Hon. Annette King
July 17 2003 Speech Notes

Royal NZ College of GPs Conference – ‘Towards Unity’

Thank you very much for inviting me today. It is great to have arrived without any hiccups this time! The last time I tried to conference of GPs in the South Island, my plane circled Christchurch unable to land because of fog.

When I finally did manage to get to the conference, I found it was well and truly open, Patch Adams had spoken and my presence was redundant.

But the trip became worthwhile later when I walked into a café and saw a strange man in funny clothes. It was the great Patch Adams himself.

I was very pleased to get here in time to see your keynote speaker today. When I recently visited the UK I spent time at the Department of Health discussing primary health care reforms, and I was very interested to listen to Professor Wilkin’s paper on the restructuring of primary health care.

Given that the theme of your conference is ‘Towards Unity’, I think it is important to begin today by thanking the Royal New Zealand College of GPs for the positive, professional way you have engaged with me over a wide range of issues concerning primary health care and the role of GPs.

If I was asked to describe the College’s approach in two words, they would be constructive and innovative. And if I was asked to describe the relationship I’ve had with the College over the years I have been Health Minister, the word I would use is productive.

It is certainly far different from the approach of some organisations in health. Perhaps the appropriate word in those cases is the ‘head-butting’ approach. That’s the opposite of productive, and no way to move the health sector forward.

Your retiring president, Helen Rodenberg, can take much credit for the constructive relationship, and I congratulate Helen for all she has achieved in her two-year term. She has certainly presided over a period of significant change.

I also look forward to working with your new president. Congratulations Jim on your new role, and on your special birthday this week. Jim is the first president with Maori ancestry, and was a strong force behind creating a Maori faculty, Te Akoranga a Maui, in the College. That faculty has a key role given all that needs to be done to improve Maori health.

I also want to congratulate Claire Austin for her recent paper ‘Primary Health Care in New Zealand – Viable but Vulnerable’, and I want to thank her for making an advance copy available to me. Claire talks of making sure we don’t overlook important issues like change management and building capacity as we implement the Primary Health Care Strategy.

I agree with her. It is easy, when you have health goals in mind, to concentrate on those goals and on policy, but we must always remember the people who are instrumental in realising those goals. We need to work hard on all the significant relationships within primary health care.

Given the constructive dialogue I have with the College, I want to acknowledge today that I am aware the College intends to continue to urge the Government to bring forward funding more quickly for the Primary Health Care Strategy. I received the College’s action plan on this issue yesterday.

You will understand I cannot comment now in any detail on this issue, but I have already asked the Ministry of Health about what options I might have within the total health budget, recognising that that budget is a finite one. I am prepared to take a paper to Cabinet when I have received those options.

I am certainly happy to discuss this matter further with the College and listen to what you have to say. In our relationship we can, and do, listen to each other, even if we can’t always meet all each other’s expectations.

I accept that any approach you make to me will be on the basis of your commitment to supporting the Primary Health Care Strategy. I welcome that continuing commitment.

Your theme ‘Towards Unity’ represents a concept that can sometimes be easier said than done. Talking about collaboration is easy, but putting it into practice can be a different story. We need to be unified around where our priorities are to improve the health of New Zealanders.

All the arguments about money, roles, and power can distract us so that we lose sight of our mutual goals to improve the health of all our people.
To achieve these goals we must work together, and evidence of this is provided by a recently released report, Ethnic Mortality Trends in New Zealand 1980 –1999.

Like most of you, I am sure, I was distressed at the evidence that Maori and Pacific people have been missing out on life expectancy gains made by other New Zealanders.

I strongly believe that no New Zealander wants to see other New Zealanders dying earlier than they should. But, in the reverse of your conference theme, there is no unity of approach toward improving health and life expectancy for all New Zealanders.

In fact, when the Government talks about wanting to improve the health of Maori or Pacific peoples, some political parties attack these policies as racist, or simply race-based. When we talk about getting in early with preventative health care, they label us as having Maori-only policies.

