By Mark Vella
CEO, Total Healthcare PHO
There are a number of positives in the Government’s recent Health and Disability System Review and its focus on population health and wellbeing, but I also have a number of concerns.
Total Healthcare PHO endorses GPNZ’s support for the broad direction of the report and, in particular, we applaud its acknowledgement of the long-term funding issues facing general practice; the focus on improving Māori health; its long-term planning approach; its focus on health data and technology; the development of a workforce based on service needs; and attention to facilities and equipment planning and development services.
However, I am concerned about the review’s focus on structural rather than functional changes that are needed to deliver better outcomes for local populations.
Extra load for primary care
Currently, general practice gets just a little over 5% of a multi billion dollar health spend and yet the majority of need is in the community. Total Healthcare’s providers are seeing more than 3,000 patients a day, or 1 million patients a year, a fraction of that seen on a busy ED day in hospital.
The DHBs will need to recognise the extra load that is proposed by the review on primary care providers whose job it is to prioritise patients’ needs, especially those with high needs. However, there is the real risk that any opportunity we have now to increase discretionary funding and services for this population could be diluted by competing demands within a much larger new-look DHB.
I agree with the GPNZ that robust systems will be needed to prevent hospital projects or deficits swallowing up funds earmarked for services that help to ring fence care within the community.
Loss of community input
I am also concerned about the potential loss of grass roots community input into healthcare decision-making. At present, Total Healthcare PHO has a strong community voice through our board that guides our spending towards where it is most needed.
For example, our PHO discretionary funding assists high needs patients with services such as Tāmaki Health’s Best Start to Life programme for vulnerable mothers and innovative mental wellbeing initiatives. These are services that reduce the strain on secondary healthcare and other agencies.
The introduction of 'networks'
The review suggests removal of the requirements for DHBs to contract PHOs for primary healthcare services, along with the Alliance arrangements required by the PHO services agreement and DHB operating policy. However, the review goes on to recommend the recognition or establishment of connected provider 'networks' – either public, private, NGO or kaupapa Māori - to offer tier one services. These would have joint accountability for achieving outcomes; offer a wider range of services (eg from maternity and general practice through to providing mental and behavioural services and outreach); and give priority to maternity, Well Child/Tamariki Ora, home care and outreach programmes.
The review’s concept of a network reflects quite closely what we are already investing in and achieving within the Total Healthcare region. Therefore, it is my view that even if the recommendation is implemented over the next five to ten years, this PHO is in good shape and well placed to continue to flourish, if change is implemented, as a 'network'.
