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Chadwick: Improving maternity services in PHOs

14 March, 2008
Improving maternity services in PHOs

Kia ora koutou katoa – thank you for inviting me to join your meeting today. It is wonderful to have this opportunity to meet the members of the PHO Alliance, with 33 PHOs across the country, and an enrolled population of around 2.5 million people.

I am here today to talk about an area of health which is very close to my heart – maternity – and how I feel maternity services can be better connected to the network of community primary health care services now involved with PHOs.

Maternity services are currently funded separately from general primary health care services. This means that the links or connectedness between maternity services and primary health care varies between DHBs and PHOs.

Maternity services in some areas are very well connected to primary health care and Well Child services, while others are less so. Our aim is to improve these links across the board to offer New Zealand women a better overall service and therefore improve Kiwi health.

My responsibilities as Associate Minister of Health focus mainly on women’s and children’s health, and I feel that maternity services are central to these areas. It’s an area of health that we can improve by working better together. The first few years are critical in a child’s development and the Labour-led government is committed to giving all children the best possible start.

Primary Health Strategy
As you will be aware, one of the main aims of the Primary Health Care Strategy when it was introduced in 2001 was to improve coordination across primary health care services and encourage the development of collaborative, multi-disciplinary teams.

More specifically, while the Strategy notes that providers of first-line services will usually involve nurses and doctors, it states that providers of primary care services will continue to involve pharmacists, midwives and a range of other practitioners.

With the establishment of PHOs and the completion of the funding roll-outs last July, the focus of the implementation of the Primary Health Care Strategy will increasingly shift towards ensuring that these aims and a full population health approach are met.

It is encouraging that DHBs and PHOs are becoming increasingly involved in the provision of primary maternity services and this should increase further with DHBs involvement in the strategic advisory group which is looking at issues across the maternity spectrum.

Maternity Services Strategic Advisory
The Maternity Services Strategic Advisory Group has been set up to develop a vision of maternity services in New Zealand, and it is also coming up with a programme of how this can be achieved.

The people in this group have a wide range of expertise including midwifery, screening, obstetrics, general practice, Maori, Pacific and DHB providers.

Initially, the Strategic Advisory Group is identifying three main issues:
• What are the key issues across the maternity sector?
• What strategies could address them?
• And it will then come up with an action plan to achieve them.

A key role for the Group will also be to promote greater collaboration and co-ordination among clinicians and between services, exploring ways that primary maternity and primary health care services could be better aligned with the developing PHO environment.

The Ministry and DHBs will work with the Strategic Advisory Group to develop a draft strategic vision for maternity services, which will then go out for consultation – I urge everyone here to have a say in that process. Once this consultation is done, we will prepare an action plan for maternity services, including goals for the short term and for the longer term.

I intend to widen the sector involvement in this area, and have them reporting directly to me. I will be meeting the strategic group very shortly to assess where they are currently at with their thinking.

I am advised that one current issue relating to maternity services and primary health care is uncertainty over whether midwives are able to access the $3 co-payments on prescriptions for patients enrolled in a PHO.

The national policy is that access to the $3 co-payment is not restricted to any particular health professional with prescribing rights. The original policy indicated that ‘any prescriber working in the PHO practice where the patient is enrolled can issue a prescription eligible for reduced pharmaceutical co-payment’. This can include nurse prescribers, dentists and midwives.

It’s also worth noting that the Ministry of Health considers that prescribers who do not work directly in a PHO or PHO practice can still have access to reduced pharmaceutical co-payments if they are prescribing for a PHO enrollee.

However, prescribers who do not work in a PHO must have an arrangement with it that enables them to determine the enrolment status of their patient. For example, a memorandum of understanding can exist with the PHO about providing access to enrolment information for the prescriber.

While such arrangements require thinking outside of the box, this is what is needed if PHO’s are serious about achieving the aims of the Primary Health Care Strategy to improve health and reduce inequalities.

Section 88
One factor that allows different collegial and employment arrangements to develop is that PHOs are now in a position to hold a Section 88 Notice for Maternity Services.

While I know some people are wary about developing closer relationships between Lead Maternity Carers and PHOs, I’m advised that there are positive results already.

I have heard, for example, that Hauora Hokianga PHO in Northland employs two midwives in a level one maternity unit in their health centre. There are good working relationships between the midwives and the GPs, and the PHO provides administrative support and manages all claiming.

This arrangement would also help support all members of the practice to organise continuing education far more easily than they could as sole practitioners. I commend the efforts that have led to this development, and I’m very interested in hearing of any other similar examples.

To conclude, I’d like to take this opportunity to encourage all of you to think about how PHOs can work better with midwives, so that together we can all provide better primary maternity services to our communities throughout the country.


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