In order to really make a difference to the appalling health statistics for Maori and other ethnic groups, we need unity among health professionals, politicians and other New Zealanders who can make a difference. Leadership in this area is not just a Government role. It must also come from health professionals and the health sector generally.

I recently read a summary of the techniques of leadership. It began with ‘Know your job’. That is particularly important in primary health care. But one technique that really stuck out for me was being willing to identify with causes. There can be no better cause in this country than seeking better health for all New Zealanders.

We need leadership and unity in addressing population-health goals. Good examples are tackling the diabetes epidemic, obesity, cancer, cardio-vascular disease, and reducing smoking.

Smoking is an obvious area where we need to speak with one voice. Can you believe that there are still health spokespersons for political parties who do not support a ban on second-hand smoke in clubs, pubs and cafes?

And I have an equally staggering example of hypocrisy around the issue of second hand smoke. While the World Health Assembly in Geneva was unanimously adopting the Framework Convention on Tobacco Control in May, UN staff and delegates continued to smoke in the building.

This was despite the fact that the building was declared ‘Smokefree’ for the first time in its history, following a New Zealand initiative in 2002.

I felt really let down that the ‘Smokefree’ rule was so openly flouted. When I raised the issue with the UN Deputy Secretary General, he said the UN had no say over what diplomats did. I reminded him gently that every country at the WHA had just agreed to adopt the Tobacco Convention.

Another example of disunity around crucial population health goals is the way some political parties have trivialised the fight against obesity by trying to raise spectres of a non-existent Fat Tax.

It would be far more to the advantage of New Zealanders if they took serious heed of the warnings health professionals are giving us about childhood obesity, and if they unified around a population health approach.

Primary health care gives us our best chance to take a unified approach through the Primary Health Care Strategy, and through PHOs. But we still have those who believe the way to fix problems is to target individuals only, rather than whole population groups.

The ethnic mortality report proves that has not worked. We need to address vulnerable populations and we need to do it through utilizing and acknowledging the value of all our health professional workforce.

Although some still refuse to acknowledge it, we know that low-income earners, Maori and Pacific people are those at most risk of not seeking primary health care. The greatest immediate health benefits can be obtained by targeting primary health care funding where it is needed most.

That is why our primary health care approach is aimed at ensuring very deprived populations are covered first. Ultimately, however, we want to provide low cost primary health care for all New Zealanders.

PHOs are not simply a vehicle for cheaper visits for patients. They will do far more than that. As they mature they will provide the expertise and resources of a range of health professionals to make their communities healthier. The role of Maori within PHOs offers a good example of how this can work.

PHOs have some promising models that involve Maori in decision-making. Some governance models include an equal mix of governance between Maori and GPs; in others Maori providers have a 30 percent say; and in others local community representatives share in governance.

These models do not necessarily show unity in their approach, because they are doing things in different ways, but they do show unity in their philosophy. They all recognise that teamwork and involving the community are prerequisites for doing a better job than we’ve done in the past.

One thing we clearly need to do better is to reach people who simply have not been seeking primary health care when they need it. To do that requires money as well as innovation. That is why we are funding good proposals that will achieve better access.

The Ministry is pleased with the quality and focus of many proposals. Chronic disease management will need a great deal of attention in the future. PHOs are well placed to target diseases like diabetes by reaching out in various ways to their communities, through, for example, cheaper GP visits or through health education led by nurses and dieticians.

The Wellington Independent Practitioners' Association set an excellent example of teamwork and reaching out with its retinal screening-programme, winning the supreme award at the Health Innovation Awards.

There will continue to be much discussion and debate between GPs and the Government about the future of primary health care, but I am sure GPs will keep coming up with innovative programmes like WIPA’s.

The Government agrees with the College that there must be strong emphasis on quality, particularly maintaining and enhancing standards of practice. Agreement to provide $1 million toward the initial implementation of the College’s accreditation project has been reached, and I am pleased to announce this today.

We acknowledge the benefits of a thorough, systematic approach to raise the overall quality of general practice care across the country.

