The New Zealand Medical Association supports the key concepts of the Primary Health Care Strategy, released today (Thursday), which have the potential to improve the health of New Zealanders and their access to primary health services. However, we continue to have concerns about the availability of funding for the Strategy.

The NZMA was instrumental in encouraging the previous Government to start developing a strategic approach to primary care, in the face of ad hoc decision-making in this area. We are pleased the current Government recognised its value and continued with the Strategy.

"This Strategy introduces a substantially new system of primary care, based on enrolment of patients and population based funding," said NZMA Chairman Dr Pippa MacKay. "Major changes are proposed for the future of primary care. General practitioners, who are at the core of primary care, will be at the forefront of these new developments.

"The Strategy will introduce more effective ways for General Practice to engage with its communities and provide enhanced services, and will allow many existing successful and effective primary care initiatives to be developed further.

"The Strategy proposes new services and greater access to primary care, particularly for groups who have had difficulties accessing health care. It also acknowledges that more funding will be needed to make this happen."

Dr MacKay said the NZMA was particularly pleased that the report acknowledged that levels of government funding limit the access of New Zealanders to primary care. Compared with many other similar countries, primary care here has received relatively low levels of state funding in recent years.

"This is a fundamental point. Without adequate funding, the positive changes proposed in this document will struggle to succeed. Specifically, funding is needed to increase services, improve access, and to help set up the new structures outlined in the Strategy."

The NZMA is concerned that the report does not identify a specific funding strategy, nor are there any costings for the proposals. All that is promised is that funding will be considered as part of the 2001/2002 Budget process. It will have to compete with other government priorities.

Dr MacKay said the Strategy would raise public expectations about improvements in primary care. But unless adequate funding is forthcoming, those expectations will not be met.

The NZMA is also concerned that services may continue to be fragmented under the new system. The report refers to certain services (such as maternity, sexual health, and family planning) as developing "parallel" to mainstream services. The NZMA considers that these services are also firmly part of General Practice and should continue to available there.

Also, with contracting being carried out by 21 District Health Boards, it is important that services are delivered in a nationally consistent way, while allowing for diversity at a local level.

The Strategy proposes voluntary enrolment of patients, but it is very difficult to have an effective population based system without almost total enrolment. The Government must take innovative measures to encourage enrolment.

"Overall, the Strategy should provide real opportunities for General Practice to take a more effective role, particularly in health promotion and disease management. We welcome the report's strategic direction and look forward to having input into the detail to make it work effectively."

ENDS

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