Jo Goodhew MP

National Party Associate Health Spokeswoman

19 July 2008

Address to Royal New Zealand College of General Practice, Queenstown.

Good morning.  Today I am going to talk particularly on how you in primary care will play a pivotal role in the future of the health system, and ideas to deal with the health workforce crisis. I am also going to touch on why we need a new approach for the future of health.

Background

My eleven-year background as a Practice Nurse in a Timaru general practice equipped me with an understanding of the importance of the General Practice team in the provision of healthcare to New Zealanders. I have seen first hand the regard that your patients hold you in and have had the privilege of being part of a general practice team.

I can tell you, National is ambitious for the country’s health service. We believe New Zealanders could be getting much better service for the investment they are making.

Consultation

From the feedback on our 50 page health discussion document, ‘Better, Sooner, More Convenient’ it is clear that hundreds of New Zealanders feel strongly about the health service and making it perform better than it currently does. Patients, clinicians and organizations told us of the frustrations in their own experiences of the health sector.

Despite a doubling of the health budget, New Zealanders have to be sicker to get elective surgery and, on a population basis, fewer people are getting surgery than eight years ago. 

And this is a real challenge. Research by Victoria University shows surgical output needs to grow by around 51% from 2001 to 2026 just to deliver the inadequate current levels of elective surgery, and grow by 77% to address real elective surgery need.

All around the country patients tell us they are waiting longer for care, including waiting longer to see their local GP.

Primary Care

To respond to the future public demand for more personalised care, closer to home, National looks to primary care as a major part of the solution. And we will ensure funding to make this happen.

Faster Access To Tests And Treatment

National believes that more of the diagnostic and outpatient services currently carried out in hospitals should be provided in primary care.  We want to facilitate your patients’ access to specialist diagnostics like CTs, ultrasounds and colonoscopies. Community-based cardiology could provide much earlier access to ECHOs and other cardiology diagnostics.  Direct referral to community-based services will improve patient access.

We want to help GPs and hospital specialists to provide specialist assessments (FSAs) in the community, in primary care. We want to see your patients access more minor surgery, by specially trained GPs.

Integrated Family Health Centres

But the failure to move healthcare from secondary to primary care in any significant way, despite its constant re-statement as a policy objective, is one of the greatest puzzles of health policy over the past few decades.

British academic Professor Paul Corrigan suggests that the lack of critical mass in a general practice – small scale – has been the main barrier.  Issues like capital, operating costs, and personnel, prove daunting for any small business looking to change its configuration.

Unlike Britain, general practice in New Zealand has evolved over the past 15 years to be strongly networked, with high levels of clinical competence and a wide range of innovative services.

There is an opportunity to build on these advances.  We've worked closely with many in primary care to progress our thinking in this area.

National believes that, multi-disciplinary Integrated Family Health Centres bringing together a variety of health services in a convenient location will provide patients with a wider range of health services, faster.

Not every general practice will want to become part of a large multi-practitioner health centre, nor will there be any requirement for them to do so.  Smaller practices provide quality care and will choose to operate as they see fit.

Ultimately, patients have told us that they want quality care, sooner and as close to home as possible.  They also tell us that they want to know that the fees they pay are reasonable and will not rise unchecked.  National will, for that reason, maintain the GP fee review process and we will work with you to reduce associated cost and bureaucracy.

After Hours

General Practice is far from immune to the workforce crisis.  Recent research has shown that the provision of After Hours care is putting unworkable pressure on the goodwill and work-life balance of an already stretched workforce.

Unfortunately the emergence of After Hours as a critical issue, and the subsequent setting up of the After Hours Working Party, is now three years down the track and the Ministry has yet to achieve a full quota of DHB plans to address the issue.  In fact, at the NZMA CME conference in Rotorua, the Associate Minister was unaware of the issue and asked you to write to the Minister about it.  Needless to say there appears to be a lack of urgency in addressing this.

National’s health discussion paper looked at the after hours telephone triage service operating in Tasmania.  The telephone service integrates with general practice - with only 7% of calls ending up with the local on-duty GP.  The service can even book business hours appointments for patients with their local GP.

Workforce

On the workforce front, National will apply a multi-pronged approach to address the growing health workforce crisis.  By contrast, since 2000 the Government’s response has been numerous committees, and a staggering 54 workforce reports.  54.  Now we really know what paralysis-by-analysis means.

National’s discussion paper proposed practical measures to address the workforce crisis including increasing the number of funded medical student places, more rural immersion and voluntary bonding through student loan write-offs in hard-to-staff areas and specialties.  

National understands that money talks when it comes to retention, but, it’s not the prime motivator for many.  Any health professional will tell you that if they feel under-valued, feel like part of the problem rather than part of the solution, and feel more of their time is spent consulting with paper rather than patients, then they will look for a change, or head overseas.

Improving job satisfaction will have a significant impact on New Zealand's ability to retain and recruit health professionals.  Reducing command and control bureaucracy will make a big difference.  Improving access to new medicines and modern equipment will also help in retaining and recruiting health professionals.

New Zealand Health Strategy  

I don’t need to tell you that much needs to be done to realise the potential of the Primary Health Care Strategy.  Even the former Minister, Pete Hodgson said progress had been slow and patchy.  Our ideas for faster access to tests and treatment, and integrated family health centres will set things moving again.

Overarching that PHC strategy, and the health system in general, is the New Zealand Health Strategy.  Released in 2000 with its 13 health priorities and 61 objectives, the strategy is looking tired, dated and outmoded.

Major national and international trends have developed since then.  Consumer choice, lifestyle changes, and technology are changing the way all services are being delivered.  Our population is aging, with significant shifts north.  The private sector could do more to supplement public services.  Workforce shortages are endemic.

National believes the future lies in working together, primary, and secondary – public, and private, with a good lead from the government.

New Zealand’s Health Strategy needs to reflect the changing demands of New Zealanders for a more responsive health system.  

Partnership

National believes that you - committed health professionals and your teams - want better for your patients, want more recognition and scope to do your job.

National seeks to deliver that to you through a new partnership with the health professions. A partnership that involves you in the planning, the delivery, and the leadership of health services.

National is ambitious for better healthcare for New Zealanders and there is no more important ingredient in that mix than you.

Ends

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