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Rural GP Network and Rural Nurse Conference

Hon. Annette King

30 August 2002 Speech Notes

New Zealand Rural GP Network and Rural Nurse National Network conference

I am delighted to have been invited to open the first combined New Zealand Rural General Practice and Rural Nurse National Network Conference.

The concept behind this conference, Professional Partnerships in Rural Health, is one that could not please me more in terms of the way the Government wants the New Zealand public health service to develop.

I am sure my colleague Damien O’Connor, Associate Minister of Health, is just as pleased to be here as I am. Damien will have special responsibilities for rural health during the next three years.

Those of you who know Damien will know that not only does he represent a predominantly rural and isolated constituency, and so is particularly conversant with difficulties faced by the health sector in rural areas, but that he is also personally strongly aware of the need for New Zealanders, wherever they live, to have access to top-level tertiary services too.

Damien will be my ears and eyes in rural New Zealand for the next three years. I cannot always know exactly what’s going on in every part of New Zealand, but Damien will work closely with rural health practitioners in ensuring we help you deliver the sort of health service you all want.

I believe that rural health professionals will show the way to the rest of New Zealand in achieving our goals for primary health care. Your sector already understands the need for a teamwork approach. That is why you are here together; and why I am so pleased to open this conference.

I want to start today by re-affirming what I see as the three priorities for me in my second term as Health Minister.

Those three priorities are implementing the Primary Health Care Strategy, creating an environment that allows the district health board sector to work as efficiently and effectively as possible across all its responsibilities, including elective surgery and mental health, and continuing to plan and develop a health workforce that meets our needs.

All three priorities impact strongly on the rural health sector, and your sector will, in fact, be an important measure of how well we are doing across the whole country.

Because there is a widespread commitment in rural New Zealand to make a new approach to primary health care work, we have got the most important building block in place already.

Your presence here is evidence of your willingness to share information and experiences, with the ultimate ambition of developing initiatives that can be used around the country to create healthier rural populations.

As I said, I am convinced rural and provincial New Zealand will lead the way in developing the new approach to providing primary health care through Primary Health Organisations, which are not-for-profit organisations of providers.

I was certainly not surprised that the first PHOs that are up and running are in low-income, high health need areas of South Auckland, but I am confident initiatives are close to fruition in places like Gisborne, combining both Maori and mainstream providers, the Far North and the West Coast of the South Island.

There is an old expression that necessity is the mother of invention. There is no denying rural areas have special health needs; and rural New Zealand is where I have found some of the most creative and thoughtful minds in the New Zealand health sector.

The Government accepts that rural communities have traditionally had difficulties retaining adequate health services and attracting new practitioners, but it does not accept that rural practice cannot be satisfying and rewarding if the right environment is created.

The Ministry of Health set up a Rural Expert Advisory Group late last year to address such issues, and this year the group released its report, Implementing the Primary Health Care Strategy in Rural New Zealand.

This plan highlights ways to help create an effective, vibrant rural primary health care sector. The ultimate goal is to achieve accessible and appropriate primary health care services for people living in rural New Zealand through emphasis on the following three aims:

- Creating a context for realising opportunities and supporting locally devised solutions to issues in primary health care

- Ensuring equitable and effective access to an appropriate range of quality primary health care services, which are delivered within the rural community or within acceptable travel times, and

- Developing, maintaining and recruiting a skilled, multidisciplinary rural workforce that works in a cooperative, coordinated and collaborative manner.

Make no mistake, it is easier to roll the aims and ambitions off the tongue than it is to realise them. I understand that fully. But this Government is the first in decades to make a real financial commitment to primary health care. We are putting in more than $400 million in new money over the next three years, and we have got to make it work.

And I am sure that everyone here is committed to working with us to put the strategy and the money to effective use in rural New Zealand.

Many of the recommended actions in the plan are directed at PHOs because, given the diversity of rural communities, they are best placed to come up with locally developed solutions. District Health Boards have to work hand-in-hand with organisations such as rural trusts, Maori health providers, IPAs and other organisations of health professionals to find the best way for PHOs to work within given populations.

The guidelines are deliberately non-prescriptive; some PHOs may operate in relatively small population areas, while others may be large organisations encompassing whole regions. Local areas must come up with the solutions that suit them best, but we are aware that PHOs need resources to assist with this process.

Health workforce issues are the most significant obstacle in the way of implementing the Primary Health Care Strategy in rural New Zealand. Equally, workforce issues determine the speed with which we can implement the Mental Health Blueprint, and workforce issues cause us to have to send cancer patients to Australia. And so on, and so on.

