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O’Connor Speech: NZ Rural GP Network

Damian O’Connor Speech: NZ Rural GP Network and Rural Nurse National Network Conference

Associate Health Minister Damien O'Connor discusses PHOs, the challenges facing rural health professionals and government initiatives to support rural health.

Good morning and welcome to you all. Thank you to the network and the convening committee for inviting me to your second Combined NZ Rural General Practice and Rural Nurse National Network Conference. I appreciate the opportunity to speak.

I understand that you have two keynote speakers visiting from overseas. May I offer a special welcome to Professor Hegney from Queensland and Professor Henry from the United Kingdom. Greetings also to the other speakers from around New Zealand. I know delegates will be looking forward to all the presentations.

The conference is a great chance to come together, exchange ideas and learn from each other in a supportive environment. Before it begins in earnest, I want to take this opportunity to thank you for the excellent and ongoing work you do providing health care for rural New Zealanders. At the same time, I want to acknowledge your colleagues who cannot be here due to workload pressures.

Today, I want to talk about Primary Health Organisations and the way we fund them, the challenges faced by the rural health professionals and government-funded initiatives to support rural health.

The value of the rural doctor and nurse

I am impressed with the theme of your Conference -- "a PRIME Spot" --- chosen to highlight the important place of rural doctors and nurses in this country's health service, and the high quality of their work. I cannot stress how much this is indeed the case, and how pivotal a role you play.

That role has really come to light for me during my travels around the country visiting rural practices and talking to medical staff. I am pleased that you have chosen to highlight the positive aspects of rural practice and rural life at this conference, because marketing and promoting the advantages of rural living is something I am passionate about, and something the government is passionate about. We have to be, in order to protect the sanctity of rural practice and support rural areas, which generate significant, export earnings.

I have been advocating, and will continue to advocate, for rural communities at every opportunity.

On this note, you will all be familiar with Martin London's work and I am glad to see Martin here at the Conference. In a recent article, "Tightening the Fences", Martin identified three main features that make rural practice attractive:

• "clinically, rural practitioners tend to do more; • practices are based on a defined community where there is the potential for high levels of participation in service delivery: • and the rural environment offers open air, space, recreation and often breathtaking beauty".

These are all valid points, but are they getting through? And are they superseding the negative perceptions surrounding rural practice?

I hear a lot about the problems of rural practice and the difficulties in recruitment and retention. Unfortunately, talk of possible solutions is not so common. This government has made a strong commitment to rural health and I will outline this commitment shortly.

Having said that, however, I believe that communities themselves have a responsibility to encourage and assist young doctors or locums to stay in rural areas by providing good support systems. Too often I hear of locums being "thrown in the deep end" and this does nothing to engender long-term attachment to an area. Rather, it is an opportunity missed.

Rural health funding initiatives

The government is listening to rural practitioners and has responded in a number of substantive ways, not least, of course, the $32 million committed up to June 2005 as part of the Primary Health Care Strategy. As you know, there has been money for:

• workforce retention - money is currently being used for direct financial incentives to GPs, as well as for provision of locum services, continuing education for GPs and nurses, and for purchasing equipment including computer links to outside practices. While there have been problems with some DHBs and variation in the utilisation of this money, the situation now seems settled.

• reasonable roster funding - this is a targeted resource aimed at those rural practitioners experiencing onerous on-call arrangements. For example: Ø I am advised that the Canterbury DHB that has used its funding for weekend locum services so that rural Canterbury GPs work no more than one in four weekends; and Ø The Auckland DHB has used its money to employ a second doctor to support Great Barrier Island's previously sole GP; and Ø other areas have recruited additional nurses to support the rural nurse specialists who provide services in remote areas;

• Rural Recruitment Service - the contract for this service was won by the NZ Rural General Practice Network, which is already helping rural practices and providers find rural doctors, long-term locums and nurse practitioners. The Network provided me with a report today advising that 84% of all Rural General Practitioners have subscribed to the service under the short-term locum or long-term locum/permanent GP service. I would encourage those practices that have not subscribed to get their forms in immediately. I am told that the Network is about to announce the first in a series of long term placements very shortly.

There have been other training initiatives which I know will be of interest to rural doctors and nurses. They include:

• a Post Graduate Primary Health Nursing Programme for rural nurses , expected to be finalised by the Clinical Training Agency (CTA) shortly. The programme will include academic papers plus clinical work at an advanced level. I understand the first 20 trainees will enrol for this course in July this year and a further 20 trainees in February 2005. The CTA will cover course fees and there will be assistance with travel and accommodation costs; • as you know, the cap at Auckland and Otago increased by 40 places from the start of this academic year. All the additional students have been sourced from rural backgrounds as the evidence suggests that they are more likely than those from urban backgrounds to choose rural practice; • the success of the Rural Rotations Programme PGY2 (Second Year Post Graduate) is a tribute to the commitment of rural GP trainers to provide the support necessary to encourage younger colleagues into rural practice.

