New PHO agreement seen as lost opportunity

1 July 2013

The lack of nurses around the table in negotiating the new PHO agreement – coming into force July 1 – doesn’t make sense, said Cathy O’Malley, the deputy director-general of health leading the negotiations.

Frustration at having no nurses at the table when primary health organisations (PHOs), district health boards, and the Ministry of Health negotiated the new agreement prompted the NZNO College of Primary Health Care Nurses and College of Nurses Aotearoa to write to the Ministry about their concerns.

O’Malley, the Ministry of Health deputy director general, for sector capability and implementation said the Ministry had involved nurses in the pre-negotiation discussions but it was not its role to dictate to PHOs who should be on their negotiating team.

“It was interesting there were no nursing participants, and I think what that indicates really is the state of play of nursing leadership at the local level,” said O’Malley.

She agreed it “didn’t make sense” not to have nurses involved in a service where nurses played a significant role.

“I think that is something that needs to be discussed more locally. Nurses have a significant role to play… and where that’s not happening, you need to look at why that’s not happening.”

Meanwhile, the Ministry had invited 15-20 nurses to be involved in a multidisciplinary meeting in June to discuss the development of the new primary health care performance framework.

College of Nurses executive director Jenny Carryer (left) said to nursing organisations it was “very significant” that 13 years after the Primary

Health Care strategy that PHOs still do not recognise the need to put nurses around the decision-making table and still had not created appropriate positions so there were nurse leaders who were obvious choices to be at negotiations at that level.

Rachael Calverley, a primary health care nursing leader and board member of the College of Primary Health Care Nurses, said the college had been trying for many years to encourage nurse involvement in similar negotiations.

“It’s an ongoing historical frustration that we tend to come into the discussion later on down the line, when nurses are quite capable of being able to articulate at high-level discussions.”

Jane O’Malley (left), Ministry of Health chief nurse, said her office obviously believed PHC nurses were critical to such discussions and one of its roles was suggesting appropriate nurses to be involved in Ministry policy development.

“Not only is it obvious that nurses are the largest workforce but also they can provide a nursing lens on health services work and how they can be improved.”

She said her office took all opportunities to encourage talks, like the alliance agreements with DHBs and the development of the new PHC performance framework, to include nurse leaders.

No radical change under new agreement to nurse ‘barriers’

The thrust of the new PHO agreement was to get PHOs and DHBs working much more strongly and collaboratively together in planning services and service design, said Cathy O’Malley.

Asked whether the new contract would reduce barriers to or promote nurse-led services in primary health care, she said the Ministry wanted to get away from silo-ed funding streams or “attaching specific money to specific professional groups”. She also said the current barriers to the development of PHC nursing services fell into two camps – the real barriers and perceived barriers.

The real barriers included a number of pieces of legislation and regulation that referred specifically to medical practitioners, which had implications for what nurses could be paid for, but a bill to amend that legislation was a step closer to being introduced to parliament. Another real barrier was nurses being unable to claim the general medical subsidy (GMS) for non-enrolled patients and this was also being looked but GMS funding was “miniscule” compared to first contact capitation funding which nurses could access.

“The misconception is around what nurses can or can’t do with capitation funding,” said Cathy O’Malley. “There is absolutely no barrier to nurses enrolling patients or being paid capitation money.”

“There is nothing in the contract that excludes nurses from participating,” she said. “I’m not at all saying that it’s an easy road for nurses out on the ground – all I’m saying is that it’s not the contract that is the problem.”

Rosemary Minto (left), chair of the College of PHC nurses, said while the new flexible funding pool provided some opportunities for change the “current private business model in general practice is still a substantial barrier to any big changes that would positively affect health service delivery for patients”.