Speech to the New Zealand Medical Association General Practitioners' Conference, Rotorua
Ki ngā pou maha o te whare hauora o Aotearoa, kei te mihi
To the pillars of our health system I acknowledge/thank you
Ki te ope hapai hauora o roto o tēnei rūma, kei te mihi
To our health force here in the room today, I acknowledge/thank you
He taura tangata, he taura kaupapa mahi e hono ana tatou katoa i tēnei rā
I acknowledge these ties that bind and bring us together for today’s event
Mauri ora ki a tātou katoa.
I would like to begin by acknowledging your chair, Dr Alistair Humphrey, and all members of the NZMA and the wider health and disability workforce.
It is a pleasure to join you here in Rotorua. Thank you for the opportunity to speak to you and hear from you about your experiences.
Thank you for your mahi, especially over the past year.
COVID-19 has added many additional challenges and layers of complexity. I recognise that and would like to acknowledge your on-going service and dedication to care for our people.
The value of general practice
General practice is often the front door for many people’s experience of the health system.
However, it has been under pressure for a long time, with GP shortages, rising levels of workforce burnout, a funding model that has not been reviewed for some time, and more and more people coming through the door with increasingly complicated health conditions.
I hear your call for change.
Health and disability system reforms
In April I outlined my vision of a truly national health service for New Zealand – a system that focuses on treating people before they get so sick they have to be sent to hospital, that strips away unnecessary bureaucracy and duplication and, for the first time, starts giving effect to tino rangatiratanga in health.
A service in which people get the treatment they need, no matter where they live.
And a service in which doctors, nurses and other healthcare workers can concentrate on doing what they do best – healing people.
As GPs, you are part of the critical frontline. For most people, even treatment of their most complex health issues starts with you.
But the simple health issues start with you too. Or should do. For a growing number of New Zealanders, this is less and less the case.
And for those turning up to your surgeries, a growing number have more complicated conditions to the point where consultation over them does not easily fit into current funding models.
Martin Hefford and Don Matheson will both speak in more detail about the reforms, but let me say this: Primary and community care are at the heart of our future health system.
These services – the services you provide – help people stay well close to their homes and their communities, and are vital to stop people getting sick in the first place.
We’ve allowed the focus of our health system to drift into focusing on specialist care, with three-quarters of the Government’s health spending going to hospitals.
I can’t stand here and tell we’re going to give you all that money, but we are going to shift the balance.
In Budget 2021, we have added $46.7 million a year to primary healthcare funding, so that as our population grows, GPs can continue to provide affordable healthcare to the people who need it most.
And while we’ve got a massive catch-up job in getting our hospitals up to scratch after years of under-investment, in coming years I expect a growing share of funding to go to primary and community care.
As I have said before, seriously addressing inequity of access to healthcare, and addressing many of our non-communicable disease challenges will only be achieved by strengthening the primary and community health sector. I am committed to seeing this happen.
Let me come back to the reforms. The focus at this stage is the structure and operating model of the system.
- DHBs will be disestablished on July 1 next year.
- All public hospitals will be run by a new agency, Health NZ, which will also commission primary and community health services.
- Health services will also be commissioned by the Māori Health Authority.
- The system will be overseen by the Ministry of Health, which will also be responsible for a new Public Health Agency.
We’re in the foundation phase at the moment – finalising the detailed design and establishing interim boards to get the Māori Health Authority and Health NZ under way.
In September, the interim bodies should be in place and the transition will start in March.
I expect to pass all necessary legislation in April, and the new structures will be in place in July next year.
One of our goals for primary and community care is to bring services closer to home, and to give people more influence over the day-to-day care they get in the community, because it is services like pharmacies, physios and, of course, GPs, that help people stay well.
These services need to work together, which is why under the new system we’ll be looking to primary-care clusters to come together to provide top-quality integrated healthcare services for their communities.
I’m talking about things like connected back-office functions so you can work more closely with specialists and pharmacists to create a health service that, for the patients, feels seamless rather than disconnected. Patients won’t have to repeat themselves all the time, or face delays in treatment because the right people weren’t involved or informed.
The current GP workforce is unsustainable – it is ageing, and there simply aren’t enough doctors to go around.
I met with representatives of the Royal New Zealand College of General Practice on the 12th of March to discuss the outcome and proposed solutions to their 2021 Member Burnout Survey.
RNZCGP is working with the Ministry on some solutions that will, in the short-term, provide a level of relief to specialist GPs from the pressure that the sector is under.
We know that the status quo isn’t an option. There are systemic funding and other issues requiring a long-term system overhaul for the benefit of both patients and the workforce.
Martin Hefford will provide more information and context on the role of general practice in the new system, and Don Matheson will speak to primary care transformation but you have my commitment that we have heard the desire for change and will make it happen.
On-going work – Abortion and End of Life Choice
The Abortion Law Reform implementation has a focus on being patient-centred, with a goal of a safer, more accessible, and more equitable abortion service.
The Ministry is working across several workstreams that are all in various stages of progress to ensure support will be provided to improve issues around access and equity.
The work to implement the End of Life Choice Act 2019 is progressing well.
The Ministry is responsible for the implementation of the Act and establishing a functional medically assisted dying system for 7 November 2021.
The first training module for health professionals was delivered on 19 May 2021 to provide an overview of the End of Life Choice Act 2019.
Additionally, there are public, health practitioner and provider information sheets on the Ministry’s website. A broad range of health and disability service stakeholders continue to be engaged as we progress towards implementation.
As a Government we recognise and value the work that GPs and the primary care sector do – you are one of the fundamental pillars of our health system.
The current system, however, no longer serves our needs well.
Our goal is a health system that helps all New Zealanders to live longer in good health and have the best possible quality of life.
The changes we are undertaking with the health reforms, combined with our investment into programmes and technology, will lay the foundations for a better future and good health for all.
Nō reira, tēnā koutou, tēnā koutou, tēnā tātou katoa