Primary healthcare news, information & resources


Health Budget 2020: Triumph of hope over experience?


A blog by Pinnacle CEO Helen Parker

"Budget 2020 provides almost $5.6 billion for the health sector, so it can respond to the pandemic while maintaining the sustainable delivery of existing services.

(That's my bold there, key words right?) Fantastic! We're in there. Wait for it...

"This investment includes $3.9 billions of operating funding for the 20 District Health Boards (DHBs) across New Zealand."

Ok, I'm getting a bit nervous now but we still have 1.7 billion so listen on...

"This represents the largest ever annual investment in our DHBs and will ensure they can continue providing essential health services for our growing and changing population."

Uh oh. He also only just mentioned hospitals. Anxiety increases.  Where's that other 1.7 million going? Oh, not anywhere near primary care. *Sigh*

So, what message can we take away from the Budget? 

Well let's start with the positive. The commitment that the burden of recovery from COVID-19 will not fall on those who can bear it the least. The focus on creating employment given it's a major determinant in health and wellbeing. The financial support for Maori support services is also very welcome given the impact of COVID-19 discriminates unfavourably against those with poorer health indicators.

But... on the back of the Ministry of Health pulling the third tranche of funding, the absence of any budget recognition of primary care; its fundamental role in health and its pivotal role in successful coronavirus management and recovery is quite worrying. Both are sending out a very strong message that, at best, could be seen as naïve and attributable to a legacy and archaic DHB dominated model or, for the conspiracy theorists, a clear signal that by starving a critical element of the system another political agenda is at play. I can imagine some of you are finding it hard to contain your anger given the high level of goodwill over the last few weeks that has probably now come to an end. And who could blame you.

But where to from here? What are the options?

  1. Well, there are some that have been calling for strike action for a while. One of the challenges of being owner-operators is the tension between acting in the best interests of the business and also in the interests of patients. While tempting, it could lead to a significant public mistrust in the profession that won't help the cause. And it would require national sign up to have any impact and that's highly unlikely. So...
  2. Some form of work to rule. Continue to deliver just the primary care that you're funded for - I know we could debate even that. There is an expectation that general practice will pick up the backlog of planned care from the hospital, will deliver more in primary care per se. You could say no. After all, the hospitals have just had a budget mention and a hefty fiscal bonus. Again, it would require all practices to be onside. Some practices will welcome extending the scope of clinical work and the additional income (we're working on that) and believe it is better for patients. So...
  3. We engage with the DHBs in the hope we can direct some of that $3.9milion to primary care.

Yes, I know option three is a triumph of hope over experience if past history is anything to go by. Hospitals have hoovered up any cash available leaving primary care scratching for crumbs under the funding table and they are rewarded for being in deficit.The international primary care paradox is alive and well; general practice (and privately owned general practice at that) is viewed by politicians,and some funders, as both a major part of the health problem but yet always a major solution, COVID-19 a live example.  But, to my immense frustration, they have absolutely no understanding of the economic and health evidence base for strong primary care, and that only receiving 5.4 per cent of the Vote Health budget for delivering most health care activity is actually the major problem and why hospital costs are so high.

But despite all that, I do believe (on your behalf) there is some hope and signs in getting significantly more than crumbs from the DHB budget bonus if we demonstrate we are so much more the solution than hospital care - and if we just get a bit smarter at how we play that primary care card. Here's why...

  • It was our lobbying, with the other large networks and GPNZ, that got us the additional COVID-19 funding and the virtual consult fee. We were listened to and DHBs supported us.
  • Investing in PowerBI has given us the ability to tell a far better story with our data about primary care demand and capacity. It clearly shows the primary care sponge has absorbed a high level of demand and complexity for no additional funding for some years, but that sponge is full. A credible story for more funding.
  • We are close to publishing a clear and concise Pinnacle strategy which details the role and function of general practice in delivering national and local priorities, especially in its contribution to reducing the health inequalities that are unacceptable. DHBs have to deliver on this next year and need us.
  • We have positive relationships with our DHB funders, strengthened by the need for collaboration for during the COVID-19 response, that are already enabling us to have productive conversations about funding and service development in primary care.
  • We have increased our national advocacy activity not only for more funding but flying the evidence base flag that a strong primary care system is better for health outcomes and value for the health dollar.
  • With GPNZ, which now represents most of primary care, we are working on a very strong response to any health system review recommendations that may weaken the role of general practice in the system that is backed by evidence  - back to the data.  
  • We've heard there will be a discussion between DHBs, primary care and the Ministry.
  • I'm an optimist.

Even with that, I'm not naïve to think we still have some major political battles to fight if we are to get the recognition and funding that primary care deserves. But there are some other things we can do to help our cause.

  • We have to hit population health targets to support our story, accepting some achievement is out of practice control. We have a practice support team that can help you and we've learnt a lot from the Health Care Home programme that can be shared.
  • We can, and should, collect more outcome-based data to build a stronger primary care story. We are going to do some focused work over the next few months to ditch the collection of (relatively) interesting but low value input data and shift to data collection that contributes to the picture of overall outcomes. I'd value your support in this as I think this will have the biggest impact in demonstrating once and for all the value of primary care.
  • Build and improve the connections between practices and local NGOs, kaupapa Maori and other community services so we get the best value for patients with the resources already out there. And so we're not seen as working in isolation from others who contribute to health and wellbeing.

And if we can do that, I think we could experience triumph rather than live in eternal hope! As always, I'm keen to her your views, suggestions and comments on how you would like Pinnacle to respond. (We could always invest in racing on your behalf..?)

Contact me if you'd like to talk about this blog, or anything else on your mind, helen.parker@pinnacle.health.nz.

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