Where’s the devil when you need that detail?

Initial response to the Health and Disability System Review: Final Report

So finally, we get to see the strategic direction and strong indication of where we may be heading, from the Health and Disability System Review published yesterday. The Review calls for a complete transformation of how health services are governed, organised, structured, commissioned, funded, and contracted.

Central to the Review is a reduction in DHBs from 20 to 8-12 and a strengthening of their role in the system for driving improved population health outcomes. No element of the system is left untouched and the inter-dependency of the proposed reforms are emphasised.

Quite rightly, equity of health outcomes for Maori features heavily together with the need for a one system approach to consistency of services across the country, integrated care networks and a much clearer accountability for outcomes.

It relies, perhaps misguidedly, on structural reform delivering this agenda and it does feel like a 'transforming DHBs' report. Much of the report aspiration could be delivered within current structures such as ringfencing primary care and community services funding. For those interested in learning more you can read the executive overview, or the full report on the Review website.

We do want to highlight however one of the most significant recommendations impacting on primary care: the removal of the current national PHO contract which is seen as a barrier to improving care and outcomes, and that the proposed new national 'health authority', Health NZ, should develop options for contracting for general practice services. The report suggests these could include:

• a capitation-based contract with updated weighting for different populations
• modular contracts to allow funding to support expanded primary health care teams
• a contracting framework for working with larger groups of connected providers
• salaried arrangements to support services in high need and rural areas.

Regardless of the option used, the report also suggests 'all contracts should be informed by nationally agreed salary scales. This would ensure:

• general practitioners are paid proportionate to their capabilities as medical specialists
• practice nurses are paid equitably relative to their colleagues working in hospitals
• all workforces are paid fairly regardless of where they work in the country'.

So not necessarily detrimental to general practice and could be a positive change, but as we all know, the devil is in the detail!

All we can do at the moment is speculate as to what actual implementation of the report will look like and we won't know that for sure until the new government post-September announces their policy response to all the recommendations.

It does raise the question of how PHOs fit (or not) in the future health system and what role GP networks like Pinnacle can play. We believe it's a critical one and as your member network and PHO Board, we will now spend time reviewing the report in depth and continue to have a loud and strong voice nationally advocating for the role and future funding of primary care.

We are keen to hear your views so we have informed discussions on your behalf and will create opportunities for this to happen virtually, in-person and in all our existing forums. Most importantly, we will keep you up to date with news and developments when we can.

Nga mihi,

Brendon Eade, Pinnacle Incorporated deputy chair, and
Helen Parker, Pinnacle Incorporated chief executive.