Part 2: The Primary Health Care Strategy

Ministry of Health: Monitoring the progress of the Primary Health Care Strategy.

2.1
In this Part, to provide the context for our audit, we:

About the Primary Health Care Strategy

2.2
“Primary health care” covers a broad range of out-of-hospital services. Not all of these services are government funded. Primary health care includes services such as:

  • GP and mobile nursing services;
  • pharmacy and laboratory services;
  • community health services such as maternity, family planning and sexual health services, dentistry, and mental health services; and
  • physiotherapy, chiropractic, and osteopathy services.

2.3
Putting a national strategy into practice can be difficult, especially if it involves changing the way people think about and deliver services, which is what the Strategy intends to achieve. The Strategy also introduced new organisations and funding mechanisms that altered relationships between different parties in the health sector.

2.4
The Strategy was the Government’s response to concerns the Minister of Health (the Minister) at the time had highlighted in an earlier discussion document The Future Shape of Primary Health Care.1 The four main concerns were:

  • differences in the health of different groups of people (called populations);
  • high levels of preventable illness;
  • high levels of preventable hospital admissions; and
  • barriers to getting primary health care services.

2.5
The Future Shape of Primary Health Care also discussed the need to ensure that government funds spent on general practice, prescribed medicines, and diagnostic tests reach the people in greatest need. It identified concerns about the number and distribution of services in some rural and urban areas, the cost of using services, and how acceptable services were to users.

2.6
The Minister launched the Strategy in February 2001. It set out a vision for primary health care services. The vision statement includes six inherent goals:

People will be part of local primary health care services that [1] improve their health, [2] keep them well, [3] are easy to get to and [4] co-ordinate their ongoing care.

People will be part of local primary health care services that [5] focus on better health for a population, and [6] actively work to reduce health inequalities between different groups.2

2.7
Figure 2 sets out the Six Key Directions and Five Priorities for Early Action listed in the Strategy. According to the Minister, the Strategy would “evolve over the next few years and may not be fully realised for five to ten years”.3

Figure 2
The Strategy’s Six Key Directions and Five Priorities for Early Action

The Six Key Directions identified in the Strategy are:
  • work with local communities and enrolled populations;
  • identify and remove health inequalities;
  • offer access to comprehensive services to improve, maintain, and restore people’s health;
  • co-ordinate care across service areas;
  • develop the primary health care workforce; and
  • continuously improve quality, using good information.

The Six Key Directions had 40 corresponding actions, which we have not reproduced here because of their length. The actions include enrolling people with PHOs, making PHOs openly accountable to the public for the quality standards they plan to achieve, and having DHBs actively monitor the availability and effectiveness of information about primary health care.
The Strategy’s Five Priorities for Early Action are:
  • reducing the barriers, particularly financial barriers, for the groups with the greatest health need, both in terms of additional services to improve health and to improve access to first-contact services;
  • supporting the development of PHOs that work with the people enrolled with them;
  • encouraging developments that emphasise multi-disciplinary approaches to services and decision-making;
  • supporting the development of services by Māori and Pacific providers; and
  • facilitating a smooth transition to widespread enrolment with PHOs through a public information and education campaign to explain enrolment and promote its benefits for communities.

Source: Hon. Annette King (2001), The Primary Health Care Strategy, Wellington, pages vii-ix.

2.8
New entities, called PHOs, were to be created as the core means for improving primary health care services, although any organisation or health care worker with a primary health care role could contribute to the Strategy’s goals. PHOs were to be funded differently from the existing methods, and primary health care funding was to be increased. The Government said it would provide an extra $2.2 billion over several years from 2002 to carry out the Strategy.

2.9
The principles for “ensuring a stable and constructive transition” were:

  • in the first instance, protect the gains already made and build on successful initiatives
  • involve, discuss and collaborate with the primary health care sector, providers and communities in the implementation of the Strategy
  • focus on stepwise, evolutionary, change which is progressively consistent with the Primary Health Care Strategy.4

2.10
The Government regards the Strategy as introducing the most significant changes to primary health care in more than 50 years. The Government saw the Strategy as an essential step in achieving the New Zealand Health Strategy, which is a foundation strategy for the health and disability sector. The New Zealand Health Strategy focuses on tackling health inequalities. It aims to ensure that health services are directed at those areas that will ensure the highest benefits for the total population.

The health and disability sector, and the Ministry’s responsibilities for the Strategy

2.11
The New Zealand Public Health and Disability Act 2000 established DHBs, and 21 of them were created on 1 January 2001. Through Crown Funding Agreements, the Minister holds DHBs responsible for providing, or funding the provision of, health and disability services in their district.5

2.12
The Ministry is responsible for ensuring that the Strategy is carried out. This includes monitoring and reporting progress, and using the information it has to inform its decision-making and ensure that the Strategy’s goals will be achieved. DHBs are responsible for carrying out the Strategy in their own districts. DHBs may provide some primary health care services, and contract with PHOs and other providers for other services. PHOs are responsible for looking after their enrolled patients.

2.13
The Appendices to this report describe in greater detail the changes to the structure and funding of primary health care services that are part of carrying out the Strategy.

1: Hon. Annette King (2000), The Future Shape of Primary Health Care: A Discussion Document, Wellington.

2: Hon. Annette King (2001), The Primary Health Care Strategy, Wellington, page vii.

3: Hon. Annette King (2001), The Primary Health Care Strategy, Wellington, page viii.

4: Hon. Annette King (2001), The Primary Health Care Strategy, Wellington, page 27.

5: The Ministry’s website describes in detail the health and disability system (see www.moh.govt.nz).

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