rural location
WORKFORCE INITIATIVES UNDER DEVELOPMENT
Primary health care nursing innovations funding will support the development of new models of primary health care nursing. This will allow new models of nursing practice to develop and reduce current fragmentation and duplication of services and assist in the transition of primary health care delivery to PHOs.
National recruitment initiatives will be developed during 2002/04. These will include a nationally organised recruitment service to assist with finding locums, long term replacements and permanent recruits; and incentives for new graduates in areas of skill shortage to take up rural practice.