New Zealand Doctor

Martin Hefford, CEO Tū Ora Compass Health is writing from a 12 week sabbatical in the UK, hosted by the Kings Fund in London and the Health Service Management Centre in Birmingham.

20 July 2019

Where is our long-term plan?

GP colleagues were a bit worried when I said I was going to the NHS as a visiting Fellow. ‘’but the NHS is completely dysfunctional!’’ they said (but substitute a shorter alternative for ‘dysfunctional’). And early conversations here back up the sentiment: ‘’It is difficult to overstate how fragile primary care is at the moment.’’ said one GP I spoke to. People here talk about 8 minute consultations, 2 weeks wait for a routine appointment, and an estimated shortfall of some 5,000 GPs (out of 30,000).

But there are things that I immediately warm to here. Key decision makers in England seem to have finally accepted that urgent and sustained action is needed. The Government have published an NHS Long Term Plan that includes a 3.4% per year real NHS funding increase, (over and above GDP growth) for the next 5 years. It also includes a 25% increase in medical school places, and a 50% increase in clinical nursing placements.

Training new GPs takes 10 years or more, hence the NHS 5 year GP contract signed in January includes provisions to fund around 20,000 more allied health workers in primary care to do tasks that are currently performed by GPs (but that don’t need to be), to provide more immediate relief for hard working GPs. The roles include clinical pharmacists, physician associates, physiotherapists, community paramedics; and additional ‘social prescribing link workers’. The investment is the equivalent of about $NZ3 million per 50,000 population – about $NZ60 per enrolled person.

The roles will be part of the general practice team (or more properly the primary health care team). They are not intended to be based in community service hubs or outpatient centres. They are to be first contact resources shared within small clusters of GP practices – called local clinical networks. A feature I like is that each network of local GPs can decide on the mix of allied health roles they want for their practices – within the overall additional funding. Interestingly the one area that seems lacking is investment in primary mental health (which is the one area that the NZ Government have announced an investment in).

There is an amount of trepidation as well as significant excitement about the reforms. The general sense is that it’s a good plan – the trepidation is about whether implementation will live up to the hype.

So yes, the NHS primary care system may be in a parlous state, but at least they recognise it and are taking action. NZ is in danger of missing clear signs of trouble here and delaying action until we too are at crisis point. College survey data show that 47% of GPs intend to retire in the next 10 years. That could give us a worse GP shortage than the NHS. So where is our 5 year investment plan for primary health care?

The Labour led Government have said that primary care is one of their three health priorities. To paraphrase Joe Biden: “Don’t tell me what your priorities are. Show me your budget and I’ll tell you what your priorities are. “