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O'Connor speech to NZ Rural GP Conference

13 May 2005


NZ Rural GP Conference

Good morning and a warm welcome to you all at this annual conference of the Rural General Practice Network.

My thanks to Dr Tim Malloy, Dr Michael Miller, the Network Board and Executive and guest speakers for their contributions to the Conference.

It's also wonderful to see such a large number of delegates and supporters from such a range of backgrounds - rural general practices, urban general practices, DHBs, PHOs, Plunket and St John and students from universities across New Zealand.

I’m sure you'll find this conference valuable both for education and networking purposes.

I understand there are also several overseas guests in our midst. May I offer a warm welcome to Dr Jan Muhring from the Netherlands, Dr Katy Roff from the UK and Dr Tom van Herck from Belgium. Welcome to New Zealand; I'm delighted to hear you're either working or intending to work in rural practice in New Zealand. Don’t believe what they tell you, it's a walk in the park.

I'd like to take this opportunity to also acknowledge colleagues who aren't here today because of work commitments. And this includes my colleague, Health Minister Annette King, who's in Geneva on World Health Assembly business.
Annette has asked me to extend her apologies and read the following message on her behalf…

A year is a long time in rural general practice. I feel like the 12 months since I addressed the Network have been jam packed with rural health – learning curves, achievements, challenges and triumphs. And if I feel like that, I can only imagine what a busy year you've all had!

Not wishing to emulate John Campbell, I nonetheless wish to say I'm really very honoured to be here this morning. This is such an important opportunity to come together, exchange ideas and take stock of where we are and what we've achieved.

I'm also very taken with the conference theme, ‘Variety – the spice of rural life’. As Rural Affairs Minister, I absolutely endorse this catchphrase. I can attest to the spice and excitement of rural life in New Zealand and I imagine practicing medicine in rural New Zealand only adds to the zing.

It's very much the variety inherent in rural general practice that makes it so special. But of course, with unique advantages, come unique challenges. These challenges require attention, and I'll address some of them shortly.

Along with its exclusive concerns, the rural health sector is also subject to many of the same health issues as the rest of New Zealand. This is where the Government’s Primary Health Care Strategy works well to reduce inequalities, improve health overall and ensure low-cost access to health care.

The development of Primary Health Organisations underpins all work in the primary health care area. We need effective, efficient PHOs with strong community involvement.

I see the community focus of PHOs and the Primary Health Care Strategy as providing opportunities for rural communities to work together and share decision-making. With these goals in mind we can provide top quality rural primary health care services that are accessible to all rural New Zealanders.

A key challenge that I know concerns many of you is the retention and recruitment of staff.

There will always be difficulties and trade-offs associated with working in rural areas, and we need to ensure it remains an attractive career option for health professionals. Associating it with variety and spice is a good start!

Additional funding is making a difference. I’m sure you're aware - and I'm even more certain I would have mentioned last year – that in 2002 we announced funding of $32 million over three years. Last year, I announced an additional $10.9 million per annum from 2005/2006.

This rural premium comprises Rural Workforce Retention Funding and Reasonable Roster Funding. The aim of this extra financial support is to develop local solutions for local needs, and ensure sustainable services and retention of the rural workforce.

But the funding is only a partial answer. We need to work together to develop effective strategies to create favourable working conditions and deliver high standards of community health care.

Creating supportive professional working environments, access to professional development, time off duty, financial incentives and the ability to enter and leave rural practice with minimum restrictions are just a few ways we may be able to solve some of the retention and recruitment problems.

Ongoing analysis of how to best meet the needs of the rural sector is crucial. In February I hosted a rural health forum in Wellington that brought together a range of health professionals, community representatives, academics and government officials.

It was a really good day. There was frank and honest discussion around the issues facing primary health care in rural communities, the main ones being retention and recruitment. As a result of the forum, the Ministry of Health is currently reviewing rural workforce retention funding.

The Review is likely to consider issues such as eligibility, the Rural Ranking Score, how well this funding supports the wider primary health care team and the possibility of applying this funding to a wider range of health care professionals, such as midwives, pharmacists and allied health professionals. I have asked the Ministry to consult you throughout the review process.

Access to accurate data is also essential in managing rural workforce issues. The Ministry of Health is currently seeking proposals from the rural sector to complete the annual rural workforce survey for 2003 and 2004.

Another challenge facing rural health professionals is onerous on-call arrangements. Reasonable Roster Funding is a targeted resource to be applied in locations where, for geographical reasons, doctors and nurses providing first level services are experiencing difficult on-call arrangements.

Of course it's not enough to simply focus on retaining and recruiting a rural health workforce. We need to provide opportunity for those already on board to train further and upskill.

The Government's Primary Health Care Nurse Practitioner (Rural) Scholarships recognise the importance of upping knowledge and skills. They also recognise the valuable contribution rural nurse practitioners make to improving the health of rural New Zealanders.