Today, I want to make a further announcement that will enhance rural practice. Last year the government introduced six Primary Health Care Nurse Practitioner (rural) Scholarships. In the 2005 academic year, there will be a further six of these scholarships. A total of $280,000 has been earmarked for these scholarships. The Minister of Health has decided that the PHCNP (Rural) scholarships should become an ongoing programme and has committed funding in outyears for this to occur. This is good news for the rural health team in New Zealand.

I am pleased about these initiatives and I look forward, as I am sure you do, to seeing the short and long-term improvements they will bring to rural practice.

Current and Future Work

Good work is also continuing to bolster the rural workforce. This work includes: • bonding, provided such an arrangement is consistent with bonding processes for other health professionals; • contracting by the CTA to provide a Primary Health Care Nursing (Rural) 800 level certificate from the middle of this year: • exploring incentives for recent health practitioner graduates to take up rural practice; • an after hours services project to be scoped this month; and • a wider primary healthcare workforce project to be scoped by the Ministry this month with a rural focus looking at ways of encouraging recent medical and nursing graduates into rural practice.

So, there's a lot of work going on and many of you here will be involved in that work. I really look forward to the findings and I will be taking a close interest. Primary Health Organisations

I now want to turn to PHOs. Most rural practices are now part of a PHO and many of you here today will be involved in one. Some have struggled to get up and running and I know we have some challenging issues to resolve, especially here in the South Island.

At the beginning of this year there were 33 PHOs that were rural or included rural areas. Today Annette King is announcing 10 new PHOs, including new PHOs in Otago, Southland and Otaki. PHOs are considerably diverse, and while providers and communities have moved towards forming PHOs at their own pace, the speed has still been remarkable. More than three million New Zealanders are now enrolled, with almost one in three New Zealanders having access to lower-cost primary health care as a result.

Yet another important landmark is that from today, all those enrolled in Access-funded PHOs and all under 18-year-olds enrolled in all PHOs --- will now be able to access prescribed medicines for no more than $3 a prescription item. From July 1, all New Zealanders aged 65 and over enrolled in all PHOs will also be entitled to the $3 prescription fee.

In the next phase of PHO development, PHOs will be encouraged to widen their scope of services and rural PHOs are well placed to be leaders in this development. Some rural PHOs started with a broader scope of services as a continuation of the existing pattern of service delivery through their range of service contracts. More PHOs will be encouraged to provide a wider package of services to include well-child or dental health services as an example.

I am disappointed that despite the obvious success of PHOs and the willingness of New Zealanders generally, and health professionals in particular, to become involved, that there has still been unfortunate and ill-informed criticism of PHO funding. The criticism that funding is race-based rather than needs-based flies in the face of evidence and research and my Government totally refutes any suggestion that funding is not needs-based.

But then, so do most of the reputable and informed health academics, researchers and practitioners.

Let me give you a good example that emerged this week. Statistics New Zealand has released the latest data on the life expectancy of New Zealanders, and once again they highlight the significant longevity advantage non-Maori have over Maori.

Life expectancy at birth for Maori girls is 73.2 years, compared with 81.9 years for non-Maori girls. Maori boys have a life expectancy of 69 years, compared with 77.2 years for non-Maori boys.

Some people will always object to race being a determinant of health need. But you will find very few people brave enough to say: "I don't mind if my neighbour dies eight-and-a-half years before I do."

It is clear that the state of Maori health continues to represent a very significant area of NEED, although I am pleased that the average gap in life expectancy between Maori and non-Maori across genders is now 8.5 years compared with 9.1 years in 1995-97.

The inference that can be drawn from this improvement is that funding directed toward Maori health providers, incidentally under initiatives sparked by National in the late 1990s, works. I hope that we will continue to see benefits from the extra funding now being directed into primary health care by our Government.

The future for PHOs is an exciting one. In many ways, rural PHOs, with their already well-established networks and multi-disciplinary teams, where each member is valued for the skills they bring, are well placed to lead the way forward.

..And before I finish, just one more thing.

As a rural MP, I am very well aware of the frustrations you all face over cellphone coverage of your practices.

If a man can't go for a walk with his wife, because his cellphone doesn't get coverage, as I understand the case is in Whangamata, and I assume is the case in other areas around the country, then we need to work on this area of vital infrastructure. I've asked my office to arrange meetings with Telecom and Vodafone, so I can discuss the issue and find out what we can do about the problem.

I will keep you posted on the result. I may have to keep you posted in case the phones don't work!

So, thank you again for the opportunity to speak at your Conference. I wish you all the best for the next two days here in Christchurch.

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