Health reforms leave some Northland GPs feeling overlooked

Northland GP Dr Melissa Gilbert-Smith claims Northland GPs have not been consulted on reforms to the health sector. Photo / Michael Cunningham

A raft of recently announced reforms to the health sector has left some Northland GPs questioning where they fit in the proposed structure.

"I feel like we've been disregarded as an expert workforce. I don't feel we've been engaged enough in the reform process or how we can contribute to things being better," said General Practitioner at Kensington Health, Dr Melissa Gilbert-Smith.

Currently, the Ministry of Health and 20 district health boards (DHBs) across the country are responsible for the commissioning of primary and community care services, including general practices, community pharmacies, aged care services, pharmacists, midwives, mental health services, physiotherapists, and dentists. However, the new structure will see the establishment of a Māori Health Authority and a new entity called Health NZ, both of which will be responsible for the co-commissioning and provision of all healthcare services in Aotearoa.

"At the moment, it is too easy for funding and focus to be drawn away from community-based care towards hospitals and specialist services – even though we know that quality, accessible primary care is vital to keep people well for longer, and avoid more serious illness," the Ministry of Health stated in a whitepaper released on the reforms.

Dr Melissa Gilbert-Smith says a coalition of Northland GPs has been formed to express their concerns to the Government over their current lack of input into addressing health system inequities. Photo / Michael Cunningham

Gilbert-Smith said: "We've got inequity across our workforce as well as across our population ... We are perfectly placed to address what's going on, including inequities, but our funding models don't allow us to address the issues."

She said GPs are well-positioned to address inequities in the health system but are not being listened to by the current Primary Health Organisations (PHOs) and DHBs. She claims PHOs and DHBs have failed to communicate with local GPs on the proposed changes and in turn, are missing out on valuable information from those working at a ground level. According to Gilbert-Smith, a coalition of Northland GPs has been formed, aimed at expressing their concerns directly to the Government.

"Honestly, their [the PHOs'] board conduct in terms of addressing issues - they might as well not exist. We haven't had a sufficient response from the DHB and we've had no response from the PHO so we are going direct to Government now ... They're not going to do it without general practice, so we should be being brought along, and I don't feel like we are. We're being left until last and I feel like that's a mistake," Gilbert-Smith said.

Despite the criticism, CEO of Ngāti Hine Health Trust and chairman of Northland's PHO Mahitahi Hauora, Geoff Milner (Ngāti Porou, Ngāti Kahungunu), hopes those operating in the sector in Te Tai Tokerau can move forward together with a focus on improving the inequity that exists in the health system.

Ngati Hine Health Trust CEO and chairman of Mahi Tahi Hauora, Geoff Milner, and Health Minister Andrew Little hongi. Photo / Tania Whyte

According to Milner, the breakdowns between the DHBs, PHOs and GPs have occurred because they are overworked, underfunded and operating in an outdated system. He said the groups need to work together and look to the future, identifying issues in the region and coming up with solutions.

"The system had very small parameters within which DHBs and management could move. We can either stay in yesterday or move into the future ... The opportunity for all of us here whose sole job is to serve the community, the patients and the whānau is to now get around the table and identify what these reforms provide for us collectively," Milner said.

"There is a need for a locality plan that documents the needs in our region and how the existing systems can co-ordinate and work better together, combining to present the resource requirements needed to deliver their locality plan to Health NZ and the Māori Health Authority."

While the reforms may look good on paper, Gilbert-Smith said Northland's problems will continue to worsen unless immediate action is taken. She claims a large number of Northland's approximately 180-strong GP workforce are looking to retire or move into part-time work. With the region already struggling to attract funding and staff, Gilbert-Smith said general practices cannot keep up with demand.

"We're fitting people in all the time. Our practice does things like preferentially enrol Māori, even though our books are closed. We subsidise a whole lot of services that we don't get funded for," said Gilbert-Smith.

"We just don't have the models of care and the funding structure to enable us to be proactive, we're in a completely reactive model. If we were enabled, as an expert workforce that already has relationships, to go upstream and find out how to ensure Māori can get what they need when they need it, we could do that. We're just not funded to do that."