Acknowledging that rural nurses face difficulties in accessing post-graduate education, we provided $240 000 last year to help six registered nurses complete their study in order to gain nurse practitioner status.

This year a further $280 000 in scholarships is being provided. We can all look forward to the new and enhanced skills of these nurses being applied in the delivery of health care in rural areas.

Providing timely and effective emergency responses is an extra responsibility often taken on by rural GPs and nurses, who are far from hospital emergency departments and specialist services.

Rural GPs and nurses have long played an important part in the rural emergency response team, providing additional skills and expertise to support rural ambulance services.

The PRIME system is intended to provide the support necessary for this important role – namely training, equipment, remuneration, communication and quality review.

I'm aware that there has been some inconsistency in the development of PRIME. It hasn't been implemented smoothly in all parts of the country and support has not always been available or appropriate.

The Ministry of Health and ACC have taken these concerns on board and are working to address them. Improvements in the availability of training and equipment are already occurring.

Rural practitioners will be consulted on and participate in future developments to the PRIME scheme.

Accessible, effective and sustainable after-hours services continue to be a challenge in rural areas and elsewhere. This was another issue that stood out at the forum.

To address this challenge, a joint DHB/Health Ministry led Working Party has been established, with members drawn from professional medical and nursing groups, rural and Maori providers, accident and medical services and PHOs.

I'm sure that Tim Malloy, who is a Working Party member, will see to it that rural issues get consideration.

Supportive communities and close-knit networks have a key role to play in supporting our rural health care professionals.

As such, I'm pleased to be able to tell you about the newly formed Community Council, another avenue through which rural issues can be raised and discussed.

The council is designed to offer a community perspective on the implementation of the Primary Health Care Strategy and the development of PHOs. It's the community equivalent of the PHO taskforce and is comprised of community members on PHO boards.

The Council's work and advice will align with the key directions of PHOs, which are to work with local communities, identify and remove health inequalities, offer access to comprehensive services, co-ordinate care across service areas and continuously improve quality.

We're also working at the community level with Local Government New Zealand. Following the success of the rural health forum in February, I called for a half-day health forum for local government officials. This will be held at the end of June and will involve Mayors and council chief executives in particular. I see it as another opportunity to promote rural health issues.

So there's a round up of all the good work going on to assist rural health practitioners.

National Travel and Accommodation Policy

I'd now like to use this platform to announce some very exciting news for rural health consumers.

As you'll know, there are currently several travel and accommodation policies in place to assist those travelling long distances for specialist care. Eligibility, reimbursement and administration under these schemes vary between DHBs, which has caused frustration and been a bone of contention for many rural people.

I'm pleased to say, come January, a new improved national Travel and Accommodation Policy will come into effect. In what marks a big investment by the government, the policy will be worth $36m annually and will extend eligibility to tens of thousands more New Zealanders. Most of these people will be rural.

The policy specifically targets those travelling long distances, those who incur high travel costs as a result of frequent specialist visits and those finding it difficult to access specialist services because of low income. These people will receive assistance with their travel and accommodation costs.

From 1 January HealthPAC will administer all travel and accommodation claims, meaning claimants only have to call one toll free number for information, regardless of where in the country they live and where they need to travel. Those who are eligible can expect reimbursement within a few days of travel.

During my time as Associate Health Minister, I've received a lot of letters from rural people frustrated at the current policies. The changes I'm announcing today will make a huge difference for these people and many others. It's imperative that all New Zealanders, no matter where they live, have access to timely, quality healthcare and it's very exciting for me to be able to offer these improvements to rural New Zealanders.

At the end of my address to last year's Network conference I mentioned the difficulties a Whangamata doctor was having going for walks with his wife. For those of you who weren't at the conference, this may sound like more of a personal matter than one pursuant to rural general practice, but it was mentioned in the context of cellphone coverage, or lack thereof, and the limits this places on many rural GPs.

I've since met with Telecom to discuss the issue and see if we can't find a solution. As a result, Telecom is exploring the capabilities of the CDMA/ Sat phone, which flicks over to satellite when you fall out of Telecom's network coverage. In other words, you should get full coverage at all times, minus a few very isolated spots.

Such a device has the potential to transform the lives of rural GPs – you'd no longer be confined to your homes when on call. Think of all the golf!

Telecom has said it's intent on bringing the unit to market, but there are still t's to be crossed and I's dotted. The unit must be technically tested and certain approvals granted. I understand Telecom will talk more to you about this tomorrow.

This Conference is a prime opportunity to further the collaboration, innovation and community responsiveness already alive and kicking in the rural sector. I'm pleased to note the Conference Programme reflects the Conference theme, with a wide variety of educative and practical sessions. There's definitely something for everyone!

Now, like any good government minister, I keep my ear close to the ground, and I'd like you to know I've heard rumours with regards the dramatic prowess of certain Conference delegates, due to be revealed during the performance segment of tonight's Conference dinner. So let me wish you all the best, for your respective performances, for your conference and for the year ahead.


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