Lack of Govt cash kills family-health

Cindy Farquhar

One of the groups planning an overhaul of primary healthcare services has given up on creating "integrated family heath centres" because the Government is offering no money to help set them up.

The new centres are central to the National Government's restructuring of primary healthcare.

In its 2008 election policy, National promised to "work with primary care to promote integrated family health centres", which the party sees as important in delivering its commitment to "better, sooner, more convenient care".

Groups of primary health organisations, general practices and district health boards around the country have submitted business cases to the Ministry of Health on how they plan to set up the centres, which will provide some "secondary" hospital services.

In addition to primary healthcare, they might offer minor skin surgery, referral to diagnostic imaging and consultations with hospital specialists.

The largest bid nationally involves 274 Auckland region general practice teams, 11 primary health organisations (PHOs) and three district health boards. It covers more than one million enrolled patients.

This bid, by the Greater Auckland Integrated Health Network, initially proposed creating up to 12 integrated family health centres. But in its formal business case to the ministry, the network has now quit that concept in favour of a simpler structure involving three "community health hubs", after GPs rejected the earlier model.

New Zealand Doctor magazine reported the hubs would have an accident and medical service and facilities to look after patients experiencing an acute episode of illness, as well as providing community support services and caring for patients immediately after they were discharged from hospital.

The network's spokeswoman, Professor Cindy Farquhar, said, when asked if GPs were concerned by the absence of Government funding for integrated family health centres, "Yes, that was a bit of a challenge. In this proposal there is no new money."

General practices are mainly private businesses and the Government has no power to force them to create new types of clinics. It has put up $6 million this financial year, but only to manage the change, not to finance new or altered facilities.

Professor Farquhar said the Auckland network rejected integrated family health centres because they would duplicate existing services.

"Our view was that we didn't want to enrol patients in integrated family health centres when they were already enrolled in general practices. We were looking more for the idea of providing hospital services in the community, along with nurse-led clinics and access to radiology.

"We are still resolving the idea of walk-in services and also after-hours care and I do believe that's critical to reducing the acute demand in emergency departments in DHB hospitals, particularly acute admissions."

Health Minister Tony Ryall said he was not concerned by the Auckland network giving up on integrated family health centres because it was not inconsistent with the Government's direction.

"We have said we want to have more hospital-type services provided out in the community. Auckland [already] has a number of services that look like integrated family health centres."