HEALTH Minister Annette King said today the Primary Health Care Strategy looks forward to a time when doctors, nurses
and other in the front line of health services are working closely together with their communities to improve health,
avoid illness and make sure everyone gets care when they need it.
Mrs King launched the strategy at Tapu te Ranga Marae in Wellington.
"New Zealand has limited resources to spend on all social services. The key to securing better health for people,
therefore, is to spend our health dollars where they can do the most good. If we can keep people out of the expensive
hospital system, then that makes huge sense."
Mrs King said a stronger population-based approach to primary health care was needed. "This means looking at the needs
of groups of people and keeping them healthy as well as just caring for individuals when they get sick. Obviously this
change can not happen overnight. But the benefits will start to become apparent in the next year as District Health
Boards fund organisations to work with communities and respond to their individual needs and priorities.
"The strategy sets the framework for more preventative care services, better access to services, comprehensive care, and
improved coordination between primary health care providers and secondary providers of services.
"The strategy encourages the establishment of Primary Health Organisations and Maori Development Organisations made up
of a wide of range of health providers including doctors, nurses, and other health professionals working together. They
will be not for profit organisations, funded by DHBs according to the needs of their enrolled populations, rather than
just on an individual fee for service approach."
Mrs King said there was international evidence that user charges for health services impacted more on those who were
poorer or sicker. "The Government will reduce cost barriers over time, with priority for those with greatest need. As
funds become available (either by transfer from other parts of the health budget or through new funds) more support will
be given to a wider range of people.
"The strategy also promotes sharing of information. When successful initiatives are put in place in one area, these
ideas will be shared with other regions too.
"This document is a high-level document. It doesn't prescribe minute detail about how the strategy will work in each
community, because there must be flexibility to meet individual community needs.
"The document takes the wide view. We want our communities to be well, and we'll give them all the encouragement we can
within our means."
For more information, contact John Harvey (04) 471 9305. Background questions and answers, and other contacts for
information, attached.
Questions and Answers
What is Primary Health Care?
Primary health care means essential healthcare based on practical, scientifically sound, culturally appropriate and
socially acceptable methods; that is universally accessible to people in their communities; involves community
participation; is integral to, and a central function of, New Zealand's health system; and is the first level of contact
with our health system.
What is the New Zealand Primary Health Care Strategy?
The Primary Health Care Strategy sets a clear direction for the future development of primary health care. It is the
first time a New Zealand Government has announced such a clear and comprehensive vision of how primary health care
should be organised and delivered. It sets the framework for implementing a population-focused health and disability
sector at the primary health care level. This means more preventative care to avoid unnecessary hospitalisation, better
access to services, comprehensive care and more coordination between primary health care providers and secondary
providers of services. It also means good quality care which meets agreed national standards.
What is the New Zealand Health Strategy?
The NZHS provides an overall framework for the health sector, with the aim of directing health services at those areas
that will ensure the greatest benefits for our population, focusing in particular on tackling inequalities in health.
Primary healthcare is one of the five service priority areas in the NZHS.
What is the New Zealand Disability Strategy?
The NZDS, once developed, will aim to identify how to remove the barriers faced by people with disability to enable
their full participation in society. The strategy will identify barriers, goals, action areas and targets across all
relevant sectors in order to guide policy and service development.
How is the Primary Health Care Strategy linked to the NZHS and NZDS?
Primary health care services need to be organised and delivered in a way that ensures the best health and independence
for populations. The strategy provides direction for District Health Boards. DHBs will work through Primary Health
Organisations to achieve local health goals.
How is the Primary Health Care Strategy intended to work?
The Strategy outlines a move to a system where services are organised around the needs of a defined group of people.
Primary Health Organisations and Maori Development Organisations will be the local structures to achieve this. They will
be funded by DHBs, and comprise primary health care practitioners, health clinics, Maori and Pacific providers. People
will join a Primary Health Organisation by enrolling with a general practice or local health clinic that is part of the
organisation. Membership of the Primary Health Organisations will be voluntary.
These organisations will work with communities, respond to the needs and priorities of each community and improve and
maintain the health of the population, as well as provide first line services to restore people's health when they are
unwell. They are expected to involve their communities in the governing process and must be able to show they are
responsive to community priorities and needs. Primary Health Organisations will be not-for-profit bodies and will be
fully and openly accountable for all public funds. They will be able to contract for services from private, for-profit
providers such as general practices or to directly employ doctors, nurses and other health workers.
Will the strategy have any impact on promoting free visits to GPs?
One principle in the NZHS is to ensure timely and equitable access for all New Zealanders to a comprehensive range of
services, regardless of their ability to pay. The fees charged for first level care in general practice are a barrier
for many people. Reducing or removing fees will help people get the care and advice they need earlier, and keep them
well and out of hospital. Under the Primary Health Care Strategy the Government will reduce cost barriers over time.
