Tony Ryall

30 March, 2009
Speech to New Zealand Rural General Practitioners' Network

Thank you for the invitation to speak here at the New Zealand Rural General Practice Network, Annual Conference. It is a privilege to address an organisation as committed as this one is to improving health services for rural communities.

The work of the GP Network extends well beyond just General Practitioners.

Yours is a broad sector involving clinicians of many disciplines with a vital interface with the local community. This is evidenced by the many exhibition stands present during the conference and from the diverse roles of conference participants.

Last evening I was pleased to be able to take part in the awards ceremony and to present the Peter Snow memorial award. Peter Snow was an extraordinary rural clinician and community leader and I was honoured to have been invited to present the award that acknowledged this great man.

I extend my congratulations to all the awardees.

The Government recognises the important role vibrant rural communities and families play in New Zealand and we are committed to ensuring the sector continues to thrive - even though we face a significant challenge in a worsening economic situation.

The Government is committed to supporting health professionals working at the frontline and despite the economic climate we will maintain the current funding for rural primary health care.

Now more than ever it is vital the sector gets maximum benefit from that existing funding and I'm pleased your organisation will be undertaking a joint work programme with the Ministry of Health to look at frontline support for rural primary care.

Rural General Practice funding has several different components - the rural premium, rural bonus and rural after- hours funding. In the project, the New Zealand Rural GP Network and the Ministry will together look for ways to best use this funding.

The project is expected to take up to two years, with any changes expected to be put in place in 2011, though a detailed timeline is yet to be developed.

In the meantime, the current rural funding - the $4 million rural bonus and the $11 million rural premium - will continue to be allocated via existing funding mechanisms.

The additional $5 million for rural after-hours services will be allocated to general practices on the basis of the Rural Premium Funding Formula to those practices actively participating in a rural after-hours delivery during this period of time.

The Ministry/Rural GP Network joint project will enable you to play a more strategic role in the development of rural health provision.

Raising the Travel Allowance

I am pleased to announce that the Government is raising the travel allowance that patients can claim if they are referred by their specialist to another specialist and have to travel long distances or frequently.

The amount that people can claim under the National Travel Assistance Scheme hadn't been reviewed for twenty years, so tomorrow I'll be announcing a 40% increase, from 20 cents per kilometre to 28 cents per kilometre.

I know that even this 40% increase will not cover the actual cost of travel for people, but in tough financial times every bit extra will help. Especially for rural people who have health issues that are not easy to manage close to home.

We want nurses and doctors to be much more involved - to have much more influence on the way health services are delivered.

So as the new Minister of Health I was keen to change the rules to the way nurses and doctors become representatives on the councils that regulate their professions.

Unlike the previous administration which wanted to control and appoint every last position, this government trusts health professionals.

We believe you can make a significant contribution to the regulation of your professions - and you should be able to choose which among you will have direct influence.

The first elections to the Nursing Council will be held in September 2009, when two health practitioner members will be elected for a term of two years. The next elections will be held in 2011 when the three health practitioner members will be elected for a term of three years. The elections will be run by the Nursing Council.

The remaining members of the Nursing Council, three health practitioner members and three lay members (which includes one extra) will be appointed by the Minister of Health.

The government has also given doctors the final say in electing four out of the eight health practitioner members of the Medical Council. And congratulations to those elected.

(The council also has four lay members appointed by the Minister).

We are serious about creating greater clinical leadership in the public health system.

Globally, clinical leadership is recognised as a fundamental driver of a better health service and our doctors and nurses have been waiting nine long years for that.

I have also issued a significant document called 'In Good Hands' which was written by clinicians, and which will help District Health Boards introduce greater clinical leadership and governance into the public health system.

For the first time ever, the new Government has instructed District Health Boards to institute effective clinical leadership and we will hold Board Chairs accountable for it. They in turn will be required to hold their senior management teams accountable for achieving genuine clinical leadership and engagement at all levels of health service delivery.

Clinicians themselves will have to step up and take on the responsibility and accountability that goes with a much greater leadership role. The principle is clear: if doctors and nurses are being held accountable for the quality of the care they deliver, they should have the power to engage in how those services are delivered.

This will not mean getting rid of good management in our health services. Nor is it about our leading doctors and nurses giving up patients to be managers.

Our nation's best health managers know that clinical leadership is key to the health services' success.

We want to use the wealth of frontline experience nurses and doctors and other health practitioners have accumulated to improve quality of care and rebuild confidence in the public health system.

