General Practice New Zealand (GPNZ) welcomes the clarity and insights delivered in the proactively released cabinet paper Achieving pae ora through primary and community healthcare.

GPNZ Chair and Porirua-based GP, Dr Bryan Betty, says the paper clearly outlines the stresses and challenges facing the sector, along with a work programme to address them.

“The direction of the paper is positive, anything that highlights primary and community and prioritises development of the system is a good start.”

The paper acknowledges funding issues which are compromising providers ability to provide accessible, high-quality care, along with some other barriers such as co-payments, restrictions in availability, patient complexity, lack of culturally safe services and siloed service provision.

“We deliver most of the care, for most of the people, most of the time. We absolutely have to get the primary and community settings right before we can deliver on the outcomes set through the Pae Ora Act.”

Improving access to care including ensuring equitable access to services for priority populations, an effective focus on prevention, addressing workforce shortages, reducing unmet need are all named as challenges, and it is pleasing to see them noted in the current context of increasing volume and complexity of work now being undertaken in general practice.

“What was positive was seeing some of the facts and figures we put forward earlier this year used in this paper. This makes it clear the difficulties and current issues we face in the system are being heard.”

The cabinet paper provides some clarity on design principals, policy parameters and the roles each of the three key health entities. Design features agreed to in principle that will underpin primary and community healthcare in the reformed system are:

• comprehensive and accessible
• continuous
• coordinated
• individual and whānau centred
• fit for purpose and continually improving.

“The rationale behind these principles is easy to get behind. Emphasis on continuous care should be a cornerstone of our work, but sadly it is being eroded in our current environment. Whānau voice and choice is also elevated in these principles.

“The words ‘fit for purpose’ are a highlight. For so long now we’ve been advocating within a system that is flawed, it isn’t delivering equitably for all, and it simply isn’t sustainable. Its is a relief to know this is front and centre in the next phase of policy work.”

However, Dr Betty does emphasise some concern around the 10-year timeframe and lack of detail on investment, with the paper stating it doesn’t have financial implications.

“Obviously any time frame other than ‘immediate’ is hard for us to hear when we know the system needs these changes yesterday.

“A decade is a long horizon, and while we acknowledge change of this nature takes time, we’ll be pushing hard on short-term improvements. Working via the General Practice Leaders’ Forum we have already outlined a number of things that can happen at relative pace and little cost in our joint 20-point plan.”

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