Workforce issues represent the single biggest area of shameful neglect bequeathed to New Zealand by a National Government that believed throughout the 1990s that the market would provide the health professionals the country needed.

The theory was nonsense, and for years we will be struggling to address the shortages of trained professionals. That is why it has become even more important to encourage teamwork in primary health care as one enduring, effective and innovative solution to the shortages we face.

One of the advisory group’s key recommendations is to develop a rural primary health care premium directed to PHOs in rural communities.

This would be aimed at providing a flexible resource to support the rural primary health care team, retain the rural workforce and therefore ensure sustainable, accessible and appropriate primary health care services for rural communities.

I do not propose to repeat all the detail today, but many of you will be aware that I announced on May 30 that $32 million has been allocated over the next three years to support the retention and recruitment of the rural primary health care workforce.

The rural primary health care premium will be in two parts: the first to enable extra payments to support primary health care workers to stay in rural areas, the second to enable those practising in such areas to maintain reasonable on-call rosters.

The workforce retention component of the premium will be a flexible resource for supporting and retaining the primary health care team.

PHOs will also be able to apply a range of retention strategies, for example providing support to enable the practitioner to take extra leave, training support, or a direct monetary incentive.

The amount of funding will increase with an area’s isolation. Rural areas will be graded on the basis of an already-existing rural ranking score. Funding will be allocated for every 1200 people on a practice register.

For example, a practice population of 1200 people, that has a low rural ranking score, would earn a premium of $8900 for its PHO.

At the other end of the scale of isolation, a similar practice population, with a high rural ranking score, would earn $22,500 for its PHO to spend on workforce retention.

Reasonable on-call rosters are important for maintaining rural people’s access to urgent primary health care out of normal business hours as well as aiding practitioner recruitment and retention.

The reasonable roster allowance will be allocated on a case-by-case basis where practitioners are on call every second or third night, or even every night, and where, because of their distance from other medical centres, they cannot share rosters.

The medium-term intention is to make the rural primary health care premium available through PHOs, but I realise some rural communities need assistance now.

Reasonable roster money will be available on application straight away, but only a portion of workforce retention funding will made available through DHBs in the first year. After two years both the money for rosters and rural retention will be available through PHOs. These new payments will be in addition to the existing rural bonus and other rural initiatives.

The Ministry of Health will also be developing a number of national initiatives, as recommended by the advisory group, in areas such recruitment programmes for both short term and long term professionals, incentives to recent graduates to take up rural practice, and funding of post-graduate training programmes. Funding provision has been made.

Our health sector clearly faces difficulties in delivering effective and appropriate health services to its rural communities. This is due in part to the geographical isolation of communities and our small population base.

However, by mobilising communities to seek primary health care and providing people with the ability to participate in the health sector, via DHBs and PHOs, we can make a real difference in peoples’ health.

Today I am releasing a series of papers from the Ministry of Health containing general advice to me on the best opportunities for the health sector over the next three years. Government departments and agencies traditionally present such papers to incoming portfolio ministers in a new government.

I am pleased that the papers from the Ministry happily coincide with the thrust of this week’s Speech from the Throne. That speech emphasised that the Government would continue the general policy direction established since the 1999 election.

The Ministry, whose theme is doing better for New Zealanders, argues likewise that it is essential to build in these next three years on the considerable foundations that have been laid in restoring the public health service over the past three years.

The Government strongly believes that improving the conditions for economic growth is its key task. Health has done very well in terms of its share of the Government’s resources over the past three years. If the country can continue to build the conditions for New Zealand’s long-term sustainable rate of economic growth, then we can continue to direct health resources where they need to be directed.

Thank you again for inviting me today to this important conference, and for welcoming Damien as well.

I would like to close today by reinforcing how crucial it is for GPs, nurses and all health professionals to work alongside each other in rural areas of New Zealand.

Earlier this year I met the spouses of a number of GPs, and gained from then an insight into the effect of the workload of general practice. I know there are many GPs who increasingly question whether they should besmall businesses or simply be doctors.

Issues such as these can be determined as part of locally developed solutions in rural New Zealand.

Provided those solutions all have as their bottom line a common desire to make primary health care affordable and accessible for all New Zealanders - while at the same time making the work as rewarding as possible for our health professionals - we can certainly do better for New Zealanders.

That is my aim, and I am sure you share it.


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