South GP Continuing Medical Education Conference

Opening remarks

It’s a pleasure to be here in Canterbury. I’d like to thank the New Zealand Medical Association for inviting me today. I’d also like to acknowledge Lesley Clarke, CEO of the NZMA and Dr Kate Braddock, Chair of the GP Council of the NZMA.

Primary care

Primary care plays a crucial role in improving the health outcomes of New Zealanders and lifting performance across the health sector.

I’d like to take this opportunity to thank you all for your commitment and dedication in providing important health services in our communities.

I know that in Canterbury, GPs have played a significant role in keeping 30,000 people out of hospital in the past year alone. Your acute demand management service has improved people’s lives and also their expectations of the health system.

Mental health

I know that you are continuing to deal with some tough challenges as a result of the earthquakes.

A range of whole of government responses are in place to support Cantabrians, and the DHB has put significant investment and resource into mental health services to reflect the community’s needs.

You have played a pivotal role in the mental health and psychosocial recovery. I know that for example, the way you’ve expanded your businesses to provide Brief Intervention Counselling through your practices has been vital to meeting the increased mental health needs of your community.

Commitment to Christchurch

The Government is committed to re-establishing high quality health facilities in Christchurch.

The Christchurch and Burwood Hospital developments represent the most expensive hospital projects ever in New Zealand, together costing an estimated $650 million.

Later today I’ll be visiting the site of the new Acute Services Building which is now well into the foundation construction phase.  

Overview - 10 months on

I’d like to start with an update on the sector. I believe our health sector is in good shape. The feedback I’ve been getting on my travels around the country, is that although there are still challenges, we are heading in the right direction.

The first 10 months of the Government’s third term, and my time overseeing health has required swift and clear decision-making to deal with some long standing issues.

It’s important to focus on the day to day management of the sector, and keep on top of issues. This enables you to look at the more aspirational stuff.

We listened to the feedback from DHBs and I decided to close down HBL, moving implementation of the shared services programme to a DHB-owned vehicle where the responsibility should sit.

We acted on Southern DHB. My decision to appoint a Commissioner was based on the need to deal with the clearly deteriorating financial issues, and to help move the DHB over time to where we can plan for their overdue hospital rebuild.

In the tightest of budgets where the Government is working hard to make New Zealand one of the world’s first nations to balance its books, we obtained $400 million extra to grow our public health services this year.

We have record performance on our health targets. Our results since 2008 – 50,000 more elective surgeries, 93 per cent of children immunisation up from 67 per cent, and 95 per cent of ED patients are seen in six hours. We also have a record 5,500 more doctors and nurses working in our DHBs.

Priorities

In terms of other key priorities. We need to continue to change the way healthcare is delivered, with more people getting the care they need away from hospitals.

We need to further harness the skills of our workforce so we are utilising the full range of skills of the wider health team.

I want to see continued progress on NCDs. Our largest health burden stems from people suffering from chronic conditions. Tackling obesity is another key area I’m focused on.

There will also be a continued focus on the health targets. They’re not just about numbers, the targets are about delivering better and faster access to important services.

The latest results show that DHBs are making good overall progress and that’s a tribute to your hard work. However, there’s always more work to be done.

Economic health overview

It will never feel like there’s enough dollars in health. The Government has made health our number one funding priority despite economic challenges, and it’s an important part of our plan to deliver better care for families.

Budget 2015

Health received the largest share of new funding in Budget 2015. $15.9 billion, an increase of around $400 million on last year, and $4 billion since 2008/09.

We’re investing around $1.7 billion over the next four years for new initiatives and to meet cost pressures and population growth. This includes more funding for elective surgery, palliative care, and free doctors’ visits and prescriptions for children aged under 13.

I want to see more services being accessed in primary care settings, so an extra $35 million will be invested in primary care in 2015/16. This is the largest increase for the primary healthcare sector in the last six budgets.

Health Strategy

It’s important to have a clear focus on the strategic direction. I signalled in November last year of the need to refresh the Health Strategy, the top level document which sets the direction for the sector, which has not been updated since 2000.

I want to set a new vision and road map for the next three to five years for the sector.

We need a clear, unified direction based on a shared set of values. Strategic guidance on what we need to do, and how we should go about achieving it, is vital for success.

Following extensive engagement and input from a range of stakeholders, I received the initial draft last month. There will be further opportunity to provide feedback on the draft strategy when it’s released for consultation in the coming weeks.

Funding and performance measurement

The Health Strategy will have implications for primary care – how we fund services and how we measure performance.

I have decided to continue with the current IPIF (Integrated Performance and Incentive Framework) measures focused on health targets in 2015/16, and will not be introducing new measures at this stage.

I have asked officials to work with the sector, particularly clinicians at the coal face, to develop more outcome focused and aspirational performance measures.

Only a small number of measures need to be reported nationally – a clear focus on a few things that really count is the ideal approach. I am often told by the sector that the burden of reporting is high, and I want to ensure the purpose of any reporting is well thought through.

Many of you have raised concerns with me around Very Low Cost Access funding and how it’s not well targeted.

I know it’s important to focus funding on those who need it the most. I’ve asked officials to look at getting together a group to advise me on primary care funding, including VLCA.

We need a measurement and accountability system that enables good performance to be rewarded and poor performance to be identified and addressed.