The Ministry is hosting the 3rd Asia Pacific Forum on Quality Improvement in Health Care in September. At that Forum I will launch a document designed to support continuous quality improvement in the health sector.

I’m sure the Ministry will continue to refine the document after considering submissions made before the recent deadline.

I share the College’s desire to move away from a name, blame and shame culture in New Zealand. We have seen some examples of this in the past couple of weeks concerning GPs and emergency departments in hospitals and meningococcal cases.

If we can change the culture, maybe the media will stop simply focusing on tragic individual cases and look to how the system can be, and is being, improved.

The quality issue is also a strong feature of the Health Practitioners Competence Assurance Bill, which is designed to protect the public by ensuring practitioners retain their competence throughout their careers.

The HPCA Bill will also promote workforce flexibility while ensuring quality and safety are maintained. I hope the Bill allows some GPs to develop new scopes of practice and extend their skills where appropriate.

Ongoing education throughout a career also has a major role in quality care, and I’m well aware your College has always been closely involved in the training and continuing education of GPs.

We have to make sure we train and retain enough GPs in New Zealand. I have no doubt we will need more doctors in the future as demands on the health system increase because of an ageing population, increased public expectations, and more emphasis on population and preventative health.

I am sure you have been following the progress of the Health Workforce Advisory Committee I set up in 2001. I know that in its next report HWAC will include a component on medical workforce needs.

At the March HWAC summit I was pleased to announce an increase in funded full-time medical students from 285 to 325 each year. We must encourage more of these students into General Practice, because GPs remain unevenly distributed around the country, particularly in rural areas.

The College and the Clinical Training Agency have been working together. One result is a substantial increase in GP training funding, and there have been several other key improvements announced recently.

GP training bursary allowances have been increased in the intensive clinical training year so that they become more competitive with DHB salaries. Fifty places in Stage One of the GP Education Training programme are now funded at $55,000 each. The total amount has increased by $600,000 to around $3.3 million a year.

Doctors are now being encouraged to consider rural primary practice as part of their choice of speciality. From this month, placements for post-graduate Year Two doctors to undertake a 12-week rotation in a rural setting will be doubled to 20.

And the CTA will fund 345 places in 2003-04, and 100 places in subsequent years, for the Advance Vocation Education Programme. This leads to Fellowship of the College and to vocational registration, and will help in training doctors to practise independently as GPs.

All those increased allocations show a commitment to tackle the lack of GPs emerging from the education system.

As I said, it is particularly important to recruit and retain a skilled GP workforce in rural areas. There is no doubt that it is difficult and expensive for rural health providers to maintain appropriate levels of staffing.

We have committed $32 million in rural health initiatives over three years from 2002-03. Most of this funding consists of a rural premium to be used flexibly to support local workforce solutions.

One area of focus is better working conditions, such as time-off or time-out. This will enable continuing professional development as well as allow rural GPs to enjoy the environment they live in and to take breaks.

Onerous rosters are an issue in rural areas, but innovative approaches, such as urban GPs providing weekend relief, are being developed. The Rural Locum Support Scheme has also provided locum services to over 80 practices. This contract is being extended for another three years.
A new rural recruitment service will begin this year to help providers recruit GPs, longer-term locums and rural nurse practitioners with prescribing competencies. This service will relieve providers of some of the cost and time spent in the past on recruiting new practitioners.

Before I finish talking about rural primary health care, I want particularly to note one College initiative for which the CTA is providing funding. This is the decision to take the seminar programme for the intensive clinical training programme to remote practices on the East Coast.

Four Maori GPs in this area, who had been unable to take time off for the full programme, have now had a chance to complete their training and ultimately work unsupervised. I think that is great news.

Thank you again for inviting me here today. We are only one year into a new approach towards primary health care. There will be a number of challenges along the way, but already we are seeing some shining lights. I want the Primary Health Care Strategy to work. I know you do too. ‘Towards Unity’ is the approach we must take.

I really value the close relationships the College of GPs has built with the Ministry and other primary health care organisations, and I also value your impressive contributions to enhancing the health of New Zealanders.

ENDS

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