'Supporting and Strengthening General Practice Education: Muscling Up'

Good morning and thank you for inviting me to open your convention..."Muscling Up"

It is a pleasure to be here with you again.

Thank you Karen Thomas for the introduction.

And thanks Dr Harry Pert - President of the Royal New Zealand College of GPs - and Vice President Dr Townsend for your warm welcome. 

I'm sure you're going to have an interesting time of it over the next couple of days.

The convention organising committee has done a great job putting together an informative and interesting programme for you.

And tomorrow Professor Des Gorman will be delivering a keynote address on the future of general practice education - followed by a panel discussion.

This is a priority for the Government - we have a number of new initiatives around training and retaining doctors and we'd like your input - it should be an interesting discussion.

First I want to acknowledge you - GP educators - thank you for your commitment and your hard work in training and mentoring our GPs. 

 You do a crucial job.

It is probably one of the most important jobs in the sector. 

I say this because it is increasingly clear that the people you are training today will be the leaders of our health services of the future. 

We want to deliver a fit for purpose and enduring health service into the future - we will be relying on GPs to provide it.

If demand for health services is to double over the next 10 years,   then we are not in a position to double the size of Auckland Hospital or double the number of doctors or nurses.

That is why we need to move services to a lower cost platform that can deliver care closer to home ... and that is primary care.

The international evidence is clear - health systems that have a stronger primary health service get better results.

It will be General Practice that will take up that load - the GP who will be the cornerstone of the health services of the future.

As American health researcher Dr Barbara Starfield says, "a good relationship with a primary care doctor, is associated with better care, more appropriate care, better health and much lower health costs."

Places that have more GPs have better health services whatever their population and income mix.

You are the key to the future.

It makes sense.

We face increasing costs with newer and newer health technology - and the public are wanting more and better services.

We live in difficult economic times - and we will continue to do so for quite some time yet.

There are encouraging signs that we're coming out of the recession.

My colleague Bill English just yesterday announced the fourth consecutive quarter of economic growth.

But there is a long way to go before the Government can relax its quite tight control on spending.

We had the worst global financial crisis in 70 years.

New Zealand used to have large Government surpluses.

But this week we borrowed $240 million and next week we will borrow another $240 million and we'll do the same every week after that for the next four years - just to keep public services like Health ticking over. 

But this is not unique to New Zealand. 

Overseas Situation

Governments around the world - including New Zealand - are suffering massive reductions in revenue. 

And public services, including health services, are only now starting to feel the pinch. 

A new austerity drive is sweeping across Europe.

In Ireland, the Government has cut public service salaries - including doctors, nurses and teachers - by up to 15%.

Spain has announced a 5% pay cut in public sector pay, including Health, and a wage freeze for 2011.

Italy has established a 3 year wage freeze for all public servants and will not replace one in five staff who leave. 

Progressive pay cuts of up to 10% are planned for high earners in the public sector.

Canada has frozen wages in the public service for the next two to three years.

The new Coalition Government in Britain has just announced - among other measures - that it will freeze public service pay for two years.

Government agencies other than the NHS are facing 25% spending reductions over four years and the sales tax is going up to 20%.

New Zealand is part of the same world, and the same international economy. 

We face the same challenges and uncertainty.  They are real and with us.

Living within our means is not some right-wing agenda...it is what every country is confronting.

I can not emphasise enough just how serious the economic climate has been and still is - or how it will impact on the way we are able to deliver health services to New Zealanders.

The UK Government says it will shield its national health services from spending restraint - but the NHS is still expecting to make 20 billion pounds in efficiency savings over the next four years. 

I suspect this will ultimately mean less medical recruitment which will have an impact on the flow of international medical graduates around the world.

But here in New Zealand this Government is protecting and growing the public health service.

We have increased Vote Health by an additional $2.1 billion over the next four years.

That includes:

an extra $144 million net over four years for primary health care across DHBs and the Ministry of Health

The launch of a new bowel cancer screening pilot

Significant new investments in getting your patients more elective surgery and neglected disability support services

And another big increase in the Pharmac budget so we can give kiwis better access to more innovative new medicines.

For the second year in a row we in health have been the single biggest recipient in our budget.

We are protecting our public health services in real terms against inflation and fully funded population growth. 

Efficiency is still critical. Every dollar we can save in Health goes back into Health. Because the goal is better service for New Zealanders.

Workforce

And that is where we need you.

Our clinical workforce is the greatest asset that the health service has.

This government came into power inheriting a workforce crisis and a quite disengaged clinical population.

We are working hard to fix that.

Our Voluntary Bonding Scheme - which we'll confirm this next week - has 1,400 graduate doctors, nurses and midwives signed up to work in hard to staff regions and specialities. 

We are funding an additional 200 places for medical students over the next five years and we're funding additional places for GP vocational training.

GP training reform

Professor Des Gorman and Health Workforce New Zealand along with the Medical Council and the Royal New Zealand College of GPs are also working together on a national project to change the way GPs are trained.

That is underway now.

They're consulting this winter with you - with clinicians, universities, professional bodies, DHBs and primary care networks.

The profession is giving us a very clear message that you want to update the way we educate our GPs to ensure that fit for purpose, enduring future health service I was talking about earlier. 

Your input will be pivotal to this.

The discussion will be fascinating.

Questions that can only be resolved with the input of the medical profession are:

• how a medical apprenticeship should be delivered in both hospital and community settings?
• what needs to be done to enable such arrangements?
• and what we need to do to support SMOs and GPs to ensure appropriate mentoring and training opportunities for RMOs and registrars?

Please make every effort to share your views, your experiences and your ideas with the group.

Expressions of Interest

And seeking your leadership and engagement is part of the motivation behind the Government's request for Expressions of Interest (EOI) to try and get some changes in primary care we can give patients better services. 

We wanted you to set the agenda to make the primary health care strategy happen.

It is worth me restating the objectives of the government's drive in primary care policy.

As I said earlier this morning, if demand for health services is to double over the next 10 years, then we are not in a position to double Auckland Hospital or double the number of nurses.

That is why we need to move services to a lower cost platform that can deliver care closer to home ... and that is primary care.

The primary-care led EOI process and the Integrated Family Health Centre concept in particular are patient centred.

They are also part of a prudent strategy to begin future - proofing our health system to deal with increasing demographic and financial pressures.

The evidence base for this comprehensive multi-disciplinary approach suggests that these will greatly help patients to get the right care in the right place.

That doesn't often happen now because the necessary primary teams and infrastructure do not broadly exist.

This is about beginning to prepare the public health service for the future.

And that is why we turned to you.  For your ideas.  For your leadership.

Our goal in government is to work with you and to provide New Zealanders with better access to a wider range of health services closer to home. It's a goal many of you share.

These initiatives will commence as they are ready over the coming months, and they will take different forms.

The nine primary health care groupings cover 60 per cent of New Zealand's population, and we expect to see them working with their DHBs to deliver better services closer to home than in the past.

But advances will be made carefully, inclusively and with strong clinical engagement.

We encourage primary care networks and DHBs outside the scope of the initial nine to develop their ideas for better patient care.

Closing

In closing, thank you for the work you are doing to give New Zealanders high quality primary care services.

Thanks for what you're doing to help the next generation of GPs.

I encourage you again to step up and play a role in the future.

And all the best with your conference.