Turning around the ocean liner - the shifting of resources to the primary health sector

April 2015 Vol 15 (2)

Nursing Review caught up with Minister of Health and former GP, Hon Dr JONATHAN COLEMAN, recently to talk about his plans to move more funding from the secondary to the primary health sector, and his views on the nursing and physician assistant roles.

Jonathan ColemanJonathan Coleman says he has made it very clear to district health boards that he wants to see more resources transferred to the primary health sector.

“I have signalled that, if DHBs are not coming up with clear plans on how they are going to shift resources into primary care, I’m going to direct them,” the former GP told Nursing Review.

Coleman returned to New Zealand after a lengthy OE at the end of 2001 – the year that the Primary Health Care Strategy was launched – with plans to transform the primary health sector. Many nurses viewed the 2001 strategy as opening up new opportunities for nursing to make a difference and a number have also expressed frustration that it has yet to live up to its promise.

“I think Labour made very limited progress since the time of the launch of that strategy,” says Coleman. “But the strategy laid out the direction we need to go. I’m keen to see the pace pick up around that.”

Extensive health background

Dr Coleman trained at The University of Auckland Medical School and gained a diploma in obstetrics before leaving on his OE to the UK where he underwent his GP training. After a short stint in the Flying Doctor Service in Australia, he returned to the UK to work in a general practice in Islington, a London suburb whose most famous resident at the time was then-Labour Party leader Tony Blair. “But I arrived a few months before the May 1997 general election [which Labour won] so he moved straight out [to 10 Downing St].

Coleman says while gentrification was well underway in the inner London suburb at the time, it was still a very mixed area socio-economically, with big council estates and quite significant deprivation.

“So I’ve worked across the whole spectrum of general practice both in the UK and back here in New Zealand.”

During his time in London he completed an MBA from the London Business School and on returning to New Zealand he worked as a consultant with PricewaterhouseCoopers on health sector issues four days a week and spent one day a week as a GP in Otara.

In 2005 Coleman won the Northcote seat for National and entered Parliament as its health spokesman; in 2006 he admitted an error of judgement by smoking a cigar in British American Tobacco’s corporate box during an U2 concert and in 2008 he first entered Cabinet. Following former health minister Tony Ryall’s resignation, Coleman picked up the health portfolio in late 2014.

Real shift” envisaged

Talking to Nursing Review five months after taking on the health minister’s role, Coleman says he is serious about seeing a “real shift” in resources as “we’ve got to have a truly integrated system”.

“It’s much better for the patients. We’ve got to have a system that is based around the patients and that they are living longer, healthier lives closer to home.

“But we’ve also got to see – in the interests of the long-term financial sustainability of the system – action taken earlier and for that reason services will be logically provided away from the hospital. “And I think if you look at the future of the healthcare system, where we want more services devolved out into primary care, nurses are an absolutely essential part of the team. We’ve got to use all the resources we’ve got right across the healthcare workforce and nurses have a big role to play. And I envisage an expanding role in the future.”

He says he is currently considering a mechanism to ensure DHBs make clear plans to shift resources and it may involve asking boards to demonstrate how a “certain proportion” of their revenue and resources is directed out into the community.

Coleman says this won’t be simple. “As you can see, by the fact the PHC strategy was launched in 2001, this is pretty complex work and it’s like trying to turn around an ocean liner. But for the long-term sustainability of our system it has to happen.”

Funding for nurses too?

Nursing Review asked the minister how the resources shifted from the secondary to the primary sector were likely to be distributed, particularly as the nursing sector was a bit bemused by the Government’s initial announcement last year of free primary health care for under-13s only pertaining, in effect, to free GP visits.

The minister says that is “a fair point”, as in actual fact the policy was for free primary care visits for under-13s and, of course, that includes nurse practitioner (NP) visits. (A few days earlier on 13 March, at the Rural General Practice Network’s annual conference in Rotorua – an audience of rural GPs, NPs and nurses – the minister’s speech had referred only to free GP visits.)

Coleman told Nursing Review that NPs were a group that the Government was “really keen to see grow”. At the time of talking to Nursing Review, he was waiting on a report from Health Workforce New Zealand on trialling an NP training proposal put forward jointly by Massey University and The University of Auckland. When asked about whether new funding would be considered for the trial, he said that was still to be decided.

“Obviously we can’t deliver it without funding. But right across health and government there’s always pressure on where funding will come from and what we put it into and where the trade-offs are made.”

PA evaluation due soon

Nursing Review also asked Coleman for his opinion on the physician assistant (PA) role; with some in the nursing sectorexpressing disquiet that promotion and funding of the PA demonstrations was detracting from supporting the NP workforce to grow.

Coleman says he is expecting the final evaluation of the PA demonstration on his desk in April and support of a PA training programme would depend largely on demand.

“But I’m keen to use all the skills that we’ve got in the nursing workforce and to get them prescribing more and enable them to have more autonomy and take on more responsibility.

“So we haven’t said definitely that the PA thing is going ahead. We’re still waiting on the evaluation. And I think we’ve got to see how that fits together with NPs.”

Finally, Nursing Review asked the minister whether he had any mechanism for ensuring fairer pay for two groups of nurses serving high needs and vulnerable populations: residential aged care and iwi/Māori provider nurses.

With time running short, he pointed to the current pay negotiations in the public sector and that a number of “legal issues” playing out at the moment may have relevance for “wider labour market issues”. He also says as yet no-one has raised the issue of mandatory nursing staff levels in rest homes with him “but I’m happy to hear about that”.

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