Shifting services closer to home and integration

I’ve made it clear to DHBs that I expect them to move services closer to home, and they need to demonstrate how they plan to do this in their annual plans.

Integration and care closer to home will help develop a more efficient and sustainable health system. It will provide a better experience for the patient, enabling them to move smoothly between different providers.

The integrated way you work here in Canterbury, and the wider South Island is helping to keep patients flowing through the system.

In Canterbury, you were also the first in the country to work in a true alliance framework and this is something I’m encouraging other DHBs to do.

It was great to see the Canterbury Clinical Network recognised in last month’s IPANZ Awards. Taking out the Prime Minister’s award was recognition of the hard work by many people in this room, bringing the alliancing concept to life.

Prevention and early intervention

I want to see greater focus on prevention and earlier intervention through initiatives delivered in the community.

Through sound fiscal management we extended free GP visits and prescriptions to all children under 13.

Thank you for your support, it has exceeded expectations with 97 per cent of general practices across the country now opted into the scheme. This programme is benefiting over 750,000 children and their families.

It is estimated up to a quarter of GP consultations are related to arthritis, lower back pain, orthopaedic or other bone, muscle and joint conditions.

We invested $6 million in Budget 2015 to create new community based multi-disciplinary early intervention teams for diagnosis and management of musculoskeletal conditions.

These new Mobility Action Teams will work with a range of community health services, including GPs, dieticians and physiotherapists. There will also be close links with hospital services such as rheumatology, orthopaedic and pain services.

The first meeting of the Expert Advisory Group, chaired by rheumatologist Peter Jones, met recently to agree the principles, criteria and approach for the new teams.

Tackling obesity

Tackling obesity is another key area I’m focused on. As Minister of Health and Minister for Sport, I want to see greater linkages between these portfolios.

New Zealand is not unique in its battle with obesity. The causes are complex and there is no single solution. We already have several initiatives underway.

Budget 2014 allocated $40 million over four years for Healthy Families NZ. The initiative challenges communities to think differently about how to address the underlying causes of poor health at a local level.

So far there are Healthy Families NZ programmes in East Cape and Invercargill, and I‘ve been impressed at what local community leaders are doing.

Each year over $60 million is invested on a range of initiatives to promote healthy lifestyles, including KiwiSport, Green Prescriptions, and fruit in schools. We’re also adopting a voluntary new Health Star Rating front of package labelling system.

I also have officials looking at what else can be done in this area - particularly on the complex issue of childhood obesity.

E-Health

E-Health solutions offer better, safer, more efficient healthcare. They are also an important enabler of new models of care and providing care closer to home.

Patient portals are, for example, a key e-health initiative. More than 55,000 people in 160 practices are using a patient portal.

I’ve been watching with interest the success of Health Pathways – your home-grown clinically-led advice for clinicians which is now used in 23 regions in Australia and New Zealand.

I also know that having HealthOne your electronic patient record used throughout the South Island is great news for patients.

Another key IT enabler is telehealth. I’ve just come from Christchurch Hospital where I launched the New Zealand Telehealth Resource Centre website.

It brings together information about the various regulations, standards and guidelines that apply to telehealth, and includes case studies of where telehealth is already providing benefits.

Primary care workforce

Part of care closer to home includes harnessing the full potential of our health workforce, growing the use of our pharmacists to help people manage their long term conditions, and growing the use of nurse specialists.

I am committed to seeing the numbers of GPs and multidisciplinary teams grow to improve access to healthcare for all New Zealanders.

Health Workforce New Zealand and the Royal New Zealand College of General Practitioners are working together to increase the number of first-year GP registrars.

First-year GP registrar numbers have increased from 124 in 2014 to 169 in 2015.  I am told that application rates for 2016 have set a new record.

The Medical Council’s initiative to require all prevocational medical trainees to complete a community attachment will contribute significantly to GP recruitment and to a closer understanding and linkages between primary and secondary care.

Medical schools also have a part to play at senior undergraduate level through rural immersion programmes, placements in GP or community care practices, and a growing emphasis on multidisciplinary exposure and the education of generalists.

With more care delivered in the primary setting it is important to ensure we have a sustainable nursing workforce to meet the needs of the population.

Overall the nursing workforce is ageing. We are working to encourage new graduate and younger nurses to work in primary care.

Almost half of the 145 nurse practitioners registered in New Zealand work in community and primary care settings. With their advanced skills and prescribing authority nurse practitioners are a growing resource in primary care.

As health needs change we need to have our workforce practicing to the full extent of their scopes of practice. I have recently agreed to officials progressing an application to allow appropriately skilled and educated registered nurses in primary health and specialty teams to practice as designated prescribers.

Closing Remarks

I am looking for leadership and ideas from the sector about how to support changes to new models of care and enhance the breadth of services provided in primary and community settings.

Clinical engagement, a team based approach, and putting patients at the centre of care are fundamental in achieving greater integration and delivering services closer to home.

I want to assure you that the Government will continue to place a top priority on delivering better health services for New Zealanders. I am confident that together we can meet the challenges we face.

I’m personally very enthusiastic about the team approach to our nationwide health service. From the front desk staff, nurses, to the doctors, management, and Board members – we are all part of the same team, and we must not lose sight of that.

I consider it a privilege to head this team, and I want to take the opportunity again to thank you all for your commitment and dedication. Keep up the great work. I wish you a productive time here today.