Better clinical engagement will improve quality and job satisfaction. This will help the public health service retain skilled clinicians and attract new staff.

Along with that we will challenge the health professions to become leaders in improving the delivery and quality of patient care across all parts of the health system; to work collaboratively with management; and to deal effectively with any poor standards of practice where you see it.

Government's Priorities in Rural Primary Health Care

We'd Iike the Network and the Ministry to work together to develop the Government's priorities in primary health care.

We want GPs with special skills to provide a wider range of minor surgery in their clinics and improve the ability of GPs to refer patients directly for specialist diagnostic testing, where this is clinically appropriate.

Solutions for better, sooner, more convenient primary health care in cities and towns will not necessarily be appropriate for the country. That is where the Rural GP Network can advise the Ministry. Especially around the further development of primary health care including Integrated Family Health Centres and shifting secondary services into primary health care.

Workforce

The joint work programme on frontline support for rural primary care also demonstrates the Government's commitment to address the crisis facing our health workforce.

New Zealand is desperately short of nurses, midwives and doctors.

The Government is committed to addressing the crisis we have inherited in the health workforce which is often most keenly felt in rural areas. Your own Network has done research into barriers to the recruitment and retention of young doctors and nurses in rural areas.

Voluntary Bonding Scheme

One of the Government's key policy measures for tackling workforce challenges is the Voluntary Bonding Scheme.

The Government launched the Voluntary Bonding Scheme as part of our 100 Days Action Plan.

This fresh approach will offer student loan debt write offs and cash incentives to encourage young midwives, doctors and nurses to stay in the country and work in hard-to-staff specialties and communities.

Research shows that the longer new graduates stay in a community or specialty during their training years, the more likely they are to stay on once their training is complete. The new voluntary scheme will encourage career choice and encourage qualifying professionals to establish their careers in New Zealand.

We discussed with sector representatives which specialities and areas were hardest to staff and we've built the scheme with flexibility in mind so that it will be as responsive as possible.

Hard to staff areas for doctors and midwives include DHBs with large rural components such as Northland, Tairawhiti and West Coast DHBs. Hard to staff specialties include General Practitioners.

In the first year the scheme is expected to cover 100 doctors and 250 midwives and nurses, working for up to five years in areas with critical workforce shortages.

Another similar sized group will be added to the scheme each year. When fully in place the $10 million a year scheme will result in up to 500 doctors and 1,250 nurses and midwives a year working in either hard-to-staff specialties or areas.

Increasing GP training places and GPs

The Government is also investing in an expansion of medical student places, and GP training places. We will increase funded medical school places by 200 (from the current 365) over five years, starting in 2010. This will help New Zealand move towards self-sufficiency in the medical workforce, and focuses on the Government's plan to move health funding towards frontline services.

We are aiming to increase the number of GP registrar training places to 154 per annum. This increase in numbers has begun, and is designed as a short term measure to address New Zealand's GP workforce shortage.

More of this training needs to be in rural and provincial areas as research shows this will increase the likelihood of trainees going on to work in such areas. The Government will establish a fund to help rural GP practices take on rural immersion students, which will encourage more medical students to do more of their training in rural and provincial areas.

Ministerial Group

As you know, the new Government has inherited a health system that is struggling. The previous government left an overstretched workforce, growing concerns about frontline services, a burgeoning health bureaucracy, and growing calls for doctors and nurses to have more say in their health system.

However the Government is committed to supporting health professionals working at the front line. You may be aware of my announcement of a Ministerial Group to advise on improving the public health system.

The Group includes some of the most experienced and capable health and financial professionals in New Zealand. It will review health spending and bureaucracy to improve services to patients.

As an outcome of the Group's review, I expect some existing programmes, committees and strategies will disappear so funds can be reinvested back into improving patient services and supporting our frontline staff. Every dollar saved will go back into frontline care.

The Ministerial Group will also investigate ways to give nurses and doctors more say over how the health system is run. It will complete its work in six months and disband.

Closing

As I have outlined, the Government is committed to supporting you as you work on the frontline of rural primary care. I look forward to a constructive relationship with you as the Government works towards delivering better, sooner and more convenient health services to all New Zealanders.

Each of you here today is committed to improving the health of New Zealand's rural communities through high quality general practice care.

Thank you for everything that you do.

Enjoy the conference this weekend and return to your homes safely.

ENDS

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