Priority will be given to those with the greatest needs. As funds become available (either by transfer from other parts
of the health budget or by preferentially using new funds), more support will be given to a wider range of people.
When will we see benefits of the Primary Health Care Strategy?
The first benefits will start to be seen in 2001. The agreements with DHBs will spell out more clearly than before what
primary health care services people can expect in towns of different sizes. Primary Health Organisations will be formed
and will build up links with their local communities as well as with the DHB. People will start to enrol with a general
practice or health clinic and in that way will join up with a Primary Health Organisation to get the benefit of more
coordinated care, with more attention paid to how to keep healthy and avoid disease. Doctors, nurses and other
practitioners who provide services will start to work in new ways, eg, ensuring continuity of care for the elderly and
those with ongoing conditions, being paid to look after the health of those who have enrolled, and improving referrals
to specialists and diagnostic services. Other early initiatives are likely to include projects around rural services and
exploring ways to address cost barriers for places where there is the greatest need. As funds become available in future
years the Strategy will be able to be widened.
How will funding be allocated to meet the needs of local communities?
Primary health care is a high priority for additional funding within Vote Health as it is central to removing
inequalities and improving health. However, more funding for primary health care will need to be considered against
other health priorities as well as funding for other areas of Government and DHB expenditure. The first priority for any
extra funding will be groups within the greatest health need. Primary Health Organisations will be funded according to
the needs of their enrolled populations, rather than on the number of services providers have given in the past. The
implementation will be developed and communicated through funding agreements and other accountability documents for DHB
performance.
What impact will the Strategy have on the primary health care workforce?
The Strategy will have significant implications for the number, mix, distribution and education of the primary health
care workforce. The current mix and distribution of the primary health care workforce has been largely an unplanned
response to demand and various initiatives and incentives. The future mix, distribution and education will be managed by
a Health Workforce Advisory Committee to ensure a better balance to meet wider needs of New Zealanders.
What impact will the Strategy have on rural communities?
DHBs are expected to achieve minimum standards for first-contact service coverage levels according to the size and
geographical nature of the district and its communities. It is accepted that the needs of rural communities require
special consideration. The Ministry is facilitating development of a coherent approach to rural health service
provision, including the issues of attracting and retaining the appropriate workforce. The HWAC will consider national
workforce implications.
Does the Strategy allow for specific services to meet the need of Maori and Pacific people?
It promotes development of Maori and Pacific provider services, as well as improving the delivery of mainstream services
for these groups. In recent years Maori have begun to develop specific culturally competent health services for their
own people which are usually delivered by Maori health practitioners. Work has also been undertaken regarding Maori
co-purchasing and Maori Development Organisations which work to improve the funding and delivery of services to Maori.
These achievements will be built on with DHBs continuing to contract with Maori providers. Similarly with Pacific
services, new initiatives are emerging which involve a wide range of practitioners and services. DHBs will fund and
support further development of Pacific providers and organisations.
What are the benefits of having Primary Health Organisations?
Primary Health Organisations will be required to identify and address those groups in their populations who have poor
health or are missing out on services. In addition, primary health care organisations will act as advocates for and
involve their communities in finding ways to improve health for the most disadvantaged. Their funding will be based on
the population they serve so those with greater need (especially older populations, those from deprived areas, Mäori and
Pacific people) will have more funds to address poor health.
How will Primary Health Organisations deal with multiple enrolments by individuals?
Enrolments will be checked against the unique patient identifier - the National Health Index - to determine if a person
is already enrolled with a Primary Health Organisation and to ensure there is no duplication.
Will Primary Health Organisations be able to refuse enrolments?
They will not be allowed to refuse people because of their need for health services. However, they may seek to limit
enrolments to people within their geographical DHB, though this would need to be approved by the DHB.
Will there continue to be variation in the cost of primary health care?
The Government will reduce cost barriers over time. Priority will be given for those with the greatest needs. As funds
become available (either by transfer from other parts of the health budget or by preferentially using new funds) more
support will be given to a wider range of people.
What gains have already been made in terms of improving Primary Health Care in New Zealand?
Health gains have already been made in terms of Maori and Pacific Island provider development; various rural initiatives
such as the coordinated approach in Dargaville; better use of prescriptions, laboratory tests and other referrals;
increased rates of coverage for preventive care; improved collaboration between community and hospital providers; and
improved coordination of care, eg, for people with diabetes or in care of the elderly. Some gains have been quite
widespread, others are so far limited to certain pilot initiatives.
How will the Strategy develop to meet the needs of future generations?
The Strategy is a 'living document' which will evolve over time as populations, technology and other factors change.